Psych Flashcards
(124 cards)
1
Q
Indications for ECT
A
- Mania (long lasting episode)
- Depression that is life-threatening
- Catatonia
2
Q
Side Effect of olanzapine
A
Weight gain (possibly give metformin to combat this)
3
Q
Examples of opioids (narcotics)
A
Heroin, oxycodone, morphine
4
Q
What substances cause pinpoint pupils
A
- Opiods
- Alcohol
- Benzo (valium)
- barbiturates
5
Q
What substances cause dilated pupils
A
- Hallucinogens (pot, LSD, mushrooms)
- Stimulants (cocaine, acid, meth)
- A.D
- Amphetamines
6
Q
Opiod withdrawal treatment
A
methadone
7
Q
Opiod overdose
A
Naloxone
8
Q
Alcohol withdrawal treatment
A
benzodiazepine
such as chlordiazepoxide hydrochloride or diazepam,
9
Q
Drug used to induce vomitting if you drink alcohol
A
disulfiram (used to treat chronic alcoholism, NOT detox)
10
Q
Anti-alcohol drugs (other than disulfiram)
A
Acamprosate
Naltrexone
These both decrease the effect of alcohol
11
Q
Chlorpromazine vs Clomipramine
A
Chlorpromazine = anti-psychotic Clomipramine = TCA
12
Q
Side effects of typical anti-psychotics
A
- Parkinsonism
- Tardive Dyskinesia (lip smacking)
- Akathisia (severe restlessness)
- Acute dystonia (torticollis, oculogyric crisis)
Hyperprolacinaemia - galactorrhea in men and amenorrhoea in women
13
Q
Names of typical anti-psychotics
A
- Chlorpromazine
2. Haloperidol
14
Q
Names of atypical anti-psychotics
A
- Olanzapine
- Risperidone
- Aripiprazole
- Clozapine
- Quetiapine
- Amisulpiride
15
Q
How do atypical anti-psychotics works?
A
the atypical antipsychotics integrate with the serotonin (5-HT), norepinephrine and dopamine (D) receptors in order to effectively treat schizophrenia. An activated 5-HT2A receptor upregulates the D2 receptor, which can cause schizophrenia in humans. Therefore, many antipsychotics block the 5-HT2A receptor. Some also directly block dopamine
One theory of atypicality is that the newer drugs block 5-HT2A receptors at the same time as they block dopamine receptors and that, somehow, this serotonin-dopamine balance confers atypicality.
16
Q
How do typical anti-psychotics work?
A
Are dopamine antagonists
17
Q
Can hypothyroidism and phenylketonuria cause LD
A
Yes they can, but they are both preventable
18
Q
Fragile X
A
More common in males
Most common inherited disease causing LD
Causes learning disability and cognitive impairment
LD can be very mild or severe
19
Q
Cognitive Deficits
A
It is an inclusive term used to describe impairment in an individual’s mental processes that lead to the acquisition of information and knowledge, and drive how an individual understands and acts in the world. The following areas constitute domains of cognitive functioning: Attention
20
Q
What are the main causes of death in a person with schizophrenia
A
CVD, respiratory issues, diabetes
21
Q
Side effects of atypical antipsychotics
A
Metabolic side effects (heart disease, diabetes, weight) DVT and VTE
22
Q
Management of first episode of psychosis
A
give minimum effective dose medication (atypical or typical) for 2 weeks. If no response after 4 weeks consider changing med. If partial response, reassess after 8 weeks
23
Q
When to stop medication after the remission of the first psychotic episode
A
a duration maintenance treatment with antipsychotics should be at least 18 months
24
Q
When to offer Clozapine
A
After treatment on 2 antipsychotics (including a SGA)
25
Bloods for Clozapine
weekly for 18 weeks
fortnightly for 1 year
monthly for life
26
Side effects of Clozapine
1. Agranulocytosis
2. Constipation
3. Hypersalavation (give hyosine)
4. Lowers seizure threshold (give Na valproate)
5. myocarditis, pericarditis, cardiomyopathy
27
What is capgras syndrome?
AKA imposter syndrome
| Someone they know (spouse, friend) has been replaced by an imposter
28
What is de clerambault's syndrome
Delusional love
29
Features of de clerambault's syndrome
More common in females
| Have a desire for a sexual relationship
30
hebephrenia
Disorganised schizophrenia
Disorganized behavior and speech (see formal thought disorder), including loosened associations and schizophasia ("word salad"), and flat or inappropriate affect. In addition, psychiatrists must rule out any possible sign of catatonic schizophrenia.
