Psychiatry Flashcards

Question

Symptoms of mania

Answer 1

- Pressured speech. Lots of projects/things going on. - Delusions. - Increased energy/activity - Decreased need for sleep - Overfamiliarity. - Impulsivity.

Answer 2

- Low mood. - Lacking energy. - Loss of pleasure. - Sleep disturbance. - Appetite change. - Feelings of guilt, hopelessness. - Suicidal thoughts.

Answer 3

Hypomania - routine ref to CMHT Severe mania/depression - urgent ref to CMHT Taper down new SSRI as could have caused manic switch. Mania with Agitation: IM neuroleptic or benzodiazepine, potential psychiatric admission. Mania without Agitation: Oral antipsychotic (haloperidol, olanzapine, quetiapine, or risperidone). Acute Depression: Mood stabilizer increase if already on. If not, consider SSRI and atypical antipsychotic cover.

Answer 4

- About 4 weeks after acute episode resolution - Maintenance therapy: mood stabilizers such as Lithium (first line) or Valproate (second line), and psychotherapy (high-intensity - CBT, Interpersonal Therapy).

Answer 5

A common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment, and is hard to control.

Answer 6

- Family history of anxiety - Physical or emotional stress - History of physical, sexual, or emotional trauma

Answer 7

- ≥ 6m excessive worry, difficult to control that is disproportionate to the inherent risk - Not confined to another mental disorder, substance abuse or medical condition At least 3 out of: - Restlessness/nervousness - Being easily fatigued - Poor concentration - Irritability - Muscle tension - Sleep disturbance

Answer 8

- Hyperthyroidism - Medication induced anxiety (e.g. salbutamol) - Substance misuse

Answer 9

Rule out organic causes - TFT (hyperthyroidism), urine drug screen (e.g. alcohol) - Clinical diagnosis after other causes ruled out

Answer 10

NICE recommends step-wise approach: Step 1: for all people with GAD - Education about GAD and active monitoring Step 2: - Low-intensity psychological interventions : e.g. self-help, guided self-help or psychoeducational groups Step 3: - High-intensity psychological interventions (CBT or applied relaxation) or SSRI, 1st line is sertraline Step 4 : refer for specialist treatment

Answer 11

A mental health disorder characterised by the presence of persistent obsessions and/or compulsions. These are time consuming (e.g., take more than 1 hour per day) and/or cause clinically significant distress or impairment in daily functioning.

Answer 12

- Family history of OCD -PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) - Pregnancy

Answer 13

Biological Factors: Genetic predisposition, neurobiological abnormalities. Psychological Factors: Early life experiences. Often co-exists with other mental health conditions. Environmental Factors: Trauma, stressors

Answer 14

Obsessions: Intrusive, unwanted thoughts or images causing distress. Compulsions: Repetitive behaviors or mental acts aimed at reducing anxiety. These obsession and complusions take significant time investment and have a significant impact on daily life.

Answer 15

Symptom severity assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Scores: - 8 - 15 = Mild OCD - 16 - 23 = Moderate OCD - 24 - 31 = Severe OCD, - 32 - 40 = extremely severe OCD

Answer 16

GAD Major depressive disorder Body dysmorphic disorder

Answer 17

Mild functional impairment: - Low-intensity CBT, including exposure and response prevention (ERP) Moderate functional impairment: - Offer a choice of intensive CBT including ERP or an SSRI (e.g. serataline, fluxotine) Severe functional impairment: - Combined treatment with intensive CBT (including ERP) and an SSRI - Continue effective med for 12 months, then review if needs to continue

Answer 18

Postpartum psychosis is a severe mental health disorder that typically occurs within the first two weeks postpartum, characterised by symptoms including paranoia, delusions, hallucinations, mania, depression, and confusion.

Answer 19

Postpartum psychosis is a severe mental health disorder that typically occurs within the first two weeks postpartum, characterised by symptoms including paranoia, delusions, hallucinations, mania, depression, and confusion.

Answer 20

Postpartum psychosis is a severe mental health disorder that typically occurs within the first two weeks postpartum, characterised by symptoms including paranoia, delusions, hallucinations, mania, depression, and confusion.

