Psych Flashcards
(186 cards)
1
Q
thyroid abnormality in anorexia
A
low T3 (all else norm)
2
Q
schizotypal personality disorder
A
lack close friends other than family
have odd & eccentric beliefs
3
Q
schizoid personality disorder
A
lack close friends
no interest in sexual relationships
indifferent to praise
NO odd behaviours or beliefs
4
Q
paranoid PD
A
cant confide in others
question loyalty of friends
see hidden meanings in benign things
5
Q
histrionic PD
A
crave centre of attention
sexually inappropriate or suggestible
relationships presumed more intimate than they are
6
Q
antisocial PD
A
break the law deceptive - always lying impulsive - cant plan ahead disregard for safety of others lack of remorse
7
Q
avoidant PD
A
avoids social situations for fear of being disliked
fears of embarrassment etc in relationships
views self as inept or inferior to others
8
Q
borderline PD
A
unstable relationships
always making attempts to avoid abandonment
recurrent suidical behavior
chronic emptiness
unstable self image
9
Q
narcissitic PD
A
\++ self importance sense of entitlement lack of empathy need for admiration chronic envy
10
Q
role of frontal lobe
A
executive functioning
personality
voluntary movement
expressive language (brocas)
11
Q
role of parietal lobe
A
2 point discrimination
reading
writing
knowing right from left
12
Q
role of temporal lobe
A
memory
hearing
receptive language (wernickes)
13
Q
role of occipital lobe
A
primary visual cortex
14
Q
passivity phenomenen
A
the feeling of being the Mx or control of other people
15
Q
delusion definition
A
a fixed false belief
16
Q
persecutory delusion
A
false belief of being malevolently treated in some way
17
Q
somatic delusion
A
false belief of having a physical defect or medical condition
18
Q
loosening of associations
A
muddled talk that is illogical.
talks freely but no info given.
19
Q
knight’s move thinking
A
pt jumps from subject to subject with no apparent link
20
Q
flight of ideas
A
pt jumps from subject to subject but words are associated with rhyme / can see slight connection
21
Q
tangential thinking
A
pt moves from point to point and never comes back to the question being asked
22
Q
circumstantiality
A
pt gives excessive detail when answering q, but does eventually come back to answer it
23
Q
how long should a depressive ep last for it to be called depression
A
2w
24
Q
core symptoms of depression
A
low mood
loss of pleasure/interest in activities
low energy
25
additional features of depression
```
disturbed sleep
unreasonable guilt
feelings of worthlessness
reduced concentration
change in appetite
loss of confidence
suicidal behaviour
```
26
Mx mild depression
no anti-depressants
| behavioural changes e.g. sleep hygiene
27
criteria for moderate depression
at least 2 core symptoms + additional symptoms
| total at least 6
28
criteria for severe depression
all 3 core symptoms + additional symptoms
| total at least 8
29
somatic depression
increased appetite
changes in sleep
lack of energy
aches and pains
30
cotards syndrome
delusion belief that they are dead or non-existent
| seen in severe depression
31
psychotic depression
usually 2nd person derogatory delusions (worthlessness)
32
Mx depression
SSRI or SNRI
33
ECT indications
catatonia
severe depression refractory to meds
psychotic symptoms
34
how long should someone take anti-depressant for
at least 6m
35
neurotransmitter causes sedation
reduced histamine
36
woman hearing things, but knew it was inside her head
pseudo-hallucination
37
neurotransmitter reduced in depression
serotonin
38
man who says he is losing memory and doesnt like going out because of this. low mood and wife died. MMSE 28/3- - DDx?
