Psych Flashcards
(85 cards)
1
Q
How is generalised anxiety disorder diagnosed?
A
Clinical diagnosis- DSM-5 criteria
2
Q
What are the criteria for the DSM-5 classification of GAD?
A
1) Excessive anxiety and worry for > 6 months
2) Difficulty controlling worry
3) At least 3 of the following: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleeping difficulty
4) Anxiety is causing significant distress in social, occupational etc. situations
5) Not better explained by another psychiatric condition
6) Anxiety not attributable to a medical condition or medication
3
Q
What are the side effects of SSRIs?
A
Nausea Vomiting Abdominal discomfort Diarrhoea Insomnia Agitation/ alerting Sexual dysfunction Hyponatraemia
4
Q
Definition of anorexia nervosa
A
Abnormally low body weight associated with an intense fear of gaining weight and a distorted perception of body image
5
Q
Atypical anti-psychotic examples
A
Clozapine Olanzapine Risperidone Quetiapine Amisulpride Aripiprazole
6
Q
Side effects specific to atypical antipsychotics
A
Weight gain
Agranulocytosis
Hyperprolactinaemia
7
Q
Side effects of ECT
A
Headache Nausea Short term memory impairment Memory loss of the events prior to ECT Cardiac arrhythmia Impaired memory long term
8
Q
Side effects of mirtazapine
A
Increased appetite/ weight gain Sedation Headache Dry mouth Dizziness Postural hypotension Tremor Peripheral oedema
9
Q
What is erotmania?
A
Delusional disorder that is characterised by the patient’s belief that a famous actor is in love with them with no other symptoms suggesting psychosis or mood disturbance
10
Q
What factors would suggest a diagnosis of depression over dementia?
A
Short history and rapid onset
Biological symptoms e.g weight loss, sleep disturbance
Patient worried about poor memory
Reluctant to take tests, disappointed with results
Global memory loss
11
Q
Common side effects of TCAs
A
Sedation Dry mouth Blurred vision Oesophageal reflux Constipation Urinary hesitancy Sexual problems Postural hypotension
12
Q
What medication interact with SSRIs?
A
NSAIDs- co-prescribe with PPI Warfarin Aspirin Triptans MAOIs
13
Q
What are Schneider’s first rank symptoms of schizophrenia?
A
Auditory hallucinations
Thought disorder
Passivity phenomena
Delusional perceptions
14
Q
What are the features of alcohol withdrawal?
A
Symptoms start at 6-12 hours Tremour Sweating Tachycardia Anxiety Seizures: 36 hours Delirium: 48-72 hours
15
Q
Clinical features of anorexia nervosa
A
Dry skin Lanugo hair Osteoporosis Muscle wasting Proximal myopathy Bradycardia Hypotension Arrhythmias Enlarged salivary galnds Hypokalaemia Low FSH, LH, oestrogen and testosterone Raised cortisol and growth hormone Impaired glucose tolerance Hypercholesterolaemia Hypercarotinaemia Low T3
16
Q
Mechanism of action of antipsychotics
A
Dopamine receptor antagonist
17
Q
Adverse effects of clozapine
A
Agranulocytosis Reduced seizure threshold Constipation Myocarditis Hypersalivation
18
Q
Mechanism of action of benzodiazepines
A
Enhance the effect of the inhibitory
19
Q
Uses of benzodiazpines
A
Sedation Hypnotic Anxiolytic Anticonvulsant Muscle relaxant
20
Q
Symptoms of benzodiazepine withdrawal syndrome
A
Insomnia Irritability Anxiety Tremor Loss of appetite Tinnitus Perspiration Perceptual disturbances Seizures
21
Q
Examples of typical antipsychotics
A
Haloperidol Fluphenazine Prochlorperazine Trifluroperazine Chlorpromazine
22
Q
Side effects of lithium
A
Nausea Diarrhoea Nephrotoxicity Fine tremor Thyroid enlargement T wave inversion Weight gain Idiopathic intracranial hypertension Leucocytosis Hyperparathyroidism
23
Q
Monitoring of lithium
A
Lithium levels should be checked weekly until levels are stable and 12 hours after dose is changed
After stable, levels should be checked every 3 months
Thyroid and renal function should be checked every 6 months
24
Q
Management of PTSD
A
1st- psychological treatment (EMDR, CBT)
2nd- mirtazapine, paroxetine, SSRI
25
Risk factors for dementia
```
Increasing age
Female sex
Ethnicity
Genetics
Low levels of education
Midlife hearing loss
Physical inactivity
Hypertension
Obesity
Smoking
Type 2 diabetes
Depression
Social isolation
```
26
Causes of dementia
Alzheimer's disease
Lewy body dementia
CVS
27
Indications for psychotherapy
Eating disorders
Mild/moderate depression
Neurotic illness
Personality disorders
28
Contraindications to psychotherapy
Acute psychosis
Severe depressive illness
Dementia/ delirium
Acute suicide risk
29
What is transference?