Answer 21

- significant life stressor - personality disorder - family history of psychotic disorder - pregnancy or 4 weeks postnatal - previous psychiatric symptoms in women

Answer 22

Postpartum depression: insidious onset, low mood, tearfulness, anxiety

Answer 23

Rule out thyroid disorders, sepsis etc. Clinical diagnosis with full psychiatric evaluation

Answer 24

- Antipsychotic medications - olanzapine and quetiapine are safe to take while breastfeeding - Mood stabilisers in some cases - Important to consider potential risk to mother or infant, consider referral to specialist mother and baby unit, particularly when the mother experiences command hallucinations, thoughts of self-harm or suicide, or delusional beliefs regarding the baby's role or identity.

Answer 25

Psychosis is a syndrome associated with dysregulation of the neurotransmitters dopamine and serotonin, and abnormal functioning of key brain circuits. People with psychosis typically experience hallucinations (e.g., auditory, visual, tactile), delusions, and disorganised thoughts and actions.

Answer 26

Primary (“non-organic”) - Schizophrenia - Schizoaffective disorder - Secondary to substance abuse - Part of MDD or bipolar Specific medical (“organic”) aetiologies - Withdrawal syndrome - Dementia - Encephalitis - Traumatic brain injury

Answer 27

- Complete psychiatric and medical history - ask about head injuries, seizures, STIs, new or worsening headaches, and cerebrovascular disease. Collateral hx to chart onset and course - Complete mental state exam - FBC, comprehensive metabolic profile (U&E), thyroid function tests, urine toxicology, and parathyroid hormone, calcium, vitamin B12, folate, and niacin.

Answer 28

Schizophrenia is a chronic or relapsing and remitting form of psychosis characterized by positive symptoms (such as hallucinations, delusions, thought disorders) and negative symptoms (including alogia (poverty of speech), anhedonia, and avolition (severe lack of motivation).

Answer 29

- Strong: Family history of schizophrenia

Answer 30

Positive Symptoms ('ABCD' Mnemonic) or first rank symptoms: Auditory Hallucinations: usually third-person auditory experiences Broadcasting of Thoughts: belief that one's thoughts are being broadcasted to others. Control Issues: the sense of external control over one's thoughts or actions. Delusional Perception: distorted interpretations of reality, often with false beliefs. Negative Symptoms: - Alogia - Anhedonia - Affective incongruity - Avolition Risk Indicators: Potential risks to harm self or others: command hallucinations, a history of deliberate self-harm or suicidal ideation, and fixation on specific individuals.

Answer 31

ICD-11 Criteria: Symptoms present for at least 1 month, causing significant impairment. DSM-5 Criteria: Symptoms persist for at least 6 months, encompassing at least one month of active-phase symptoms (one 'ABCD' symptom). Zero to finals say that a specialist will use DSM-5 to make a diagnosis

Answer 32

Symptoms that form part of the ICD-11 criteria for schizophrenia. At least one first-rank symptom must be present for a diagnosis of schizophrenia. These include: - thought echo, thought insertion or withdrawal and thought broadcasting, - delusions of control, or passivity - delusional perception, other strange delusions, - Auditory hallucinations commenting on the patient's behaviour or talking about the patient in the third person.

Answer 33

Clinical diagnosis based on diagnostic criteria. See "investigations for psychosis" for tests to rule out organic causes

Answer 34

- Ensure safety of patient and yourself - sedatives like lorazepam, promethazine may be used to manage dangerous behaviour. - Oral atypical antipsychotics such as risperidone/olanzapine/quetiapine. - Refer for psychiatric liaison review.

Answer 35

First-line - Oral antipsychotic (usually atypical) e.g. risperidone - Psychological interventions: such as CBT, art therapy, and family interventions

Answer 36

Schizoaffective disorder is an illness that combines elements of both schizophrenia and mood disorders.

