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Flashcards in psych Deck (109):
1

TCA overdose

IV bicarbonate

2

When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.

Discontinuation symptoms
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

3

clozapine is associated with

a granulocytosis (see below)

weight gain
excessive salivation
agranulocytosis
neutropenia
myocarditis
arrhythmias




agranulocytosis is the term used when the bone marrow (soft tissue inside bone) fails to make enough granulocytes. neutropenia is the term used when the bone marrow fails to make enough of a specific group of granulocytes called neutrophils.

4

typically involves loss of motor or sensory function
the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering)

Conversion disorder

5

Antipsychotics


Extrapyramidal side-effects
Parkinsonism
acute dystonia (e.g. torticollis, oculogyric crisis)
akathisia (severe restlessness)
tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:
increased risk of stroke
increased risk of venous thromboembolism

Other side-effects
antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
raised prolactin: galactorrhoea, impaired glucose tolerance
neuroleptic malignant syndrome: pyrexia, muscle stiffness
reduced seizure threshold (greater with atypicals)
prolonged QT interval (particularly haloperidol)

6

whats the time-frame for whitdrawing of anti-depressants?

When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.

7

How would you prescribe anti-psychotic depending on the MMSE score?

20-25 Mild - Ache Inhibtor
10-20 Moderate NMDA receptor inhibtor Memntamine

8

what is the most important test to perform when using clozapine?

FBC

9

The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:

increased risk of stroke
increased risk of venous thromboembolism

10

Extrapyramidal side-effects

Parkinsonism
acute dystonia (e.g. torticollis, oculogyric crisis)
akathisia (severe restlessness)
tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting o

11

other side effects of anti-psychotic

Other side-effects
antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
raised prolactin: galactorrhoea, impaired glucose tolerance
neuroleptic malignant syndrome: pyrexia, muscle stiffness
reduced seizure threshold (greater with atypicals)
prolonged QT interval (particularly haloperidol)

12

Whats the miminum time time that anti-depressants should be continued for?

6 months

13

what are the SSRI drug interactions?


Interactions
NSAIDs: NICE guidelines advise 'do not normally offer SSRIs', but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin: see above
triptans: avoid SSRIs

14

admission for assessment for up to 28 days, not renewable
an Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors
one of the doctors should be 'approved' under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)

Section 2

15

admission for treatment for up to 6 months, can be renewed
AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours

Section 3

16

72 hour assessment order
used as an emergency, when a section 2 would involve an unacceptable delay
a GP and an AMHP or NR
often changed to a section 2 upon arrival at hospital


Section 4

17

a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

Section 5(2)

18

similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

Section 5(4)

19

Supervised Community Treatment (Community Treatment Order)

Section 17a

20

a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety

Section 135

21

someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety

Section 136

22

whats the first line SSRI used in the treatment of psychiatric problems?

Drug treatment
NICE suggest sertraline should be considered the first-line SSRI

23

A 45-year-old man with schizophrenia taking chlorpromazine develops a bilateral resting tremor. What side-effect of antipsychotic medication is this an example of?

Parkinsonism

24

Alcohol withdrawal

symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

25


Q1) Suicide risk. What is the highest predictor of doing it again? bad relationship with mum, feeling hopeless about future, previous self-harm?

1) Previous sucide-attempt
2) Feeling hopeless about the future
3) Psychiatric condition
4) Stress
5) Physical abuse

2) Feeling hopeless about the future

26

Guy who has visual hallucination and likely to fall over. but he is not giving consent to help regarding his falls and delirium. He wants to leave hosp. Difficult to understand what he is saying Q: what is a big reason that makes you think he does not have consent?

(Options: due to lack of understanding, due to lack of processing, due to his visual hallucination, due to him not communicating properly) CURB

27

Woman wants to know what risk her baby has of getting schizophrenia, since the baby’s father has it.

