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MRCP Part 1 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Acute stress disorder is defined as an acute stress reaction that occurs ……

A

in the first4 weeks after a person has been exposed to a traumatic event

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2
Q

Treatment of Acute stress disorder

A
  1. trauma-focused cognitive-behavioural therapy (CBT)is usually used first-line
  2. benzodiazepines ( sometimes used for acute symptoms e.g. agitation, sleep disturbance)
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3
Q

chronic alcohol consumption

  1. enhances ……..
  2. inhibits
A
  1. enhances GABA mediated inhibition in the CNS (similar to benzodiazepines)
  2. inhibits NMDA-type glutamate receptors
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4
Q

alcohol withdrawal

  1. decreased inhibitory……..
  2. increased …..
A
  1. decreased inhibitory GABA
  2. increased NMDA glutamate transmission)
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5
Q

In alcohol withdrawal

  1. tremor, sweating, tachycardia, anxiety start at … hours
  2. peak incidence of seizures at ….. hours
  3. peak incidence ofdelirium tremens is at ….. hours
A
  1. 6-12 hours
  2. at 36 hours
  3. at 48-72 hours
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6
Q

Management of alcohol withdrawal

A
  1. patients with Hx of complex withdrawals from alcohol should be admitted for monitoring until withdrawals stabilised
  2. first-line:long-acting benzodiazepinese.g.chlordiazepoxide or diazepam.
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7
Q

Treatment of alcohol withdrawal in patients with hepatic failure.

A

Lorazepam is preferable

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8
Q

Anorexia nervosa is associated with Physiological abnormalities

A
  1. hypercholesterolaemia
  2. hypercarotinaemia
  3. impaired glucose tolerance
  4. raised cortisol and growth hormone
  5. low T3, FSH, LH, oestrogens and testosterone
  6. hypokalaemia
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9
Q

Features of Anorexia nervosa

A

reduced body mass index

bradycardia

hypotension

enlarged salivary glands

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10
Q

Causes of aphonia

A

recurrent laryngeal nerve palsy (e.g. Post-thyroidectomy)

psychogenic

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11
Q

mental disorder where patients have a significantly distorted body image

A

Body dysmorphic disorder

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12
Q

mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent.

A

Cotard syndrome

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13
Q

Cotard syndrome is associated with

A

severe depression and psychotic disorders

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14
Q

form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.

A

De Clerambault’s syndrome, also known as erotomania

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15
Q

condition where a patient has a fixed, false belief (delusion) that they are infested by ‘bugs’e.g. worms, parasites, mites, bacteria, fungus.

A

Delusional parasitosis

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16
Q

Depression in older people

  1. Features
  2. Treatment
A
  1. Features
    - physical complaints (e.g. hypochondriasis)
    - agitation
    - insomnia
  2. SSRIs first line
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17
Q

Factors suggesting diagnosis of depression over dementia

A
  1. short history, rapid onset
  2. biological symptoms e.g. weight loss,sleep disturbance
  3. patient worried about poor memory
  4. mini-mental test score: variable
  5. global memory loss (dementia characteristically causes recent memory loss)
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18
Q

Electroconvulsive therapy
The only absolute contraindications is

A

raised intracranial pressure.

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19
Q

Short-term side-effects of Electroconvulsive therapy

A

headache

nausea

short term memory impairment

memory loss of events prior to ECT

cardiac arrhythmia

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20
Q

Long-term side-effects of Electroconvulsive therapy

A

some patients report impaired memory

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21
Q

anterograde amnesia: inability to acquire new memories

retrograde amnesia

confabulation

Features of……?

A

Korsakoff’s syndrome

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22
Q

pathological jealousy where a person is convinced their partner is cheating on them without any real proof.

A

Othello’s syndrome

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23
Q

Features of Post-concussion syndrome

A

headache

fatigue

anxiety/depression

dizziness

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24
Q

transient paralysis of skeletal muscles which occurs when awakening from sleep or less often while falling asleep.