Answer 37

Schizophrenia Drug-induced psy chosis

Answer 38

Drug-induced psychosis Organic psychosis e.g. brain injuries, encephalitis

Answer 39

- Positive symptoms (see schizophrenia flashcards) - Negative symptoms - Disorders of perception (e.g. hallucinations) - Delusions - Emotional disturbance

Answer 40

- urine drug screen - STI screening (HIV can cause psyh symptoms) - FBC (rule out anaemia as it can cause mood disturbances) - TFT (fatigue, anxiety, depression, and irritability can be related to thyroid disorder)

Answer 41

Acute psychotic episode: start oral antipsychotics (e.g. paliperidone) Multi-episode disorder: atypical antipsychotics (e.g. olanzapine, risperidone except clozapine + psychological therapy (CBT)

Answer 42

- FHx of schizophrenia - Substance misuse

Answer 43

Cluster A: odd, eccentric presentation Cluster B: dramatic tendencies Cluster C: anxious tendencies

Answer 44

- Paranoid personality disorder - Schizoid personality disorder - Schizotypal personality disorder

Answer 45

- Histrionic - Emotionally unstable (borderline) - Narcissistic - Antisocial

Answer 46

- Avoidant PD - Obsessive-complusive PD - Dependent PD

Answer 47

EUPD is characterised by unstable and intense mood states often occurring in concert with idealisation and devaluation of others; chronic dysphoria (general unease and dissatisfaction) is common

Answer 48

Four domains: Unstable self-image - Low self-esteem - Recurrent suicidal or self-harming behaviour Impulsivity - Self-sabotaging or risk-taking behaviour e.g. risky sexual practices, substance misuse - Difficulty controlling temper Poor interpersonal relationships - Short romantic relationships - Feelings of abandonment - Idealisation and devaluation of others (splitting) Paranoia - Quasi-psychotic thoughts in response to stress: transient psychosis (don't need meds)

Answer 49

A misperception of real external stimuli.

Answer 50

Perceptions occurring in the absence of an external physical stimulus. Can be auditory, visual or olfactory.

Answer 51

Pseudo-hallucinations appear to arise in the subjective inner space of the mind, not through one of the external sensory organs - this is how they differ from hallucinations.

Answer 52

An over-valued idea is a false or exaggerated belief sustained beyond logic or reason e.g. I am the best employee ever.

Answer 53

A false, unshakable idea which is out of keeping with the patients educational, cultural and social background; it is held with extraordinary conviction and certainty.

Answer 54

- Persecutory. - Grandiose. - Nihilistic (Cotard’s syndrome). - Religious. - Hypochondriacal

Answer 55

The idea that someone has been replaced by an impostor.

Answer 56

- Clinical diagnosis that requires assessment by a psychiatrist - Suicide risk assessment if required

Answer 57

Before starting treatment: - Suicide risk screening - PHQ-9 questionnaire - GAD7 tool 1st line is psychotherapy: DBT (dialectical behaviour therapy)

Answer 58

Post-traumatic stress disorder (PTSD) is a disorder that might develop (either immediately or delayed) following exposure to a stressful event or situation of an exceptionally threatening or catastrophic nature.

Answer 59

- serious accident - witness of school violence or domestic violence - natural disaster - terrorist attack

Answer 60

- Intrusion symptoms - involuntarily re-experiencing traumatic event e.g. flashbacks, nightmares - Avoidance symptoms - avoiding reminders - negative changes in mood and cognition e.g. reduced ability to feel happiness - Changes in arousal/reactivity - e.g. hypervigilance Symptom must persist for a mont and cause functional impairment for a diagnosis

Answer 61

Clinical diagnosis by a psychiatrist using diagnostic criteria from DSM5 or ICD-11. Screening tool such as Trauma Screening Questionnaire (TSQ) can be used in primary care.

Answer 62

Moderate/severe PTSD - referral to psych for psychotherapy/pharmacotherapy (e.g. SNRI venlafaxine or SSRI sertraline) 1st line psychotherapy: Trauma-focused CBT) More severe cases - eye movement desensitisation and reprocessing (EMDR) therapy Risk assessment for risk of self-harm/suicide

Answer 63

Intellectual disability may be either generalised (cognitive impairment) or specific to one area (learning difficulty). Children with cognitive impairment have below-average IQ, at <70.

