psych Flashcards
(204 cards)
1
Q
side effects of mirtazepine
A
increase in appetite
sedation
2
Q
Where does mirtazepine act?
A
Alpha2 receptor antagonist
3
Q
what causes the tyramine cheese reaction?
A
Monoamine Oxidise Inhibitor (phenelzine)
>HTN crisis
4
Q
what is akathisia?
A
inner restlessness, inability to keep still
5
Q
what causes akathisia?
A
long term AP use
EPSE
6
Q
threatening behaviour in a public space - appropriate course action?
A
call police 136
7
Q
best psychotherapy for schizophrenia?
A
CBT
8
Q
what type of side effects with imipramine AD?
A
anti-muscarinic
blurred vision, dried mouth
9
Q
common tricyclic AD side effects?
A
drowsiness
dry mouth
blurred vision
constipation
urinary retention
long QT
weight gain
10
Q
When is ECT mainly indicated
A
in life threatening depression, where catatonia is present
11
Q
patients with poor oral compliance to APs - what is best option for these patients?
A
Switch to once monthly IM injection depot
12
Q
adverse effects atypical APs
A
weight gain
hyperprolactinaemia
stroke/VTE
13
Q
adverse effects clozapine?
A
agranulocytosis
neutropaenia
seizures
constipation
myocarditis
hypersalivation
14
Q
first line tx mild depression
A
psychological therapy - IAPT
15
Q
what can cause an increase in clozapine blood levels?
A
smoking cessation
16
Q
what causes a decrease in clozapine levels?
A
starting smoking/increasing smoking
stopping drinking alcohol
omitting doses
17
Q
strongest risk factor for psychotic disorders?
A
positive family history
18
Q
other risk factors associated with psych disorders?
A
black carribean
migration
urban environment
cannabis use
19
Q
are SSRI’s addictive?
A
No
20
Q
how long should someone who has been started on SSRI continue taking them before stopping, even if feeling better after a few weeks?
A
6/12
21
Q
what type of PD can be rigid with morals/ethics/values and cannot delegate work?
A
Anankastic/obsessive-compulsive
22
Q
hypomania vs mania: time course?
A
mania>7days
hypomania <7days (3-4)
23
Q
mania vs hypomania key symptoms difference?
A
Mania - psychotic sx
24
Q
what can Lithium cause?
A
benign leucocytosis
25
Lithium therapeutic range?
0.4-1.0
26
increased high suicide risk features?
left a note
planning
avoid discovery
final acts - sorting out finances
violent means
27
protective factors vs suicide?
family support
children at home
religious belief
28
speech presentation in mania?
pressured
flight of ideas
poor attention
29
duloxetine MOA?
SNRI -
duo - 2!
30
what type of drug is venlafaxine?
SNRI
check BP
31
mirtazepine MOA:
Noradrenergic and specific serotonergic AD
32
change in Lithium dose - when do you recheck levels?
1 week later and 12 hours after the last dose was taken
33
Over how long should an SSRI be withdrawn?
over 4 weeks, gradually
(Not needed with fluoxetine - longer half life)
34
suicide risk factors:
male
previous self-harm
substance misuse
psych disorder
chronic disease
age
social isolation
35
differentiate OCD from psychosis?
True need and belief in obsession/compulsion - poor insight
36
what does lanugo hair indicate and what causes it?
Anorexia nervosa
loss of body fat
37
physical symptoms of AN?
lanugo hair
failure secondary sex characteristics
bradycardia
cold intolerance
yellow tinge skin (hypercarotenaemia)
38
post-concussion syndrome:
headache
fatigue
anxiety/depression
dizziness
39
how will affects of clozapine affect FBC?
decreased leukocytes
40
How long missed clozapine doses can wait before having to retitrate up slowly?
2 days
41
alcohol withdrawal: seizures - how long will this sx take to manifest?
36 hours
42
alcohol withdrawal: delirium tremens - over what timeframe will this manifest?
72 hours
43
alcohol withdrawal: sx start over what timeframe?
6-12 hours
44
alcohol withdrawal mx:
chlordiazepoxide (decreasing doses)
pabrinex for thymine deficiency
45
which psychotic disorder is insomia a feature of?
