Psychiatry Flashcards

Question

Difference between dementia & pseudodementia?

Answer 1

Cognitive impairment due to the presence of a mood-related mental health concern, most often depression (giving up). Pseudodementia have **INSIGHT**

Answer 2

Tardive Dykinesia

Answer 3

- obsessive thoughts and compulsive rituals - Compulsions are repetitive purposeful, intentional behaviours conducted to prevent an adverse outcome - Mild obsessional or compulsive behaviour can be considered as a reasonable response to stress - SSRIs are the treatment of choice

Answer 4

- Also called delusional misidentification syndrome - Disorder in which a person believes that an identical-looking has replaced a friend, spouse, parent, or other close family member impostor - commonly occurs in patients with paranoid schizophrenia, dementia and brain injury

Answer 5

C- Have you ever felt you should Cut down on your drinking? A- Have people Annoyed you by criticizing your drinking? G- Have you ever felt bad or Guilty about your drinking? E- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? (Eye-opener)

Answer 6

Complicated: > 6 months in stage 2 Complex: < 6 months with stages alternation

Answer 7

Complicated grief: - symptoms persist longer than six months - Avoidance of situations that serve as reminders of the loss is also common Avoidant Personality Disorder:

Answer 8

CBT and SSRI

Answer 9

Obsessive Compulsive Disorder (CBT in the form of exposure & response prevention)

Answer 10

- Low WBC (agranulocytosis) - recurrent infections - metabolic syndrome - hypersalivation - sedation

Answer 11

Egodystonic

Answer 12

-1 or more somatic symptoms that are distressing or result in significant disruption of daily life - Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)

Answer 13

hypochondriasis: already have a diagnosis **failure to respond to reassurance** is an explicit criterion illness anxiety disorder: has as its primary focus preoccupation with having or acquiring a serious (and undiagnosed) medical illness (think **general overall health**)

Answer 14

A. One or more symptoms of altered voluntary motor or sensory function. B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. C. The symptom or deficit is not better explained by another medical or mental disorder. D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. Individuals with conversion disorder conversion disorder have symptoms that simulate or mimic neurological illness. Typical symptoms include paralysis, abnormal movements, inability to speak (aphonia), blindness, and deafness. Pseudoseizures are also common and may occur in individuals with genuine epileptic seizures. Individuals with conversion disorders are commonly seen on neurology wards and on psychiatry consultation-liaison services at general hospitals

Answer 15

Wait it out? Activated charcoal of option is given history of patient ingesting within 2 hours

Answer 16

No proper medication to treat withdrawal. but to treat symptoms that arise such as mood disorders in which case : TCA

Answer 17

- Stroke -seizures -hyperthermia

Answer 18

**Agitation**: benzodiazepines (lorazepam IV if not cooperative, diazepam oral if patient cooperative) **Hypertension**: nitrates (nitroprusside), beta blockers (metoprolol 2-5mg IV) **Hyperthermia**: evaporative cooling, icepacks and maintenance of intravascular volume and urine flow with IV normal saline solution. **Seizures**: Phenothiazines as last resort

Answer 19

- common in the elderly - due diminished brain dopamine stores - caused by neuroleptic drugs - Tardive dyskinesia is the primary symptom - Treatment is to cease offending neuroleptic

Answer 20

identical symptoms: - rigidity - bradykinesia - postural instability Differentiating symptoms: - involuntary movements of face and tongue (tardive) - Stiffness

Answer 21

attribution of one’s feelings or beliefs to another

Answer 22

the exaggeration of an individual’s qualities by an admirer

Answer 23

transformation of psychologic stressors into physical complaints

Answer 24

the selection of a particular object or event to represent other meanings

Answer 25

psychologic separation of all good qualities into one individual and all bad qualities into another

Answer 26

They are synergistic (increase concentration of serotonin in the body)

Answer 27

Difficulty/Inability to main personal relationships (close friend or romantic partner)

Answer 28

BPD: - impulsivity in at least two areas that are potentially self-damaging - A pattern of **unstable and intense interpersonal relationships** characterized by alternating between extremes of idealization and devaluation **Dialectical behaviour therapy** Cyclothymic: - many periods of depressed mood and many episodes of hypomanic mood for at least **2 years** - During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time