7-9%?,

28

What blood test should be frequently done if someone is on Lithium?

thyroid and renal function should be checked every 6 months

29

Guy on medication for schizophrenia get muscle rigidity, altered consciousness, high blood pressure, tachycardia. Mgmt? Neuroleptic Malignant syndrome Management

stop antipsychotic
IV fluids to prevent renal failure
dantrolene* may be useful in selected cases (muscle relaxant acts on ryanoide receptors)
bromocriptine, dopamine agonist, may also be used

30

60 year old woman, short term memory loss, struggling to complete her normal daily tasks, ataxia and dysphagia. What would you see on MRI?

Hippocampal atrophy

31

40 year old man with moderate learning disability. He has a Hb of ~6 (below the normal range). Refuses blood transfusion but happy to take oral iron therapy. What law do you use to assess his decision (or something along those lines).

Mental Capacity Act;

32

What is high in anorexia nervosa?

G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

33

Man with treatment resistant schizophrenia on clozapine, recently stopped smoking. High level of clozapine now. Most likely consequence?

Neutropenia, Agranulocytosis (1%), seizures (3%)

34

Alcoholic comes to GP requesting home detoxification. Previous history of delirium tremens. What would you do

refer to local specialist alcohol service

35

misperception of a real stimulus Person sees flower on wallpaper - sees them as moving snakes.

illusion

36

insects crawling underneath the skin

Formication

37

Person sees things smaller

Micropsia

38

term may also describe a perception thought to come from outside but at the same time recognised as possibly not being real

pseudo hallucination

39

Voices may be in the second person (addressing the
patient directly as ‘you’)

second person auditory hallucination

40

Those particularly suggesting schizophrenia discuss or
argue about the patient, give a running commentary of the patient’s actions. Say the patient’s thoughts aloud (thought echo).

third person auditory hallucination,

41

Agitated psych patient threating violence - what do you do?

talk to consultant

42

also known as factitious disorder, the intentional production of physical or psychological symptoms

Munchausen's syndrome:

43

Woman with abdominal pain, weight loss, lethargy and feeling low.

malignancy

44

Man who drinks and takes some drugs. Split up with girlfriends, cutting himself.

Borderline Personality Disorder

45

Someone who just started on an antipsychotic and becomes tachycardia, hyperthermia, sweating, urine drug screen negative.

Neuroleptic malignancy syndrome

46

Which of the following condition would a kid’s twin brother has if he was diagnosed with it?

ADHA

47

Diagnosed bipolar disorder –

sudden renal failure, what do you check? Lithium levels

48

Starting 21 year old with depression + suicidal idealization on antidepressants, what is your follow up plan?

Start citalopram or flux? and review in 1w

49

Someone is brought in by their mother to AE and appears psychotic what section would you put them under?

5(2)

50

Someone with acute dystonia what would you give?

Procyclidine

51

Someone with bulimia, BMI 22, well and keen to get treatment

Fluoxetine + CBT

52

11. Someone who lost her husband 7 months ago and started hearing voices of him saying to join him a month ago –

abnormal grief response

53

12. Alcoholic and had previous delirious tremens and wants detox at home what would you do?

• Previous delirium tremens or alcohol withdrawal seizures or presence of autonomic overactivity or age <18 years are all associated with a higher risk of developing acute alcohol withdrawal and these patients should be admitted
• Benzodiazepines are the recommended drugs for detoxification. They have a slower onset of action and therefore are less likely to lead to abuse. A reducing dose of chlordiazepoxide over 5-7 days is commonly used.[9]
• Ideally, see the patient daily and dispense the medication daily.
• Diazepam is an alternative.
• You can check for alcohol on the breath or use a breathalyser to confirm that the patient is abstinent.
• Stop the benzodiazepine once detoxification is complete or if the patient relapses and starts drinking again during detoxification.
• A British Medical Journal (BMJ) review has suggested the following regimen for moderate alcohol dependence in the community or as an inpatient:

54

13. Someone with depression and has made plans to end his life comes to your GP surgery with his sister what would you do?

Get them to go to AE.