Schizophrenia
circadian rhythms affected
46
SSRI discontinuation syndrome features:
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
Gi sx
paraesthesia
47
involuntary movements including grimacing and sticking out the tongue, excess blinking - what is this ?
tardive dyskinesia
48
how is tardive diskinesia treated?
Tetrabenazine
49
what would treat the side effect akathisia?
Propranolol
50
how would acute dystonia (sfx) be treated?
procyclidine
benztropine
51
AP EPSE's?
parkinsonism
acute dystonia
akathisia
tardive dyskinesia
52
what might present to A and E with hypokalaemia causing palpitations and show a metabolic alkylosis on BG with low Cl-?
BN - vomiting
53
which disorder will present with persistent belief in underlying disease with refusal to accept negative test results?
Hypocondriacal disorder (illness anxiety disorder)
54
how will somatisation disorder present?
multiple physical SYMPTOMS for 2+years
refusal to accept negative tests
55
which disorder commonly presents with numbness/loss sensation/motor function
conversion disorder
56
In conversion disorder, is the patient faking for gain?
No, not feigning sx, or seeking material gain
may be indifferent - la belle indifference
57
which disorder presents because of separating of certain memories from consciousness and involves psych sx such as fugue, stupor, amnesia ?
Dissociative disorder
58
What is Munchausens also known as?
Factitious disorder
59
What is Munchausens ?
factitious conjuring of physical / psych sx
60
What is malingering?
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
61
what increased risk do APs have in elderly?
VTE-stroke
62
Schneider's first rank schizophrenia sx (4)
auditory hallucinations (3rd - commentary)
delusional perception
thought disorder
passivity phenomenon
persecutory delusions
incongruent affect
63
which drugs can cause urinary retention?
Tricyclics ADs
64
what is the AD of choice in children and adolescents?
Fluoxetine
65
differentiating between knight's move thinking and flight of ideas?
knights move illogical leaps from topics,
flight of ideas there are discernible links between topics
66
what is flight of ideas a feature of (disease)
BPAD
67
why can APs cause breast tenderness/enlargement?
hyperprolactinaemia
68
which AP has best side effect profile?
Aripiprazole
69
what type of drugs are associated with hyponatraemia?
SSRIs - check U+Es if confusion
70
which scale can used to assess alcohol withdrawal severity?
Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale
71
which personality disorder would favour male gender over female gender?
Anti-social
72
what is first line treatment in Anorexia Nervosa?
family therapy
73
what type of memory loss in ECT is sfx?
retrograde
74
poor prognosis factors for schizophrenia?
strong family history
gradual onset
low IQ
premorbid history of social withdrawal
lack of obvious precipitant
75
what type of incontinence is associated with amitryptaline?
overflow incontinence
76
how may tardive dyskinesia present?
chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements
77
she was lying beside an insulin syringe when they found her, despite her not having diabetes
Munchausens
78
charles-bonnet syndrome?
visual hallucinations associated with eye disease (ARMD)
79
risk factors for charles-bonnet syndrome?
Advanced age
Peripheral visual impairment (ARMD)
Social isolation
Sensory deprivation
Early cognitive impairment
80
pattern of global memory loss rather than short-term memory loss
psuedo-dementia
(depression)
81
what is cortad's syndrome?
believes dead
82
with anxiety, which condition is it important to rule out?
hyperthyroid disease
83
can normal grief reaction present with psychological features eg hallucinations?
yes
84
flight of ideas is linked only by rhyme or similar sounding words.
What is the medical term for this psychiatric symptom?
Clang association
85
what is zopiclone sfx?
increased risk of fall in elderly
86
re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems
PTSD
87
Indifference to praise and criticism
Preference for solitary activities
Lack of interest in sexual interactions
Lack of desire for companionship
Emotional coldness
Few interests
Few friends or confidants other than family
schizoid PD
all negative schizophrenia sx
88
Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent
schizotypal PD
89
is clozapine depot ok to use?
not in UK
90
in poor compliance with APs, what should be trialled?
