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Flashcards in Psych Deck (43)
1

What are the causes of delirium?? (It's a mnemonic!!!!)

"DELIRIUM"
Degenrative
Epilepsy (post-ictal state)
Liver failure
Intracranial (SAH/abscess/trauma)
Rheumatoid chorea
Infections (pneumonia/sepsis)
Ureamia
Metabolic (electrolyte disturbance)

2

Management approach for somebody with delirium (it's a menmonic!!!)

"DELirium"
Diagnose and treat underlying cause
Environment and Medications - ensure calm, consistent nursing staff. Presence of a family member/friend can be reassuring. Increase visual acuity (spectacles)/ensure they can hear (to avoid misinterpretation of stimuli). Clocks/calendars.
Legal issues: capacity/consent and ?legislation.

3

Mnemonic for psych history.

"SOCk SOAP"

1. when did symptoms START
2. what was the ONSET - sudden/gradual
3. what are the symptoms' CHARACTERISTICS - constant/intermittent/worsening
4. SOCIAL impact
5. OCCUPATIONAL impact
6. ASSOCIATED symptoms: "DOPAS" Depression/Mania, OCD, Psychosis, Anxiety, Substances
7. PERSONAL history: "SO FAR" Social issues, Occupational record, Forensic history, Alcohol/substance, Relationships.

4

What is a person's lifetime risk of developing schizophrenia if no relatives of theirs have schizophrenia?

1%

5

What is a person's lifetime risk of developing schizophrenia if one parent has schizophrenia?

10%

6

What is a person's lifetime risk of developing schizophrenia if both of their parents have schizophrenia?

50%

7

What is a person's lifetime risk of developing schizophrenia if their monozygotic twin has schizophrenia?

50%

8

What is a person's lifetime risk of developing schizophrenia if their sibling has schizophrenia?

10%

9

What is a person's lifetime risk of developing schizophrenia if their dizygotic twin has schizophrenia?

10%

10

How can treatment-resistant schizophrenia be defined?

A lack of satisfactory clinical improvement despite the sequential use of at least two antipsychotics for 6-8 weeks, one of which should be a second generation antipsychotic.

11

Acute dystonia is a potential side-effect of antipsychotics. What pharmacological agent might you use to treat this side-effect?

Use an anticholinergic, e.g. parenteral procyclidine.

12

What side-effect should you be aware of specifically when using chlorpromazine?

photosensitivity

13

What side-effect should you be aware of specifically when using haloperidol?

QTc prolongation (take a baseline ECG)

14

What side-effects should you be aware of specifically when using Clozapine?

Agranulocytosis
Hypersalivation

15

Which first generation antipsychotics can be given as IM depots?

Haloperidol
Flupentixol
Zuclopenthixol

16

Which second generation antipsychotics can be given as IM depots?

Risperidone

17

Side effects of antipsychotics? (It's a mnemonic!)

"HE Met C"

Hormonal - increased serum prolactin
Extrapyramidal - akathisia, dyskinesias, dystonia
Metabolic - Weight gain, diabetes
Cardio - QT prolongation

18

What's the general 'biological' approach to schizophrenia management?

Antipsychotics
Physical health check before starting antipsychotics (BMI, BP, cardio exam, diet, physical activity, glucose, assess for movement disorders)
Consider benzodiazepines if there are behaviour disturbances, insomnia, aggression, agitation

19

What's the general 'psychological' approahc to schizophrenia management?

Support, advice, reassure the patient/carers
CBT - shown to improve insight and help patient spot early signs
Family therapy - shown to reduce relapse/readmission rates

20

What's the general 'social' approach to schizophrenia management?

Optimise integration into community.
Assess for a Care Programme Approach (CPA)
Involve: Social services, local authorities, local/national support groups.
Involve: Community psychiatric nurses (CPNs), consultants, OTs, psychologists, social workers.
Financial benefits
Accomodation
Support for carers
Occupation
Daytime activities

21

Treatment for benzodiazepine overdose?

IV Flumazenil

22

What pharmacological agent would you like to use to tranquilise an agitated/aggressive patient?

