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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Section 2

A

4 weeks (28 days)

2 doctors make recommendation, AMHP arranges assessment
Can be for safety

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2
Q

Section 3

A

6 months
can be renewed
for TREATMENT only
2 doctors + AMHP

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3
Q

Section 5(2)

A

gives doctors the ability to detain in hospital for 72 hours

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4
Q

Section 5(4)

A

gives nurses the ability to detain in hospital for 6 hours

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5
Q

Section 136

A

Police can take you (or keep you at) a place of safety

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6
Q

Section 4

A

72 hour assessment order
used as emergency when a section 2 would involve unacceptable delay e.g. outpatients inc. emergency department
a GP/doctor + AMHP or NR

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7
Q

Grandiose delusions

A

delusions with a strong positive affect where patients believe they have highly positive traits e.g “I’m rich” “I’m the Prime Minister”. Associated with mania.

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8
Q

Delusions of control

A

to a sensation that an external party is controlling an individuals thoughts or actions.
Seen in psychosis.

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9
Q

Persecutory delusions

A

a set of delusional conditions in which the patient believes they are being persecuted.
May be seen in psychosis.

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10
Q

Capgras delusion

A

A delusion that either oneself or another person has been replaced by an exact clone.
May be part of a psychotic illness or as a result of trauma to the brain.

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11
Q

Ekbom’s syndrome

A

A delusional belief where a patient feels that they are infested with parasites.
They often complain of feeling “crawling” in the skin.
It can appear as part of a psychotic illness or a secondary organic disease such as B12 deficiency, hypothyroidism and neurological disorders.

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12
Q

Cotard Delusion

A

A belief that a patient is dead, non-existent or ‘rotting’
may occur in psychosis but can appear as a result of parietal lobe lesions.

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13
Q

Othello syndrome

A

strong delusional belief that their spouse or partner is unfaithful with little or any proof to back up their claim.
associated with alcohol abuse, psychosis and right frontal lobe damage.

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14
Q

Preferred SSRIs in breastfeeding women w/ postpartum depression

A

Sertraline or Paroxetine

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15
Q

What is Bipolar Affective Disorder?

A

A mental disorder characterised by periods of depression and periods of elevated mood (mania)

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16
Q

Clinical Features of Bipolar Affective Disorder

A

Periods of depression: withdrawn, tearful, low mood, poor sleep, anhedonia, may experience suicidal thoughts or make attempts

Manic episodes: elevated modd or irritability, make impulsive and dangerous decisions, need for sleep reduced, often have pressured speech and exhibit flight of ideas. Mood congruent delusions may be present.

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17
Q

Dx of Bipolar Affective Disorder

A

diagnosed when a person has at least one episode of a manic or a hypomanic state, and one major depressive episode

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18
Q

symptoms needed to diagnose mania

A

At least three of the following:
Elevated self-esteem
Reduced need for sleep
Increased rate of speech
Flight of ideas
Easily distracted
An increased interest in goals or activities
Psychomotor agitation (pacing, hand wringing etc.)
Increased pursuit of activities with a high risk of danger

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19
Q

Hypomania diagnostic definition

A

“the episode (should not be) severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalisation, and there are no psychotic features”

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20
Q

Diagnostic criteria for depressive episode in Bipolar Affective Disorder

A

At least four of the following, should be new or suddenly worse, and must last for at least 2 weeks:

Changes in appetite or weight, sleep, or psychomotor activity
Decreased energy
Feelings of worthlessness or guilt
Trouble thinking, concentrating, or making decisions
Thoughts of death or suicidal plans or attempts

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21
Q

Chronic Mx Bipolar Affective Disorder

A

Lithium: acts as mood stabiliser
Valproate: 2nd line

Access to CBT, interpersonal therapy or couples/family therapy.

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22
Q

Acute Mx Bipolar Affective Disorder

1) Acute mania
2) Acute depression

A

1) Acute mania w/ agitation: IM benzodiazepine or a neuroleptic, may need urgent admission to a secure unit.
Acute mania w/o agitation: oral antipsychotic, if necessary, sedation and a mood stabiliser such as lithium.