depression
39
how long must GAD symptoms be present for diagnosis
6m
40
Mx GAD
1. CBT +/- SSRI (sertraline)
Drugs also 1st line are:
- SNRI
- atypical antidepressants
- pregabalin
41
how long must stay on meds for in GAD
18m if responding to Tx
42
Mx panic disorder
CBT or drug treatment
1. SSRI
if not responding after 12w, give TCA (clomipramine, imipramine)
43
Mx social phobia
SSRI + CBT with emphasis on exposure
44
Mx specific phobia
exposure therapy
45
features of PTSD
1. flashbacks
2. nightmares
3. emotional numbing
4. dissociation
5. re-enactment
6. increased arousal
7. avoidance
46
timeline of PTSD
```
<48h = acute stress reaction
<4w = acute stress disorder
<3m = acute PTSD
>3m = chronic PTSD
```
47
Mx PTSD
NOT debriefing
<4w = watchful waiting
1. Trauma focussed CBT or Eye movement Desensitisation + Reprogramming
48
how long do OCD symptoms need to be present for Dx
2w
49
Mx OCD
CBT - Exposure and Response Prevention
| Drugs - SSRI, TCA (clomipramine)
50
Neurotransmitter changes in GAD
decreased GABA
decreased serotonin
increased noradrenaline
51
Persistent sexual thoughts about woman at his church, more he thinks about it, worse it gets, keeps telling you he is in a happy marriage - Dx?
OCD
52
Boy doesn’t like doing presentations, drinking more and more on nights out - Dx?
social phobia
53
Woman anxious, phoning her parents all the time - Dx?
GAD
54
Totally random panic attacks, tingling in fingers, sweating, palpitations - Dx?
panic disorder
55
Mind racing with worries and drinks alcohol to calm -Dx?
GAD
56
pathology of SCZ
increased mesolimbic dopamine
57
heritability of SCZ
80%
58
-ve symptoms of SCZ
```
apathy
incongruity
catatonia
anhedonia (inability to derive pleasure)
avolition (poor motivation)
```
59
How many 2nd gen anti-psychotics should be tried before putting pt on Clozapine
2
60
delusional perception
normal object is perceived with delusional insight
61
how long must symptoms of SCZ be present for diagnosis
1m
62
who can help with explaining diagnosis to schizophrenic's parents?
community psychiatric nurse
63
paraphrenia
late onset SCZ (>65)
64
Woman with prominent negative symptoms of schizophrenia, social withdrawal etc - who should she see
OT
65
Dismantling electrical equipment because of fear of recording - Dx?
SCZ
66
symptoms of hypomania
increased talkativeness
decreased need for sleepy
increased sexual energy
mild spending sprees
67
how long do hypomania symptoms need to last for diagnosis
4 d
68
symptoms of mania
```
flight of ideas
grandiose delusions
pressure of speech
reduced need for sleep
loss of normal social inhibitions
distractability
marked sexual indiscretions
```
69
how long do mania symptoms need to last for diagnosis
1w
70
Mx acute mania
1. aripiprazole or olanzapine
| 2. haloperidol or lorazepam
71
long term Mx bipolar
mood stabiliser:
1. Lithium carbonate
2. sodium valproate
2. carbamazepine
72
Mx depression in bipolar
fluoxetine
73
Dx of anorexia nervosa
wt loss at least 15% below expected weight for age and height
self-perception of being too fat
self-induced wt loss
widespread endocrine disorder
74
subtypes of anorexia nervosa
restrictive
binging/purging
75
BMI categories for anorexia nervosa
low risk: 17.5-16
mod risk: 16-15
high risk: 15-13
v high risk: <13
76
effect of anorexia on K levels
low
77
effect of anorexia on FSH and LH
low
78
effect of anorexia on oestrogen and testosterone
low
79
effect of anorexia on cortisol
increased
80
effect of anorexia on GH
increased
81
effect of anorexia on cholesterol
increased
82
Dx of bulimia nervosa
recurrent episodes of overeating
preoccupation with eating and strong desire or compulsion to eat
counter-acts episodes of eating with self-induced vomiting or purging
83
refeeding syndrome
the metabolic abnormalities that occur when feeding a person following a period of starvation
84
metabolic abnormalities in refeeding syndrome
hypokalaemia
hypophosphataemia
hypomagnesaemia
85
prevention of refeeding syndrome
if person hasnt eaten for >5 days, for first 2 days re-feed them at less than 50% of their daily requirements
86
complication of hypomagnesaemia
torsades de pointes
87
binge drinker, self-harm repeatedly, overly sexual/lots of brief relationships - PD?
borderline PD
88
irritable, callous, no responsibility, expects family to do everything - PD?
dissocial PD
89
biggest risk factor for borderline PD
sexual abuse
90
man who works really hard, doesn't spend any money on his wife - PD?
