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Psych Flashcards

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1
Q

Personality Disorder definition

A

attitudes, beliefs, behaviours cause longstanding problem in daily life.

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2
Q

Sx of Personality Disorder

A

cant control emotions

struggle with friendships

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3
Q

type A Personality Disorder

A

suspicious

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4
Q

type B Personality Disorder

A

emotional and impulsive

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5
Q

type C Personality Disorder

A

anxious

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6
Q

causes of delirium

A

UTI, RTI, steroids/analgesics, dehydration, anaemia, metabolic disturbance, liver/kidney dysfn, alcohol/ drugs withdrawal, constipation

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7
Q

Sx of delirium

A 
confusion
[hypoactive] clouding of consciousness, decreased awareness/disorientation,
drowsy/lethargic, speech difficulty
vivid dreams
[hyperctive] illusions/hallucination
paranoia
agitation/ restless
anxious/frightened/irritable
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8
Q

difference between delirium and dementia

A

progressive vs fluctuating

chronic vs acute

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9
Q

management of delirium

A

treat the cause - hydration, Abx
re-orientate [clock, Xmove rooms]
reassurance, family presence

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10
Q

medical management of aggressive pateint

A

IM lorazepam

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11
Q

confusion, poor mobility, hemiparesis, recent fall. Ix? looking for?

A

CT head, subdural heamatoma

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12
Q

recent DM Dx, aggression & confusion. cause and Ix?

A

hypoglycaemia, blood glucose

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13
Q

76 yr old, ^confusion, urine incont. Ix?

A

mid stream urine culture

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14
Q

disregard for social obligations/ feelings of others. what type of PD?

A 
type A (suspicious) -
 antisocial/dissocial
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15
Q

misinterpretation of ext stimuli

A

illusion

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16
Q

assault, says he felt an alien guide his movements. What type of delusion?

A

delusion of passivity

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17
Q

depression, Hx of cardiac arrythmia. amitryptilline or fluoxetine?

A

fluoxetine. Amitr. is cardiotoxic

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18
Q

weight loss, Xeating/drinking 3/7, psychomotor retardation, pov of speech, flat affect. Mx?

A

ECT

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19
Q

mania Tx

A

olanzapine

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20
Q

low mood 5yrs, tired, depressed, no other Sx, able to cope day to day. Dx?

A

dysthymia (doesnt fulfil criteria for depressive episode)

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21
Q

depression, started hearing the voice of the devil. Dx?

A

psychotic depression

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22
Q

Sx of lithium toxicity

A

anorexia, nausea, diarrhoea, muscle weakness, drowsy, ataxia, coarse tremor, muscle twitching

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23
Q

cheese + phenelzine (MAOI)

