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4th Year Key Summaries > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

Diagnostic criteria for schizophrenia

A

DEAD
D - disorders of thought possession (insertion, withdrawal, broadcasting)
E - experiences of passivity (other people are controlling their thoughts or impulses - passivity phenomenon)
A - auditory hallucinations (thought echo, running commentary, being constantly referred to in the third person)
D - delusions that persist (culturally inappropriate)

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2
Q

Negative schizophernia symptoms

A

LESS
L - loss of volition, underactivity and social withdrawal
E - emotional flatness, lose normal modulation of mood
S - speech is reduced, monosyllabic if at all
S - slowness of movement

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3
Q

Objective signs of opioid withdrawal

A 
Watering eyes
Dilated pupils
Rhinorrhoea
Agitiation
Perspiration
Respiratory depression
Piloerection
Tachycardia
Vomiting
Shivering
Yawning
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4
Q

Signs of depression

A

SLUMP
S - suicidal ideation or plans
L - lack of interest, enjoyment (anhedonia), energy, appetite or libido
U - unworthiness
M - morning wakening - EARLY
P - poor concentration, psychomotor retardation or agitation

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5
Q

First line psychological therapy for PTSD

A

CBT

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6
Q

Three core features of ADHD

A

Inattention/distractibility
Hyperactivity
Impulsivity

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7
Q

Diagnostic criteria of depression (not symptoms)

A

Symptoms present for most of every day for at least 2 weeks. NO MANIC OR HYPOMANIC EPISODES IN LIFETIME. Not attributable to neurological disease or substance use/abuse

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8
Q

Differential diagnosis of depression

9+

A 
Normal response
SAD
Dysthymia
Cyclothymia
BPD
Stroke/tumour/trauma
Endocrine - hypothyroid, addisons, hyperpara
Infection
Iatrogenic
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9
Q

Three core symptoms of depression

A

Low mood
Anhedonia
Fatigue

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10
Q

Additional symptoms of depression

A 
Loss of concentration
Poor memory
Sleep disturbance
Suicidal ideation
Appetite loss
Weight loss
Unreasonable guilt
Loss of confidence 
Psychomotor retardation
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11
Q

Criteria for mild, moderate and severe dementia

A

Mild - 2 core 2 additional
Mod - 2 core 4 additional
Sev - 3 core 4 additional, or any psychotic symptoms

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12
Q

Difference between acute stress disorder and PTSD

A

PTSD in symptoms persist longer than 1 month

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13
Q

First line treatment for bipolar disorder

A

Lithium

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14
Q

SSRI of choice in young people and children

A

Fluoxetine

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15
Q

Drugs which increase VTE and stroke risk in the elderly

A

Antipsychotics

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16
Q

Psychotic symptoms which differentiate mania from hypomania

A

Delusions of grandeur

Auditory hallucinations

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17
Q

Side effects of antipsychotics

A 
Parkinsonism
Acute dystonia
Akathsia 
Tardive dyskinesia
Antimuscarinic - dry mouth, blurred vision, urinary retention, constipation
Sedation
Weight gain
Prolonged QT
Neuroleptic malignant syndrome
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18
Q

Common side effects of TCAs

A 
Dry mouth
Drowsiness
Blurred vision
Constipation
Urinary retention
Long QT in overdose
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19
Q

Common SSRI side effects

A

GI upset
RIsk of GI blues - give PPI if also on NSAID
Anxiety/agitation
Drug interactions

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20
Q

Four groups of first rank symptoms in schizophrenia (ABCD)

A

Auditory hallucination
Broadcasting of thought
Controlled thought (passivity phenomena)
Delusional perceptions