Olanzapine depot
91
Stopping of voluntary movement or staying still in an unusual position = ?
catatonia
92
vomiting, can be use of laxatives or diuretics or exercising
purging
93
what asthma drug might lead to psychosis?
pred
CS
94
lack close friends other than family and can have odd or eccentric behaviour, speech and beliefs??
schizotypal
95
Sudden onset psychosis following course of corticosteroids??
steroid-induced psychosis
96
which foods when taken alongside monoamine oxidase inhibitors cause a hypertensive crisis to occur?
cheese (tyramine)
97
Chronic insomnia may be diagnosed after how long?
3 months
98
how many nights a week must one struggle to get to sleep or stay asleep for dx of chronic insomnia?
3/7
99
OCD tx:
exposure response therapy
if severe + SSRI, CBT
100
how long before OCD dx?
2/52
101
how long PTSD sx before dx can be made?
1 month
102
clozapine - what needs monitoring??
FBC - Agranulocytosis/neutropenia
103
bloods: Anorexia nervosa - ?
most things low
Gs and Cs raised:
growth hormone
glucose
salivary Glands
Cortisol
cholesterol
carotinaemia
104
SSRI + NSAID =
GI bleed risk - GIVE A PPI
105
when does tardive dyskinesia present?
after many years APs
106
agitation, hyperthermia, hyperreflexia, sweating and dilated pupils.
serotonin syndrome
(SSRI+MAO-I)
107
ECT sfx:
nausea
cardiac arrhythmias
short term memory impairment
headache
108
sertraline in 1st trimester pregnancy:
congenital heart defects
109
He says that over the last year he has been experiencing nearly constant nervousness, which gets worse at random points, and is not associated with any particular trigger. During the worst of these he becomes short of breath and feels his heart beating in his chest. There are no other symptoms of note, and nothing found on examination.
GAD
110
GAD characterised by:
free floating, persistent anxiety
111
Panic disorder: description
random panic attacks on the back of no usual anxiety
112
SSRI use during third trimester -
risk of persistent pulmonary hypertension of the newborn
113
most common endocrine disorder developing as a result of chronic lithium toxicity
hypothyroidism (6-18/12)
114
adverse Li effects
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia
115
once established, how often do you check Li dose?
3 months and 12 hours after last dose
116
what should be checked every 6/12 in Li use:
thyroid and renal function
117
Othello syndrome - define>
delusional jealously, usually believing their partner is unfaithful
118
which endocrine condition can anorexia nervosa cause in some individuals?
hypothyroidism
119
panic disorder, what is the most appropriate first-line drug treatment?
SSRI
120
if no response by 12 weeks on SSRI, 2nd line for panic disorder?
imipramine, clomipramine
121
Erotomania - define
presence of delusion (of a famous person being in love with them) with absence of other psychotic symptoms
De Clerambault's
122
what type of AP sfx is oculogyric crisis?
acute dystonia
another eg is torticollis
123
The risk of developing schizophrenia if one monozygotic twin is affected is approximately:
50%
124
Symptoms of mania in primary care: Mx->
urgent referral to CMHT
125
PTSD features:
hyperarousal
nightmares
avoidance
emotional numbing
126
Metabolic side effects of antipsychotics include: (olanzapine)
dysglycaemia, dyslipidaemia, and diabetes mellitus
127
Benzos: MOA:
enhance the effect of GABA, the main inhibitory neurotransmitter
128
how do benzos affect Chloride channels?
Frequently bend
increase the frequency of Cl channels
129
how do barbituates affect GABA?
during BarbBQ
enhance effect of GABA by increasing duration of Cl channel opening
130
in trauma leading to worsening headaches, more forgetful, more irritable -> think:
post-concussion syndrome
131
how long do post-concussion syndrome symptoms last after trauma?