31
paraphrenia
mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) without deterioration of intellect or personality (its negative symptom).
32
Symptoms in generalised anxiety disorder
1. Apprehension
2. Motor tension
3. Autonomic overactivity
33
SSRI discontinuation syndrome presents with...
Selective serotonin reuptake inhibitor discontinuation syndrome can present with a wide variety of symptoms including diarrhoea, vomiting and abdominal pain.
34
1st rank symptoms in schizophrenia
1. Auditory hallucinations
2. Thought interference
3. Passivity phenomenon
4. Delusional perceptions
35
wernicke syndrome.
| Triad
brain disorder caused by lack of B-1.
| Causes: Ataxia, nystagmus and confusion
36
Korsakoff syndrome
Consequence of prolonged wernicke syndrome. Dense short term memory loss.
Make up answers to questions (confabulation)
37
Differential diagnosis for psychosis
```
depression with psychosis
mania with psychosis
schizophrenia
schizoaffective disorder
Puerpural psychosis
delusional disorder (mainly old people)
Acute sudden psychosis (sleep deprivation)
```
38
Differential diagnosis for depression
depression
Bipolar
Seasonal affective disorder
Post-natal depression
39
Anxiety disorders
```
GAD
OCD
PTSD
Social anxiety
Phobias
```
40
Neurodevelopment disorders that cause mental health issues
```
kleinfelters (psychosis)
turners (depression)
Huntingtons (sexually disinhibited)
ADHD
Autism (increase risk of schizo)
learning disability
```
41
Types of personality disorders (10)
1. Avoidant
2. Schizotypal- little nuts
3. Schizoid
4. boarder-line
5. OCD
6. Paranoid
7. Histrionic
8. Narcissistic
9. Anti-social
10. Dependant
42
Weight decrease in anorexia nervosa
15% decrease (due to avoidance)
43
upper or lower class have anorexia?
upper class
44
Risk of death by suicide in anorexia
20%
45
```
Anorexia features:
HR
BP
Growth hormone
Glucose intolerence
Salivary glands
Cortisol
Cholesterol
```
```
Anorexia features:
HR decrease
BP decrease
Growth hormone increase
Glucose intolerence increase
Salivary glands increase
Cortisol increase
Cholesterol increase
```
46
Eating disorder associated with over eating
bulimia
47
How do people with bulimia counteract overeating ?
vomiting
purging
exercise
starvation
48
Bulimia is associated with which neurodevelopment disorder
ADHD
49
Appetitive pathway involves which system
dopamine
50
Aversive pathway involves which system
serotonin
51
Baby blues within how long
2 weeks
52
Postnatal depression time scale
3-6 months
53
Endocrine changes in depression
increased CRH
| Increased TSH
54
Volume of hippocampus in depression
decreases. Hippocampus is associated with memory, long term in particular. It is found in the medial temporal lobe
55
What do SSRI work on
SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by limiting its reabsorption into the presynaptic cell, increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor.
56
Length of duration of hypomania to diagnose
| Symptoms
```
4 days plus.
At least 3 of:
increase activity
decrease sleep
increase talkative
increase sex
increase spending
```
57
Length of duration of mania to diagnose
| Symptoms
```
7 days plus
At least 3 of:
reckless money driving
marked sexual energy
flight of ideas
grandiosity
```
58
BP1 vs BP2
BP1: mania and depression
BP2: hypomania and depression (chronic) more common
59
Bipolar diagnosis
2 or more episodes where patients mood and activity levels are significantly disturbed
If the patient has single episode of mania/hypomania = bipolar
60
Brain changes in bipolar
Decreased grey mater volume
| increased metabolism in amygdala
61
Mood vs affect
Mood is underlying
| Affect is outwardly expression
62
Tests used to assess the severity of depression
Hamiltons rating scale for depression (HRSD)
| Montgomery-Asperg depression rating scale (MADRS)
63
What type of anti-depressants are associated with HTN crisis
MAOI- phenelzine, iproniazid.
| HTN overdose can occur with thiamine containing foods- cheese, pickled herring
64
What anti-depressant does not cause discontinuation syndrome
Fluoxentine
65
What SSRI is now first line for panic disorders, OCD and anxiety
Setraline- most cost effective drug
66
What Anti-depressant is recommended in the elder
Setraline
67
Function of aversive/defensive system
promote survival in event of threat
68
Function of appetitive/approach system
function to mediate seeking and approaching behaviours (pleasure)
69
Common adverse effects of SSRI
abdo pain (nausea and vomiting)
70
What do you have to do before giving citalopram
Do ECG, as citalopram has increased risk of causing long QT syndrome
71
GABA. What it is? what does it do?