A

hypertensive crisis

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24
Q

overdose of diazepam causes what problem

A

resp depression

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25
euphoria, hypervigilance, dilated pupils,cardiac arrhythmia. What drug?
amphetamine
26
apathy, pupil constrict, drowsy, slurred speech. drug?
opoid
27
labile mood, slurred speech, unsteady gait, nystagmus. drug?
alcohol
28
opoid agonist used in dependence management
methadone
29
alcohol dependence Tx, causes Rn when take alcohol
disulfiram
30
anxiolytic used for alcohol withdrawal Sx
chlordiazepoxide (librium)
31
name a recreational drug that is a CNS stimulant, and can cause paranoid psychosis
amphet
32
name a recreational drug that causes euphoria, sociability, death due to hyperthermia
ecstasy
33
name a recreational drug that is a hallucinogen, and causes synaesthesia
LSD
34
believes news is talking about him
delusion of reference
35
thoughts sucked out of head by alien
thought withdrawal
36
army satellites direct sun beams that make my arm move
somatic passivity
37
^antipsychotic dose, sustained contraction of one muscle group
acute dystonic reaction
38
haloperidol reaction. fever, fluctuating consciousness, rigidity, tachycardia, raised creat phos
neuroleptic malignant syndrome
39
abnorm chewing movements, grimacing, Hx haloperidol
tardive dyskinesia
40
define generalized anxiety disorder
excessive worrying for 6/12 | and 3 of the following: sleep disturbance, poor concentration, muscle tension, fatigue, irritable, restless
41
Difference between GAD and panic disorder
Panic: Recurring and regular panic attacks often for no apparent reason. Nausea, sweating, trembling, SOB. GAD: feel anxious all the time about everyday events
42
GAD risk factors/ aetiology
``` women 35-59 alcohol and drug use Family history/ Genetics Serotonin and noradrenaline imbalance Traumatic events – child abuse, domestic violence Chronic illness ```
43
describe the psychodynamic psychological theory
Conscious AND UNCONSCIOUS desires determine personality. Childhood experience shapes personality. Id [devil], superego [angel], ego [reality]. based on past
44
describes the cognitive behavioural psychological theory
thoughts determine behaviour. Dysfunctional thoughts lead to extreme emotions. based on present
45
investigations for GAD
urine drug screen TFTs pheochromocytoma [BP, blood/urine metadrenaline/ normetadrenaline] ECG
46
Mx for GAD
CBT, mindfulness, relaxation SSRIs [sertraline], SNRIs, pregabalin caffeine, alcohol, exercise
47
recurrent, multiple unexplained physical symptoms, with no medical cause found. Diagnosis?
somatisation disorder
48
young man who visited a prostitute on one occasion is convinced he has gonorrhoea despite recurrent tests being negative. Diagnosis?
hypochondriacal delusion
49
name 6 Sx of mania
``` mood elevation irritability grandiosity decreased sleep talkative flight of ideas ^sociability distractibility psychomotor agitation sexual disinhibition risk taking ```
50
name 6 Sx of depression
``` low mood anhedonia anergia poor sleep EMW decreased appetite feelings of worthlessness suicidal thoughts self harm poor concentration psychomotor retardation ```
51
risk factors for mood disorders
``` genes family member childhood trauma/abuse serotonin deficiency hypothyroidism stress Socio-economic status menopause COCP alcohol/drug use ```
52
bipolar disorder. Treatment mood stabiliser
lithium carbonate
53
Outline the categories of the Mental State Examination in psychiatry
``` ASEPTIC appearance and behaviour speech emotion [mood] perceptions thoughts insight cognition ```
54
components of the personal history in psychiatry
``` early development childhood behaviour education employment relationships ```
55
what are the 3 levels of psychiatric patient "insight"
1. awareness of abnormal experience 2. result of a disease process 3. open to intervention
56
what are the components of a psychiatric risk assessment
``` risk to self [suicide/SH] thoughts of harming others accidental risk to self/others self-neglect vulnerability ```
57
3 core Sx of depression
Low mood anergia anhedonia
58
Sx of depression, other than the 3 core Sx
``` sleep disturbance(EMW) Change in appetite Change in libido Diurnal mood variation Agitation Loss of confidence poor concentration Guilt Hopelessness Suicidal ideation ```
59
describe some of the psychotic symptoms you might see in depression with psychosis
nihilistic and guilt delusions | derogatory voices
60
define bipolar 1 and 2
Bipolar I – mania + depression | Bipolar II – more episodes of depression, only mild hypomania
61
1st rank Sx of schizophrenia
Thought alienation Passivity phenomena 3rd person auditory hallucinations Delusional perception
62
secondary Sx of schizophrenia
``` Delusions 2nd person auditory hallucinations Hallucinations in any other modality Thought disorder Catatonic behaviour Negative symptoms ```