3/12
132
benzos (lorazopam) sfx:
anterograde amnesia
133
23-yom finds when he wakes up and less often when he is falling asleep he is 'paralysed' and unable to move. This sometimes associated with what the patient describes as 'hallucinations' such as seeing another person in the room. He is becoming increasingly anxious about these recent episodes. Dx?
sleep paralysis
134
Mx: sleep paralysis-
if troublesome clonazepam may be used
135
Borderline personality disorder?
history of recurrent self-harm and intense interpersonal relationships
136
SSRI of choice in post-MI?
sertraline
137
The patient's reply to most of the questions consisted of sentences which did not make any sense such as - 'painting pizza prince bus brush'. This is a good example of which of the following thought disorder?
word salad
(psychosis and mania)
138
Echolalia:
repeating what someone else said exactly
139
perseveration:
repeating the same word/sentence
140
short history and rapid onset memory loss:
depression
141
PHQ9 for?
depression
142
SADPERSONs score?
suicide risk
143
re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems
PTSD
144
prefer to be alone, don't like relationships, low libido
schizoid
145
pseudohallucinations?
after normal bereavement - do not imply psychosis
146
PTSD management -
trauma-focused cognitive behavioural therapy or EMDR
if needs meds - venlafaxine or SSRI
147
suicide risk:
Gender - males are three times as likely to take their own life as females
Age - people aged 35-49 years now have the highest suicide rate
Mental illness
The treatment and care they receive after making a suicide attempt
Physically disabling or painful illnesses including chronic pain
Alcohol and drug misuse
The loss of a job
Debt
Living alone - becoming socially excluded or isolated;
Bereavement
Family breakdown and conflict including divorce and family mental health problems
Imprisonment
148
paroxetine in pregnancy:
risk of congenital malformations
149
haloperidol for treatment-resistant schizophrenia. She presents to her general practitioner with a 1-day history of neck pain and difficulty moving the neck. On examination, she has normal observation except a mild tachycardia of 105 and neck stiffness with restricted range of motion. Her neck is involuntarily flexed to the right. She has normal facial movements.
acute dystonia - TORTICOLLIS
150
can PDs be dx in children?
no hasa to be pervasive >18 only
151
Symptoms of hypomania in primary care
routine referral to CMHT
152
how long must sx be present for dx of : depressive episode?
2 weeks
153
elderly patients with new sudden onset psychosis: Ix?
CT head
154
class of drugs most likely to interfere with SSRI?
triptan (causes seratonin syndrome)
155
risk factor for generalised anxiety disorder:
Aged 35- 54
Being divorced or separated
Living alone
Being a lone parent
156
Sleep disturbance, stress triggers and normal mini-mental test score with global memory loss suggest
depression rather than dementia
157
pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
Neuroleptic malignant syndrome
158
Neuroleptic malignant syndrome Tx:
stop antipsychotic
patients should be transferred to a medical ward if they are on a psychiatric ward and often they are nursed in intensive care units
IV fluids to prevent renal failure
dantrolene* may be useful in selected cases
bromocriptine, dopamine agonist, may also be used
159
neuromuscular excitation (e.g. hyperreflexia, myoclonus, rigidity)
autonomic nervous system excitation (e.g. hyperthermia)
altered mental state
serotonin syndrome
160
mx: serotonin syndrome:
supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
161
long QT in?
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron
162
mx:long QT:
BBs
163
3 risk factors for ADHD:
- Prematurity
- Maternal smoking/alcohol/drugs during pregnancy
- FHx
- Socioeconomic status
- Epilepsy
- Looked after
- Acquired brain injury
164
Inattention sx in ADHD:
- Reluctant to engage in mentally-engaging tasks
- Easily distracted
- Loses things
- Doesn’t like homework
- Failure to plan/organise tasks
165
hyperactivity sx ADHD:
- Talks excessively
- Interruptive/ intrusive to others
- Spontaneously leave the seat when expected to sit
166
questionnaire for Dx of ADHD:
SNAP-iv for parents and teachers to complete
167
ASD questionnaire:
ADOS
168
MSE signs of depression:
- blunted affect
- Psychomotor retardation
- Catatonia
- Unkempt
- Poor eye contact
- Non-spontaneous speech
169
type of delusions in depression:
nihilistic
derogatory
persecutory
guilt
hypochondriacal
170
Name three underlying principles of the Mental Health Act (3).