Obsessive Compulsive PD
91
neurotransmitter affected in anorexia
reduced serotonin
92
ECG abnormality in anorexia
prolonged QT
93
criteria of dependence
```
strong desire to take substance
difficulty controlling use
physiological withdrawal state
tolerance
neglect of other pleasures
persistence despite evidence of harm
```
94
role of the pre-frontal cortex
sets goals and focusses attention (last to develop), thats why young people are more impulsive
95
what causes symptoms of alcohol withdrawal (neurotransmitters)
++ glutamate
and
-- GABA
96
high risk alcohol drinking (units)
>35 units/wk
97
how many hrs after stopping alcohol do symptoms of withdrawal start
6-12h
98
how many hrs after stopping alcohol do symptoms of withdrawal peak
24-48h
99
what complication happens 36h after stopping alcohol
generalised seizures
100
what complication happens 72h after stopping alcohol
delirium tremens
101
delirium tremens presentation
```
agitation
fever
confusion
disorientation
paranoia
hallucinations
```
102
cause of wernickes encephalopathy
thiamine deficiency (B1)
103
presentation wernickes encephalopathy
1. confusion
2. ataxia
3. opthalmoplegia
104
complication of wernicke's encephalopathy
korsakoff's syndrome
105
dexotification definition
the process of becoming alcohol/substance free
106
medicines given for alcohol detox
```
Chlordiazepoxide or Diazepam
+
Pabrinex (IV thiamine)
+
hydration
```
107
medication given for alcohol relapse prevention
1. Naltrexone
2. Acamprostate
3. Disulfiram
108
signs of opiate intoxification
pinpoint pupils
resp depression
euphoria
109
opioid replacement therapy
Methadone or Buprenorphine (no decrease in dose)
110
opioid detoxification therapy
Methadone or Buprenorphine (decrease dose gradually to get them drug free)
111
Mx BZD overdose
Flumazenil (ONLY iatrogenic overdose)
112
BZD detoxification
Chlordiazepoxide or Diazepam
| - reduce dose every 2-3w in steps
113
BZD detoxification
Chlordiazepoxide or Diazepam
| - reduce dose every 2-3w in steps
114
side effects of diazepam and chlordiazepoxide
eye irritation
tremor
urinary retention
115
borderline LD - IQ and mental age
IQ 70-84
| Mental age 12-15y
116
mild LD - IQ and mental age
IQ 50-69
| Mental age 9-12y
117
moderate LD - IQ and mental age
IQ 35-49
| Mental age 6-9y
118
severe LD - IQ and mental age
IQ 20-34
| Mental age 3-6y
119
profound LD - IQ and mental age
IQ <20
| Mental age <3y
120
triad of ADHD
inattention
hyperactivity
impulsivity
- has to be developmentally inappropriate, impairing, pervasive and long-standing
121
test for ADHD
no test! clinical Dx
122
Mx ADHD
psychological
1. classroom training and parent training
2. social skills training
pharmacological
1. methylphenidate (ritalin)
2. lisdexamfetamine
3. dexamfetamine
123
What Ix needs to be done prior to starting ADHD meds and why
ECG - all ADHD drugs can be cardiotoxic
124
Triad of ASD
language impairment
abnormal thought and behaviour
qualitative impairment in social interaction
125
Asperger's syndrome
autistic features without aloneness or linguistic difficulty
126
person w learning difficulties, doesn't understand what psych pills are for - whos best to see?
community mental health nurse or community psychiatric nurse
127
person w learning difficulties and cant communicate, who is best to see
SALT
128
boy running out in front of cars, learning difficulties, trouble with the police, inattention - Dx?
ADHD
129
criteria to detain under MHA
1. mental disorder (mental illness, LD, PD)
2. pt has impaired decision making with regards to Tx of mental disorder
3. pt at risk to self or others
4. less restrictive measures not appropriate
5. necessary
130
power of attorney
under the AWI act
can only be granted when a person has capacity
- looks after financial/welfare things
131
welfare guardian
under the AWI act
can only be granted when the person has already lost capacity
- looks after financial/welfare things
132
who can use place of safety order
police
133
can police go into someones house for place of safety order
no -need a warrant
| place of safety only applies if person is in a public place
134
how long can someone de detained in place of safety
24h
135
how long does nurse's holding power last
2h
136
who can order emergency detention
FY2 or above
137
MHO approval needed for emergency detention ?
