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Finals > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Give some side effects of lithium

A
  • nausea/vomiting, diarrhoea
  • fine tremor
  • nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
  • thyroid enlargement, may lead to hypothyroidism
  • ECG: T wave flattening/inversion
  • weight gain
  • idiopathic intracranial hypertension
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2
Q

Give some side effects of Tricyclic Antidepressants

A
  • drowsiness
  • dry mouth
  • blurred vision
  • constipation
  • urinary retention
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3
Q

Give some extrapyramidal side effects of antipsychotics

A
  • Parkinsonism
  • acute dystonia (e.g. torticollis, oculogyric crisis)
  • akathisia (severe restlessness)
  • tardive dyskinesia
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4
Q

Give some other side effects of antipsychotics

A
  • antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
  • sedation, weight gain
  • raised prolactin: galactorrhoea, impaired glucose tolerance
  • neuroleptic malignant syndrome: pyrexia, muscle stiffness
  • reduced seizure threshold (greater with atypicals)
  • prolonged QT interval (particularly haloperidol)
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5
Q

What can prolonged use of antipsychotics increase the risk of?

A

Stroke

VTE

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6
Q

What is somatisation disorder?

A
  • multiple physical SYMPTOMS present for at least 2 years

- patient refuses to accept reassurance or negative test results

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7
Q

Why is hypochondrial disorder?

A
  • persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
  • patient refuses to accept reassurance or negative test results
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8
Q

What is 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)
  • patients may be indifferent to their apparent disorder
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9
Q

What is Munchausen’s syndrome?

A
  • also known as factitious disorder

- the intentional production of physical or psychological symptoms

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10
Q

What is Malingering?

A

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain (place to sleep, food etc)

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11
Q

What is fixation?

A

Lack of progression through development, whereby a person persists in a child-like state of maturity on a given topic.

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12
Q

What is dissociation?

A

Immature ego defence where one’s personal identity is temporarily and drastically modified to avoid the distress of a given situation.

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13
Q

What is sublimation?

A

Mature ego defence where the person takes an unacceptable personality trait and uses it to drive a respectable work that doesn’t conflict with their value system (e.g. aggressive person becomes soldier)

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14
Q

What is reaction formation?

A

Where unacceptable emotions are (unconsciously) repressed and replaced by their exact opposite. It’s an immature defence system (e.g. someone with homoerotic fantasies engaging in homophobic causes)

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15
Q

What is splitting?

A

A common immature defence mechanism where the pt is unable to reconcile both good and bad traits in a person, and therefore sees all people as either all good or all bad

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16
Q

What therapy is recommended first-line for PTSD?

A

CBT

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17
Q

What is Capgras syndrome?

A

When a pt believes that a loved one has been replaced by an exact double

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18
Q

What is Othello syndrome?

A

Pts have a delusional belief that their partner is cheating on them, despite no proof. Pts repeatedly accuse their partners, test them, stalk them and seek evidence to confirm their delusions (more common in men than women)

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19
Q

What is Cotard syndrome?

A

When severely depressed pts have intense nihilistic delusions (e.g. that part of their body is dead or rotting etc)

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20
Q

What is erotomania?

A

Usually affects women who believe that somebody is deeply in love with them. The subject of their delusions is usually a famous person.

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21
Q

What is a primary delusion?

A

A delusion that arises out of the blue

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22
Q

What is a secondary delusion?

A

A delusion that arises out of an underlying mood, from another psychotic phenomenon or from a defect in cognition or perception and is understandable in that context (e.g. primary delusion of being followed -> secondary delusion of being persecuted)

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23
Q

What is a Folie a Deux?

A

When two people who are very close share a delusion

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24
Q

Management of generalised anxiety disorder (step 1)

A

Education and active monitoring

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25
Q

Management of GAD that hasn’t improved after education and active monitoring in primary care

A

Low-intensity psychological intervention

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26
Q

Management of GAD with inadequate response to low-intensity psychological interventions, or presentations with marked functional impairement

A

Choice of a high-intensity psychological intervention (CBT) or a drug treatment

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27
Q

Management for GAD that is complex and refractory to treatment, where there is very marked functional impairment (self-neglect, risk of self-harm)

A

Highly specialist treatment, such as complex drug and/or psychological treatment regimens

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28
Q

Pt convinced they have cancer despite negative investigations

A

Hypochondrial disorder

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29
Q

How should citalopram be stopped?

A

Withdraw gradually over the next 4wks

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30
Q

Treatment of PTSD

A

CBT or eye movement desensitisation and reprocessing therapy

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31
Q

What are the main features of a formal thought disorder?