Answer 29

- SJW reduces the effectiveness of COCs and increases the risk of unintended pregnancy - SJW's extracts have been reported to induce the cytochrome P450 enzymes CYP1A2, CYP2C9 and CYP3A4, and increase intestinal P-glycoprotein expression. stimulating the liver to break down the oestrogen and progestogen constituents of the COC pill more rapidly, making COCs less effective and increasing chance of unintended pregnancy

Answer 30

SJW reduces the effectiveness of warfarin and increases the risk of stroke, ischaemia, arterial blockage etc. - SJW's extracts have been reported to induce the cytochrome P450 enzymes CYP1A2, CYP2C9 and CYP3A4, therefore metabolising warfarin at a faster rate therefore decreasing its effectiveness.

Answer 31

Correct sight impairment and redo test, or perform other cognitive tests that do not require sight (Six-item Cognitive Impairment Test)

Answer 32

CT scan (to see if there's any degeneration of brain tissue, such as atrophy)

Answer 33

- Cause of Ebstein anomaly - in cases of severe bipolar disorder, benefits may outweigh the risks - Lithium use during the first trimester of pregnancy has been reported to be associated with fetal cardiovascular anomalies (e.g. Ebstein’s anomaly) and midfacial and other defects.

Answer 34

approximately 1 in 1000 to 2000 compared with 1 in 20000 in the general population.

Answer 35

Ultrasound and echocardiogram at 16-20 weeks gestation to exclude foetal anomalies, especially cardiac anomalies

Answer 36

1st trimester: keep same dose as before pregnancy but heavily monitor foetus by US at 16-20 weeks. 2nd trimester: continue same lithium dosage. 3rd trimester: decrease lithium dosage by 25% to avoid floppy baby syndrome due to neonatal toxicity. After delivery **immediately** increase lithium dosage due to increased risk of relapse in postpartum period.

Answer 37

1st trimester: decrease dose to prevent neural tube defects 2nd semester: continue decreased dosage through to 3rd semester 3rd trimester: increase the dosage to prevent seizures

Answer 38

- Adding an antidepressant to the prophylactic mood stabilizer: the choices of the drug would be the same as for major depression. SSRls first line. - Increasing the dose of prophylactic mood stabilizer (ONLY if the patient's psychosis is indicated in coming back, otherwise continue same dose)

Answer 39

- OCD - GAD

Answer 40

Divided by Clusters: -A -B -C -Other

Answer 41

- Paranoid Personality Disorder - Schizoid Personality Disorder - Schizotypal Personality Disorder

Answer 42

- Antisocial Personality Disorder - Borderline Personality Disorder - Histrionic Personality Disorder - Narcissistic Personality Disorder

Answer 43

- Avoidant Personality Disorder - Dependent Personality Disorder - Obsessive-Compulsive Personality Disorder

Answer 44

Personality Change: - Labile type - Masochistic - Disinhibited type - Aggressive type - Passive Aggressive type - Apathetic type - Combined type - Unspecified type

Answer 45

- Anorexia Nervosa - Bulimia Nervosa

Answer 46

> 1 day and < 1 month

Answer 47

> 1 month and < 6 months

Answer 48

> 6 months

Answer 49

Schizophrenia + major affective disorder

Answer 50

six stages between birth and adolescence: -oral - anal - phallic - oedipal - latency - genital

Answer 51

– Psychosis. – Phobias. – Depression. – Insomnias. – Eating disorders

Answer 52

Recurrent depressive symptoms over the course of 3-5 years

Answer 53

Paranoid ideation odd beliefs

Answer 54

Loss of motivation and social disability developing within 12 to 18 months of first recurrent depressive symptoms

Answer 55

a set of symptoms which persist for more than four weeks after exposure to traumatic experience

Answer 56

- **Hypererosal** phenomenon: - poor concentration and memory, irritability, anger, insomnia etc. – **Re-experiencing symptoms**-such as intrusive thoughts, dreams, nightmares, flashbacks, lashing out in sleep. – **Avoidance and numbing-loss of interest** in activities which previously brought enjoyment, restricted emotional response, detachment from others, deliberate attempt to keep traumatic experience out of mind. – **Reckless or self-destructive behaviour** with loss of occupational and social functioning