Benzodiazepine - lorazepam oral or i.m.

23

What parameters would you like to explore in a psychotic patient? (it's a mnemonic!)

"BeNT PerP"
Beliefs - delusions vs overvalued ideas
Negative symptoms - apathy, blunting of affect, social isolation, cognitive deficit
Thought disorders - circumstantiality, flight of ideas, knight's move, block, echolalia, perseveration
Perceptions - auditory, visual, olfactory, gustatory, somatic
Psychomotor function - catatonia

24

Differential for a patient with psychotic symptoms secondary to a medical condition or psychoactive substance usage?

Organic psychotic disorder
or
Substance-induced psychotic disorder

25

Differential for a patient with psychotic symptoms of duration

Shizophrenia-like psychotic disorder (acute/transient psychotic disorder)

26

Differential for a patient with psychotic symptoms present for longer than 3 months with delusions only?

Delusional disorder

27

Differential for a patient with typical schizophrenic symptoms in the absence of prominent mood symptoms?

Schizophrenia

28

Differential for a patient with typical psychotic symptoms in the presence of prominent mood symptoms?

Schizoaffective disorder

29

Differential for a patient with psychotic symptoms (usually mood-congruent) in the presence of prominent mood symptoms?

Depression or Mania with psychotic features

30

What investigations would you like to perform for ?dementia after taking a history?

MSE with AMTS

General exam:
- Thyroid r/o hypothyroidism
- Neuro r/o SOL, stroke
- Cardio screen for risk factors, e.g. hypertension or AF
- r/o self-neglect or falls injuries as a consequence of dementia

Bloods (looking for reversible causes):
- B12/Folate r/o deficiency/malabsorption
- TFTs, calcium, glucose, U+Es r/o hypothyroidism, hypercalcaemia, Cushing's or Addison's

CT/MRI:
- r/o SOL, subdural haematoma or normal pressure hydrocephalus

31

name the dementia

Generalised cerebral atrophy
Widened sulci
Dilated ventricles
Thinning of the width of the medial temporal lobe

Alzheimer's disease

32

name the dementia

Single/multiple areas of infarction
Cerebral atrophy
Dilated ventricles

Vascular dementia

33

name the dementia

Greater relative atrophy of the frontal and temporal lobes with knife-blade atrophy

Frontotemporal dementia

Knife-blade atrophy = atrophied gyri

34

name the dementia

Dilated ventricles with atrophy of caudate nuclei (loss of shouldering)

Huntington's disease

35

name the dementia

bilaterally evident high signal in the pulvinar (post-thalamic) region

new variant CJD

this appearance is also known as the hockey stick sign

36

List all questions of the AMTS

1. What is your age?
2. What is the time?
3. Remember this address for me (e.g. 42 West Street)
4. What year is it?
5. When is your date of birth?
6. Where are we?
7. Name who these two people are.
8. When was WW1/2?
9. Who is the current PM?
10. Count down from 20-->1
Recall the address from Q3.

37

Many physical symptoms from different parts of the body. Unable to find a particular cause.

Somatisation disorder

38

Fearing that minor symptoms may be due to a particular serious disease. Reassurance is not helpful.

Hypochondriasis

39

Neurological symptoms that have developed quickly in response to a stressful situation.

Conversion disorder

40

Great concern over an aspect of their physical appearance which is not necessarily apparent to other people.

Body dysmorphic disorder

41

Persistent pain that cannot be attributed to a physical disorder.

Pain disorder

42

What is the difference between factitious disorder and malingering?

Factitious disorder = focus on internal/primary gain of assuming the sick role (i.e. to become a patient)

Malingering = focus on external/secondary gain of being ill (i.e. avoiding military service/legal duties/getting benefits)

43

What are the pharmacological steps in treating mania/hypomania?

1. stop anti-depressants
2. Start one of the following antipsychotics:
- Haloperidol
- Olanzapine
- Quetiapine
- Risperidone
3. If not tolerated/poor response at max dose then swap for a different one
4. Try Lithium (or if not appropriate then valproate)