63
list 4 positive Sx [schizophrenia]
``` Hallucinations Delusions Passivity phenomena Thought alienation Lack of insight Disturbance in mood ```
64
list 4 negative Sx [schizo]
``` Blunting of affect Amotivation poverty of speech Poverty of thought Poor non-verbal communication Clear deterioration in functioning self neglect Lack of insight ```
65
name 5 physical Sx of panic disorder
``` Palpitations chest pain choking Tachypnoea Dry mouth Urgency of micturition Dizziness Blurred visions Parasthesiae ```
66
define hallucination
perceiving something that isnt there in the abscence of external stimuli
67
define illusion
perceiving something that isnt there with external stimuli
68
define delusion
abnormal belief, doesn't follow societies norms
69
how do the auditory hallucinations differ between functional psychosis and depression
psychosis - 3rd person auditory | depresison - 2nd person auditory
70
name 2 organic causes of hallucinations
brain tumour | temporal lobe epilepsy
71
schizophrenia- auditory/visual halluinations?
auditory, NOT visual
72
differential diagnoses for schizophrenia
``` drug induced psychosis delusional disorder head injury schizoeffective disorder hyperthyroid ```
73
Ix for psychotic Sx
urine drug screen CT TFTs
74
section 5(2) of mental health act
Dr.s holding power
75
section 5(4) of mental health act
nurses holding power
76
progression of symptoms in neurology. Give an example of a condition which would present with gradual deterioration/ intermittent exacerabtions/ rapid onset
``` gradual deterioration (tumour) intermittent exacerbations (MS) rapid onset (stroke) ```
77
a headache worse on waking or coughing indicates?
raised intracranial pressure
78
describe the diff between Wernicke’s and Broca's dysphasia
Wernicke’s - Receptive dysphasia/speech comprehension | Broca’s - Expressive dysphasia/speech production
79
tremor worse towards the end of movements suggests a problem with which part of the brain
cerebellum
80
causes of tremor at rest
PD hyperthyroidism benign essential tremor alcohol withdrawal
81
name the 4 extrapyramidal symptoms of typical antipsychotics
tardive dyskinesia dystonia akathisia parkinsonism
82
functions of dopamine
reward pleasure fine tuning motor
83
serotonin functions
``` ^mood appetite sleep memory libido ```
84
dopamine hypothesis of schizophrenia
over activity -> hallucination/delusion | under activity -> blunted, apathy
85
what is the pharmacology of antipsychotics that causes tardive dyskinesia?
D2 recpetor antagonism
86
what receptors do newer antipsychotics target as opposed to D2 receptors targeted by typicals
serotonin
87
describe the monoamine theroy of depression
predicts that underlying pathophysiology of depression lies in depleted serotonin and noradrenaline levels
88
examples of SSRIs
fluoxetine sertraline citalopram
89
examples of SNRIs
venlafaxine | duloxetine
90
side effects of SSRIs
sexual dysfunction weight gain ^bowel motility agitation
91
dietary restrictions for MAOIs and why
``` aged cheese beer red wine smoked meat/fish contain tyramine [monoamine] -> HTN crisis ```
92
side effects of tricyclics for depression and why?
dry mouth blurred vision urinary retention anticholinergic [block ACh]
93
lithium side effects
diarrhoea tremor dry mouth thirsty skin changes teratogenic
94
features of lithium toxicity
``` coarse tremor drowsy vision disturbance D+V hypokal ataxia dysarthria coma ```
95
Mx of lithium toxicity
stop lithium rehydrate haemodialysis [gastric lavage]
96
evidence required for a section 2 MHA
patient suffering from mental disorder that warrants detention for assessment danger to self or others
97
evidence required for section 3 MHA
patient suffering from mental disorder that warrants detention for treatment treatment in interest of self/ others safety treatment is available
98
evidence required for section 4 MHA
patient suffering from mental disorder that warrants detention best interests of self/others safety not enough time/risk to great for 2nd Dr to attend
99
what kind of patient are section 5(2) and 5(4) for?
patient ALREADY admitted and wants to LEAVE
100
describe the theory of psychodynamic therapy
uncovering past trauma to resolve present day symptoms
101
psychodynamic therapy - how long and how often do you meet?
approx 1 yr. Weekly
102
describe 1st, 2nd and 3rd wave CBT approaches
1st wave: Behaviour therapy 2nd wave: Cognitive (behavioural) therapy 3rd wave: combines mindfulness and acceptance techniques with the above
103
Dialectic Behavioural Therapy mostly aimed at helping people with
personality disorder
104
how does ICD10 define dementia
decline in higher cortical function
105
name the 4 As of decline in cognitive function in alzheimers
amnesia apraxia agnosia aphasia
106
neuroradiological findings in an alzheimers brain
