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Phase 3a Jess > Psych > Flashcards

Psych Flashcards

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1
Q

How long do depressive symptoms have to persist to make a diagnosis of depression?

A

2 weeks

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2
Q

What are the 3 key symptoms of depression?

A
  1. Low mood
  2. Anhedonia
  3. Energy loss
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3
Q

How do you define mild depression?

A

5 symptoms of depression AND mild functional impairment

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4
Q

How do you define severe depression?

A

Most symptoms, marked functional impairment with or without psychotic symptoms

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5
Q

Give two ways of assessing depressive symptoms

A
  1. Patient Health Questionnaire 9 (PHQ-9)

2. Hospital Anxiety snd Depression Scale (HAD score)

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6
Q

What might happen if you mix SSRI with MAO inhibitor?

A

Serotonin Syndrome

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7
Q

What key condition should tricyclics be avoided in?

A

Heart failure

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8
Q

Give and example of a MAO inhibitor

A

Phenelzine

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9
Q

What is the risk of using MAO inhibitors?

A

Hypertensive crisis

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10
Q

What might trigger bad side effects in patients on MAOis?

A

Tyrosine (avoid cheese, red wine, broad beans)

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11
Q

What drug class is Mirtazipine?

A

Noradrengergic and specific seretonergic antidepressant

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12
Q

What 4 drugs might cause serotonin syndrome?

A

SSRIs
MAO inhibitors
Amphetamines
Ecstasy

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13
Q

Give some autonomic symptoms of serotonin syndrome

A 
Tachycardia
Sweating
Fever
Tachypnoea
Fever
Arrhythmia
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14
Q

Give some cognitive symptoms of serotonin syndrome

A

Agitation
Confusion
Hallucination

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15
Q

Give some neuromuscular symptoms of serotonin syndrome

A

Tremor
Ataxia
Seizures

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16
Q

How long does hypomania need to last diagnostically?

A

<4 days

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17
Q

How to long does mania need to last diagnostically?

A

> 7 days

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18
Q

What is the DSM-IV-TR definition of ‘Bipolar’?

A

Manic episode +/- depressive

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19
Q

What must you be careful about when initiating treatment for someone with a long Hx of psych problems, but only just being diagnosed with bipolar?

A

Make sure you stop any SSRI treatment!!!!

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20
Q

What type of medication is given for people with bipolar?

A

Mood stabilisers

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21
Q

Give 3 different examples of mood stabilisers

A
  1. Lithium
  2. Antiepileptics (valproate, carbamazepine)
  3. Antipsychotics (used in acute mania)
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22
Q

Why is lithium the favoured medication for bipolar?

A

It treats both mania and depression

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23
Q

Why do patients on lithium need to be closely monitored?

A

Lithium has a very narrow therapeutic range

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24
Q

What do you need to monitor if a patient is on lithium?

A
  1. Renal function (creatinine, U+E)

