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Phase 3a medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What drug class is Citalopram?

A

SSRI

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2
Q

What drug class is Mirtazapine?

A

Tetracyclic (NASSA)

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3
Q

What drug class is Venlafaxine?

A

SNRI (Selective Serotonin and Norepinephrine Reuptake Inhibitor)

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4
Q

Which drugs enhance the effect of gamma-aminobutyric acid?

A

Benzodiazepines

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5
Q

Stopping of voluntary movement or staying still in an unusual position is called?

A

Catatonia

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6
Q

How long can a nurse hold a patient under Section 5(4) of the Mental Health Act

A

6 hours

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7
Q

What is Section 4 of the Mental Health Act and what is the duration?

A

Emergency order - 72 hours

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8
Q

What is Section 3 of the Mental Health Act and what is the duration?

A

Treatment - 6 months

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9
Q

What is Section 2 of the Mental Health Act and what is the duration?

A

Assessment - 28 days

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10
Q

How long is a doctor’s holding power under Section 5(2) of the Mental Health Act?

A

72 hours

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11
Q

Name 3 models of psychotherapy

A

Psychodynamic / CBT / Counselling / Cognitive analytical therapy / Interpersonal therapy / Dialectic behavioural therapy / (family or marital therapy)

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12
Q

Syndrome of visual hallucinations in those with visual impairment

A

Charles Bonnet syndrome

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13
Q

Name an anti cholinesterase inhibitor

A

Rivastigmine / Donepezil / Galantamine / Pyridostigmine

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14
Q

Name the three core symptoms of Depression

A

Low mood, loss of energy, loss of pleasure (anhedonia)

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15
Q

Name three symptoms of depression (other than the three core ones)

A

Changes in sleep, appetite, libido, agitation, guilt, hopelessness

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16
Q

Name the symptoms of Bipolar Affective disorder (and what is Bipolar type 1 and type 2)

A

Depression + Hypomania OR Mania
Bipolar type 1: both depression + at least one episode of mania
Bipolar type 2: major depressive episode lasting at least two weeks and at least one hypomanic episode

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17
Q

What are some differences between mania and hypomania

A

Hypomania: elevated mood, increased energy and decreased concentration, reckless behaviour, increased libido and confidence
Mania: elation, over-activity, impaired judgement, risk-taking, social disinhibition

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18
Q

Name 3 first rank symptoms and 3 second rank symptoms of Schizophrenia

A
  • First rank: Thought alienation, Passivity phenomena, 3rd person Auditory hallucination, Delusional perception
  • Second rank: Delusions, thought disorder, Catatonia, 2nd person auditory hallucination, Increased frequency of hallucinations, negative symptoms (apathy etc.)
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19
Q

Name a psychological and a physical symptom of panic disorder

A

Physical: palpitations, CP, tachypnoea, dizziness, blurry vision, dry mouth
Psychological: impending doom, fear of dying/losing control

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20
Q

Name the symptoms of OCD

A

Obsessive thoughts + compulsive acts

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21
Q

What is a delusion?

A

False, unshakeable idea/belief with extraordinary conviction + subjective certainty

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22
Q

What is a delusional perception?

A

A delusional belief resulting from a perception

ie a true perception to which patient attaches a false meaning

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23
Q

Name the 5 types of thought alienation

A 
Thought Insertion (not your own)
Thought Withdrawal (stolen from mind)
Though Broadcast (broadcast out loud)
Thought Echo (hears them spoken aloud)
Thought Block (interruption of train of thought)
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24
Q

What is a hallucination?

A

a perception occurring in absence of external physical stimulus

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25
Q

What is a perception occurring in absence of external physical stimulus called?

A

Hallucination

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26
Q

What is Catatonia?

A

A state of excited/inhibited motor activity in absence of mood disorder or neurological disease

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27
Q

SSRIs are associated with what electrolyte imbalance?

A

Hyponatraemia

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28
Q

SNRIs are associated with what complication?