2) Acute depression: mood stabilizer and/or atypical antipsychotic and/or antidepressant w/ appropriate psychosocial support

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23
Q

What is Munchausen syndrome?

A

Patients fake illnesses to receive attention
e.g. adding blood to urine, not taking medications or faking pain.

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24
Q

What is Malingering?

A

Patients intentionally fake or induce illness for secondary gain e.g. drug seeking, disability benefits, avoiding work or prison time

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25
Q

What is a conversion disorder?

A

Psychiatric condition that results in a presentation of neurological symptoms w/o any underlying neurological cause (e.g. paralysis, pseudoseizures, sensory changes)
Not an intentional process and symptoms are very ‘real’ to the patient.
Linked to emotional stress

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26
Q

What is a somatoform disorder?

A

The presence of physical symptoms that cannot be explained by a medical condition, drug or other MH disorder.
Unconscious process

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27
Q

Features of opiate intoxication (e.g. heroin)

A

drowsiness
confusion
decreased resp rate
decreased HR
constricted pupils

If heroin: needle marks

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28
Q

Features of cannabis intoxication

A

drowsiness
impaired memory
slowed reflexes & motor skills
bloodshot eyes
increased appetite
dry mouth
^ HR
paranoia

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29
Q

What receptors do opiates act on?

A

Opioid receptors

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30
Q

What receptors does cannabis act on?

A

Cannabinoid receptors

31
Q

Features of LSD intoxication

A

labile mood
hallucinations
^ BP
^ HR
^ temp
sweating
insomnia
dry mouth

32
Q

What receptors does LSD act on?

A

Dopamine receptors

33
Q

Features of stimulant intoxication? (e.g. cocaine, methamphetamine)

A

euphoria
^ BP
^ HR
^ temp

low doses: increased concentration and focus

34
Q

What receptor does cocaine act on?

A

dopamine receptors

35
Q

What receptors does methamphetamine act on?

A

TAAR1 receptors (Trace Amine-Associated Receptor 1)

36
Q

Opiate withdrawal features

A

agitation
anxiety
muscle aches or cramps
chills
runny eyes
runny nose
sweating
yawning
insomnia
gastro disturbance e.g. abdo cramps, N&V, diarrhoea
dilated pupils
‘goose bump’ skin
^ HR & BP

37
Q

Features of normal-pressure hydrocephalus

A

Urinary incontinence
Dementia
Gait abnormality (can cause falls)

38
Q

Treatment for normal pressure hydrocephalus

A

Ventriculo-peritoneal shunting

39
Q

What part of the brain is responsible for the activation of the ‘fight or flight’ response?

A

The amygdala

40
Q

What term is used to describe a phenomenon in which the patient has a fascination with repetitive mechanical tasks or with the ordering of objects?

A

Punding

41
Q

De Clerambault’s Syndrome

A

Delusional disorder in which the patient has a specific, fixed, false belief that someone is in love with them
otherwise known as erotomania

42
Q

First line treatment for PTSD?

A

Trauma-focused psychological treatments (e.g. trauma-focused CBT)

43
Q

Low levels of which neurotransmitter are associated with the development of anxiety?

A

Gamma-aminobutyric acid (GABA)

44
Q

When not to use an SSRI?

A

Increased risk of bleeding when prescribed with anticoagulants: especially in elderly
?alongside pill?

45
Q

Physical Features of Bulimia Nervosa

A

Dental Erosion
Parotid gland swelling
Russell’s sign (scarring on fingers from induced vomiting)

46
Q

What is the correct length and quantity of symptoms needed for a diagnosis of mild depression to be made?

A

5 or more symptoms, occurring nearly every day for 2 weeks

47
Q

Clinical Features of Frontotemporal Dementia

A
  • younger age than other forms
  • early personality change and frequently become disinhibited
  • language can also be affected early on
48
Q

Symptoms of hyperprolactinaemia

A

women: amenorrhoea & oligomenorrhoea

men: gynaecomastia, erectile dysfunction

both:
decreased libido
galactorrhoea
infertility
osteoporosis

49
Q

Side effects of antipsychotics

A

Hyperprolactinaemia
- prolactin production can be stimulated by dopamine receptor antagonists such as risperidone and other antipsychotic medications

50
Q

What monitoring parameter is needed after starting a patient on Venlafaxine?