55

15. If all these children have learning disability, who is most likely to have mental disorder later on?
a. Child with epilepsy (I picked this, not sure whether it’s right or not)
b. Child with long term illness
c. Child with malignancy

People with learning disability, of whatever severity, are more likely to have co-morbid epilepsy (A), with some specific syndromes being noticeable, such as Lennox–Gestaut syndrome and autistic spectrum disorders.

56

Women with sudden confusion what would you do first?

Urine dip

57

One of the criteria for learning disability?

IQ <70

58

diagnostic overshadowing

a diagnosis of a LD obscuring diagnosis of other disorders – physical and mental

59

Someone who is aggressive and needs rapid tranqulisation

haloperidol

60

Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment?

Community psychiatric nurse

61

b. Someone with schizo and need help organizing their activities after they are being discharged?

Occupational therapist

62

75 yr lady bought in with daughterShe” (not sure who it was referring to) says is anxious, being increasingly forgetful lately, thinks she has dementia

Depression.

63

You’re a GP. Elderly person presents with a history of the classical signs of Alzheimer’s. What do you do next

refer to memory clinic;

64

When interviewing a recovered Schizophrenic, what on MSE would make you think they were getting relapse?

Visual hallucination; being withdrawn?? Depends on the previous episode?]

65

Lady with social phobia. What feature would typically be associated with it?

Patients with social phobia (social anxiety disorder) have a fear of being scrutinized, ridiculed or humiliated by other people

66

Student who recently finished exams found disorientated and slurring his words or similar basically

Answer = alcohol intoxication.

67

addresses the patient's difficulties by primarily relying on insight, bringing unconscious or unclear material into awareness, and linking past and present experiences.

Brief psychodynamic psychotherapy

68

is derived partially from a psychodynamic perspective and focuses primarily on the patient's interpersonal relationships. Interpersonal therapy is fairly non-directive and addresses issues such as:
• Grief
• Role transitions
• Interpersonal role disputes, and
• Interpersonal deficits


Interpersonal therapy

69

• Dialect behavioural therapy contain the elements of Buddhism –

borderline personality disorder

70

– is a therapy that allows understanding of the relationship between the individuals

• Systemic or family therapy

71

PET scan to look at

amyloid in Alzhaimers and Parkinson

72

DAT-scan

Parkinson - Dopamine transporter scintigraphy

73

SPECT (LBD 100% specific)

single-photon emission computed tomography would show decreased perfusion of temporal lobes

74

Parkinson’s Disease Dementia – Lewy Body dementia

1st Levodopa (Carbidopa), Dopamine agonist L DOPA), MAOI (Phenelzine)
2nd AChE Inhibitors (Donezepil, Galantamine, Rivastigmine),
Glutamate agonist (Amantadine)

75

Lewy Body Dementia alpha-synuclein protein

Symptomatic treatment – no antipsychotics with Parkinsonism
Hallucinations/1st confusion AChE inhibitor, atypical anti-psychotic 2nd
Movement Levodopa (worsens hallucinations – monitor)
Depression
 Antidepressants
Sleep disturbance Clonazepam

76

hypotension

alcohol intoxication

77

Most likely effect from cheese reaction due to MAO--‐I.

hypertension

78

what's the pathology behind neuroleptic malignant syndrome?

abnormal calcium release from the endoplsmic curriculum

79

someone who lost their husband and hallucinations 7 months after

Abnormal Grief Response

80

poor memory, difficulty finding words, difficulty planning

Alzheimer disease

81

recurrent visual hallucinations, Parkinson

Levy-Body Dementia

82

woman with sudden confusion, what do you do?

urine dip

83

Patient put on section, comes back agitated, threatens to kill the staff

Assess the patient

84

OCD managment

• Mild CBT or SSRI (Citalopram/Fluoxetine)

85

Treatment of spider Phobia

CBT
Citalopram
Venlafexine

86

if the patient is on clozpine what is the most important thing to tell them about?