A

Hypertension

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29
Q

Tricyclic antidepressants (eg. Amitriptyline) can cause what urinary problem

A

urinary retention

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30
Q

Involuntary pouting of the mouth is an example of what side-effect of antipsychotic medication?

A

Tardive Dyskinesia

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31
Q

Clozapine can reduce serum levels of what?

A

Agranulocytosis = lowering of the white blood cell count, primarily neutrophils

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32
Q

Which targeted therapy is used for depression or anxiety related conditions and which therapy is an effective treatment for borderline personality disorder?

A

Cognitive Behavioural Therapy (CBT) - depression or anxiety related conditions
Dialectical Behavioural Therapy (DBT) - Borderline personality disorder

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33
Q

ICD10 definition of hallucination

A

false sensory perception in the absence of an external stimulus. Maybe organic, drug-induced or associated with mental disorder.

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34
Q

What type of false sensory perception commonly occurs in people who are grieving

A

Pseudohallucination

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35
Q

A phenomenon which involves repetition of someone else’s speech including the questions being asked

A

Echolalia

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36
Q

Acute dystonia secondary to antipsychotics is usually managed with what medication?

A

Procyclidine

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37
Q

What drug class is Fluoxetine?

A

SSRI

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38
Q

What drug class is Amitriptyline?

A

Tricyclic antidepressant

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39
Q

What is a persecutory delusion?

A

They are being mistreated or someone intends to harm them

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40
Q

What is a grandiose delusion?

A

Over-inflated sense of worth, power, knowledge or identity

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41
Q

What is a self-referential delusion?

A

Believing innocuous events to have strong personal significance

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42
Q

What is a nihilistic delusion?

A

Believing themselves to be dead or the world to no longer exist

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43
Q

What is a misidentification delusion?

A

Somebody has been replaced with an imposter

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44
Q

What is perseveration?

A

Repetition of a particular response

- Associated with brain injury or organic disease

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45
Q

Somatic passivity

A

Sensations imposed upon the body by an outside force

46
Q

Belle indifference

A

Patient unconcerned with symptoms of conversion disorder

47
Q

Paracetamol overdose management

A

ABCDE

  • IV fluids
  • Treat acidosis
  • Treat hypoglycaemia

N-acetylcysteine - Dose dependent on paracetamol level @ 4 hours

Arrange psych review

48
Q

Schizophrenia organic causes

A

Neuro

  • Injury
  • Infection
  • Tumour

Recreational drugs and alcohol; Steroid-induced

Hypernatraemia
Hypocalcaemia

Hyperthyroidism
Cushing’s

49
Q

Schizophrenia diagnostic criteria

A

1 month of symptoms

+ 1 first rank symptom

50
Q

Serotonin syndrome cognitive features

A 
Agitated 
Confused 
Euphoric 
Manic 
Hallucinating
51
Q

Serotonin syndrome autonomic features

A 
Tachycardia 
Tachypnoea 
Hypertension 
Fever 
Sweating 
Mydriasis 
Arrhythmias
52
Q

Serotonin syndrome neurological features

A 
Tremor 
Ataxia 
Incoordination 
Clonus 
Hyper-reflexive
53
Q

Serotonin syndrome causes

A

SAME OA

SSRI
Amphetamines
MAOIs
Ecstasy

Opioids

Antipsychotics

  • Lithium
  • Olanzapine
  • Risperidone
54
Q

Generalised anxiety disorder diagnostic criteria

A

Anxiety

+ 3 or more symptoms for 6 months

55
Q

PTSD diagnostic criteria

A

Within 6 months of event
Interferes with ADLs

+ TRIAD

  1. Can’t recall some of the event
  2. Avoids circumstances associated with the event
  3. Constantly relives the experience
56
Q

PTSD symptoms

A

Hyper…

  • Vigilant
  • Arousal
  • Exaggerated startle response

Physical NEGATIVES

  • Decreased concentration
  • Decreased sleep

Mood

  • Guilt
  • Depression
  • Anger
  • Emotional outbursts
57
Q

PTSD management

A

Watchful waiting

< 3 months

  • CBT
  • Medication for sleep disturbance

> 3 months

  • Eye Movement Desensitising and Processing
  • SSRI - Paroxetine
  • NaSSA - Mirtazapine
58
Q

