Psych Flashcards
(110 cards)
1
Q
What are the Core symptoms of depressive disorder?
A
- Persistent low mode
- Loss of pleasure/ interest
- Fratigue/ low energy
2
Q
What other (not core) symptoms of depression are there?
A
- Insomnia - early morning waking
- Loss concentration
- Change in appetite
- Suicidal ideation
- Psychomotor retardation
- Guilt
3
Q
What investigations might be done for a low mood?
A
Bedside - BP, Pulse, ECG, BMI
Bloods - Baseline, TFT, HbA1c, Vit B12, Folate
Special - PHQ-9
4
Q
What is the PHQ-9?
A
A questionaire used to measure the severity of depression
5
Q
What treatment are there for depression?
A
Conservative - lifestyle, watch and wait
Medical - SSRI, CBT
6
Q
What are the common side effects of SSRI?
A
Drowsiness Dry mouth GI upset Nausea Decreased labido, anorgasmia
7
Q
What RF increase risk of suicide?
A
Divorced, widowed Unemployed Illness - psych or physical Substance >45yo Previous attempt Male
8
Q
How should a SSRI be stopped?
A
Tapering dose over a minimum of 4w
Avoid during stressor events
9
Q
What are the symptoms of SSRI withdraw?
A
Mood changes Restlessness Nausea Lethargy Headaches Dizziness
10
Q
What differentials are there for low mood/ depression?
A
Depressive disorder Bipolar Grief reaction Schizophrenia/ Psychosis Organic cause
11
Q
What organic causes are there for depression?
A
hypothyroidism
Cushings
Anaemia
Drugs…
12
Q
What drugs can contribute for depression?
A
Steroids
Interferon-beta - MS treatment
PPI
Anti-hypertensive
DRUGS AND ALCHOL
13
Q
What SSRI is used post MI?
A
Sertraline - least affect on QT interval and electrolytes
14
Q
What additional side effects are there fore SNRI over SSRI?
A
Increased drowsiness
Increase BP
Increase dry mouth
15
Q
What SSRUs used for young people and DM?
A
fluoxetine
16
Q
What electrolyte abnormality can SSRIs cause?
A
Hyponatraemia via SIADH
17
Q
In elderly what causes are there in particular for low mood?
A
The 3Ds
Dementia
Depression
Drugs
18
Q
Why does SSRI increase bleeding risk?
A
serotonin receptors on platelets, can lead to thrombocytopenia
19
Q
How long does an SSRI take to become effective?
A
2-4 weeks
20
Q
What is the bigger SE with mtrazapine?
A
Weight gain
21
Q
What SSRI is used in patient with an eating disorder?
A
Fluoxetine as less weight gain
22
Q
What are the indications for ECT?
A
Treatment resistance
Pregnancy (benefit:risk)
Quick response needed
23
Q
What are the contraindications for ECT?
A
Any contraindications for general anaesthesia
24
Q
What is the main side effect of ECT?
A
retrograde amnesia
25
What structure for a risk assessment should be used?
1 - Now/ current episode
2 - How they feel now
3 - Past attempts/self harm
26
How long should SSRI be continued if there is low risk of depression relapse?
6-9 months
27
How long should SSRI be continued if there is high risk of depression relapse?
2 years
28
What is serotonin syndrome?
Serotonin excess leading to autonomic dysfunction, abdominal pain, myoclonic seizures, cardiovascular shock
29
What are the symptoms of anticholinergics?
Dry mouth, blurred vision, urinary retention, confusion
30
What are the symptoms of anti-adrenergics?
postural hypotension, sexual dysfunction, tachycardia
31
What are the symptoms of anti-histamines?
Sedation, weight gain
32
When are MAOI used?
severe depression
Watch out for hypertensive crisis
33
What classes of mood stabilisers are there?
Lithium
Anticonvulsanst - NaValproate, Carbamazapine, lamatrogine
Antipsychotics - Olanzapine, resperidone, Quetiapine
34
What is the advantage of lithium?
- Prophylaxis of mania and depression
| - Decreases suicide risk
35
What risk are there for lithium in pregnancy?