Answer 57

- disturbance of consciousness (over a short period of time that tends to fluctuate over the course of a day) - change in cognition

Answer 58

50% to 60%

Answer 59

ECT (0.8) > CBT (0.5) > Anti-depressants (0.4)

Answer 60

Stop interferon, start SSRI. deal with depression and once the depression is managed, start interferon again

Answer 61

Several impulse control disorders

Answer 62

Continue clozapine Start twice per week CBCs with differential counts

Answer 63

- discontinue clozapine - place patient in protective isolation - bone marrow specimen to see if progenitor cells being suppressed. - Do not restart Clozapine

Answer 64

Stop Clozapine Start daily CBCs Clozapine can be restarted after leukopenia is addressed and managed

Answer 65

LAAM (flumazenil)

Answer 66

it reduces seizure threshold

Answer 67

Hypertension

Answer 68

liver disease hypersomnia motor retardation

Answer 69

hypersomnia motor retardation

Answer 70

- alone but wants connection - too scared to start and maintain new relationships

Answer 71

Alone and prefers to be alone (the happy loner)

Answer 72

2 core symptoms (depressed mood, low energy, anhedonia) + 2 or more of the other symptoms for at least 2 weeks

Answer 73

Depressed mood (**CORE**) + **SIGECAPS** -- S = Sleep -- I = Interest/Enjoyment/ Anhedonia (low) (**CORE**) -- G = Guilt/Hopelessness -- E = Energy (low) (**CORE**) -- C = Concentration -- A = Appetite (low) -- P = Psychomotor retardation -- S = Suicidal thoughts

Answer 74

- early wakening and having trouble going back to sleep (also referred as **middle** insomnia) - if successful [in going back to sleep], broken sleep thereafter - early morning wakening and being unable to get back to sleep at all (also referred as **terminal** insomnia) - increased sleep latency (i.e. difficulty falling asleep) - increased REM stage - Decreased stage 3 non-REM stage (less stage 3 means less restorative periods => day light tiredness)

Answer 75

mental retardation memory impairment dementia

Answer 76

continue lithium and add SSRI (bupropion)

Answer 77

severe hepatic insufficiency alcohol abuse opioids old age COPD Benzodiazepines are contraindicated or should be used with extreme caution in the following conditions due to increased risks of severe side effects: 1. **Severe Hepatic Insufficiency**: The liver metabolizes benzodiazepines. In severe liver disease, the drug can accumulate, leading to excessive sedation, confusion, and increased risk of overdose. 2. **Alcohol Abuse**: Alcohol and benzodiazepines both depress the central nervous system. When taken together, they can cause severe drowsiness, respiratory depression, and even death. Additionally, people with a history of alcohol abuse are at higher risk of developing dependence on benzodiazepines. 3. **Opioid Use**: Combining benzodiazepines with opioids can lead to profound sedation, respiratory depression, coma, and death because both drugs depress the central nervous system. 4. **Old Age**: Elderly individuals are more sensitive to the effects of benzodiazepines, which can cause excessive sedation, confusion, falls, and fractures. The metabolism of these drugs is often slower in older adults, increasing the risk of side effects. 5. **Chronic Obstructive Pulmonary Disease (COPD)**: Benzodiazepines can depress the respiratory system, which is particularly dangerous for people with COPD, as they already have compromised lung function. This can lead to worsening of respiratory symptoms or even respiratory failure.

Answer 78

Symptoms are more subtle, and are subject to change: Hyperactivity may be replaced with restlessness, and impulsivity may be replaced with inability to control emotions or social inappropriateness. 60% will continue to exhibit symptoms into adulthood

Answer 79

Inhibition of dopamine and norepinephrine reuptake

Answer 80

**Suicide** (20%) rule out by psych eval first (notify child services & consult psychiatrist) -child harm -Infanticide (4%)

Answer 81

-occurring within 3 months of the onset of the stressor - disturbance may not have persisted for longer than 6 months after the termination of the stressor - Stressor is severe but not life-threatening - no symptoms when going through the stressor (not re-experiencing the event)