Answer 64

- Normal IQ between 85 and 115 - Borderline – IQ 70 - 85 - Mild – 50 - 69 - Moderate - 35 - 49 - Severe – 20 - 35 - Profound - below 20

Answer 65

Prenatal: - Genetic syndromes (e.g., Down syndrome and Fragile X syndrome) - Inborn errors of metabolism - Brain malformation (e.g., microcephaly) - Environmental influences (e.g., alcohol) Perinatal: - Prematurity / birth anoxia Post natal: - Hypoxic ischemic injury - Traumatic brain injury - Infections

Answer 66

- Downs syndrome - Turners - Phenylketonuria [phenylalanine hydroxylase gene and enzyme dysfunction] - Fetal alcohol syndrome

Answer 67

Thorough history including: antenatal and perinatal Hx, developmental milestones, FHx, SHx, schooling, hospital admissions Tests for measuring IQ: - Wechsler Adult Intelligence Test (WAIS) - WISC (Wechsler Intelligence Scale for Children) - IQ = (Mental Age / Chronological Age) X 100

Answer 68

- Primary prevention: education, antenatal care, vaccination, social, genetic testing and counselling. - Secondary prevention: e.g. phenylketonuria diet before development of symptoms - Tertiary prevention psychopharmacology: antipsychotics, antiepileptics, behavioural strategies - Occupational Therapy - CBT, mindfulness - Mental Health Act

Answer 69

A lack of abstract thinking, in adults this may be due to organic disease or schizophrenia.

Answer 70

A lack of logical association between thoughts, often leads to incoherent speech. It is impossible to follow the patients train of thought.

Answer 71

Irrelevant wandering in conversation, patient eventually gets to the point.

Answer 72

Repetition of a word, theme or action.

Answer 73

Giving a false account to fill a gap in memory. This is often seen in dementia patients.

Answer 74

The delusional belief that one is a passive recipient of bodily sensations from an external agency.

Answer 75

Excited or inhibited motor activity in the absence of a mood disorder or neurological disease.

Answer 76

Slowing of thoughts and movements. It can be seen in depression, Parkinson’s disease etc.

Answer 77

Wernicke's encephalopathy is a neurological disorder caused by a deficiency in thiamine (Vitamin B1), most commonly arising from chronic alcohol abuse.

Answer 78

- confusion - ataxia, - ophthalmoplegia (weakness of eye muscles) or nystagmus All three signs do not need to coexist in a single patient for diagnosis

Answer 79

Korsakoff's syndrome - Profound anterograde amnesia - Limited retrograde amnesia - Confabulation (patients fabricate memories to mask their memory deficit)

Answer 80

Thiamine level: low Blood tests: FBC, U+E, Liver Profile, Clotting, Bone Profile, Magnesium Neuroimaging: MRI shows typical changes and mamillary body atrophy in Korsakoff's syndrome.

Answer 81

- Thiamine supplement - Counselling and rehabilitation for alcohol use disorders. Korsakoff's syndrome - Ongoing thiamine supplement - Cognitive rehabilitation - Treatment of underlying causes, like alcoholism through counselling and support

Answer 82

A group of mental disorder that manifest as patient-experienced physical symptoms that suggest illness. However, these symptoms cannot be explained by an underlying medical condition or other mental disorder (e.g. anxiety, depression)

Answer 83

Divided into whether patients voluntarily or involuntarily experiences symptoms Involuntary: - Somatisation disorder - Functional neurological (conversion) disorder Voluntary: - Malingering - Factitious disorders

Answer 84

Functional neurological disorder (FND), involves symptoms of impaired motor or sensory function, which cannot be explained by medical evaluation. E.g. psychogenic non-epileptic seizures : no tongue-biting or incontinence and no abnormal EEG findings

Answer 85

The experience of multiple physical symptoms that persist for at least 2 years despite no organic explanation. Hypothesised that patients might have difficulty expressing emotional distress and instead attribute their distress to physical symptoms. Typical symptoms include: - Pain - Gastrointestinal upset - Sexual problems - Pseudoneurologic symptoms The patient will refuse to accept reassurance or negative test results.

Answer 86

Factitious disorder imposed on self (Munchausen syndrome) - Deliberately producing, feigning, or exaggerating symptoms, intention = sick role and centre of attention Factitious disorder imposed on another (Munchausen’s by proxy) - caregiver fabricates, embellishes or causes an illness or injury in a person under their care

Answer 87

Intentional production of false or exaggerated physical or psychological symptoms, motivated by external incentives e.g. avoiding work, financial gain.

Answer 88

Excessive worry about having a serious illness, despite having no or only mild symptoms. Main concern = fear of illness not symptoms themselves. Persistent belief that they have an underlying serious illness despite negatibe tests e.g. lung cancer because they have a cough

Answer 89

- Managing associated psychiatric or physical conditions - CBT - Family therapy

Answer 90

In England and Wales, the Mental Health Act 1983 as amended by the Mental Health Act 2007 (MHA) provides a legal framework for the care and treatment of individuals with mental disorders. Divided into "sections ".