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21
Q

Monozygotic concordance for schizophrenia

A

50%

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22
Q

Define mania

A

Pathological, inappropriate elevated mood

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23
Q

Does mania generally disrupt work/responsibilities? Does hypomania

A

Yes and no

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24
Q

Mania treatment

A

Antipsychotics
Mood stabilisers
Lithium
ECT

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25
Tests before prescribing lithium
U&Es TSH Pregnancy test Creatinine
26
Lithium side effects
``` Reduced appetite Nausea Diarrhoea THyroid abnormalities Polyuria/polydypsia ```
27
Main danger with lithium and quantify
Toxicity Mild - 1.5-2.0 - vomiting, diarrhoea, ataxia, diziness Mod - 2.0-2.5 - blurred vision, delirium, convulsion, syncope Sev - >2.5 - generalised convulsions, oliguria, renal failure
28
3 anticonvulsants used
Valproic acid Carbamazepine Lamotrigine
29
Side effects of valproate
``` Thrombocytopaenia Platelet dysfunction Nausea Vomiting Weight loss ```
30
3 general drugs/classes which lengthen QT interval
Amiodarone Ciprofloxacin Antipsychotics
31
3 general drugs/classes which cause parkinsonism
Metaclopramide | Antipsychotics
32
Order for long term treatment
Compulsory treatment order
33
Who can grant a compulsory treatment order
Mental health tribunal
34
Length of short term detention order
Up to 28 days
35
Required grounds for compulsory treatment order
Disorder significantly impairs decision making | Lack of long term treatment would cause serious deterioration
36
Grounds for short term detention order
Significant risk to own or others health if not detained in hospital
37
Who can grant a short term detention order
Approved medical practitioner
38
Length of emergency detention order
Up to 72 hours
39
Grounds for emergency detention order
Mental disorder demonstrably present | Decision making impaired
40
Who can grant an emergency detention order
Any medical practitioner
41
Treatment for alcohol withdrawal state and two key risks
Benzodiazapines - addiction and respiratory depression when used with alcohol
42
Act under which detention/treatment orders can be granted
Mental Health, Care and Treatment (Scotland) Act 2003
43
Define psychosis
Severe forms of mental illness which are characterised by a lack of insight. Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
44
Psychotic manifestations
Hallucinations | Delusional beliefs
45
Most common cause of psychosis
Schizophrenia
46
Positive symptoms in schizophrenia
Delusions Hallucinations Disordered thinking - those symptoms which appear to represent an excess or distortion of normal functions
47
Diagnostic criteria for schizophrenia
``` Two or more of the following: Delusions Hallucinations Disordered speech Disorganised/catatonic behaviour Negative symptoms ``` Occurring for at least 1 month and with a functional decline of 6 months or more Do not occur concurrently with substance abuse or a mood disorder episode
48
What are the two major affective psychoses
Depressive episode with psychotic symptoms - delusions of guilt, worthlessness and persecution - derogatory auditory hallucinations Manic episode with psychotic symptoms - delusions of grandeur, super powers etc - gross over-activity, irritability and behavioural disturbance, manic excitement
49
Percentage recovery after first episode of psychosis
80
50
Good prognostic factors in schizophrenia
``` Absence of family history Clear precipitating event Sudden onset Mood disturbance Prompt treatment ```
51
Poor prognostic factors in schizophrenia
``` Slow, insidious onset Persistence of negative symptoms Family history Parental substance abuse Onset in childhood ```
52
How to remember the personality clusters
A- weird B- wild C- worried
53
Cluster A PDs
Paranoid Schizoid Schizoidal
54
Cluster B PDs
Borderline Antisocial Narcissistic Histrionic
55
Cluster C PDs
Avoidant Dependent Obsessive-compulsive
56
Key therapies for GAD
SSRIs | TCAs
57
Key therapies for OCD
SSRIs | TCAs
58
Key treatments for PTSD
Trauma focused CBT | SSRI/TCA
59
3 pillars of ADHD
Hyperactivity Impulsivity Distractibility
60
How many PDs
10
61
ABCD of dementia
A - activities of daily living B - behavioural and psychiatric symptoms of dementia C - cognitive impairment D - decline
62
What is a key thing to obtain in assessing a patient for dementia
A collateral history
63
Most common form of dementia
Alzheimers 60%
64
Cognitive scoring systems
MMSE | MOCA
65
Drug treatment for Alzheimer's dementia - mild to mod and mod to sev, effects
Mild-mod: Anticholinesterase inhibitors - donezepil - rivagstigmine - galantamine Slow decline and improve non-cognitive symptoms but do not halt progression Mod-sev: Memantine
66
Signs of Alzheimer's dementia
``` Recent memory loss Executive function changes Word finding and naming difficulties Confusion Getting lost, disorientation Misplacing things ```
67
Signs of Lewy Body dementia
Vivid visual hallucinations Autonomic instability Parkinson's features (shuffling gait, bradykinesia, and falls) Rapid eye movement sleep disorder may be present
68
Signs of vascular dementia
``` Often described as stepwise progression Look for history of atherosclerotic/cardioembolic disease May closely follow stroke Slowed processing Disinhibition Behaviour preservation Difficulty initiating movement ```
69
Risk factors for suicide
``` Older age Male gender Mental illness Co-morbid physical illness Chronic pain Use of drugs or alcohol Social isolation Previous suicidal behaviour High lethality of method used (& ongoing availability of method) Physical and sexual abuse ```
70
Indicators of a serious suicide attempt
``` Use of violent means e.g. hanging, jumping from a height They thought it would kill them They planned to do it in advance e.g. making a will, leaving a suicide note They were unlikely to be discovered Alcohol or illicit drugs involved (increases chance of death, but person less likely to have intended to die) No obvious precipitant e.g. argument with partner ```
71
Treatment options for depression
Antidepressants ECT CBT IPT
72
Drug often used in treatment resistant schizophrenia and its class
Clozapine - atypical antipsychotic

4th Year Key Summaries (5 decks)

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