A

Blood Pressure
- can cause increase in BP and HR

51
Q

Biochemistry results for Anorexia Nervosa

A

Hypokalemia
Low sex hormone levels (FSH, LH, oestrogen, testosterone)
Raised growth hormone and cortisol levels
Hypercholesterolaemia

52
Q

Features of Lithium Toxicity

A

Coarse tremor
CNS disturbance inc. seizures, impaired coordination, dysarthria
Arrhythmias
Visual disturbance
Confusion

53
Q

Which specific ECG change can be associated with haloperidol use?

A

Prolongation of the QT interval

54
Q

What term is used to describe a phenomenon in Parkinson’s disease where a patient may get stuck on a word in a sentence and repeat it over again?

A

Logoclonia

55
Q

Side effects of SSRIs

A

GI upset
Anxiety and agitation
QT interval prolongation (esp. associated w/ citalopram)
Sexual dysfunction
Hyponatraemia
Gastric ulcer

56
Q

Side effects of Tricyclic antidepressants (e.g. amitriptyline, clomipramine)

A

Urinary retention
Drowsiness
Blurred vision
Constipation
Dry mouth

57
Q

Cautions with SSRIs

A

Omitted in mania
Used w/ caution in children and adolescents
Sertraline best for patients w/ ischaemic heart disease

58
Q

Cautions w/ Tricyclic antidepressants

A

Contraindicated w/ previous heart disease
Can exacerbate schizophrenia
Exacerbate long QT syndrome
Use w/ caution in pregnancy and breastfeeding

59
Q

Cautions with SNRIs

A

Contraindicated in those with a history of heart disease and high BP

60
Q

What is autoimmune encephalitis?

A

A form of non-infectious neuroinflammation that causes acute/subacute progressive mental status change

61
Q

Clinical features of Autoimmune Encephalitis

A

Wide range of symptoms:
confusion, seizures, movement disorders, behavioural changes, emotional lability, psychosis, cognitive impairment, reduced consciousness level

62
Q

Ix for autoimmune encephalitis

A

Full neuro exam
Blood tests:
- Low sodium associated w/ LG1 encephalitis
- Antibodies: LGI1, NMDA receptor, CASPR2
MRI
Lumbar puncture: ^ levels of lymphocytes in CSF

63
Q

Treatment for autoimmune encephalitis

A

1st line: steroids, IV immunoglobulin

2nd line: not responding within 2 weeks –> immunosuppressant therapy e.g. Rituximab, Cyclophosphamide

Plasma exchange can be used as an adjunctive treatment in those that are not fully responding to treatment

64
Q

What does the term ‘pica’ describe?

A

eating non-food items or food items in obscene quantities

65
Q

CT appearance for Normal Pressure Hydrocephalus

A

Enlarged ventricles and absent sulci seen on CT brain scan

66
Q

What is Wernicke’s encephalopathy?

A

Acute neurological condition due to thiamine/vitamin B1 deficiency (alcoholics)

67
Q

Wernicke’s encephalopathy triad

A

confusion, ataxia and ophthalmoplegia (weakness or paralysis of the eye muscles)

68
Q

Features of Serotonin Syndrome

A

Restlessness, diaphoresis, clonus, hyperthermia, rigidity, hyperreflexia

69
Q

Side effects of clozapine

A

Most common: constipation

Most serious: Agranulocytosis (regular full blood count monitoring)

70
Q

Which ECG change may be seen in refeeding syndrome?

A

QT prolongation
Flattened and inverted T waves
Prominent U waves
Mild ST depression
(hypokalaemia)

71
Q

What is neuroleptic malignant syndrome? (NMS)

A

A rare but potentially life-threatening adverse reaction to antipsychotics, e.g. haloperidol

72
Q

Symptoms of haloperidol

A

^ sweating, fever, rigidity, confusion, fluctuating consciousness, fluctuating BP, tachycardia

73
Q

Dx for neuroleptic malignant syndrome (NMS)

A

Raised creatine kinase

Medicine (13 decks)

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