2. TFT’s (hypothyroidism)

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25
What are the side effects of lithium?
``` L - Leukocytosis I - Insipidus T - Tremor H - Hypothyroid I - Increased U - Urine M - Mums - teratogenic ```
26
What are some signs of lithium toxicity?
Blurred vision, weakness, coarse tremor, ataxia, nausea, vomiting, oliguria, coma
27
According to WHO, what 4 domains are affected in schizophrenia?
1. Thinking 2. Language 3. Perception 4. Sense of self
28
How long do symptoms need to last in order to get diagnosed with schizophrenia?
1 month
29
What are some 1st rank symptoms in schizophrenia?
``` Delusional perception Auditory hallucinations - 3rd person Thought insertion Thought removal Thought broadcasting Somatic passivity ```
30
What are some negative symptoms in schizophrenia?
Flat affect Lack of motivation Anhedonia Poverty of speech
31
Side effects of of atypical antipsychotics
``` Metabolic syndrome T2DM Stroke Weight gain Sedative ```
32
What are the conditions for trying clozapine?
Must have tried 2 drugs for 6 weeks each
33
What do you need to look out for when a patient is on clozapine?
Agranulocytosis
34
What happens in acute dystonia?
- Facial grimacing - Involuntary upward eye movement - Muscle spasms of the tongue, face, neck and back - > back muscle spasms cause the trunk to arch forward) - Laryngeal spasms
35
What syndrome might occur when starting or increasing dose of antipsychotics?
Neuroleptic Malignant Syndrome
36
What are the symptoms of Neuroleptic Malignant Syndrome?
``` Autonomic instability Fever Stiffness (lead pipe) Seizures Coma ```
37
What would you expect from an ABG of someone with neuroleptic malignant syndrome?
Metabolic Alkalosis
38
What blood marker might be raised in neuroleptic malignant syndrome?
Creatinine kinase
39
How would you treat neuroleptic malignant syndrome?
IV fluids - prevent AKI Benzodiazepines Bromocriptine Muscle relaxants
40
Name 5 anxiety disorders
1. Generalised anxiety disorder 2. Panic 3. Post-traumatic stress 4. Phobias 5. Obsessive compulsive
41
How do you define the obsessions of OCD?
Uncontrollable, intrusive, recurrent thoughts of distressing nature
42
What is a phobia?
A strong, irrational fear or something that poses little or no real danger
43
Symptoms of PTSD (6)
``` Intrusive thoughts of traumatic event Nightmares Flashbacks Isolation Angry outbursts Hypersensitivity ```
44
What is a personality disorder?
Rigid, maladaptive traits that cause great distress or an inability to get along with others
45
What type of behaviours do cluster A PD have?
Odd or eccentric
46
What are 3 examples of cluster A PD?
Paranoid Schizoid Schizotypical
47
What type of behaviours do cluster B PD have?
Emotional, dramatic or erratic
48
What are 4 examples of cluster B PD?
Borderline Antisocial Histrionic Narcissistic
49
What type of behaviours do cluster C PD have?
Anxious or fearful
50
What are 3 examples of cluster C PD?
Obsessive compulsive Dependent Avoidant
51
Features of schizoid PD?
Detached and cold Doesn't interact with others Rich fantasy world No eye contact
52
Features of schizotypical PD?
Odd ideas and behaviour Lack or inappropriate emotion May have hallucinations/delusions but not significant to diagnose schizophrenia
53
Features of antisocial PD?
Incapable of empathy Manipulative behaviour Impulsive Aggressive (quick temper)
54
Features of BPD?
Low self esteem, intense feeling of rejection Develops very intense feelings for people very quickly Find it hard to control emotions they feel very intensely -> emotional rollercoaster Often self-harm, engage in risky behaviour Associated with depression, alcohol abuse Finds it difficult to cope with life stresses
55
Name risks for suicide
``` Sex - male Age under 19, or over 45 Depression Previous suicide attempt Ethanol abuse / drug abuse Rational thinking loss - psychosis etc. Separated from partner Organised, well thought out attempt No social support Sickness e.g. chronic illness ```
56
What are the elements of capacity?
1. Can understand information 2. Can retain information 3. Can weigh up pros and cons 4. Can formulate and communicate a decision
57
How long does a section 2 last?
28 days
58
What is a section 2 used for?
Assessment - under section
59
What is required during a section 2?
The opinion of 2 doctors. One psychiatrist and one other doctor who has prior knowledge of the patient
60
Can a section 2 be renewed?
No
61
How long does a section 3 last?
6 months
62