- Teratogenic in 1st trimester
| - Ebsteins anomaly
36
What monitoring is required for lithium?
Trough levels
UE - creatinine
TSH
37
What SE are there of lithium?
GI distress - nause, D&V
Tremor
ADH antagonism - polydipsia, polyuria (DI)
38
What advice should be given to patient with Li treatment?
Teratrogenic
| Drink plenty of water
39
What is Autistic spectrum disorder (ASD)?
A developmental triad of
- impaired social interactions
- Impaired communication
- rigidity in thinking
40
What is the Triad for attention deficit disorder (ADHD)?
- Inattention
- Impulsivity
- Hyperactivity
41
What criteria for ADHD diagnosis?
Symptoms with significant functional impairment for at least 6m under the age of 7y years.
42
Treatment of ADHD?
- lifestyle, information
- behavioural stratergies
- Methyl phenidate
43
What should be considered when the diagnosis is not ASD or ADHD?
Behavioural issues
Additionally usually seen in one environment (unlike ASD ADHD)
44
7yo struggling in large groups, fidgets, aggressive at school, Picky with food and difficult getting to sleep at home. Keeps running away when going shopping with mum. MLD?
ADHD
45
4yo with delayed speech seen by SLT. Does not make friends and plays with same cars. flaps hands, picky with food at home. MLD?
ASD
46
Fussy with food, disobedient to mother, fights sister. Doesn't stay on naught step. Normal at day care. MLD?
Behavioural issues, isolated to one environment (the home).
47
What assessment tool is used for ADHD?
CONNERS questionnaire
48
What assessment tool can be used for ASD?
ADI
ADOS-2
DISCO
49
what does the Sally Anne test assess?
Theory of the mind - assessment of deficits in empathy and understanding other. Indicates ASD
50
What pharmacological treatment is there fore aggressive behaviour in children?
Respiridone
51
What are positive symptoms of psychosis?
Hallucinations
Delusions
Thought disorders
52
What are the negative symptoms of Psychosis?
```
The A’s:
Apathy
Affect - flat
Anhedonia
Avolition
Alogia - poverty of speech
```
53
What is the pathophysiology of psychosis?
Dopamine deficit in mesocortiyal pathway leading to negative symptoms. dopamine excess in the mesolimbic pathway leading to positive symptoms.
54
What are the extrapyramidal SE of antipsychotics?
Dystonia
Akanthisia
Psuedoparkinsons
Tardative dyskinesia
55
What is Akathisia?
Restlessness, compulsion to move
56
What examples of tardative dyskinesia?
Lip smoking
Tongue protrusion
Chorea
pelvic thrusting
57
What is are the symptoms of hyperprolactinaemia?
gynecomatia, galactorrhea, decreased labido, interference with labido
58
What is the pathophysiology of a raised prolactin?
Dopamin antagonism in the tuberoinfundibular pathway stops the inhibition of prolactin
59
Psych patient has a fever, with altered mental state and autonomic dysfunction. MLD?
Neuroleptic malignant syndrome
60
What complications are there from neuroleptic malignant syndrome (NMS)?
Rhabdomyolysis
Hyperkalaemia
Renal failure
Seizures
61
What blood test can be done to confirm NMS
CK - should be raised
62
How is NMS treated?
- Cessation of medication
- ICU
- Active cooling
- Medications
63
What medications are used for NMS?
Bromocriptine
Dantrolene
Amantadine
64
What do typical antipsychotics target?
Antagonism of D2
65
What do atypical antipsychotics target?
Antagonism of dopamine and serotonin (but in an atypical way)
66
Why is the cardiovascular risk greater in atypical antipsychotics?
high cholesterol
| high triglycerides hyperglycaemia
67
What monitoring is required for Clozapine?
FBC - agranulocytosis - weekly then biweekly for 6m
LFT
Cardiovascular risk
68
What DD for psychosis?
```
Schizophrenia
Dementia
Drugs
Severe depression
Mania - bipolar
```
69
What treatment is used for first episode Psychosis?
Antipsychotic
| CBT or gamily intervention
70
What are the common SE of antipsychotic medications?