A

Sleep paralysis

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25
Q

Managment of Sleep paralysis

A

if troublesome clonazepam may be used

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26
Q

depression which occurs predominately around the winter months.

A

Seasonal affective disorder

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27
Q

Treatment of Seasonal affective disorder

A
  1. for mild depression, you would begin with psychological therapies and follow up with the patient in 2 weeks to ensure that there has been no deterioration.
  2. Following this an SSRI can be given if needed.
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28
Q

In seasonal affective disorder, you should not give the patient ……… as this can make the symptoms worse.

A

sleeping tablets

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29
Q

What is Somatisation disorder

A

multiple physical SYMPTOMSpresent for at least 2 years

patient refuses to accept reassurance or negative test results

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30
Q

Illness anxiety disorder (hypochondriasis )

A

persistent belief in the presence of an underlyingserious DISEASE, e.g. cancer

patient again refuses to accept reassurance or negative test results

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31
Q

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

A

Malingering

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32
Q

Factitious disorder

A

the intentional production of physical or psychological symptoms

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33
Q

dissociation is a process of ‘separating off’ certain memories from normal consciousness

A

Dissociative disorder

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34
Q

Functional neurological disorder (conversion disorder)

A

typically involves loss of motor or sensory function

the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)

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35
Q

Examples of Serotonin and noradrenaline reuptake inhibitor (SNRI’s)

A

venlafaxine

duloxetine

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36
Q

Treatment of Post-traumatic stress disorder

A
  1. watchful waiting may be used for mild symptoms lasting less than 4 weeks
  2. trauma-focused cognitive behavioural therapy(CBT) or eye movement desensitisation and reprocessing (EMDR) therapy
  3. drug treatments should not be used as a routine first-line treatment for adults. If drug treatment is used then venlafaxine or SSRI.
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37
Q

eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.

A

Bulimia nervosa

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38
Q

Management of bulimia nervosa

A
  1. NICE recommend bulimia-nervosa-focused guided self-help for adults
  2. eating-disorder-focused cognitive behavioural therapy
  3. high-dose fluoxetine
39
Q

Benzodiazepines enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the ………

A

the frequencyof chloride channels

40
Q

benzodiazipines increase the….1…..of chloride channels

barbiturates increase the…..2….of chloride channel opening

A
  1. frequency
  2. duration
41
Q

age-related macular degeneration, followed by glaucoma and cataract associated with ….

A

Charles-Bonnet syndrome

42
Q

Factors associated with poor prognosis of Schizophrenia

A

strong family history

gradual onset

low IQ

prodromal phase of social withdrawal

lack of obvious precipitant

43
Q

The strongest risk factor for developing a psychotic disorder is ……….

A

Family history

44
Q

management of schizophrenia

A
  1. oral atypical antipsychotics are first-line
  2. cognitive behavioural therapy should be offered to all patients
  3. close attention should be paid to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients (linked to antipsychotic medication and high smoking rates)
45
Q

Adverse effects of atypical antipsychotics

A
  1. Weight gain
  2. Hyperprolactinemia
  3. clozapine is associated with agranulocytosis
46
Q

The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:

A

increased risk of stroke

increased risk of venous thromboembolism

47
Q

Which one of atypical antipsychotics has higher risk of dyslipidemia and obesity?

A

olanzapine

48
Q

Examples of atypical antipsychotics

A
  1. clozapine
  2. olanzapine
  3. risperidone
  4. quetiapine
  5. amisulpride
  6. aripiprazole
49
Q

Hypersensitivity and an unforgiving attitude when insulted

Unwarranted tendency to questions the loyalty of friends

A

Paranoid

50
Q

Indifference to praise and criticism

Preference for solitary activities

Lack of interest in sexual interactions

Lack of desire for companionship

Emotional coldness

Few interests

Few friends or confidants other than family

A

Schizoid

51
Q

Ideas of reference (differ from delusions in that some insight is retained)