When a person redirects certain emotions, feelings or experiences onto another person
30
What is contertransference?
The reaction from the therapist in reaction to the transference
31
What is free association?
Fundamental rule of therapy for a patient to say whatever they are thinking
32
Risk factors for depression
Genetic
Adverse childhood experiences
Personality traits: anxiety, impulsivity, obsessive
Physical illness
33
Standard tests carried out to confirm a diagnosis of depression
FBC, ESR, B12/folate, U&Es, LFTs, TFTs, glucose, Ca2+
34
Definition of learning disability
IQ < 70
Impairment across a wide range of functions
Onset before 18 y/o
35
Most common cause of learning disability
Down’s syndrome
36
Pre and perinatal environmental causes of learning disability
Prenatal infection- rubella, HIV, syphilis, cytomegalovirus, toxoplasmosis
Foetal alcohol syndrome
Placental insufficiency
Placental abruption
Eclampsia
Ventricular haemorrhage
Perinatal- hypothyroidism, hyperbilirubinaemia
Cerebral palsy, hydrocephalus, spins bifida
37
Post natal causes of learning disability
```
Infection: meningitis, encephalitis
Brain tumours
Head injury
Hypoxia
Lead poisoning
Disintegrative psychoses
```
38
DiGeorge syndrome leads to an increased risk of what psychiatric disorder?
Schizophrenia
39
Genetic causes of intellectual disability
```
Downs
Cri du chat
Fragile X
Turners
Tuberous sclerosis
```
40
Clinical features of alcohol dependence
Feeling compelled to drink
Primacy of drinking over other activities
Increased tolerance to alcohol
Relief drinking- to prevent withdrawal symptoms
Stereotyped pattern of drinking
Drinking despite awareness of harmful consequences
41
Features of Wernicke's Syndrome
```
Acute encephalopathy
Delirium
Ataxia
Nystagmus
Ophthalmoplegia
```
42
Definition of hazardous drinking
More than the recommended limit (21 units for men; 14 for women)
43
Definition of harmful drinking
50 units per week for men; 35 units for women
44
First line management for adults with anorexia
CBT-ED
Maudsley anorexia nervosa treatment for adults
Specialist supportive clinical management
45
First line therapy for children with anorexia
Family therapy
46
Reasons for hospitalisation in anorexia
```
BMI <13.5
Rapid weight loss
Severe electrolyte abnormalities
Syncope
Social crisis
Suicide ideation
```
47
What electrolyte abnormalities are seen in referring syndrome?
```
Hypophosphataemia- muscle weakness
Hypokalaemia- seizures
Hypomagnesaemia- peripheral oedema
Hyponatraemi- cardiac arrhythmias
Metabolic acidosis- hypotension
Thiamine deficiency- delirium
```
48
Poor prognostic factors in anorexia
```
Long duration of symptoms
Age of onset before puberty or > 17 years
Male
Very low weight
Binge purge symptoms
Personality difficulties
Difficult family relationships
```
49
What is arbitrary inference?
Drawing a conclusion with no evidence for it
50
What is selective abstraction?
Focus on a detail while missing the broader context or features or a situation
51
What is overgeneralisation?
Coming to a conclusion based on a single incident
52
What is personalisation?
Attributing external events to oneself in an unjustified way
53
Clinical features of conduct disorder
Severe tantrums
Persistent challenging of boundaries
A short temper
Appearing spiteful or vindictive in their actions
Physical acts of cruelty to others or animals
Stealing, damaging property and arson, which may result in juvenile detention
54
Lithium in pregnancy
Contraindicated- produces symptoms of toxicity in baby
| If needed, discontinue breastfeeding
55
TCA use in pregnancy
Use with caution
56
SSRI use in pregnancy
No evidence of harm but TCAd preferred
57
Antipsychotics in pregnancy
Prescribe with caution but avoid high doses
| Clozapine contraindicated
58
Organic causes of mania
Corticosteroids
Cushing's syndrome, parathyroidism
Bromocroptine
Antidepressents
59
Management of bipolar disorder
Acute mania: Atypical antipsychotics (olanzapine, quetiapine, risperidone); Lorazepam
Bipolar depression: Quetiapine; Antidepressants can be used but need to be co-prescribed with a mood stabiliser
Long term: Lithium: Sodium valproate\Lamotrigine
60
Clinical features of mania
```
Significant elevation of mood
Psychomotor agitation- increased activity
Grandiosity- ideas of self importance
Inflated self esteem
Poor attention/ concentration
Increased speech
Accelerated thinking
Loss of normal social and sexual inhibitions
Participation in gratifying behaviour (gambling, excessive spending etc.)