What is panic disorder

A

Frequent panic attacks present for 1 month

Period of intense fear…

  • Rapid onset
  • Peaks at 10 minutes
  • Spontaneous or situational
59
Q

Panic disorder physical symptoms

A

Tachycardia
Palpitations
Chest pain

Dizziness
Blurred vision
Paraesthesia

Dry mouth
Abdo pain
Choking sensation

Sweating
Trembling

60
Q

Panic disorder psychological symptoms

A

Feeling of impending doom

Fear of dying
Fear of losing control

Depersonalisation
Derealisation

61
Q

Panic disorder management

A

CBT
SSRI

Review in 12 weeks

TCA - Clomipramine

Refer

62
Q

MSE sections

A
  • Appearance and behaviour
  • Speech – rate, tone, volume
  • Mood and affect:
    Current mood +/- variation
    Congruent/incongruent affect
  • Thoughts:
    Content – delusions, obsessions, compulsions
    Form – loosening of association, thought block
  • Perception – hallucinations
  • Orientation – date, place, time
  • Insight
63
Q

Depression core symptoms

A
  • Persistently depressed mood and anhedonia (somatic) – must have at least 1 of these
  • Weight change, psychomotor agitation/retardation and fatigue/anergia
  • Feelings of worthlessness or excessive/inappropriate guilt
  • Inability to concentrate
  • Suicidal thoughts/acts
64
Q

How many symptoms for mild, moderate and severe depression?

A
  • Mild depression: 5 core symptoms + minor social/occupational impairment
  • Moderate depression: ≥5 core symptoms + variable degree of social/occupational impairment
  • Severe depression: ≥5 core symptoms + significant social/occupational impairment - can occur with or without psychotic symptoms.
65
Q

Depression questionnaires

A

Patient Health Questionnaire-9 (PHQ-9)
Hospital Anxiety & Depression Scale (HADS)
Becks Depression Inventory-2 (BDI-II)

66
Q

Dysthymic disorder features + Mx

A
  • Chronic (>2yrs), low-grade depressive symptoms
  • Clinical features similar to depression
  • Epidemiology: 1:2 M:F, usually early age onset (<20yrs)
  • Course: less severe, more chronic
    Management
  • SSRI/TCA, CBT may be useful
67
Q

Seasonal affective disorder features + Mx

A
  • Clear seasonal pattern to recurrent depressive episodes
  • Usually January/February (‘winter depression’)
  • Low self- esteem, hypersomnia, fatigue, increased appetite/weight gain
  • Decreased social and occupational functioning
  • Symptoms mild-moderate

Management
- Light therapy, then SSRI

68
Q

How long postpartum to be classified as Post-Natal Depression?

A

Significant depressive episode related to childbirth (<6month post-partum)

69
Q

Criteria for GAD Dx

A
  • Excessive anxiety and worry about everyday events/activities and difficulty controlling the worry on most days for 6 months
  • Should cause clinically significant distress/impairment in social, occupational or other important areas of functioning
  • At least 3 associated symptoms

Associated symptoms

  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or ‘mind going blank’
  • Irritability
  • Muscle tension
  • Sleep disturbance
70
Q

Panic disorder features (PANICSD mnemonic)

A 
P – Palpitations
A – Abdominal distress 
N – Numbness/nausea
I – Intense fear of death
C – Choking/chest pain 
S – Sweating/shaking/SOB
D – depersonalization/derealization
71
Q

Assessment + Mx of panic disorder

A

Assessment

  • Psychiatric Hx + MSE
  • Bloods: FBC, TFTs and glucose
  • ECG: sinus tachycardia
  • Rule out GAD with GAD-7

Treatment

  • SSRIs (e.g., sertraline) > TCA (e.g. imipramine)
  • Don’t give BDZ!
  • CBT and self-help methods
72
Q

Mx of phobic anxiety

A
  • Behavioural therapy i.e., graded exposure therapy

- Education/anxiety management

73
Q

Classic quadrad of PTSD

A
  • Reliving the situation
  • Avoidance
  • Hyperarousal
  • Emotional numbing
74
Q

PTSD - features present how long after event and last how long?