- Respect for patients past and wishes and feelings
- Respect for diversity
- Minimise restriction on liberty
- Involve patients in planning
171
when can a section 3 be renewed?
after 6/12
172
a litre of 50% whisky each day - units?
50 per day (50x1000/1000)
173
alcohol dependence sx (3):
- Subjective awareness of compulsion
- Narrowing of repitoir
- Primacy of alcohol
- Spends more money and time on drink
- Reinstatement
- Avoidance of withdrawals with a drink
- Drink seeking behaviour
174
questionnaire for dependence to alcohol?
SADQ
175
when can someone not undergo detox in community (2):
- If no social support
- Previous failed detox
- Pregnancy
- Abuse
- Poor physical health
- Previous MH hx
- Homeless
176
3 long term alcohol abstinence medicines to help maintain abstinence:
Disulfiram (vom after alc)
Acamprosate (cravings reducer)
Naltrexone (relapse prevention)
177
in learning disability - what could lead to increase in challenging behaviours?
physical pain
needs not being met
178
learning disability 3 core criteria:
low intelligence - IQ<70
present from birth/early childhood
wide ranging impact on function
179
inverse care law define:
availability of good medical or social care tends to vary inversely with the need of the population served.
180
first choice tx: manic episode:
AP - olanzapine
lithium/valproate mood stabaliser
181
which antiepileptic drug is not effective as a mood stabaliser?
lamotrigine
182
suicide attempt and not previously known to services - mx?
once medically stable admit to psych ward
183
what is not part of normal grief reaction?
insomnia
184
what is circumstantiality of speech and what does it indicate?
round the houses but will eventually answer Q
thought disorder- schizophrenia
185
when to use lorazepam over chlordiazepoxide ?
if liver failure
186
Antidepressant medication should be ???????????? when a patient is about to commence ECT treatment?
reduced but not stopped (SSRIs)
187
GAD mx:
1. SSRI
2. different SSRI/SNRI
188
PTSD sx but <4/52?
Acute stress disorder
189
neologism?
formation of new words
190
A 45-year-old man describes successful abstinence from alcohol for the past six months following inpatient detoxification. During his admission, he was started on a 'deterrent' medication. He takes this medication daily and reports that if he consumes alcohol he will 'violently vomit'. -?
disulfiram
191
A 45-year-old man describes successful abstinence from alcohol for the past six months following inpatient detoxification. During his admission, he was prescribed an 'anti-craving medication'. He takes this medication three times a day and would like you to continue the prescription as he finds it very helpful. It is safe in combination with alcohol and he has experienced no side effects. ???
acamprosate
192
A 38-year-old man presents with opioid dependence syndrome presents to clinic. He currently takes 30 mL of methadone daily. He wishes to come off of his methadone as he finds it too sedating and is finding the stigma of being on methadone challenging. He reports friends have successfully come off methadone after stitching to a 'tablet that goes under your tongue' and wishes to try this.?
buprenorphine
193
patients who are overly sensitive and can be unforgiving if insulted, question loyalty of those around them and are reluctant to confide in others - dx?
paranoid personality disorder
194
early morning waking and changes in appetite and weight - what type of symptoms?
somatic depression sx
195
An effective treatment for borderline personality disorder is?
dialectical behaviour therapy (DBT)
196
highest risk SSRI for stopping suddenly?
paroxetine
197
personality disorder is characterised by inappropriate sexual seductiveness, suggestibility and intense relationships?
histrionic
198
what is an obsession?
intrusive, unpleasant and unwanted thought
199
what is a compulsion?
senseless action taken to reduce the anxiety
200
23M wants referral to plastics. Treated for anxiety and depression with fluoxetine, off work with back pain 3/12.C/o ears are too big in proportion to his face. Seldom leaves the house. OE ears normal. What is the most appropriate description of this behaviour?
dysmorphophobia
201
Safest TCA in overdose?
Lofepramine
(Amitriptyline, dosulepin most dangerous)
202
I'm diabetic neuropathy what is first line treatment?
Duloxetine
203
Patient with a fixed, false belief (delusion) that they are infested by 'bugs' →
delusional parasitosis
204
rx for bulimia once CBT has been tried?
high dose fluoxetine