gaba binding causes opening of ion channels, allowing the flow of Cl into cells and K out of cells, resulting in hyper-polarisation
72
How does lithium work?
inhibits gylcogen synthase kinase 3
73
Symptoms of Serotonin syndrome
confusion, fever, irregular heart beat, seizures, D+V, sweats, headache
74
Management of Serotonin syndrome
Hospital: fluids, benzo (agitation and seizures) and PERIACTIN- cypoheptadine (blocks serotonin production)
75
PD: Antisocial
```
failure to conform to social norms
Deceptive (always lying)
Impulsive
Aggressive
Lack of remorse
Irresponsible
FOUND IN JAIL
```
76
PD: Which one?
Avoids interaction due to fear of rejection
Wants to be liked
restrant in intimate relationships
Social isolation but want contact
Don't take risks due to fear of being ridiculed
Avoidant
77
PD: Boarderline
```
DAWN
NIGHTMARE GF/BF
impulsive
temper
recurrent suicidal behaviour
```
78
PD:
Need reassurance from other with regards to daily decisions
Difficulty expressing disagreement
Search for relationship for added care and support
Dependant
79
PD: histrionic
Inappropriate sexual seductiveness
centre of attention
self-dramatic
Physical appearance is used for attention seeking
80
```
PD: Grandiose sense of importance
fantasies of unlimited success, power and beauty
chronic envy
Lack of empathy
sense of entitlement
```
Narcissistic PD
| DONALD
81
PD: Schizotypal
```
BIT NUTS
ideas of reference (insight is maintained)
odd beliefs
lack of friends
odd speech but not incoherent
paranoid
strange behaviour
```
82
PD: Paranoid
```
Hypersensitive
Unforgiving attitude
Questions loyalty of friends
tendency to perceive attack on character
hidden meaning in things
```
83
```
PD:
indifferent to praise/criticism
Likes solitary activities
reduced interest in sex
appears cold
no friends other than family
```
Schizoid
| BATMAN
84
PD:
| OCD
just the usual.
unwilling to pass on tasks
can't throw out old things with sedimental value
85
Type 1 simple trauma
events that are abrupt.
| often lasting a few minutes and as long as a few hours can be referred to as short term
86
Type 2 complex trauma
sustained and repeated trauma
87
Brain response in PTSD
Events fail to get stored in long term memory because the limbic brain/emotional brain keeps getting triggered. They don't want to remember but they can seem to forget
88
3 key features of PTSD
1. Hypervigilence
2. Avoidance
3. Flashbacks
others: desensitisation, emotional numbing
89
Symptoms following trauma:
1. up to 48 hours
2. 2 days- 2 weeks
3. 2weeks-3months
4. 3months +
1. Acute stress reaction
2. Acute stress disorder
3. Acute PTSD
4. Chronic PTSD
90
Treatment for PTSD
If least than 4 weeks - just wait and watch
| EMDR (CBT)
91
Egodystonic vs egosyntonic
Ego-syntonic refers to instincts or ideas that are acceptable to the self; that are compatible with one's values and ways of thinking. ... Ego-dystonic refers to thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one's self-concept.
E.g.
Egosyntonic: comfortable with it. putting DVD's in order
Egodystonic: standing on one leg waiting for dishwasher to finish
92
Obsessions
THOUGHTS: recurrent, intrusive, distressing
93
Complusions
BEHAVIOURS: repetitive seemingly purposeful. they feel driven to do these
94
OCD:
Familial?
Comorbidities:
Gender:
Familial: yes
Comorbidities: 90%. PD, hypochondriasis, schizo, autism
Gender: slightly higher in females
95
Poor prognosis in OCD
male, early onset, tics and multiple symptoms
96
Neuroimaging in OCD
increased metabolism and blood flow in the orbitofrontal cortex, caudate nucleus and cingulate cortex
97
What increases your risk of developing OCD in children
b-haemolytic strep and auto antibodies to the basal ganglia
98
Anxiolytic
substance which inhibits anxiety
99
Withdrawal symptoms of benzo
Decreased appetite
perspiration
tinnitus
100
How to withdrawal from benzo (valium, Xanax)
Put patient on equivalent dose of diazepam/chlordiazepoxide
101
Antidepressants and anxiety
Acutely SSRI increase extra-cellular 5-HT and have antigenic properties. When given chronically anxiolytic properties appear
Other drugs for anxiety= pregabalin, BB
102
What is psychosis ?