Odd beliefsand magical thinking

Unusual perceptual disturbances

Paranoid ideation and suspiciousness

Odd, eccentric behaviour

Lack of close friends other than family members

Inappropriate affect

Odd speech without being incoherent

A

Schizotypal

52
Q

4 Side effects of SSRIs

A
  1. gastrointestinal symptoms are the most common side-effect
  2. increased risk of gastrointestinal bleeding in patients taking SSRIs. A proton pump inhibitor should be prescribed if a patient is also taking a NSAID
  3. Hyponatremia
  4. increased anxiety and agitation after starting a SSRI
53
Q

citalopram and escitalopram are associated with dose-dependent QT interval prolongation and should not be used in those with

A
  1. congenital long QT syndrome.
  2. known pre-existing QT interval prolongation.
  3. in combination with other medicines that prolong the QT interval
54
Q

7 Discontinuation symptoms of SSRI

A

increased mood change

restlessness

difficulty sleeping

unsteadiness

sweating

gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting

paraesthesia

55
Q

When stopping a SSRI the dose should be gradually reduced over ……. period

A

4 week

56
Q

warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering …..

A

mirtazapine

57
Q

triptans & SSRI increase risk of….

A

serotonin syndrome

58
Q

monoamine oxidase inhibitors (MAOIs) & SSRI increase risk of….

A

serotonin syndrome

59
Q

Which one of SSRI has a higher incidence of discontinuation symptoms?

A

Paroxetine

60
Q

antidepressant therapy they should continue on treatment for at least………. after remission as this reduces the risk of relapse.

A

6 months

61
Q

SSRIs and pregnancy
1. Use during the first trimester gives a small increased risk of …

  1. Use during the third trimester can result in……
  2. Paroxetine has an increased risk of ………, particularly in the first trimester
A
  1. congenital heart defects
  2. persistent pulmonary hypertension of the newborn
  3. congenital malformations
62
Q

Which one of SSRI is useful post myocardial infarctionas there is more evidence for its safe use in this situation than other antidepressants

A

sertraline

63
Q

9 Adverse effects of lithium

A
  1. nausea/vomiting, diarrhoea
  2. Fine tremor
  3. nephrogenic diabetes insipidus
  4. thyroid enlargement, may lead to hypothyroidism
  5. ECG: T wave flattening/inversion
  6. Weight gain
  7. idiopathic intracranial hypertension
  8. leucocytosis
  9. hyperparathyroidism and resultant hypercalcaemia
64
Q

Monitoring of patients on lithium therapy
1. lithium blood level should ‘normally’ be checked every…..

  1. thyroid and renal function should be checked every …..
A
  1. 3 months
  2. 6 months
65
Q

serotonin and noradrenaline are metabolised by ……… in the presynaptic cell

A

monoamine oxidase

66
Q

Drug treatment of generalised anxiety disorder

A
  1. sertraline should be considered the first-line SSRI
  2. if sertraline is ineffective, offer an alternative SSRI or a serotonin-noradrenaline reuptake inhibitor (SNRI)
  3. If cannot tolerate SSRIs or SNRIs, consider offering pregabalin
67
Q

Management of panic disorder

A
  • either cognitive behavioural therapy or drug treatment
  • SSRIs are first-line. If contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered
68
Q

Mechanism of action of Typical antipsychotics

A

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways

69
Q

Examples of Typical antipsychotics

A

Haloperidol
Chlorpromazine

70
Q

Examples of Atypical antipsychotics

A

Clozapine
Risperidone
Olanzapine

71
Q

Mechanism of action of Atypical antipsychotics

A

Act on a variety of receptors (D2, D3, D4, 5-HT

72
Q

Extrapyramidal side-effects of Antipsychotics

A
  1. Parkinsonism
  2. acute dystonia
  3. akathisia (severe restlessness)
  4. tardive dyskinesia
73
Q