Answer 91

S135 – allows police with court order to access patient’s home and remove them S136 – allows police to remove person with suspected/confirmed mental disorder in a public place to a place of safety for assessment and treatment

Answer 92

Mental Capacity Act 2005 (MCA) defines mental capacity as the ability of an individual to make their own decisions. An individual (aged 16 years or older) has the capacity to make a specific decision if they can: - communicate their decision, - understand information given to them to make a particular decision, - retain that information, and - Balance or weigh up the information to make the decision.

Answer 93

CURB (Communicate, Understand, Retain, Balance)

Answer 94

- Assume capacity – until proven otherwise - Maximise decision-making capacity by providing support - Freedom to make seemingly unwise decisions Best interests - if decision made on person's behalf - Least restrictive option – if making decision on someone's behalf, the one that achieves the goal while interferes least with person's freedom must be chosen

Answer 95

Psychological therapy describes the interaction between a therapist and a client that aims to impart beneficial changes in the client’s thoughts, feelings and behaviours.

Answer 96

Section 2 - 28 days. Compulsory detention for assessment, diagnosis, and treatment unknown, can be extended into section 3 Section 3 - 6 months. compulsory detention for assessment, diagnosis and treatment known Section 5(2) - doctor's holding powers - 72hrs. Allows time for Section 2 or Section 3 assessment.

Answer 97

CBT is a type of talking therapy that helps the patient learn more helpful ways of thinking and reacting in everyday situations. Changing the way they think, and what they do. It combines behavioural and cognitive therapy, and focuses on current challenges rather than past experiences.

Answer 98

Depression, generalised anxiety, OCD, PTSD, Eating disorder, psychosis.

Answer 99

DBT is based on CBT, but specifically designed for people with EUPD. AIms to teach patients to: - Understand and accept difficult feelings - Learn skills to manage these feelings

Answer 100

A type of talking therapy that focuses on connecting the past and present, and therefore helping the patient to understand unconscious processes that are giving rise to symptoms or difficult repeating patterns.

Answer 101

‘Dialectics’ means trying to balance seemingly contradictory positions Balancing accepting yourself and your experiences as you are and changing your behaviour at the same time

Answer 102

Family attend together. Therapist works with a family’s strengths to help family members think about and try different ways of behaving with each other.

Answer 103

- Selective Serotonin Reuptake inhibitor - Selective presynaptic blockade of serotonin reuptake pumps. - Antidepressant to treat depression, anxiety disorders, OCD

Answer 104

- Fluoxetine - Sertraline - Citalopram

Answer 105

- Serotonin and noradrenaline reuptake inhibitor. - Presynaptic blockade of both noradrenaline and serotonin reuptake pumps. - Treatment of depression, anxiety disorder

Answer 106

- Venlafaxine, duloxetine

Answer 107

- Lithium - Valproate (epilepsy, acute mania) - Lamotrigine (epilepsy) - Carbamazepine (epilepsy) Antipsychotics such as olanzapine and quetiapine are increasingly used too.

Answer 108

- Acute mania - Prophylaxis of bipolar affective disorder (prevention of relapse) - Treatment-resistant depression

Answer 109

0.4–1.0 mmol/L - Thirst, polydipsia, polyuria, weight gain Toxic levels: >1.5 mmol/L - Nausea and vomiting, coarse tremor, ataxia, muscle weakness - Dangerously toxic levels: >2 mmol/L nystagmus, dysarthria, impaired consciousness, hypotension, convulsions, coma

Answer 110

Supportive: adequate hydration, renal function and electrolyte balance. - Anticonvulsants for convulsions and haemodialysis if renal failure

Answer 111

- Olanzapine - Quetiapine - Risperidone - Aripiprazole - Clozapine (if other antipsychotics fail) Lower risk of extrapyramidal side effects (EPSE) than typical (1st gen) antipsychotics

Answer 112

Typical antipsychotics work as dopamine D2 receptor antagonists in the brain Atypical antipsychotics work mainly as dopamine receptor antagonists ,as well as other receptors.