What is a section 3 used for?
Treatment (admission)
63
What is required for a section 3?
2 doctors. One psychiatrist and one doctor who has prior knowledge of the patient
64
Can a section 3 be renewed?
Yes
65
What is a section 4 used for?
Emergency situations when only one person is available for assessment - to detain until another can be found
66
How long does a section 4 last?
Up to 72 hours - patient must be seen in this time
67
What is a section 5?
To detain when a patient is already in hospital
68
Who can give a section 5?
Nurse or doctor
69
What is a section 135 used for?
Allowing police to enter private property to take someone to a place of safety
70
How long does a section 135 last?
72 hours
71
What is a section 136 used for?
Allowing police to take person from public place to place of safety
72
How long does section 136 last?
72 hours
73
How do you diagnose panic disorder?
4 unexpected episodes in 4 weeks
74
What treatment can you sometimes use in panic disorder/generalised anxiety, that you cannot use in PTSD?
Benzodiazepines
75
What are 3 key symptoms for phobia disorders?
1. Anxiety 2. Anticipatory anxiety 4. Avoidance
76
What are is the age criteria for late onset schizophrenia?
>45 years
77
Why might late onset schizophrenia not be diagnosed until really late?
Elderly people with this condition tend to isolate themselves
78
What is less likely to happen in late onset schizophrenia than in younger patients?
Emotional blunting Personality decline Negative symptoms
79
What is different about the hallucinations in late onset schizophrenia?
In multiple modalities
80
Does late onset schizophrenia have better or worse prognosis?
Better
81
What would suggest delusional disorder rather than late onset schizophrenia?
Long standing delusions, but no persistent hallucinations
82
What would suggest psychotic depression rather than late onset schizophrenia? (4)
1. Nihilistic delusions (Cotard's syndrome) 2. 2nd person derogatory auditory hallucinations 3. Pain - somatic delusions 4. Depression
83
What is Charles Bonnet Syndrome?
When blind people have complex visual hallucinations
84
What 3 conditions is ECT used in?
1. Depression 2. Catatonia 3. Mania (only if not responding to Tx)
85
What are the side effects of ECT?
``` Retrograde amnesia Prolonged seizure (>120 seconds) Manic switch Headaches Muscle pain Mortality ```
86
What types of disinhibition are seen in mania?
1. Social 2. Sexual 3. Financial
87
What do you need to be aware of when taking a newly diagnosed bipolar patient of antidepressants (previously used for suspected depression)?
Some antidepressants (e.g. paroxetine) have short half lives. Take off slowly
88
What are the 3 types of acute confusion?
Hypoalert Hyperalert Mixed
89
What time frame is criteria for acute confusion?
<6 weeks
90
What symptoms are in delirium that are not seen in dementia?
Inattention (cannot focus on tasks) | Fluctuations regularly
91
How to manage delirium?
``` Fluids Encourage movement Keep in own, quiet room Keep clocks and calendars in room Normalise sleep/wake cycle ```
92
Name 3 different screening tools for Alzheimers
1. Mini mental state exam 2. AMTS 3. MOCA
93
What are the 2 microscopic changes in Alzheimer's?
1. Plaques (beta amyloid deposits between nerve cells) | 2. Tangles (tau protein twists)
94
What might you see on MRI head in Alzheimers?
Ventricules enlarged and cerebral atrophy
95
What is different about Lewy body dementia?
No memory problems initially | Parkinsonisms
96
Which dementia tends to present in younger patients (45-65)?
Fronto-temporal
97
What is schizoactive disorder?
Psychosis AND mood disorder (depression/bipolar)
98
Why might someone with anorexia have peripheral oedema?
Due to low albumin
99
What might U and E's show in someone with anorexia?
High urea | Low potassium and sodium
100
What might LFTs show in someone with anorexia?
High ALT and AST | Low ALP
101
What might a dipstick of someone with anorexia show?
Ketones
102
What do you need to be careful for in treatment of anorexia?
Refeeding Syndrome
103
How might you notice re-feeding syndrome?
Pedal oedema due to vast fluid shifts
104
What causes re-feeding syndrome?
Electrolyte imbalance due to too sudden change. Massive increase in insulin, which binds to cell walls and increases electrolyte absorption
105
What might happen as a complication of re-feeding syndrome?
Prolonged QT syndrome Weakness Confusion Neuromuscular dysfunction
106
What is the most important thing to monitor in anorexia recovery?
