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Psychiatry Flashcards

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1
Q

Forms of delusion (5)

A
  • reference
  • control
  • guilt
  • grandiosity
  • persecution
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2
Q

Somatisation disorder

A

Multiple physical symptoms and investigations with no physical cause.

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3
Q

Hypochondriasis

A

Persistent belief in the presence of an underlying serious disease
Refuses to accept reassurance or negative result

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4
Q

Munchausen/fictitious disorder

A

Intentional production/ falsification of psychological signs and symptoms to obtain medical attention and treatment

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5
Q

Malingering

A

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

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6
Q

Conversion/ dissociative disorder

A

Loss of motor or sensory function without organic cause

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7
Q

La belle indifference

A

La belle indifference is defined as a paradoxical absence of psychological distress despite having a serious medical illness or symptoms related to a health condition.

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8
Q

Gander syndrome/ prison psychosis

A

Deliberately acts as if/she has physical or mental illness when they aren’t really sick

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9
Q

Cowards delusion / nihilistic delusion

A

Holds belief they are dead or do not exist

Or have lost their blood or internal organs

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10
Q

Capgras syndrome

A

Irrational belief someone they now has been replaced by an imposter

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11
Q

Fregoli delusion

A

Delusional belief the different people (>1) are in fact a single person that changes appearance / is in disguise

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12
Q

Acute alcohol withdrawal

  • symptoms
  • treatment
A

Sweating , agitation , tremors, altered mental ion
1 - Chlordiazepoxide
2- thiamine vit B1

If seizure of hallucination - delirium tremendous
- IV lorazepam or diazepam

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13
Q

Wenickes encephalopathy
Symptoms
treatment

A

CAS - confusion , ataxia, squint : ophthalmoplegia, nystagmus, diplopia

IV vitamin B1(thiamine), IV pabrinex or high potency Vit B complex

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14
Q

Medication to give alcoholic to serve as detergent when he takes alcohol

A

Disulfiram

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15
Q

Medication to help reduce withdrawal sx in alcoholics

A

Chlordiazepoxide

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16
Q

Acamprostate use

A

Reduces craving for alcohol

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17
Q

Chronic alcoholism liver fn

A

Raised MCV , GGT

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18
Q

Anorexia nervosa management
BMI <15
BMI 15-17.5
>17.5

A

BMI <15 ,+ rapid wt loss and evidence of system failure
= urgent referral to medical/pads ward

Severe electrolyte imbalance, Brady,hypoglycaemic
- acute medical ward regardless of BMI

15-17.5 + no system failure / complications =
Routine referral to eating disorder unit / local community mental health team

Severe self harm - high risk of suicide
- admit to an acute psychiatric ward

> 17.5 w/o complications - build trusting relationship and encourage self help books and food diary

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19
Q

Autism spectrum disorder

Features

A 
Impaired language and communication
“ social relationships
Compulsive behaviour 
Collects things 
Decreased IQ in most children
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20
Q

Management of insomnia in ADHD patient

A

1st line - sleep hygiene

2nd - melatonin

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21
Q

Mania vs hypomania

A

Mania - > 7days , severe functional impairment, may have psychotic symptoms

Hypomania - < 7 day , function not impaired, no psychotic symptoms

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22
Q

Treatment of bipolar disorder

A

Mood stabilisers - lithium

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23
Q

Features of lithium toxicity

A
  • coarse tremor (fine tremor at therapeutic level)
    -muscular twitching
  • nausea & vomitng
  • drowsiness, confusion
    __
    Hyperreflexia
    Seizure - severe toxicity
    Coma - severe toxicity
    Blurred vision
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24
Q

Management of lithium toxicity

A

Serum lithium levels
Mild-moderate toxicity- normal resuscitation + normal saline
Haemodialysis - severe toxicity