Answer 113

Extrapyramidal side effects: - Parkinsonism (rigidity, bradykinesia, resting tremor) - Dystonia (involuntary muscle spasms/contractions) - Akathisia (restlessness) - Tardive dyskinesia (rhythmic involuntary movements) Atypical antipsychotics - Metabolic syndrome (highest risk is olanzapine) - Diabetes, Hypertension, Obesity - Hyperprolactinaemia : highest risk with risperidone - QTc prolongation Aripiprazole has a generally good side-effect profile

Answer 114

A drug that induces sleep. Please note that hypnotics can also reduce anxiety at lower doses (e.g. benzos, anxiolytic at low dose, hypnotics at higher dose)

Answer 115

A drug that helps reduce anxiety. Please note that anxiolytics can also induce sleep at higher doses

Answer 116

- Diazepam (long-acting) - Nitrazepam - Lorezepam (short-acting) - Chlordiazepoxide

Answer 117

Simple withdrawal (6-12 hours after last drink): - Insomnia - Tremor - Anxiety - Agitation - Nausea and vomiting - Sweating - Palpitations Alcohol hallucinosis (12-24 hours post-drink): - Hallucinations of visual, tactile or auditory origin.

Answer 118

72 hours post-drink: - Delusions - Confusion - Seizures - Tachycardia - Hypertension - Hyperthermia

Answer 119

If > 15 units/ day or > 20 on AUDIT questionnaire (identifies alcohol dependency) - Chlordiazepoxide in a reducing regimen,based on CIWA score (severity of withdrawal) and local protocol. - Rapid-acting benzodiazepines (IV lorazepam) for seizures. - Pabrinex to prevent Wernicke's encephalopathy. 1st line for delirium tremens - oral lorazepam

Answer 120

- Parkinsonism/dystonia - Anticholinergics e.g. procycline and consider reducing or switching meds - Akathisia - Propranolol or short-term benzo - Tardive dyskinesia - no effective treatment, consider benzo, withdraw antipsychotics

Answer 121

A rare, life-threatening reaction to antipsychotics. Hyperthermia is a hallmark feature. Altered consciousness (confusion to catatonia), fluctuating BP, profuse sweating, "lead-pipe" rigidity

Answer 122

Discontinuation of causative med. Supportive Care: - Cooling blankets and IV fluids - Bromocriptine: dopamine agonist - Dantrolene: muscle relaxant Continuous monitoring of vital signs, and fluid balance

Answer 123

Serotonin Syndrome similar to NMS but associated with serotonergic medications. Presents with hyperthermia, autonomic dysregulation, and altered mental status.

Answer 124

A potentially life-threatening condition linked with increased serotonergic activity in the central nervous system. Usually presents within few months of starting SSRI or drug interaction.

Answer 125

Triad of mental status changes, autonomic hyperactivity, neuromuscular abnormalities. Mental status changes: agitation, restlessness, and disorientation. Autonomic hyperactivity: hyperthermia, tachycardia, hypertension Neuromuscular abnormalities: tremor, clonus, hyperreflexia, and in severe cases, seizures.

Answer 126

- Discontinue causative med - ABCDE - Supportive care - Hospitalisation if needed - Benzo or antiserotonergic agent cyproheptadine in moderate/severe cases

Answer 127

Delirium is an acute, fluctuating change in mental status, with inattention, disorganised thinking and altered consciousness. Often seen in the elderly and can be life-threatening. - Hyperactive Delirium: increased psychomotor activity, restlessness, agitation, and hallucinations. - Hypoactive Delirium: lethargy, reduced responsiveness, and withdrawal. - Mixed Delirium

Answer 128

- 4 As Test (alertness, AMT, attention, acute/fluctuating) - ECG, urine MC+S (not if > 65) - Bloods: FBC, U+E, LFT, TFT, cultures - Imaging: CXR, abdo US, MRI/CT head if no identifiable cause

Answer 129

- Hospital admission for treatment and monitoring - 1st line: correct any precipitating factors : such as infection, medications, constipation, urinary retention, dehydration and pain - Optimise management of co-morbidities Antipsychotics/ benzodiazepines: avoid if possible.

Answer 130

Bone marrow suppression with agranulocytosis (severe neutropenia). PAtients need FBC prior to treatment, then weekly FBCs for a few weeks then monthly FBCs for duration of treatment.