A

Exposure to traumatic event, above features present within 6 months of event, features last > 1 month.

75
Q

Assessment + Mx of PTSD

A

Assessment

  • Psychiatric history + MSE
  • Trauma Screening Questionnaire (TSQ)

Treatment

  • First-line: Trauma-focused CBT + Eye movement desensitization and reprocessing (EMDR)
  • Sertraline/venlafaxine
  • Zopiclone
76
Q

Obsession vs Compulsion

A
  • Obsession: an idea, image or impulse recognised by patient as their own, but which is experienced as repetitive, intrusive and distressing
    (E.g., Aggressive impulses, contamination, need for order, repeated doubts, sexual imagery etc.)
  • Compulsion: behaviour or action recognised by patient as unnecessary and purposeless but which they cannot resist performing repeatedly
    (E.g., Checking, cleaning (overt), mental acts (covert), ordering etc.)
77
Q

Mx of OCD

A
  • CBT + exposure and response prevention (ERP)
  • Behavioural therapy/psychotherapy (supportive)
  • Pharmacological approach: SSRI (first-line), clomipramine (second-line)
78
Q

Mania vs Hypomania

A

Mania:

  • Elevated, expansive, euphoric, or irritable mood with ≥3 characteristic symptoms of mania on most days for 1 week
  • Increased energy
  • Pressure of thought, flight of ideas, pressure of speech and word salad
  • Increased self-esteem and reduced attention
  • Tendency to engage in risky behaviour
  • Other: excitement, irritability, aggressiveness and suspiciousness
  • Marked disruption of work, social activities and family life

Hypomania: ≥3 characteristic symptoms lasting ≥4 days and be present most of the day, almost every day

  • Shares mania symptoms
  • Symptoms evident to lesser degree
  • Not severe enough to interfere with social or occupational functioning
  • Does not result in hospital admission
  • No psychotic features
79
Q

Bipolar disorder psychotic symptoms

A
  • Occur in up to 75% of manic episodes
  • Grandiose delusions e.g., special powers
  • Persecutory delusions may develop from suspiciousness
  • Auditory and visual hallucinations
  • Catatonia i.e., manic stupor
  • Total loss of insight
80
Q

Bipolar I vs Bipolar II

A

Bipolar I disorder: characterised by episodes of depression, mania or mixed states separated by periods of normal mood

Bipolar II disorder:do not experience mania but have periods of hypomania, depression or mixed states

81
Q

Lithium adverse effects

A

weight gain, subclinical/clinical hypothyroidism, renal impairment and teratogenic

82
Q

Pharmacological Tx of Bipolar

A
  • Manic episode: lithium ± benzodiazepine (e.g., clonazepam or lorazepam)
  • Depressive episode: SSRI
  • Maintenance: Lithium
83
Q

Schizophrenia risk factors

A
  • Bimodal age distribution
  • Family history of schizophrenia
  • Pre-morbid schizoid personality
  • Abuse
  • Delayed developmental milestones
  • Obstetric risk factors
  • Substance abuse
  • Significant life event
  • Cerebral injury
  • Acute psychosis
84
Q

Antipsychotics + SE’s

A

Antipsychotics (PO or depot):
Atypical: Risperidone, Quetiapine, Aripiprazole, Olanzapine, Clozapine
Typical: Haloperidol, Chlorpromazine

Side effects:
Extra-pyramidal – akathisia, tardive dyskinesia, dystonia, NMS
Metabolic – weight gain, diabetes, liver dysfunction
General – dry mouth, constipation, sexual dysfunction, ECG changes

Specific:
Risperidone – hyperprolactinaemia
Clozapine – agranulocytosis, cardiomyopathy
Monitoring – FBC, prolactin, U&E, LFT, ECG, HbA1c, weight measurement

