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4th year revision > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is schizophrenia?

A

Psychiatric condition characterised by disturbed thoughts, perception, mood and personality. There are positive and negative symptoms. The higher number of positive symptoms the more severe/poorer prognosis there is.

Positive symptoms are: delusions, hallucinations, disorganised thoughts/speech
Negative symptoms: decreased motivation, poor self care, social withdrawal

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2
Q

Risk factors for schizophrenia?

A 
FH
Premature birth
Abnormal early development 
Social isolation
Abnormal/disruptive family upbringing 
Drug use (e.g. cannabis)
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3
Q

What are the first rank symptoms of schizophrenia?

A 
Auditory hallucinations,
Thought broadcast 
Thought withdrawal 
Thought insertion
Delusional perception and of control
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4
Q

How long do symptoms need to be present to make a diagnosis of schizophrenia?

A

For at least one month

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5
Q

How is a diagnosis made for Schizophrenia?

A

Based on clinical presentation + CT (to rule out pathological causes such as masses)
+ toxicology screen

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6
Q

Management of Psychosis?

A

1st line - Olanzapine, Risperidone and Clozapine are now first line (due to lower risk of extrapyrimdal symptoms)
2nd line (for medications)- Chlorpromazine (& other 1st gen)
+
CBT
3rd line - Clozapine

Treatment resistant schizophrenia may receive ECT

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7
Q

What are poor prognostic factors in schizophrenia?

A 
FH of schizophrenia 
History of substance use 
Young age of onset 
Male gender
Insidious (chronic) onset 
No recognised precipitant 
Chaotic/toxic home relationships/environment 
Poor employment record
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8
Q

What are good prognostic factors for schizophrenia?

A 
Older age 
Acute onset 
Recognisable precipitant 
Stable and nurturing relationships/home environment 
FH of mood disorders
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9
Q

What is OCD?

A

An anxiety disorder characterised with obsessional thoughts and or compulsive acts.
Occurs most commonly in late adolescence/early 20s – can happen at any age though
Linked to inadequate serotonin regulation

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10
Q

How does it present?

A

Obsessions are thoughts/images that are: recurrent, persistent/intrusive, occurring against persons will, recognised as a product of ones own mind, if resisted – causes anxiety

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11
Q

Diagnosis of OCD?

A

Symptoms must be present on most days for at least 2 weeks to be diagnosed as OCD

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12
Q

Management of OCD?

A

First line – CBT or psychological therapies

2nd line – SSRI (Sertraline)

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13
Q

What does Section 5 (2) of the MHA refer to?

A

is the EDC – allows medical professionals to detain patient in hospital for up to 72 hours where they must be assessed by a senior psychiatrist or consultant

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14
Q

What does section 2 of the MHA refer to?

A

This is the equivalent of a STDC in Scotland – will detain a patient in hospital for up to 28 days to allow for full assessment and initiation of treatment

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15
Q

What is PTSD?

A

A condition that develops following a stressful/traumatic experience and typically seen in patients who were in armed forces, endured natural disasters/violent assault/sexual assault

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16
Q

Symptoms of PTSD?

A

Re-experiencing/flashbacks to the event, nightmares, intrusive memories
Avoidance: so avoiding place the event happened/situations similar
Hypervigilance, sleep problems, irritability, difficulty concentrating, feeling detached

Must be present for 1 month

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17
Q

Diagnosis of PTSD?

A

Clinical diagnosis. NICE guidance suggests PTSD can be mild, moderate or severe

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18
Q

Management of PTSD?

A

CBT or EMDR (eye movement desensitisation - not combat related Mx…)
Pharmacological – SSRI or venlafaxine

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19
Q

What is Capgras syndrome?

A

When a patient believes that a closely related person (family or close friend) has been replaced by an exact double

20
Q

What is Othello syndrome?

A

Patients have a delusional belief that their partner is cheating on them despite no proof. Patients repeatedly accuse partners and test the, even stalk them to seek evidence.

21
Q

What is Cotard syndrome?

A

Occurs when severely depressed or suicidal patients have intense nihilistic delusions (such as – belief that themselves of part f their body are dead or dying)

22
Q

What is De Clerambault syndrome?

A

Patients believe that someone is deeply in love with them. They believe the person is so infatuated with them that they cannot live without them. Subject of their delusion is usually famous – athlete/movie star etc

23
Q

What is Fregoli syndrome?

A

Fregoli syndrome is the delusional belief that one or more familiar persons, usually persecutors following the patient, repeatedly change their appearance.