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25
Diuretic and NSAID effect on lithium
Increase renal absorption of lithium - leads to toxicity
26
Lithium and planning pregnancy
Teratogenic - ebstein anomaly, thyroid disease, floppy baby syndrome If planning to get pregnant - reduce gradually & stop before pregnancy confirmed
27
Woman on lithium gets pregnant | What should be done?
Consider stopping it gradually over 4 weeks if she is well
28
Woman on lithium while pregnant | What. Should be done?
Check lithium levels monthly until 36 weeks | Then weekly until birth
29
How often should lithium levels be checked
1 week after starting Every 3 months - check lithium 12 hours after last dose (narrow therapeutic range) LFT U&E -every 6 months
30
2 important tests to be done before initiating lithium
Thyroid & kidney function
31
Tests to be done before prescribing amiodarone
Serum U&E s
32
SSRI + lithium in bipolar patient
SSRI can worsen episodes of mania Antidepressants precipitate manic episodes Should be stopped if mania is worsened
33
Advice on stopping antidepressants
Continue for at least 6 months in total even if there is improvement
34
First line in depression - how long do they take to work
SSRIs - take 2-4 weeks to work
35
Depression management
Psychotherapy - CBT + SSRIs(fluoxetine, sertraline, citalopram) No response 2- 4 weeks - check adherence to meds If adherent and no response after 4 weeks - up the dose or change SSRI Or shift to different class of antidepressants - mirtazapine
36
Best antidepressants in MI patients
SSRIs - sertraline | 2nd line - citalopram
37
SSRIs
Citalopram Fluoxetine - DOC when antidepressant indicated Sertraline - post MI Paroxetine
38
SNRIs
Venlafaxine , Duloxetine
39
Tricyclic antidepressants
Amitriptyline
40
Presynaptic alpha antagonist
Mirtazapine | ^ atypical antidepressant
41
Postpartum blues Features Treatment
3-7 days following birth Common in primi Anxious tearful irritable , crying T- reassurance
42
Postnatal depression Features Treatment
Peaks @ 3-4 weeks postpartum , can occur anytime in first 6 months Occasional thoughts of harming baby - feels she can’t look after baby properly or wont be a good mother T - CBT , then SSRIs If breastfeeding — sertraline
43
Puerperal psychosis. Feature Treatment
``` 2-4 days postpartum, - peaks @ 2 weeks Can present anytime after delivery Severe mood swings + disordered perception Thought of harming baby Suicidal thoughts ``` t- ECT , mood stabilisers, antidepressant
44
Depressed person, no point in living Refuses help/treatment What should you do?
Compulsory admission under the mental health act
45
Hormone disturbance in Schizophrenia
Dopamine
46
Schizophrenia symptoms
Auditory hallucinations Thought disorders - insertion, withdrawal, broadcast, blocking Passivity phenomena - body sensation controlled externally Delusional perceptions
47
Management of schizophrenia
Risperidone , Olanzapine | Quetiapine
48
Hypnagogic hallucination
Auditory hallucination while going to sleep
49
Hypnopompic hallucination
Auditory hallucination waking up
50
Management of panic attacks - long term
CBT SSRIs - sertraline, fluoxetine Acute episode - simple breathing exercise + reassurance
51
Panic disorder management - before attack - during
Before - b blocker | During - rebreathe into paper bag
52
Management of GAD
CBT | SSRI - sertraline
53
Othello syndrome
Over jealousy, suspecting unfaithful partner
54
Ekbom’s syndrome
Delusion of parasite infection
55
OCD | 1st line of treatment
CBT | - exposure and response prevention (part of CBT)
56
PTSD | Features
``` Symptoms present for >1 month Re -experiencing Avoidance Hyperarousal Emotional numbing - depersonalisation Depression ```
57
PTSD treatment
1- CBT 2- SSRI Watchful wait for mild symptoms <4weeks
58
Agoraphobia | Management
Fear of open spaces | - CBT + graded exposure
59
Opioid/heroin overdose Low RR low HR low BP pinpoint pupils Treatment
Naloxone
60
Opioid addict wants to quit, what will help combat withdrawal?
Methadone
61
Tourette’s | Age group
Repetitive tics - motor + vocal | 6-13 yrs old
62
Asperger syndrome affects __
Social net reactions + behaviour
63
Rents syndrome
Normal development until 2-3 yrs old | Regression in motor social language and coordination skills after
64
Willis ekbom syndrome vs ekbom syndrome
WEs - restless leg syndrome, check ferritin If low give iron , if normal give dopamine agonist Ekbom - delusion of parasite infestation
65
Incongruent affect seen in
Bipolar disorder | Schizophrenia
66
Long term antipsychotic us + continuous involuntary movements Management