85
Q

Section 2 (Duration, Purpose + Professionals)

A
  • Duration: 28 days
  • Non-renewable
  • Purpose – assessment and treatment
  • Professionals: TWO doctors (ONE S12) + ONE approved mental health professional (AMHP)
  • Evidence: Patient is suffering from mental disorder
  • Being detained for their own health/safety or others protection
86
Q

Section 3 (Duration, Purpose + Professionals)

A
  • Duration: 6 months
  • Renewable
  • Purpose – long term treatment
  • Professionals: TWO doctors (ONE S12) + 1 AMHP
  • Evidence: Section 2 rationale
  • Appropriate treatment is available
87
Q

Section 4 (Duration, Purpose + Professionals)

A
  • Duration – 72 hours, non-renewable
  • Purpose – to hold patient until assessment by S12 doctor
  • Professionals: ONE doctor + ONE AMHP
  • Evidence – Section 2 rationale
88
Q

Section 5(2) + 5(4) (Duration, Purpose + Professionals)

A

Purpose – patient is in hospital but wants to leave, cannot be treated coercively

5(4):
 - Duration - 6 hours
 - Initiated by nurse
5(2):
 - 72 hours
 - Initiated by doctor in charge of patient’s care
89
Q

Section 135 + 136 (Duration, Purpose + Professionals)

A

135:
- Duration – 36 hours
- Purpose - police allowed to enter patient’s home to move to a place of safety
136:
- Duration – 24 hours
- Purpose – police can move patient with mental disorder in a public place to place of safety

90
Q

Neuroleptic Malignant Syndrome features, Ix + Mx

A
  • Adverse reaction to dopamine receptor agonists (anti-psychotics)
  • Abrupt withdrawal of dopaminergic medication
  • Altered mental state
  • Hypertonia
  • Autonomic dysfunction
  • Hyperthermia

Ix - Bloods – FBC, CK, U and Es / Imaging – CT/MRI head / Infection screen - urine/blood culture, LP
Mx - Withdraw anti-psychotic medication / Supportive treatment

91
Q

Serotonin Syndrome features + Mx

A
  • Caused by antidepressants – SSRI and SNRI
  • OR opioid analgesics, MAOI, lithium
  • Altered mental state
  • Neuromuscular dysfunction
  • Autonomic dysregulation (hyperactive bowels, tachy, excessive sweating, tremor, HT)

Mx: Withdraw offending medication / Supportive treatment / If recent overdose – activated charcoal

92
Q

Paranoid vs Schizoid vs Schizotypal

A
  • Paranoid = sensitive, suspicious, unforgiving, jealous, distrust, preoccupied with conspiratorial explanations and self-referential
  • Schizoid = Emotionally cold, detached affect, lack of interest in others, indifferent to praise/criticism, tasks done alone, sexual drive low
  • Schizotypal = Interpersonal discomfort with peculiar ideas, perceptions, appearance, eccentric behaviour, speech and beliefs are odd, inability to maintain friendships, lack of companionship
    (Schizotypal are more eccentric!)
93
Q

Assessment + Mx of substance (drug) abuse

A

Assessment

  • Psychiatric Hx + MSE
  • Physical exam: weight, dentition, signs of IVDU
  • Signs of withdrawal
  • Bloods: FBC, U&Es, LFTs, clotting profile, drug level and screen for blood-borne infections
  • Urinalysis: toxicology
  • ECG, echocardiogram and CXR

Mx

  • Self-help groups/Motivational interviewing/CBT
  • Pharmacological: opioid dependence
  • Substitute prescribing/detoxification: Methadone, buprenorphine or dihydrocodeine
  • Withdrawal symptom relief: Lofexidine
  • Relapse prevention: Naltrexone
  • Overdose: Naloxone
94
Q

Alcohol dependence (SAWDRINK mnemonic)

A

S – Subjective awareness of compulsion to drink
A – avoidance or relief of withdrawal by further drinking
W – Withdrawal symptoms
D – Drink-seeking behaviour
R – Reinstatement of drinking after attempted abstinence
I – Increased tolerance
N – Narrowing of drinking repertoire