Answer 82

1. History of many physical complaints beginning before the age of 30 2. Each of the following criteria must be met: - 4 Pain symptoms: Headaches, abdominal pains, back and joint pain, pain during menstruation or sexual intercourse, chest pain. - 2 GI symptoms: Nausea, bloating, vomiting other than during pregnancy, diarrhoea or intolerance to several foods. - 1 sexual symptom: Erectile dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout the pregnancy. - 1 Pseudo-neurologic symptoms: Conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty in swallowing, lump in throat, aphonia, hallucinations, loss of sensations, visual problems, urinary retention

Answer 83

- between 6-12 months after the delivery, with a peak at 12 weeks Symptoms: - marked mood swings -anxiety - agitation - poor memory and concentration - depressed mood and weight loss

Answer 84

- Hypothyroidism

Answer 85

– Family history of depression. - Family history of Autism – Substance Misuse. – Unemployment – Low socioeconomic status. – Elderly person with cognitive decline or bereavement. – All family members who have experienced family violence. – Experience of child abuse - intellectual development delay - Perfectionism and obssessionality

Answer 86

- anger management issues - depression - anxiety - poor sleep

Answer 87

first-generation (typical) antipsychotics: -haloperidol - chlorpromazine

Answer 88

second generation (atypical) antipsychotics: - olanzapine - quetiapine -clozapine, - amisulpride - aripiprazole - risperidone

Answer 89

- Anxiety -Depression -Alcohol or substance misuse -Eating disorders -Body dysmorphic disorders -Chronic physical health problems (skin problems due to excessive hand washing)

Answer 90

1st line: -CBT -Brief behavioural therapy - Exercise 2nd line: - sleep onset insomnia: short acting benzodiazepine temazepam - sleep maintenance: Zolpidem up to 4 weeks Chronic long term: melatonin

Answer 91

1. A self-reported complaint of poor sleep quality 2. Sleep difficulties occur despite adequate sleep opportunity. Impaired sleep produces deficits in daytime function. 4. Sleep difficulty occurs **three nights per week** and is present **for three months**

Answer 92

type 2 diabetes - raises the level of triglycerides in the blood BUT no effect on serum cholesterol level - Aripiprazole is a substitute

Answer 93

1. Do you feel hopeless? 2. Have you felt that you've lost interest in your usual activities?

Answer 94

Benzodiazepine (Diazepam)

Answer 95

6 and 24 hours after the last drink

Answer 96

-Alopecia/hair thinning -acne -nephrogenic diabetes insipidus - weight gain - hypothyroidism - difficulty sleeping

Answer 97

Seizures Tremors Fever Hyperreflexia

Answer 98

1. Uncomfortable when not the center of attention 2. Seductive or provocative behavior 3. Shifting and shallow emotions 4. Uses appearance to draw attention 5. Impressionistic and vague speech 6. Dramatic or exaggerated emotions 7. Suggestible 8. Considers relationships more intimate than they are

Answer 99

1- Psychomotor retardation. 2- Increased appetite or hyperphagia 3- Increased sleep or hypersomnia. 4- Early onset of first depression before 25 years of age. 5- Delusions and hallucinations. 6- Positive family history of bipolar disorder

Answer 100

– Chronic cough – Increased risk of stroke and heart disease – Poorer academic achievement – Increased risk of suicide attempts – Drug-induced Psychosis

Answer 101

3 weeks. Increase dose of the initial medication first, and wait until 4-6 weeks after 4-6 weeks change to another antipsychotic of the same generation (depending on positive/negative symptoms)

Answer 102

– Excessive perspiration – Trembling – Blushing when trying to speak – Nausea or diarrhoea – The person fears others will take notice – The person fears that they would make a mistake, and that would lead to embarrassment

Answer 103

Family therapy

Answer 104

– Persistent stubbornness and refusal to comply with instructions or unwillingness to compromise with adults or peers. – Deliberate and persistent testing of the limits. – Failing to accept responsibility for one’s own actions and blaming others for one’s own mistakes. – Deliberately annoying others. – Frequently losing one’s temper

Answer 105

3 days (monitoring for serotonin syndrome)

Answer 106

behavioural and emotional symptoms that develop within 3 months of **exposure to an identifiable stressor** and these rarely last more than 6 months after the stressor has ended.