8 side-effects of sSRI

A
  1. antimuscarinic:dry mouth,blurred vision,urinary retention,constipation
  2. sedation
  3. weight gain
  4. Hyperprolactinemia
  5. impaired glucose tolerance
  6. neuroleptic malignant syndrome
  7. reduced seizure threshold
  8. prolonged QT interval
74
Q

The primary mechanism by which TCAs exert their antidepressant effects is through the inhibition of the reuptake of neurotransmitters

A
  1. Serotonin (5-HT)
  2. Noradrenaline (NA)
75
Q

Side effects of TCA

A
  1. lengthening of QT interval
  2. postural hypotension
  3. drowsiness
  4. Dry mouth
  5. Blurry vision
  6. Constipation
  7. Urinary retention
76
Q

What is the safest TCA in overdosage

A

Lofepramine

77
Q

Which TCA is the most dangerous in overdose ?

A

amitriptyline and dosulepin

78
Q

Less sedative preparations of TCA

A
  1. Nortriptyline
  2. Imipramine
  3. Lofepramine
  • NIL
79
Q

Difficulty making everyday decisions without excessive reassurance from others

Need for others to assume responsibility for major areas of their life

A

Dependent

80
Q

Preoccupied with ideas that they are being criticised or rejected in social situations

Restraint in intimate relationships due to the fear of being ridiculed

Reluctance to take personal risks due to fears of embarrassment

A

Avoidant

81
Q

Risk factors of Obsessive-compulsive disorder

A

family history

age: peak onset is between 10-20 years

pregnancy/postnatal period

history of abuse, bullying, neglect

82
Q

Management of Obsessive-compulsive disorder
Iffunctional impairment is mild

A
  • cognitive behavioural therapy
  • If this is insufficient or can’t engage in psychological therapy, then offer a choice of either a course of an SSRI or more intensive CBT
83
Q

Management of Obsessive-compulsive disorder
Iffunctional impairment is moderat

A
  • either a course of anSSRI(any SSRI for OCD but fluoxetine specifically for body dysmorphic disorder) or more intensive CBT (including ERP)
  • considerclomipramine(as an alternative first-line drug treatment to an SSRI) if the person prefers clomipramine or has had a previous good response to it, or if an SSRI is contraindicated
84
Q

Management of Obsessive-compulsive disorder
Iffunctional impairment is severe

A

refer to the secondary care mental health team for assessment

whilst awaiting assessment - offer combined treatment with anSSRIand CBT (including ERP) or consider clomipramine as an alternative as above

85
Q

What is a classic somatic symptom of depression and often develops earlier than general insomnia.

A

Early morning waking

86
Q

Which personality disorder is characterised by inappropriate sexual seductiveness, suggestibility and intense relationships

A

Histrionic personality disorder

87
Q

Which personality disorder is associated with impulsivity, feelings of emptiness, fear of abandonment and unstable self image?

A

Borderline personality disorder

88
Q

Hyperprolactinaemia is uncommon with certain ….. antipsychotics -

A

atypical

89
Q

What is the first-line pharmacological therapy for generalised anxiety disorder

A

SSRIs

90
Q

What is characterised by a person believing their friend or relative had been replaced by an exact double.

A

Capgras syndrome

91
Q

monoamine oxidase inhibitors, hypertensive reactions with tyramine containing foods e.g.

A

cheese,
pickled herring,
Bovril,
Oxo,
Marmite,
broad beans

92
Q

Which drug is used in the management of extrapyramidal symptoms caused by antipsychotics.

A

Procyclidine, an anticholinergic drug

93
Q

Risk of developing schizophrenia

monozygotic twin has schizophrenia = ……%

parent has schizophrenia = ……%

sibling has schizophrenia = ……%

no relatives with schizophrenia = … %

A

monozygotic twin has schizophrenia = 50%

parent has schizophrenia = 10-15%

sibling has schizophrenia = 10%

no relatives with schizophrenia = 1%

MRCP Part 1 (15 decks)

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