24
Q

What is Folie a deux?

A

‘Shared psychosis’
Two people who live close to each other share a delusion. Typically a family member has a true psychosis and another family member living with them starts to develop their own psychosis.

25
Q

What is Korsakoff’s amnesia?

A

Occurs usually in patients who have a long history of alcohol abuse
They develop severe thiamine deficiency (Vit b1) and this presents as anterograde amnesia, confabulations and history of alcoholism.
Can also lead to beriberi

26
Q

What is beri beri?

A 
Deficiency in thiamine (Vit B1) 
All the D's 
Dementia, 
Difficulty walking...
Loss of muscle function 
Nystagmus
27
Q

What is the key type of history technique they use in Korsakoff’s?

A

Confabulation

28
Q

Cluster A personality disorders…

A

Odd & eccentric.

Includes: Schizoid personality disorder and Paranoid personality disorders. Can be emotionally cold, introspective and unable to form close relationships

29
Q

Cluster B personality disorders…

A

Dramatic and erratic/emotional personality disorders.

Includes: borderline & histrionic (regina George - vain, easily influenced). Intense unstable relationships, impulsive people who are attention seeking.

30
Q

Cluster C personality disorders…

A

Anxious personality traits such as OCPD

Includes OCPD, Avoidant personality disorder

31
Q

What is Bipolar disorder?

A

A relapsing and remitting mood disorder which has periods of elated mood (mania & hypomania) and periods of depressed mood

32
Q

Symptoms of hypomania?

A

elated mood in excess of what would be expected + less need for sleep, impaired concentration and distractibility

Symptoms must be present for at least 4 days
Should be relatively mild/moderate and not impair daily functioning

Insight should be maintained + no psychotic features

33
Q

Symptoms of Mania?

A

Elevated mood impairing daily functioning + flight of ideas + pressured speech

Symptoms must be present for at least 7 days

Symptoms have massive consequences: excessive spending, promiscuity etc

No insight + may have mood congruent psychotic features (grandiose delusions)

34
Q

Mx of Acute phase (when hypomanic/manic)

If on Olanzapine and Fluoxetine and then develops acute mania - what Mx advice?

A

1st line - Olanazpine (mania/hypomania)
1st depressive - Quetiapine

If they are on depressive Mx - stop in mania/hypomania

35
Q

Long term management of Bipolar?

A

Mood stabilisers
1st line - Lithium (test 12 hrs after dose weekly for 4 weeks), then monthly for 6 months then 3 months
2nd line - Lamotrigine (if pregnant)

36
Q

Side effects of Lithium

A

Tremor, metallic taste, dry mouth, polyuria, weight gain and hypothyroidism

Lithium is also the most common cause of nephrogenic diabetes insipidus

Overdose of lithium - Stop Lithium & IV fluids

37
Q

Monitoring of Lithium

A

Initially weekly, then once stabilised - 3 monthly

Lithium can cause neural defects so switch to Lamotrigine if patient becomes pregnant

Look at previous slide for correct answer!

38
Q

Generalised anxiety disorder is..

A

A group of anxiety disorders in which symptoms of anxiety are inappropriate and excessive. Can lead to avoidant behaviour and low mood.

39
Q

How does GAD present?

A 
Presents with varying symptoms: 
Sweating 
Palpitations/accelerated heart rate 
Difficulty breathing 
Irritability 
Muscle tension 
Chest pain/discomfort 
Feeling loss of control 
Excessive fear of death
Hypervigilance
40
Q

How is GAD diagnosed?

A 
Symptoms and signs must be present for at least 6 months with 3 of the following:
Irritability
Nervousness
Poor concentration
Insomnia 
Easily fatigues 
Muscle tension
Restless
41
Q

Management of GAD?

A

1st line - CBT

1st line Meds - SSRIs
2nd line Meds - Venlafaxine

42
Q

Drug Side effects

A

…

43
Q

What is tardive dyskinesia?

Which drugs give you tardive dyskinesia?

Treatment?

A

Tardive dyskinesia
- repetitive, involuntary & purposeless movements such as lip smacking or grimacing

Haloperidol & prochlorperazine

Mx - tetrabenazine

44
Q

Which drug has a risk of agranulocytosis?

A

Clozapine

45
Q

Main side effects of SSRI’s (sertraline)?

A

Feeling weak,
Lethargic
Muscle cramps
*Hyponatraemia

4th year revision (14 decks)

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