Raised prolactin
Sedation
DM
71
What is section 135 used for?
For Police to gain asses to property
72
What is section 136 used for?
Removal of a patient from a public place
73
What is section 2 used for?
Admission and assessment for uptimes o 28 days. Can start treatment
74
What is section 3 used for?
Admission and Treatment for 3m before 2nd opinion.
75
What is a section 4 used for?
Assessment for treatment. 72 hours. Recommendation by doctor
76
What is section 5 (2) for?
RN for emergency holding for 6hours
77
What is section 5(4) for?
Doctor for emergency holding for 72 hours.
78
Which have more EPSE, typical or atypical antipsychotics?
typical antipsychotics have more EPSE SE.
79
What type of antipsychotic is clozapine?
atypical
80
What is included in a risk assessment?
Health
Self
Others
81
What is Lofepramine?
An SNRI with a lower overdose profile
82
What is included in the health assessment?
Nutrition
Dehydrations
Medical conditions and medication taking
83
What is Donepezil, rivastigmine and galantamine?
Acetylcholinesterase inhibitors
84
What is memantine?
A glutamate receptor antagonist
85
When is rivastigmine used for memory?
Parkinson's disease
| Lewy body dementia
86
When Memantine used?
Severe a Alzheimers disease or AChE intolerance/ contraindication
87
What is the cholinergic hypothesis?
Deteriorating cognition is associated with decrease in cholinergic neurones and therefore ACh
88
What is the MOA of memantine?
Decreasing glutamate decreases excitotoxicity
89
Where is donepezil metabolised?
At the liver - therefore affected by liver enzymes inducers etc.
90
Where is mamentine metabolised?
it is excreted from kidney, therefore do UE
91
Side effects of cholinergic activity?
Nausea, vomiting, diarrhoea
Insomnia
Dizziness
Urinary incontinence
92
What may make the SE of AChE inhibitors worse?
Beta blockers
93
What may make the side effects of mamentine worse?
Glutamate receptor antagonists like ketamine. Can lead to a pharmacological psychosis
94
What investigation should be done before starting AChE inhibitor?
ECG - QTc interval, LBBB
| UE - mamentine
95
When should AChE inhibitors be prescribed with caution?
Gastric ulcer
| seizures
96
hat are the side effects Clozapine side effect?
Sedation
Hyper-salivation
Constipation
97
Why is an ECG used for antipsychotics?
QTc prolongation
| Myocarditis
98
How long does psychosis have to last until diagnosable as schizophrenia?
1 month
99
Why is sodium valproate used in psychiatry with an antipsychotic?
Used for low mood
| Treatment of a lower seizure threshold due to antipsychotics
100
What is he time course of pupura psychosis?
Within 2 weeks of birth. Insidious onset with behavioural and confusion learning upto psychosis.
Thought to be part of underlying bipolar/effective disorder.
101
What medication is used for behavioural and psychotic symptoms of dementia?
Low dose clozapine or quetiapine
Due to neuroleptic sensitivity
102
What is used for REM sleep behaviour disorder?
Clonezapam
103
What criteria are there for a conduct disorder?
Persistant repetitive:
- Destruction
- Deceit and theft
- Violation of rules
- Aggression
104
How is a conduct disorder deferent to oppositional defiant syndrome?
Oppostitional defiant syndrome usually isn't violent or infringe on rights of others outside social norms. This is usually isolated to the home
105
What categories are there of personality disorders are there?
Cluster A - Eccentric, odd
Cluster B - Emotional, dramatic
Cluster C - Anxious, fearful
106
What personality disorders are there which are relater to Cluster C?
Avoidant
Obsessive-compulsive
Dependent
107
What personality disorders are there which are relater to Cluster A?
Paranoid
Schizotype
Schizoid
108
What personality disorders are there which are relater to cluster B?
EUPD/ Borderline
Histrionic
Narcissistic
109
What is a schizoid personality disorder?
Uninterested in relationships and voluntary isolationist . Has a rich imagination
110
What is a schizotypal personality disorder?
Hold usual beliefs, difficulty forming close relationships