POTASSIUM! (and other electrolytes/vital signs/ECG)
107
What kind of scan might it be wise to give someone with anorexia?
DEXA
108
How do benzodiazepines work?
Increase GABA
109
What are the side effects of Benzos?
Respiratory depression | Addiction
110
What are the side effect of SSRIs?
``` Increase bleeding Hyponatraemia Increase suicide potential N and V Insomnia Low libido ```
111
What are the side effects of tricyclics?
Sleepy | Dry mouth
112
What are the side effects of 1st generation (typical) antipsychotics?
Parkinsonisms Hyperprolactinaemia Prolonged QT
113
How do 1st gen (typical) antipsychotics work?
Block dopamine D2 receptors
114
What is the main side effect of atypical antipsychotics?
Metabolic syndrome (weight gain, constipation, hyperlipidaemia)
115
When might you consider trying Clozapine?
When 2 other atypicals have been tried
116
What do you need to do extra for Clozapine patients?
Monitor FBC regularly for agranulocytosis
117
What is the main complaint side effect when using clozapine?
Constipation
118
What cannot be used alongside lithium?
ACEi or ibuprophen
119
What causes Korsakoff's? (1 mark)
Thiamine (B1) deficiency
120
What can patients not do if they have Korsakoff's?
Form new memories
121
What are the symptoms of Korsakoff's?
Can only retain old memories Gait problems LONG TERM Eye movement problems LONG TERM
122
Where does Korsakoff's permanently damage?
Cerebellum
123
What are the 3 key symptoms for Wernicke's?
1. Ophthalmoplegia 2. Ataxia 3. Confusion
124
Which muscle is most commonly affected in Wernicke's?
Lateral rectus (causing lateral nystagmus)
125
Where are the lesions in Wernicke's?
CNS
126
What is the treatment given during alcohol withdrawal?
Chlordiazepoxide
127
What are some symptoms of delirium tremens?
Confusion, hallucinations, seizure, sweating, shaking
128
What are 6 long term liver problems associated with alcohol?
1. Hepatitis 2. Clotting problems (10, 9, 7, 2) 3. Asterixis 4. Varices 5. Hypoglycaemia 6. Jaundice 7. Low albumin
129
Why do people with alcoholism end up malnourished?
Plugs form in the pancreatic ducts, causing blockage of digestive products and autodigestion
130
Name cardiac problems associated with alcoholism?
Alcoholic myopathy Hypertrophy Atrial fibrillation
131
What are the dysfunctional areas of development associated with autism?
Language and communication | Socialising
132
What are the 2 key ASD traits?
1. Social communication and interaction | 2. Restricted or repetitive behaviour
133
How does Aspergers differ to other autism?
No language or cognitive problems (just socialising and restricted behaviour)
134
What are the criteria for being diagnosed with Tourette's?
>2 motor tics >1 vocal tic Persisted for 1 year or more Started before age 18
135
What is the medication used for ADHD?
Methylphenidate
136
What 3 key symptoms make up ADHD?
1. Inattention 2. Overly active 3. Impulsive
137
What age range is ADHD diagnosed?
6-12 years
138
What time frame do symptoms need to persist in order to consider ADHD?
6 months
139
What do you use to counteract opiate overdose?
Naloxone
140
What do you use to counteract benzodiazepine overdose?
Flumazenil
141
What do you use to counteract paracetamol overdose?
Acetylcystine | N.B. If <1h post-OD you can use activated charcoal
142
What time do you need to treat paracetamol overdose in in order for there to be therapeutic benefit?
Under 8 hours
143
Why might paracetamol overdose only present 24-72hours after the OD?
This is when acute liver failure occurs
144
What do you need to measure in a suspected paracetamol OD?
Thrombin time INR Salicylate levels
145
What symptoms would hint benzodiazepine OD?
``` Slate grey cyanosis Ataxia Blurred and slurred Euphoria Agitated ```
146
What conditions are antipsychotics used in (other than psychosis)?
ADHD PTSD OCD Generalised anxiety
147
What two organs are affected by lithium?
1. Kidneys | 2. Thyroid
148
What do you need to be careful using SSRIs with? (and what do you need to do about it)
NSAIDs - prescribe PPI with it Warfarin/heparin
149
What is a cardiac side effect of citalopram?
Prolonged QT syndrome
150
Give 3 extrapyramidal side effects of antipsychotics
1. Parkinsonism 2. Akathisia 3. Tardive dyskinesia 4. Acute dystonia
151
Give 4 antimuscarinic side effects of anti psychotics?
1. Dry mouth 2. Blurred vision 3. Urinary retention 4. Constipation

Phase 3a Jess (8 decks)

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