Answer 107

Presence of an identifiable stressor

Answer 108

Grief usually occurs after loss of something like any close relative or property, however, there are l**ess behavioural symptoms **and it is a self-limiting condition

Answer 109

– Headaches – Insomnia – Muscle aches – Fever – Nausea and vomiting – Sweating – Stomach pains – Diarrhoea – Craving

Answer 110

pinpoint pupils respiratory depression decreased level of consciousness

Answer 111

- codeine detoxication and rehabilitation programme - methadone programme as an outpatient

Answer 112

psychosis lasting at least 1 day but less than 1 month

Answer 113

Diazepam (unless px has severe liver disease)

Answer 114

– Recollections, nightmares, flashbacks about the trigger event. – Avoiding the event that resembles the traumatic event. – Insomnia. – Irritability. – Hypervigilance. Difficulty in concentrating

Answer 115

Passive aggression Acting out Dissociation Projection Autistic fantasy: Devaluation, Idealization, Splitting

Answer 116

Intellectualization Isolation Repression Reaction formation Displacement Somatization Undoing Rationalization

Answer 117

Suppression Altruism Humour Sublimation

Answer 118

Denial (of external reality) Distortion (of external reality)

Answer 119

- CBT - benzodiazepine (temazepam)

Answer 120

- CBT (gold standard) - Melatonin (>55) -Zolpidem (case dependant)

Answer 121

Insomnia for more than 4 weeks

Answer 122

**Hyponatremia** **muscle aches/cramps lethargy** tiredness confusion seizures

Answer 123

mood reflects person's **INTERNAL** emotional experience (e.g. `good`, `ok`, `frustrated`, `angry`)

Answer 124

affect reflects the person's **EXTERNAL** emotional expression - which can be evaluated by the interviewer. It can be described as: - EUTHYMIC (normal, well-balanced mood) - DYSTHYMIC (sullen, flat) - EUPHORIC (intensely elated mood)

Answer 125

- Circumstantiality - Tangentiality - flight of ideas - poverty of thought - disorganised (word salad)

Answer 126

patient veers off into unrelated topics before eventually answering the question

Answer 127

patient never answers the original question

Answer 128

patient has so many thoughts that they cannot keep track of them (e.g. manic state)

Answer 129

patient has complete lack of spontaneous thinking (e.g depression, psychosis)

Answer 130

words said make no sense (word salad)

Answer 131

specific ideas and beliefs that a patient has in mind. can only be assessed through what patient says - suicidal ideation - homicidal ideation - preoccupations - delusions

Answer 132

thoughts that command the entirety of the person's attention to the point where they cannot focus on anything else)

Answer 133

one's ability to accurately take in information about the world. Most common: - illusions - Hallucinations

Answer 134

false beliefs that are inconsistent with patient's background and cannot be corrected by reasoning

Answer 135

misperceptions of genuine stimuli

Answer 136

false perceptions in the absence of any external stimuli (e.g. auditory, visual)

Answer 137

- Guns - Recent suicide attempts - Ongoing thoughts of suicide - Self-harm - Ethanol - Substances mnemonic "Guns & ROSES"

Answer 138

- squalor and decline in personal hygiene - sometimes hoarding useless items - significant frontal lobe impairment

Answer 139

- formed visual hallucinations in blind or partially sighted elderly who are not delirious - always ocular or occipital disease not psychiatric - vivid, colourful, and well-organised hallucinations - experience may last for seconds or hours at a time - patient has good insight - hallucinations are not distressing, but may be quite engaging

Answer 140

2 forms: 1. '**/restless legs' syndrome** 2. delusional infestation with parasites or worms in schizophrenic patients

Answer 141

patient believes they have lost important body parts, blood, internal organs, or even their soul - prevalent in schizophrenia, bipolar disorder, non-dominant temporoparietal lesions and migraine.

Answer 142

kg/height^2

Answer 143

- Benzodiazepines (lower seizure threshold) - Water (amitriptyline)

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Psychiatry Flashcards

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