Answer 131

- Current suicidal plan - Hx of self harm - Hx of mental illness including substance misuse - Hx of childhood abuse/neglect - FHx - Male sex - Physical illness (e.g. chronic pain) - Marital status - single/widowed/divorced - Professions (un/self-employed, doctors, dentists, farmers)

Answer 132

Firstly, ensure the patient's and your safety. Psychiatric assessment covering: - Current suicide intent - Access to lethal means - Risk and protective factors using biopsychosocial model - FInal acts: making a will, goodbye texts, giving possessions away.

Answer 133

- Determine treatment setting - section if needed - Safety plan - regular reviews - Assessment for psychotherapy - Treat any underlying psychiatric illness

Answer 134

A treatment that involves sending electric currents through the patient's brain. Carried out under general anesthesia. Once anesthesia is applied - lasting 5 mins. - Psychiatrist attaches 2 electrodes to patient's head and electric current passed through for 15 secs - induces seizure. Done with patient consent, or if patient does not have capacity and ET is in their best interest then opinion from second psychiatrist is needed.

Answer 135

- Treatment resistant depression - Severe mania - Certain types of schizophrenia - catatonic states, positive psychotic symptoms and schizoaffective disorder.

Answer 136

Loss of memory, confusion, headache, nausea and muscle pains

Answer 137

- FBC - TFT - Lipid profile - HbA1c - ECG (antipsychotics can cause QT interval prolongation

Answer 138

- Drowsiness - Confusion - Decreased respiratory rate - Decreased heart rate - Constricted pupils - Track marks (if IVDU)

Answer 139

- Tachycardia - Hypertension, - Hyperthermia - Diaphoresis (excessive sweating) - Mydriasis (dilated pupils) - Agitation.

Answer 140

-Non-body packer - Benzos e.g. diazepam for seizure, HTN, agitation - IV saline - External cooling - Monitoring until vitals have returned to baseline - Body packer - bowel irrigation or surgery

Answer 141

Tachycardia, hyperthermia, volume depletion, agitation (sometimes aggression), seizures, and rhabdomyolysis Diagnosis = high index of suspicion and urine drug screen.

Answer 142

If mild - supportive care + reassurance Otherwise - active cooling, IV fluids, sedation with benzodiazepine

Answer 143

Risk factor presence - depression, alcohol and illicit drug use - Main symptom is excessive sedation but excessive sedation, bit coma, respiratory depression, and even death present if larger doses.

Answer 144

ABCDE assessment, fluid resus, supportive symptom management e.g. assisted ventilation in resp depression

Answer 145

- Drowsiness - Confusion - Cardiac arrhythmias - Seizures - Vomiting - Headache - Flushing - Dilated pupils

Answer 146

- Consider ICU admission - Check ECG for QRS prolongation - administer sodium carbonate bolus then infusion - Consider activated Charcoal within 2-4 hours of overdose - Consider invasive ventilation - IV fluids

Answer 147

Broad symptoms - No symptoms - Nausea and vomiting - Haematuria and proteinuria - Jaundice - Abdominal pain - Coma

Answer 148

FBC, U+E, LFT, clotting, VBG (severe metabolic acidosis), blood paracetamol levels. Treatment decisions guided by nomogram

Answer 149

Administer activated charcoal

Answer 150

Wait until 4 hours to take level and treat with N-acetylcysteine based on level

Answer 151

N-acetylcysteine immediately if ≥8 hrs getting levels

Answer 152

Tolerance in substance misuse is when the body gets used to the substance after long term and they consume higher doses of the drug to obtain the same drug-reinforcing effect

Answer 153

Start N-acetylcysteine immediately

Answer 154

A group of symptoms that occur upon cessation or reduction in the use of a drug.

Answer 155

Start N-acetylcysteine immediately if patient has: - Jaundice, right upper quadrant tenderness, elevated ALT, INR >1.3 or detectable paracetamol conc

Answer 156

Weight gain Malnutrition Liver cirrhosis Withdrawal symptoms - Increased autonomic activity, agitation, and nervousness. - Generalised seizures and a confusional state (delirium) = severe cases.

Answer 157

Start N-acetylcysteine immediately

Answer 158

Adverse impacts on interpersonal relationships Failure to fulfil obligations at home, school or work Violence when under the influence leading to domestic violence etc.