Tardive dyskinesia Depot injection of atypical antipsychotics- risperidone, olanzapine Not oral!
67
Akathisia
Long term antipsychotic use + continuous sensation of restlessness
68
Brocas aphasia
Broken speech | Know and understand what they are saying
69
Wernickes aphasia
Difficulty with speech comprehension | Fluent speech that doesn’t are sense
70
Normal grief reaction | Stages
``` <6 months after major life event Denial & isolation Anger Depression Bargaining Acceptance ```
71
Adjustment disorder
<6 months after major life event Crying hopeless withdrawn Normal grief = subtype of adjustment disorder
72
Acute stress reaction
Duration < 4 weeks | Starts few mins or hrs after stressful event
73
Antisocial personality disorder | Features
M>F Criminal act Lack of remorse Aggressive
74
Borderline personality disorder | Features
``` Unstable interpersonal relationships Marked impulsivity , inability to control anger Mood swings Self harm attempts Dramatic attention seekers ```
75
Side effects of SSRIs | Avoid use w/
GI symptoms - most common - increased risk of GI bleed SIADH Avoid w/- NSAIDs, aspirin, warfarin, triptans Fluoxetine - anorgasmia (delayed ejaculation)
76
Side effect haloperidol
Sexual dysfunction | Gynecomastia
77
Rapid tranquillisation in acute psychosis
Lorazepam > haloperidol > olanazapine | Acute episode - halo is drug of choice, esp in elderly
78
Contraindication of haloperidol
Parkinson’s | Alzheimer’s
79
Erotomania
Delusional belief that someone oh higher social status falls in love with them and makes amorous advances Delusion of love
80
Folic a deux/ shared psychosis
Shared delusional disorder
81
Serotonin syndrome
``` Overdose of SSRI Neuromuscular excitation - hyperreflexia, myoclonus, rigidity ANS excitation - hyperthermia Altered mental state Nause, diarrhoea ```
82
Neuroleptic malignant syndrome vs SSRI syndrome
Similar features in both 1 with SSRI use NMS - dopamine antagonist overdose (metoclopramide) or potent antipsychotic - clozapine , risperidone
83
LSD overdose (5)
``` Mydriasis - dilated pupils Flushing sweating Tremors Hyperreflexia Delusions + hallucinations** - smelling colours , seeing sounds ```
84
Ecstasy overdose
Nausea, flushing , hyperthermia , tachycardia, tachypnea , thirst Seeing spots of colour when eyes OPEN LSD - colours when eyes closed
85
Paracetamol overdose | - investigations
On admission - FBC UE LFT INR blood gases glucose Serum paracetamol 4 hours after ingestion**
86
When IV n-acetylcysteine should be given (6)
Staggered paracetamol overdose - tablets not takenWithin 1 hr Doubt over the time of ingestion patient presents >8hr after ingestion Jaundice or liver tenderness Unconscious pt w/ suspected overdose 4 hr post ingestion plasma conc - on or above treatment line
87
Critical dose of paracetamol
150 mg/kg in 24 hrs - approx 24 tablets
88
Activated charcoal use in paracetamol overdose
If presents within 1 hr - give activated charcoal 1g/kg = max 50g + paracetamol ingested >=150mg/kg or 24 tabs
89
Liver transplant referral in paracetamol over dose | When?
``` Arterial pH <7.3, 24 hrs after ingestion OR all of the following : PT >100 s Creatinine > 300 umol/l Grade 3 or 4 encephalopathy ```
90
Delirium tremens vs alcohol hallucinosis
DT - hallucinations begin > 48 hrs after alcohol intake in chronic alcoholic AH- few hrs after acute alcohol intake
91
AUDIT questionnaire (7)
Wake up drinking Remorse/guilt > = 8 units on single occasion male / female >= 6 No memory of wha happened night before being drunk Self injury or injury to others Cants stop once they start Health professional is concerned
92
Important association/ side effect of citalopram
Associated with a cute angle closure glaucoma
93
Depressed patient on warfarin / heparin | Med to be given?
Mirtazapine (may cause INR to rise slightly ) Don’t give SSRI
94
Drug of choice in psychotic depression
TCA - amitriptyline | Continue 6-9 months after symptom resolution
95
Drug induced Parkinson’s | Treatment
2ry to antipsychotic meds - dopamine deficiency Stop or lower dose If not suitable - give anticholinergic - procyclidine
96
Acute stress reaction Features Management
Few mins or hrs after stressful stimulus Can last up to 4 weeks Characterised by : Flashbacks + avoidant + hyperarousal Mgmt - reassure If severe and affects daily functions - trauma focused CBT *PTSD if >4 weeks
97
Risk factors of suicide
``` Previous attempts= greatest risk ;or self harm Depression and other mental illness Alcohol and drug abuse Low SE status Divorce ```
98
Most appropriate treatment of psychotic depression
ECT Refer to CBT afterwards

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