Overactivity
Reduced need for sleep
Secondary delusions
```
61
Risk factors for bipolar disorder
Early age of mood disorder onset
Positive family history
Poor or limited response to traditional antidepressants
62
Potential causes of GAD
Childhood: Insecure attachment; Poor parenting: overprotective or lacking warmth; Abuse or neglect
Life events perceived as threatening/ dangerous: Chronic anxiety post event
Personality: Neurotic traits; Selective or over attention given to potential threats; Over estimation of threats in the environment
Substance misuse: Direct anxiety provoking effects of stimulants; Rebound anxiety effects as the drug/ alcohol is metabolised; Altered thinking: more prone to assess situations as threatening
Isolation/ poor support: Unemployed: less distractions, more insecurity; Single status: feelings of insecurity
63
Conditions that mimic GAD
```
MI/ angina
Arrhythmias
Valve disease
Congestive heart failure
Asthma
Chronic obstructive pulmonary disease
PE
Anaemia
Brain tumour
Epilepsy
Hyperthyroidism
Hypoparathyroidism
Diabetes
Phaeochromocytoma
```
64
Which atypical antipsychotic has the most tolerable side effect profile?
Aripiprazole
65
Indications for SSRIs
Depression
Anxiety
OCD
66
Indications for Mirtazapine
Depression- esp. when sedation or increased appetite desirable
67
Side effects of SNRIs
Same as SSRIs but more severe
GI- nausea; vomiting; abdominal pain; diarrhoea; constipation; appetite and weight change
Increased GI bleeding- PPI should be given in patients who take NSAIDs
Headache
Sexual dysfunction (anorgasmia, delayed ejactulation)
Sweating
Restlessness
Suicidal ideation
Insomnia
Hyponatraemia (SIADH)
68
Contraindications to SSRIs and SNRIs
Mania
Poorly controlled epilepsy
Prolonged QTc interval
69
Contraindications to mirtazapine
Mania
70
Sedative TCAs
Amitriptyline
| Clomipramine
71
Less sedative TCAs
Lofepramine
| Imipramine
72
Contraindications to TCAs
```
Recent MI
Arrhythmias
Acute porphyria
Mania
High risk of overdose
```
73
Effect of antidepressants in epilepsy
Increase seizure frequency by either lowering seizure threshold or interacting with the metabolism of antiepileptics
74
Contraindications to MAOIs
Phaeochromocytoma
Cerebrovascular disease
Mania
75
Symptoms of discontinuation syndrome
```
GI disturbance
Agitation
Headache
Dizziness
Tremor
Insomnia
```
76
Indications for lithium
Acute mania
Prophylaxis of BAD
Treatment resistant depression
77
Symptoms of lithium toxicity
```
Nausea/ vomiting
Apathy
Coarse tremor
Muscle weakness
Nystagmus
Dysarthria
Impaired consciousness
Hyperreflexia
Convulsions
```
78
What medication is associated with a Steven Johnson rash?
Lamotragine
79
Side effects of sodium valpriate
```
Increased appetite and weight gain
Sedation and dizziness
Ankle swelling
Hair loss
Nausea and vomiting
Tremor
Prolonged bleeding time
Thrombocytopenia
Leucopenia
Raised liver enzymes
```
80
Side effects of lamotrigine
```
Nausea and vomiting
Headache
Aggression, irritability
Sedation, dizziness
Tremor
Steven Johnson syndrome
```
81
Side effects of carbomazepine
```
Nausea and vomiting
Skin rashes
Blurred/ double vision
Ataxia, drowsiness, fatigue
Hyponatraemia, fluid retention
Thrombocytopenia
Leucopenia
Raised liver enzymes
```
82
Side effects of antipsychotics
Worsening of negative symptoms; Dry mouth; Blurred vision; Urinary retention; Constipation; Sedation; Weight gain; Raised prolactin: galactorrhoea, impaired glucose tolerance, amenorrhoea, sexual dysfunciton; Neuroleptic malignant syndrome: pyrexia, muscle stiffness; Reduced seizure threshold; Prolonged QT interval; Increased risk of stroke and VTE; Parkinsonism; Acute dystonia; Torticollis; Oculogyric crisis; Akathisia; Tardive dyskinesia
83
Causes of ADHD
```
Strong genetic component
Exposure to chemicals in utero (alcohol, cigarettes. heroin)
Premature birth
Very low birth weight
Birth complications
Foetal hypoxia
Perinatal brain injury
Prolonged emotional deprivation during infancy
```
84
Medication options for ADHD
Ritalin (methylphenidate)- increases dopamine in the brain
Atomoxetine
Dexamfetamine
85
Cotard syndrome
Nihilistic and hypochondral delusions