to beware of agraunulocytosis

87

someone who has bipolar and kidney failure what do you give?

sodium valporate

88

treatment for social phobia

CBT

89

someone who was on haloperidol and had acute muscle spasm

procyclidine

90

someone who is agressive and needs rapid tranqualization

benzodiazepines

91

How would you treat moderate depression in young adult?

citalopram plus CBT

92

clozapine, how do receptors work?

and ziprasidone are potent 5-HT2a receptor antagonists and relatively weaker dopamine D2 antagonists

93

likely they have experienced what is more commonly known as a “bad trip.”
affects dopamine and serotonin transmitter systems.
It is usually impregnated on tabs (tiny squares of paper
with pictures on them), and ingestion causes trips of
up to 12 hours’ duration, with perceptual changes and
euphoria. Bad trips are when the experiences become
frightening and unpleasant, and sudden flashbacks can
occur, even years later. Other risks include anxiety,
depression, and psychosis.

LSD

94

It
comes as a liquid or powder that can be snorted or added
to a joint and smoked, and is associated with violent
outbursts and ongoing psychosis.

Phenylcyclidine

95

Ketamine is a powerful veterinary anaesthetic; it prevents
the brain’s awareness of pain. Because of anaesthesia,
people have severely harmed themselves while hallucinating,
e.g. pulling out their own teeth.

Ketamine (Special K)

96

Formed of white powder or tablets, amphetamines can
be dissolved and injected; swallowed, or snorted. Some
specialist teams use dexamphetamine as a replacement
for IV amphetamine dependency, aiming for stabilization
and detoxification.

Amphetamine (speed)

97

Users become very chatty, dance relentlessly,
and can show bruxism (tooth-grinding). There
may be side effects of nausea, vomiting, and sweating.
Death is associated with hyperthermia and dehydration

Ecstasy

Management
supportive
dantrolene may be used for hyperthermia if simple measures fail

98

(downers, sleepers) have a sedative
effect because they enhance the inhibitory effect of
GABA transmission. They are usually swallowed as
tablets, but can be dissolved and used IV. Their effects
are similar to alcohol, causing a feeling of calm and mild
euphoria, with slurred speech, ataxia, and stupor (or
even coma) at higher doses. Withdrawal effects are similar
to alcohol, e.g. seizures.

BDZ
Management: Flumanezil

Activated charcoal may be given via nasogastric tube.
Intravenous administration of saline, naloxone, thiamine, and/or glucose.

99

Neurological effects
seizures
mydriasis
hypertonia
hyperreflexia

cocaine

Management of cocaine toxicity
in general benzodiazipines are generally first-line for most cocaine related problems
chest pain: benzodiazipines + glyceryl trinitrate. If myocardial infarction develops then primary percutaneous coronary intervention
hypertension: benzodiazipines + sodium nitroprusside

100

rhinorrhoea
needle track marks
pinpoint pupils
drowsiness
watering eyes
yawning

heroin

1. emergency naloxone
2.methadone replacement

101

Frequently Bend - During Barbeque

GABAA drugs

102

a stimulant often taken by patients with anorexia

amphetamine

103

patients was on smth that was stopped abruptly, then got some bad side effects , you go and tell them to to wean off gradually

barbiturates

104

bulimia

NICE recoemnds CBT plus flucoxetine

105

when interviweing a schizophrenic what features would make you think he is getting relapse

visuall hallucinations

106

Anorexia Nervosa

• BMI <17.5 or 15% less than expected
• by low body weight
• intense fear of gaining weight
• body image disturbance
• Endocrine disturbance: Amenorrhoea

107

Bulimia Nervosa

• BMI>17.5
• intense fear of gaining weight
• Binging
• Purging
• Use of laxatives

108

drooling of the saliva is characteristic feature of

epiglottiis
Acute epiglottitis is rare but serious infection caused by Haemophilus influenzae type B.

109

managment of epiglottitis

1) call for help
2) PICU, trach tray ready
3) If ceftraiaxone