Qualitatively different from normal experience
Inability to distinguish between subjective experience and reality
Lack of insight
Harmful to individuals functioning and interpersonal relationships
103
Brain changes in schizophrenia
Reduced frontal lobe volume (with widened sulci)
Reduced frontal lobe grey mater
Reduced temporal cortex (esp superior temporal gyrus)
Enlarged lateral ventricle volume
Decreased cerebral (cortical and hippocampal) volume
104
Dopamine pathways (thought to be overactive in schizophrenia)
MESOLIMBIC/CORTICAL - motivation and reward system
NIGROSTRIATAL - extra-pyramidal motor system
TUBEROINFUNDIBULAR - control of prolactin release
105
What is in nigrostriatal?
substantial nigra, dorsal striatum
106
What is in mesolimbic/cortisol pathway?
hippocampus, amygdala, prefrontal cortex, ventral trigeminal area, nucleus accumben
107
Functional disorders?
symptoms that’s are unexplained by conventional physical disease processes or injuries.
It is likely that the symptoms are triggered by emotional change
Common!!
108
Functional disordered are commonly associated with ...
anxiety and depression disorders
109
Examples of functional disorders
IBS, tension headache, fibromyalgia, chronic fatigue, irritable bladder
110
Somatic features
Somatic symptom disorder involves having a significant focus on physical symptoms — such as pain or fatigue — to the point that it causes major emotional distress and problems functioning.
111
Moderate depression vs Severe depression
Subthreshold depressive symptoms: Fewer than 5 symptoms of depression.
Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.
Moderate depression: Symptoms or functional impairment are between 'mild' and 'severe'.
Severe depression: Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.
112
What is needed for diagnosis of major depression
To diagnose major depression, this requires at least one of the core symptoms:
Persistent sadness or low mood nearly every day.
Loss of interests or pleasure in most activities.
Plus some of the following symptoms:
Fatigue or loss of energy.
Worthlessness, excessive or inappropriate guilt.
Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts.
Diminished ability to think/concentrate or increased indecision.
Psychomotor agitation or retardation.
Insomnia/hypersomnia.
Changes in appetite and/or weight loss.
113
How long to take anti-depressant for if she feels better?
for one episode the patient should continue taking medication for 6months- 1 year after feeling better
114
Dopamine system dysfunction in psychosis?
Subcortical dopamine hyperactivity
115
Dopamine system dysfunction resulting in negative and cognitive systems?
Mesocortical dopamine hypoactivity
116
Grey matter function
Function. Grey matter contains most of the brain's neuronal cell bodies. The grey matter includes regions of the brain involved in muscle control, and sensory perception such as seeing and hearing, memory, emotions, speech, decision making, and self-control
117
What is grey matter lose due to?
Grey matter reductions due to reduced arborisation and not neuron loss
118
D2 blockage in substantia nigra leads to...
Extra-pyramidal side effects
119
D2 blockage in TUBEROINFUNDIBULAR leads to...
Hyperprolactinaemia
120
Learning difficulty criteria
IQ <70
Age <18
Deficit in adaptive functioning
121
Severity of learning difficulty
Mild LD IQ 50-69 (most common)
Moderate LD IQ 35-49
Severe LD IQ 20-34
Profound LD IQ < 20
Borderline LD IQ 70+
122
Chromosomal abnormalities
Downs syndrome
Patau syndrome
Edwards syndrome
cri du chat
Angelman
Prader-Willi
Velo-cardiofacial syndrome
Williams syndrome
```
Downs syndrome (Trisomy 21) 1/1000 births(maternal age 30) IQ 30-55, associated with Alzheimer Dem
94% sporadic, 3-5 % familial, 1-3% mosaicism
```
Patau syndrome Trisomy 13 0.2/1000 (18% survive 1 year)
Edwards syndrome Trisomy 18 0.3/1000 (10% survive 1 year)
cri du chat 5P- microcephlay severe/profound LD
Angelman 15Q- (maternally derived) LD, ataxia, paroxysms of laughter
Prader-Willi 15Q- (paternally derived) LD, over eating, self injurious behaviour
Velo-cardiofacial syndrome 22Q- 50% have LD, increased risk of schizophrenia
Williams syndrome 7Q 1/7500
123
```
Sex chromosomes
turners
Trisomy X
Klinefelters
Fragile X
```
```
Turners 45, XO LD rare
Trisomy X, 47 XXX
Klinefelter XXY
XYY male - IQ may be slightly lower than average
Fragile X – 1/1000
Due to faulty FMR1 gene
```
124
Triad for ASD
Language impairment
social deficit
Repetitive behaviour