A

Derailment - break in the linked association of sequential thoughts
Omission - all or part of a thought is absent without a reason
Fusion - thoughts are fused together
Substitution - inappropriate or illogical thought replaces another as though slotted into a place

32
Q

1st rank symptoms of schizophrenia

A

1) thought insertion, broadcasting and/or withdrawal
2) delusions that thoughts, feelings or actions are controlled by others
3) hallucinatory voices
4) persistent delusions

33
Q

2nd rank symptoms of schizophrenia

A

1) Persistent hallucinations in any modality
2) Breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech (knights move thinking)
3) catatonic behaviour - strange and purposeless
4) Negative symptoms - apathy, paucity of speech, blunting

34
Q

Diagnostic criteria for schizophrenia

A

At least one very clear symptom (2 or more if not clear) from 1st rank symptoms, or symptoms from at least 2 groups of 2nd rank symptoms.
Must have had symptoms for >6m and the symptoms should be present most of the time for the last month

35
Q

Management of schizophrenia

A

Antipsychotic therapy

Individualised care plan including psychosocial interventions and support for families

36
Q

What is the aim of psychological interventions in schizophrenia?

A

Promote quick recovery and relapse prevention

37
Q

Indications of good prognosis in schizophrenia

A 
Sudden onset
No negative symptoms
Supportive home
Female
Later onset of illness
No CNS ventricular enlargement
No family history
38
Q

First-line antipsychotic in schizophrenia.

What about treatment-resistant?

A

Second gen - e.g. Olanzapine, risperidone

Treatment resistant - clozapine

39
Q

Outline the diagnostic criteria for depression

A

At least 2 core symptoms (dec mood every day, anhedonia, fatigue)
Plus 2 or more typical symptoms (poor appetite, disrupted sleep, psychomotor retardation, dec libido, dec conc, guilt, low self-esteem, suicidal ideation

40
Q

Outline the criteria for mild, mod and severe depression

A

Mild - 2 core and 2 typical
Mod - 2 core and 3 or more typical
Severe - 3 core and 4 or more typical

41
Q

Differentials for schizophrenia

A

Psychosis due to another cause - drug/alcohol induced, mania etc
Schizoaffective - both symptoms of depression and schizophrenia
Schizotypal - PD which may represent a partial expression of schizophrenia
Schizophreniform - disorders that fail to meet the criteria for schizophrenia but have some symptoms

42
Q

Differentials for depression

A 
Other psychiatric disorder: bipolar, schizophrenia, anorexia, anxiety
Dysthymia
Substance misuse
Dementia
Sleep disorder
43
Q

Causes of mania

A

Steroids, illicit substances, antidepressants

Infection, stroke, neoplasm, epilepsy, metabolic disturbances

44
Q

When are pts more at risk of suicide in mania?

A 
Previous suicide attempt
Family history of suicide
Early onset
Extent of depressive symptoms
Rapid cycling
Abuse of alcohol or drugs
45
Q

Mania vs hypomania

A

Mania - irritability, euphoria, grandiosity, poor conc, flight of ideas, hypersexuality, hallucinations. Present for >1wk
Hypomania - without psychosis, impairment of daily functioning, or need for inpt treatment

46
Q

Define bipolar affective disorder

A

When depression alternates with mania

47
Q

Treatment of OCD

A

CBT

Clomipramine or SSRIs (even if not depressed)

48
Q

Define depersonalisation

A

State of disturbed perception in which people, or the self, or parts of the body are experienced as being changed, becoming unreal, remote or automatised. There is insight (so not psychosis)

49
Q

Causes of delirium

A

CNS - cerebral tumour, subdural haematoma, epilepsy
Infective - septicaemia, UTI
Vascular - stroke, HTNsive encephalopathy, SLE
Metabolic - U+E abnormality, hypoxia, liver or kidney failure, alcohol withdrawal
Endocrine
Toxic - alcohol and drugs
Deficiency - thiamine, b12, folate

50
Q

Outline the psychiatric history

A 
HPC
Psych Hx
MHx
Premorbid personality
Medication
FHx
Personal + social Hx
Drugs + alcohol
Forensic Hx
MSE
51
Q

Outline the MSE

A

Appearance - physical state, dress, hygiene
Behaviour - ‘psychomotor’, abnormal movements, eye contact
Speech - fast or slow? loud or quiet?
Thoughts - flow + content of speech, ask about preoccupations (fears, beliefs, worries, self harm), thought control
Mood - subjective, objective (mood vs affect)
Perceptions - unusual (or not?), sensory experiences, depersonalisation, derealisation
Cognition - orientation, memory, planning, daily living activities
Insight - do they think they need help? Do they think treatment will help?

