Psychiatry Flashcards
(103 cards)
1
Q
Staying still in an unusual position
A
Catatonia
-can have catatonic schizophrenia
2
Q
Drug which reduces the seizure threshold
A
Clozapine
3
Q
Antidepressant which elongates QT interval
A
Citalopram (also escitalopram)
4
Q
Atypical antipsychotic with best side effect profile (esp for hyperprolactin)
A
Aripiprazole
5
Q
Antidepressant used after MI
A
Sertraline
6
Q
How do benzos work?
A
Enhance GABA by increasing frequency of chloride channels
7
Q
Treatment of tardive dyskinesia
A
Tetrabenazine
8
Q
Lifestyle factor which increases clozapine levels
A
Smoking
9
Q
Antipsychotics in elderly- what about?
A
Stroke and VTE
10
Q
Antidepressant mechanism: Inhibit a2 and serotonin receptors, enhancing both transmission in brain
A
Noradrenergic and Specific Serotonin Antidepressant (NaSSA)
11
Q
Antidepressant mechanism: Inhibit serotonin and noradrenaline reuptake at presynaptic membrane
A
Tricyclic Antidepressants (TCAs) Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
12
Q
Antidepressant mechanism: Inhibit serotonin reuptake at presynaptic membrane
A
Selective Serotonin Reuptake Inhibitors (SSRIs)
13
Q
Antidepressant mechanism: Inhibit metabolism of monoamines
A
Monoamine Oxidase Inhibitors (MAOIs)
14
Q
Mechanism behind extrapyramidal side effects of typical antipsychotics
A
Blockade of the dopamine receptor promotes hypersensitivity of the D2 receptor in the nigrostriatal pathway
15
Q
Wernicke’s Triad
A
Confusion
Ataxia
Ophthalmoplegia (lateral recti)
16
Q
Korsakoff’s Triad
A
Retrograde amnesia
Anterograde amnesia
Confabulation
17
Q
Mechanism of methylphenidate
A
Noradrenaline-dopamine reuptake inhibitor
18
Q
Alternative to chlordiazepoxide in liver failure
A
Lorazepam (avoids increased risk of sedation)
19
Q
Who is involved in Section 135 and 136?
A
Police + AMHP + 2 docs remove the patient
20
Q
Who is involved in Mental Health Act Assessment?
A
- Patient
- Approve Mental Health Professional (AMHP)
- S12 Approved doctor (consultant psychiatrist)
- Doctor (patient’s GP ideally)
- Nearest relative (long-term partner, eldest parent)
Just need doc and AMHP for Section 4
21
Q
Rapid tranquilisation drugs
A
IM lorazepam and IM haloperidol
22
Q
Antidote for benzo-induced respiratory distress
A
Flumazenil
23
Q
Max alcohol consumption per week (in Units)
A
14 Units/week
24
Q
Definition of binge (in Units)
A
6 Units in a session
25
Baby with small eye openings, flat philtrum and thin upper lip
Foetal Alcohol Syndrome
26
Antidepressants causing GI bleeding
SSRI (need to give PPI if also on NSAID)
27
Antidepressant which must not be combined with other antidepressants
Phenelzine (Monoamine Oxidase Inhibitor)
28
Antidepressant that causes Neonatal Adaptation Syndrome (agitated, insomnia, poor feeding)
Paroxetine
29
Type 1 vs Type 2 Bipolar
Type 1: manic and depressive
| Type 2: depressive with hypomanic
30
Definition of toxic level of lithium
>1.2
31
Lithium side-effects
Decreased memory
Tremor
Hypothyroidism
32
Schneider's First-rank symptoms
Auditory hallucinations
Delusional perception
Passivity
Thought interference
33
3 types of auditory hallucinations in Schneider's
Talk about patient
Running commentary
Thought echo
34
Mechanism of antipsychotics
Block post-synaptic D2 receptors
35
4 defining features of Anorexia Nervosa
1. BMI < 17.5
2. Deliberate weight loss
3. Distorted body image
4. Endocrine dysfunction= HPG axis messed up
36
How much weight gain should anorexia aim for?
0.5kg a week
37
2 forms of psychotherapy for adults with anorexia
Eating Disorder-Focused CBT: addresses low self-esteem, perfectionism and the urge to have control of things
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA): overcome personality traits and thinking styles that foster anorexia
38
First-line psychotherapy for kids with anorexia/bulimia
Family Therapy: 20 sessions over a year --> shows role of family in helping kid recover
39
ADHD has to onset before this age
<7yrs
40
3 defining components of ADHD
1. Inattention
2. Hyperactivity
3. Impulsivity
41
Questionnaire used in ADHD
Conner's Rating Scales
42
Complication of ADHD, which is another psych disorder
Oppositional Defiant Disorder (60% ADHD)
43
Genetic disorder that causes autism
Fragile X
44
3 defining components of autism
1. Reciprocal social interaction issues (don't pick cues)
2. Communication issues
3. Repetitive/restrictive behaviour
45
Questionnaire for autism
Autism Diagnostic Inventory- Revised (ADI-R)
46
Length of time needed for GAD to be diagnosed
6 months
47
Questionnaire for anxiety
Beck Anxiety Inventory
48
Beta-blockers contraindicated in these conditions (3)
Asthma
AV Block
Diabetes (masks tachy due to hypo)
49
How do you reduce the dose of benzo?
Reduce by 1/8 every 2 weeks
50
Psychotherapy used in phobia and OCD
Exposure and Relapse Prevention
51
Questionnaire for OCD
Yale-Brown OCD Scale
52
4 components of PTSD
1. Intrusions (inc flashbacks)
2. Avoidance
3. Decreased mood
4. Hyperarousal
53
Specific therapy for PTSD
Eye Movement Desensitisation and Reprocessing (EMDR): patient recounts trauma in as much detail as possible -- while also watching therapist’s finger moving from side to side!!