no
138
how long does emergency detention last for
72h
139
does pt have right of appeal in emergency detention
no
140
who can order short term detention
Approved Medical Practitioner (need MHO approval)
141
how long does short term detention last for
28d
142
does pt have right of appeal in short term detention
yes (only before 14d)
143
does short term detention authorise Tx
yes
144
does emergency detention authorise Tx
no
145
who can order CTO
need either 2 AMPs or 1 AMP and 1 GP
146
what does a CTO require first before it is placed
tribunal
147
what happens in proposed CTO if pt too unwell to find their own solicitor
curator adalatum is used
148
how long does CTO last for
up to 6m
149
what is a T2 form
used when the patient can give consent to Tx under CTO
150
what is a T3 form
used when the patient cannot give consent to Tx under CTO
151
examples of SNRI
venlafaxine
| duloxetine
152
1st line SSRI post-MI
sertraline
153
1st line SSRI in children/adolescents
fluoxetine
154
s/e of SSRI
GI upset
increased risk of GI bleed
hyponatraemia
155
ECG complication on citalopram
QT prolongation
156
s/e of TCAs
anticholinergic effects
| QT prolongation
157
examples of MAOI
phenlezine
| isocarboxazid
158
s/e of MAOIs
anticholinergic effects
| hypertensive reaction with tyramine containing foods e.g. cheese, broad beans
159
EPSEs and timings of presentation from typical antipsychotics
acute dystonic reaction (hours-days) - muscle spams
parkinsonism (days-mths) - bradykinesia, tremor, rigidity
akathisia (months) - restlessness
tardive dyskinesia (yrs) - purposeless repetitive movements
160
examples of typical antipsychotics
haloperiodl
| chlorpromazine
161
medication always co-prescribed with typical antipsychotics
prochlorperazine
162
s/e of antipsychotics
```
anti-cholinergic effects
sedation
prolonged QT
reduced seizure threshold
increased risk of VTE and stroke
```
163
examples of atypical antipsychotics
```
risperidone
quetiapine
aripiprazole
olanzapine
clozapine
```
164
atypical antipsychotic causing wt gain
olanzapine
165
s/e of atypical antipsychotics
wt gain
| metabolic syndrome
166
antipsychotic causing prolonged QT (torsade de pointes)
haloperidol
167
antipsychotic that causes photosensitivity
chlorpromazine
168
s/e of clozapine
```
agranulocytosis
reduced seizure threshold
constipation
myocarditis
hypersalivation
```
169
monitoring of clozapine
weekly for 1st 6m
fornightly for 2nd 6m
monthly therafter
one mth after cessation
170
what must pt not do whilst on clozapine
stop or start smoking
171
person on olanzapinedevelops dry mouth, what transmitter is responsible
ACh
172
diaebtic pt has psychosis, what Tx do they get
typical antipsychotic - not atypical bcos they cause metabolic syndrome and pt already has diabetes.
173
therapeutic range of lithium
0. 4-1.0 mmol/Li
| i. e. NARROW
174
monitoring lithium levels
check levels weekly and after each dose change until conc stable
once established check evry 3m - 12h post dose
175
what blood tests are checked when pt on lithium, and how often
every 6m - renal and thyroid function
176
s/e of lithium
```
n+v
metallic taste in mouth
worsening of psoriasis
nephrotoxicity
hypothyroidism
wt gain
idiopathic intracranial HTN
fine tremor
hair loss
```
177
ECG abnormality on lithium
T wave flattening
178
psychaitrists role
diagnosis, prescription, Use of MHA and AWI, advocacy
179
who can help old man who wants to move into a care home
Social worker
180
taxi driver getting lost, giving the wrong change - Dx
alzheimers
181
Which disease has a degenerated nucleus basalis of Meynert (NBM)
Alzheimers and Parkinsons
182
man who wants to kill himself - what part of MSE does this come under
thought content
183
man has flight of ideas - what part of MSE does this come under
thought form
184
man picked up phone during interview - what part of MSE does this come under
behaviour
185
man cant complete the MMSE - what part of MSE does this come under
cognition
186
man happy when talking about his cats - what part of MSE does this come under
affect