52
Q

Differentials for low mood in a young woman

A

Depression
Depressive episode in bipolar
Adjustment disorder
Bereavement
Organic things - hypothyroid, Cushing’s, Addison’s, chronic conditions etc
Stress - e.g. exams, relationships
Explore other symptoms, could be another psych - schizophrenia, depression with psychosis

53
Q

Causes of delirium

A 
Infection
Hypoxia
Dehydration
Hypoglycaemia
Hyperglycaemia
Iatrogenic (opioids, BZDs)
54
Q

Describe delirium

A

Acute state of confusion
Fluctuating course
Features: impaired consciousness, attention, cognition and perception
May have psychotic symptoms (hallucinations, delusions, formal thought disorder)
Hyperactive and hypoactive forms

55
Q

Risk factors for developing delirium

A 
Older age
Pre-existing cognitive impairment
Sensory impairment
Poor nutrition
Iatrogenic
Frailty/co-morbidities
56
Q

Management of a pt with delirium

A 
Assess for mental capacity
Consider treatment in best interests if they don't have capacity
DOLS assessment may be required
Contact family
R/v any advanced care plans
57
Q

Outline the components used to assess whether a pt has capacity

A

Understand
Retain
Use and weigh up
Communicate decision

58
Q

Outline the four sections of the MHA that are most relevant to doctors

A

Section 2: Admission for assessment (28d)
Section 3: Admission for treatment (6m)
Section 4: Emergency admission for assessment (72h)
Section 5(2): Detention of inpt for r/v (72h)

59
Q

Who can section a pt?

A

Section application can be made by nurses, OT etc with specialist training.
Recommendation for section made by 2 docs (min of 1 being section 12 approved)
Emergency sections carried out by 1 doc with full GMC reg

60
Q

Define dementia

A

Progressive global cognitive impairment.
Memory, language, behaviour, and visuospatial or executive function
Interference with daily living

61
Q

Outline the different types of dementia

A

1) Alzheimer’s - most common, gradual progression, early deterioration in episodic memory
2) Vascular - stepwise progression, often with small vessel in brain
3) Lewy body - parkinsonism and hallucinations, often has fluctuant course
4) Fronto-temportal dementia/Pick’s disease - early personality change

62
Q

Outline the assessment of a pt with dementia

A
  • symptoms + formal standardised tool (MMSE)
  • excl organic causes
  • specialist service if <65yo, focal neuro, rapid decline, or likely genetic (community MH team for rest)
  • advise on informing DVLA
63
Q

Management of dementia

A

Non-pharm - reminiscence therapy, group cognitive stimulation programme
Pharm - anticholinesterase, NMDA antagonists

64
Q

Define bipolar disorder

A

Recurrent/relapsing mania and/or depression

Can be diagnosed with just 2 episodes of mania

65
Q

Outline the features of hypomania

A 
Present for at least 4d
Core features mild or mod
Mild or mod dysfunction
Partial insight preserved
No psychotic features
66
Q

Outline the features of mania

A 
Present for at least 7d, or needing hospital admission
Core features marked
Substantial dysfunction
Minimal or absent insight
Psychotic symptoms may occur
67
Q

Outline the options for mood stabilisation

A

Antipsychotics - olanzapine, risperidone
Antiepileptics - valproate, carbamazepine
Lithium

68
Q

Signs of lithium toxicity

A 
Coarse tremor
Ataxia
Dysarthria
Dec GCS
Convulsions
Coma
69
Q

General SEs

A

Renal impairment
Diabetes insipidus
ECG changes
Leucocytosis

70
Q

Negative symptoms of schizophrenia

A 
Apathy/anhedonia
Blunted emotional response
Reduction in speech
Social withdrawal
Poor self care
Cognitive impairment
71
Q

ICD-10 criteria for schizophrenia

A

One or more of following:

a. Thought echo, insertion, withdrawal or broadcast
b. Delusions of control or passivity; delusional perception
c. Hallucinatory voices giving a running commentary; discussing the pt among themselves or ‘originating’ from some part of the body
d. Bizarre delusions

OR
2 of more of following:
e. Other hallucinations that either occur every day for weeks or that are associated with fleeting delusions or sustained overvalued ideas
f. Thought disorganisation (loosening of association, inconherence, neologisms)
g. Catatonic symptoms
h. Negative symptoms
i. Change in personal behaviour (loss of interest, aimlessness, social withdrawal)

72
Q

When is clozapine indicated in schizophrenia

A

Failed 2 trials of medications, one being an atypical

Each over 6-8wks

73
Q

Monitoring required with clozapine

A

Monitor leucocyte and differential blood counts

Weekly for 18wks, then fortnightly for up to 1y, then monthly

74
Q

SEs of SSRIs

A

GI complaints
Sexual dysfunction
Suicidal ideation
Rare - bleeding, serotonin syndrome, hypersensitivity

75
Q

Indications for ECT

A

Treatment refractory or severe depression or mania

Catatonia

76
Q

Complications of ECT

A

Immediate: anaesthetic complications, CV instability, status epilepticus, laryngospasm, headache, nausea
Late: anterograde and retrograde amnesia

Finals (25 decks)

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