Answer 159

If blood tests are worsening The King's College Criteria predicts mortality from paracetamol overdose and advises urgent liver transplant when: - Arterial pH Less than 7.3 OR, all of: - Serum creatinine > 300 µmol/L (3.4 mg/dL) - Prothrombin time >100 s - Grade III or IV encephalopathy

Answer 160

A pattern of psychoactive substance use that is causing damage to health including physical and mental.

Answer 161

A cluster of behavioural, cognitive, and physiological patterns that develop after repeated substance use: - A strong desire to take the drug - Difficulties in controlling use - Persisting in its use despite harmful consequences - Higher priority given to drug use than to other activities - Increased tolerance

Answer 162

Assisted alcohol withdrawal if needed Psychotherapy/psychosocial treatment e.g. CBT or outpatient addiction treatment programmes & naltrexone

Answer 163

Euphoria, drowsiness, apathy, personality change

Answer 164

- Infective endocarditis - Increased risk of infections such as HIV/hep B due to needle sharing - Abscesses - Severe constipation. - Depression - Heroin use disorder.

Answer 165

Benzodiazepines potentiate the action of GABA (γ- aminobutyric acid), the main inhibitory neurotransmitter in the brain, by being positive allosteric modulators of GABA.

Answer 166

- Insomnia, especially short-acting benzodiazepines (short-term use only) - Anxiety disorders (short-term use only) - Alcohol withdrawal, especially chlordiazepoxide - Acute mania or psychosis (sedation)

Answer 167

Risk for developing dependence, especially with prolonged use and shorter acting drugs (e.g. lorazepam)

Answer 168

Phobias represent a cluster of anxiety disorders characterized by excessive and irrational fears. It encompresses specific phobia, social anxiety disorder (SAD), and agoraphobia.

Answer 169

ICD-11 criteria: Fear of open spaces, presence of crowds or the perceived difficulty of immediate easy escape to a safe place.

Answer 170

ICD-11 criteria: Fear of scrutiny by others in relatively small groups (as opposed to crowds), resulting in the avoidance of social situations. Might be specific (public speaking) or generalised (any social setting)

Answer 171

CBT is 1st line for all phobias Exposure techniques - aiming for systematic desensitization (using a graded hierarchy approach, for example). Flooding - exposing someone with a fear of heights to a tower Modelling - individual observes therapist interacting with phobic stimulus.

Answer 172

Recurrent unpredictable episodes of severe acute anxiety, which are not restricted to particular stimuli or situations. ICD-11 Criteria: - Recurrent, unexpected panic attacks. - At least one attack followed by a month of persistent concern. - Avoidance behaviors related to attacks.

Answer 173

- Difficulties in breathing - Chest discomfort - Palpitations - Hyperventilation - Shaking, sweating, dizziness - Depersonalization/derealization. - Fear of triggering situations - Development of a conditioned fear-of-fear pattern. - Concurrent agoraphobia in 30 - 50%

Answer 174

- GAD, agoraphobia - Depression - Alcohol or drug withdrawal. -Organic causes like cardiovascular/respiratory diseases, hypoglycemia

Answer 175

1st line is CBT 1st line pharmacotherapy (2nd line to CBT) is SSRI like sertraline Propranolol for physical symptoms

Answer 176

It is the theory that the bond between a child and their primary caregiver can set the tone for the child's expectations of interpersonal relationships for the rest of their life.

Answer 177

Caregivers were responsive, understanding, consistent. Child behaviour: happy, curious Adult attachment style: autonomous Adult behaviour: able to self-soothe, but also able to maintain relationships.

Answer 178

Caregivers were aloof, unresponsive, ridiculing Child behaviour: emotionally distant, withdrawn Adult attachment: ‘Dismissive’ Adult behaviour: Desire to be independent. Avoidance of intimacy.

Answer 179

Caregivers were sometimes sensitive, sometimes ignores Child was anxious, uncertain, angry Adult attachment: ‘Preoccupied’ Adult behaviour: Hypersensitive to rejection, care-seeking.

Answer 180

Caregivers were abusive, scary, scared Child was sad, angry, fearful Adult attachment style: ‘Disorganized’ Adult behaviour: Fearful, abusive, dissociative.

Answer 181

Phenomenology is the understanding and description of abnormal psychological events, the internal experiences of the patient and the resulting behaviour.

Psychiatry Flashcards

(207 cards)