95
Q

Alcohol withdrawal after 12, 36 and 72 hours

A
  • Symptoms appear 6-12hrs after last drink
    (Malaise, tremor, nausea, insomnia, transient hallucination and autonomic hypersensitivity)
  • At 36 hours: Seizures
  • At 72 hours: Delirium tremens
96
Q

Delirium Tremens features

A
  • Dehydration ± electrolyte disturbances
  • Cognitive impairment
  • Hallucinations/illusions
  • Paranoid delusions
  • Marked tremor
  • Autonomic arousal
97
Q

Wernicke’s vs Korsakoff’s features

A

Wernicke’s encephalopathy

  • Thiamine deficiency
  • Ataxia
  • Delirium
  • Hypothermia
  • Nystagmus
  • Ophthalmoplegia
  • IV Pabrinex (thiamine)

Korsakoff’s syndrome

  • Inability to lay down new memories
  • Working memory impaired with confabulation
  • Ante/retrograde amnesia
  • Disorientation to time
98
Q

Alcohol withdrawal first-line vs relapse prevention

A
  • First-line: Chlordiazepoxide + IV Thiamine

- Maintenance and relapse prevention: Acamprosate, naltrexone or disulfiram

99
Q

Dementia risk factors

A
  • Age
  • Family history
  • Genetics
  • Down’s syndrome
  • Cerebrovascular disease
  • Hyperlipidaemia
  • Lifestyle – smoking, obesity, high fat diet, alcohol
  • Poor education
100
Q

Alzheimer’s vs Lewy body vs Vascular Dementia

A 
Alzheimer’s:
 - Gradual onset + progressive
 - No insight to condition
Vascular:
 - Stepwise progression
 - Insight into condition
Lewy body:
 - Hallucinations common
 - Parkinsonian signs
101
Q

3 common screening tools for Dementia

A

MMSE
ACE III
MoCA

102
Q

Pharmacological + Non-pharmacological Mx of Dementia

A

Pharmacological:
- Acetylcholinesterase inhibitors:
- Donepezil
- Galantamine
- Rivastigmine
- Other psychiatric disturbances – antipsychotics/antidepressants/anxiolytic
Non-pharmacological:
- Lifestyle changes - diet, exercise, maintain social contacts
- Cognitive rehabilitation/occupational therapy

103
Q

3 types of delirium

A
  • Hyperactive – restlessness, agitation, delusion/hallucination
  • Hypoactive – lethargy, sedation, slow to respond
  • Mixed – hyperactive + hypoactive
104
Q

Drugs that cause Agranulocytosis

A
  • Antithyroid medications, such as carbimazole and methimazole (Tapazole)
  • Anti-inflammatory medications, such as sulfasalazine (Azulfidine), dipyrone (Metamizole), and nonsteroidal anti- - NSAIDs
  • Antipsychotics, such as clozapine (Clozaril)
  • Antimalarials, such as quinine
105
Q

Agranulocytosis features

A
  • sudden fever
  • chills
  • sore throat
  • weakness in your limbs
  • sore mouth and gums
  • mouth ulcers
  • bleeding gums
106
Q

How often should lithium levels be checked after being prescribed?

A

12 hours post-dose + 1 week after

107
Q

Anorexia features (3G’s 3C’s)

A

G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

108
Q

How does Haloperidol work?

A

Dopamine antagonist

109
Q

Four DSM-V criteria for ADHD

A
  1. ) Answers questions prematurely
  2. ) Always on the go, spontaneously moving around
  3. ) Losing important things, Forgetful
  4. ) Cannot play quietly
110
Q

Three clusters of personality types

A
  • Cluster A patients are likely to appear ‘odd’ or eccentric (paranoid, schizoid, schizotypal)
  • Cluster B includes patients often appear dramatic, emotional or erratic (antisocial, EUPD, Histrionic, Narcissistic)
  • Cluster C patient tend to appear anxious or fearful (Avoidant, Dependant, OCD)

Phase 3a medicine (24 decks)

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