54
Psychotherapy for childhood anxiety
School-based CBT prevention strategies
55
4 A's in dementia
Amnesia: recent memories lost first (appointments, car keys...)
Aphasia: can’t find right words
Agnosia: can’t recognise things (faces...)
Apraxia: can’t do skilled tasks (dressing)
56
Lewy-Body Dementia diagnostic criteria
Need 2 of the 3:
Fluctuating cognition
Visual hallucinations (people, animals)
New Parkinsonian signs --> ask about falls!
57
Questionnaire for dementia
ACE-III
58
Dementia with disinhibition and antisocial behaviour --> progresses to apathy and akinesia
Pick's Disease (frontotemporal dementia)
59
Diagnostic criteria for Learning Disability (3)
1. IQ < 70 (normal = 100)
2. Impact on daily living
3. Present before age 18
60
Definitions of Mild, Moderate, Severe and Profound LD
```
Mild = IQ 50-69
Moderate = IQ 35-49
Severe = IQ 20-34
Profound = IQ <20
```
61
If patient needs to be sectioned under Mental Health Act, Advance Decisions are not legally binding (even if make AD when competent) - true or false?
True!!
62
Dementia which day-to-day fluctuations in cognition
Lewy-Body Dementia
63
Psychotherapy used in EUPD
Dialectical Behavioural Therapy (DBT)
64
What is the name of cytoplasmic inclusion bodies (made of tau protein), found in the substantia nigra?
Pick's bodies
65
Triad of:
1. Dementia
2. Gait disturbance
3. Urinary incontinence
Normal-Pressure Hydrocephalus = increased CSF, but minor increase in pressure (as ventricles dilate to compensate)
66
Patient feels that aliens are pinching and poking him - what symptom is this?
Somatic passivity = first-rank symptom!
67
Russel's Sign in bulimia
Thick skin on dorsum of hands, after repeated gagging
68
Echolalia
Repeat what someone else says
69
Coprolalia
Swear lots, like Tourette's
70
"Over-the-counter preparation for depression", on top of SSRI -- what is the consequence?
Serotonin Syndrome (crazy HTN, tachy, hyper-reflexia)
71
Antidepressant helpful for sleeping difficulties
Amitriptyline
72
Fine, downy hair on face, arms and trunk
Lanugo hair in anorexia nervosa
73
Antipsychotics act on which pathway to improve psychotic symptoms, and which pathway to cause side effects
Mesolimbic pathway = improve symptoms
| Mesocortical pathway = side effects
74
Puerperal psychosis defined as how soon after birth?
Within 6 weeks
75
Minimum time needed for GAD diagnosis
6 months
76
Suicide incidence in UK
1 in 10,000
77
Risk of suicide in the next year after one act of self-harm
1% = 100x increased risk!
78
Memory loss with increased aggression and antisocial behaviour
Frontotemporal Dementia = Pick's Disease
79
Why do benzos have increased duration of action in old people?
Old people have increased body fat --> benzos are fat-soluble... --> falls, resp depression
80
Rapid onset of symptoms in schizo = good or bad?
Good!
81
How often should lithium be monitored?
Weekly until stable --> then 3-monthly, with TFTs and U&Es
82
Why are Down Syndrome increased risk of Alzheimer's?
Extra copy of APP gene on trisomy 21
83
Atrophy in Alzheimer's affects which part of brain?
Hippocampus = required for new learning and visuospatial skills
84
Beta-amyloid plaques made of what?
Tau protein
85
Aphasia vs agnosia vs apraxia
Aphasia: can’t find right words
Agnosia: can’t recognise things (faces...)
Apraxia: can’t do skilled tasks (dressing)
86
What do Lewy Bodies contain?
Alpha-synuclein and ubiquitin
87
Where do Lewy Bodies distribute?
Cyngulate gyrus and cerebral cortex
88
2 things you must always do in dementia PACES
```
Risk assess (impact on ADLs)
Check if patient has insight
```
89
Which 2 Personality Disorders are more common in women?
EUPD (Borderline) and Histrionic
90
IQ cut-offs
```
70 = normal
50-70 = mild
35-50 = moderate
20-35 = severe
```
91
Hypoactivity of prefrontal lobes, enlarged cerebral ventricles
Schizophrenia
92
Hyperactivity of prefrontal lobes
OCD
93
How long can urgent DoLS be used in care home?
7 days
94
Schizophrenia risk if one parent has it
15%
95
Blockage of this pathway causes galactorrhoea after antipsychotic use
Tuberoinfundibular pathway (dopamine inhibits prolactin)
96
Blockage of this pathway causes extrapyramidal symptoms after antipsychotic use
Nigrostriatal pathway
97
Dementia severity (according to MMSE)
Mild: 21-26
Moderate: 10-20
Severe: <10
98
Axis overactivated in GAD
Hypothalamic-pituitary-adrenal (adrenaline/noradrenaline)
99
Max time that Adjustment Disorder lasts
6 months
100
How to switch from fluoxetine to sertraline
Gradually reduce fluoxetine over 2 weeks
- ->wait 7 days (long half-life so needs flushing out period)
- -> start sertraline
101
Antidepressant causing thrombocytopaenia (and dry mouth/blurry vision)
Amitriptyline (TCA)
102
Antipsychotic causing "torsade de pointes"
Haloperiodol (prolonged QT)
103
1st line antidepressant in kids
Fluoxetine