shrinkage of cerebral cortex shrinkage of hippocampus enlarged ventricles
107
what kind of speech disturbance is seen in vascualr dementia
Expressive dysphasia
108
describe some personality changes in fronto-temporal dementia
Apathy, disinhibition, emotional blunting, coarsening of sociability
109
symptoms /disease course of lewy body dementia
fluctuating, rapid decline visual hallucinations parkinsonian signs frequent falls
110
alzheimers treatment
Memantine (NMDA antagonist) | donepazil, rivastigmine, galantamine
111
what age constitutes late onset schoziphrenia
>45
112
symptoms of late onset schizophrenia
paranoia delusions (partition) hallucinations
113
what symptoms are seen less in late onset schizophrenia than young
emotional blunting personality decline negative symptoms formal thought disorder
114
define formal thought disorder and give 3 examples
disorganised thinking evidenced by disordered speech e.g. poverty of speech, derailment, perseveration
115
risk factors for late onset schizophrenia
Social Isolation Sensory deficits Reclusive and suspicious pre-morbid personality Female
116
criteria for delusional disorder
long standing delusions 3 months culturally appropriate no persistent hallucination/ not 3rd person no passivity no blunting of affect no organic cause
117
define Cotard delusion
delusional belief that they are already dead, do not exist, are rotting, or have lost their blood or internal organs.
118
name 2 somatic delusions of psychotic deperession
pain, | can't swallow
119
main difference between charles bonnet and psychosis
INSIGHT
120
describe attachment theory in psych
infant needs to develop a relationship with at least one primary caregiver for successful social/ emotional development, and to learn how to effectively regulate their feelings
121
criteria for delusion
belief that is: - firmly held - not affected by rational argument /evidence to the contrary - not a conventional belief
122
types of paranoid delusions
persecutory grandiose self-referential
123
lady started on fluoxetine now feels better and asks to stop it. Advice?
continue for 6 months after remission
124
Luria's motor test is for which type of dementia
fronto-temporal/ picks
125
what is paraphrenia?
late onset schizophrenia with +ve symptoms and without -ve symptoms
126
tricyclic overdose investigation
ECG
127
side effect of citalopram on the heart/seen on ecg
prolonged QT
128
depression and insomnia. Best medication? [flouxetine, mirtazepine, diazepam]
mirtazepine - has drowsiness side effect
129
diazepam overdose drug mx
flumazenil
130
treatment for pcm overdose
n-acetyl-cysteine
131
A 57 year old man presents with an ataxic gait, nystagmus, urinary incontinence and memory impairment
normal pressure hydrocephalus
132
treatment of normal pressure hydrocephalus
shunt operation to improve the circulation of cerebrospinal fluid
133
A 33 year old unemployed gentleman was seen in hospital for assessment of recent memory loss. He appeared malnourished and apathetic. During the course of assessment there was evidence of confabulation and gait disturbance. His partner mentioned that he spent most of his evenings drinking with friends in the pub.
korsakoff's syndrome
134
A 45 year old mother of two presented to her GP with a history of low mood and forgetfulness. She also complained of poor concentration, loss of interest, tiredness and poor sleep. Her Mini mental state examination score was 21 / 30. It was noticed that most of her answers were “I don’t know.”
pseudodementia
135
management of serotonin syndrome
fluids, benzos | Cyproheptadine
136
sx of serotonin syndrome
cognitive: confusion, agitation autonomic: diarrhoea, tachycardia fever HTN neuro: ^reflexes, clonus, tremor seizure ataxia
137
define mydriasis and miosis
mydriasis - dilated pupil | miosis - constricted
138
causes of serotonin syndrome
MAOI SSRIs ecstasy Amphetamines
139
Ix for patients on lithium
tft [hypo] u and e [excretion] ECG
140
risk factors for schizophrenia | triggers
FH social isolation intrauterine infection stress, drugs
141
schizophrenia type presentation- Ix
``` cultures MSU CT head FBC TFT glucose calcium cortisol alcohol/drug screen ```
142
NEUROLEPTIC MALIGNANT SYNDROME (reaction after starting an antipsychotic/ ↑ dose). Management?
benzodiazepines fluids bromocriptine
143
Ix in neuroleptic malignant syndrome and why
ABG [Met acidosis] U and E (↑ Creatinine Kinase) FBC [Leucocytosis] ECG [prolonged QT]
144
differences between serotonin syndrome and neuroleptic malignant syndrome
rapid vs gradual mydriasis vs normal increased vs reduced relflexes
145
OCD management
CBT + SSRI
146
management of Acute Dystonic Reaction after starting haloperidol
stop drug | procyclidine
147
Ix to chelck before starting lithium
U+E ECG TFT

3A GH (8 decks)

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