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Psychiatry Flashcards

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1
Q

List the 10 components of a mental state examination

A 
Appearance
Behaviour
Mood
Speech
Thoughts
Beliefs
Perceptions
Suicide
Cognitive function
Insight
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2
Q

Name 3 mood disorders

A

Depression
Mania
Bipolar affective disorder

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3
Q

What is the classification system used for affective disorders?

A

ICD-10

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4
Q

List 5 broad effects of depression on an individual

A 
Change in mood
Change in thought content
Change in bodily function
Loss of interest
Irritability
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5
Q

List 10 symptoms of depression

A 
Anhedonia
Low mood
Retardation
Fatigue
Loss of appetite
Loss of libido
Loss of interest 
Social withdrawal
Delusions/hallucinations
Loss of confidence
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6
Q

How many general criteria and additional criteria are required for diagnoses of mild, moderate and sever depression?

A 
Mild = 2 general, 2 additional
Moderate = 2 general, 4 additional
Severe = 3 general, 5 additional
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7
Q

List the three ICD-10 general criterion for depression

A

Depressed mood
Loss of interest
Fatigue or reduced energy

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8
Q

List 4 classes of antidepressant

A

SSRIs
TCAs
Monoamine oxidase inhibitors
SNRIs

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9
Q

List 4 treatments for depression

A

Antidepressants
CBT
IPT
ECT

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10
Q

List 6 symptoms of mania

A 
Elevated mood
Increased energy
Disinhibition
Grandiosity
Decreased sleep
Extravagant spending
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11
Q

List 4 treatments for mania

A

Antipsychotics
Mood stabilisers
Lithium
ECT

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12
Q

Name 5 antipsychotics

A 
Olanzapine
Risperidone
Quetiapine
Clozapine
Aripiprazole
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13
Q

Name 3 anticonvulsants

A

Valproic acid
Lamotrigine
Carbamazepine

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14
Q

Can bipolar affective disorder be diagnosed from depression only (without mania)? Can it be diagnosed from mania only (no depression?)

A

Only mania required for diagnosis of bipolar affective disorder. Depressive episode is assumed.

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15
Q

What is CBT?

A

CBT (cognitive behavioural therapy) is a psychological therapy that aims to identify and challenge thinking errors

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16
Q

What is behavioural activation?

A

A psychological therapy which promotes activity scheduling in order to combat harmful behaviours which worsen illness

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17
Q

What is interpersonal therapy?

A

A psychological therapy which aims to identify interpersonal events that may have triggered illness and resolving them as far as possible to relieve illness

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18
Q

What is motivational interviewing?

A

A specialised form of interview where emphasis is focused on understanding individual’s predicament and motivating them to resolve it

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19
Q

What are the 5 stages of change?

A 
Pre-contemplation
Contemplation
Planning
Action
Maintenance
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20
Q

How long can a patient be detained in hospital with:

  • Emergency detention certificate
  • Short-term detention certificate
  • Compulsory treatment order
  • Nurses holding power?
A

EDC - up to 72 hours
STDC - up to 28 days
CTO - up to 6 months
NHP - up to 3 hours

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21
Q

What 5 criteria must be met for a detention order to be granted?

A 
Patient must have a mental disorder
Patient decision-making must be impaired
Necessary for treatment
Significant risk to health
Appropriate
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22
Q

What is a guardianship order?

A

The appointing of someone else to make decisions on behalf of an incapacitated adult

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23
Q

What should be completed before treating a patient without capacity to consent?

A

A certificate of incapacity

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24
Q

What is required to treat a patient with a mental disorder against his will in hospital? Can a certificate of incapacity authorise this?

A

A detention order is required. A certificate of incapacity does not authorise unconsented medical treatment of a mental disorder.

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25
List 5 symptoms of alcohol withdrawal
``` Tremor Weakness Nausea Vomiting Seizures ```
26
What condition presents normally with confusion and is a result of excessive alcohol consumption? Hint: pathophysiology is a thiamine deficiency secondary to excessive alcohol intake
Wernicke's encephalopathy
27
What screening tool is used for assessing alcohol dependence?
CAGE - Cut down? - Felt annoyed by criticism? - Guilt - Eye-opener
28
Name 3 medications used in the treatment of alcohol withdrawal
Thiamine (to prevent Wernicke's) Benzodiazepine (chlordiazepoxide) Disulfaram (deterrent - adversely reacts to alcohol consumption)
29
What cardiac risk do TCAs carry?
Can cause QT lengthening
30
List 4 side effects of TCAs
Weight gain Dry mouth Dry eyes Loss of libido
31
Name 3 TCAs
Amitriptyline Nortriptyline Doxepin
32
List 5 side effects of monoamine oxidase inhibitors
Dry mouth Weight gain Loss of libido Hypertensive crisis if taken with cheese!! Serotonin syndrome (must wait 2 weeks before switching from SSRI to MAOI)
33
List 3 side effects of SSRIs
GI upset Loss of libido Insomnia
34
List 4 SSRIs
Paroxetine Sertraline Fluoxetine Citalopram
35
List 2 SNRIs
Venlafaxine | Duloxetine
36
List 2 novel antidepressants
Mirtazapine | Buproprion
37
List a common side effect of mirtazapine
Raises cholesterol
38
Can lithium be prescribed to pregnant women?
No
39
List 5 side effects of lithium
``` GI upset Thyroid problems Polyuria Cognitive slowing Hair loss ```
40
What is the aim blood level of lithium?
Between 0.6 and 1.2
41
List 4 side effects of valproic acid
Thrombocytopenia Nausea Weight gain Sedation
42
What is the first line agent for mania?
Carbamazepine (anticonvulsant)
43
Before prescribing anticonvulsants, what four tests should be performed?
LFTs FBC Pregnancy test ECG
44
List 5 side effects of carbamazepine
``` Rash Nausea Sedation Diarrhoea AV conduction delays ```
45
List 4 side effects of lamotrigine
Nausea Sedation Dizziness Stevens Johnson's Syndrome (skin falls off)
46
What 3 tests must be done before lithium prescription?
TSH Creatinine Pregnancy test
47
What are the 4 dopaminergic pathways?
Mesocortical Mesolimbic Nigrostriatal Tuberoinfundibular
48
Are typical antipsychotics or atypical antipsychotics more favourable? Why?
Atypical favoured due to lack of extrapyramidal side effects
49
List 2 side effects of risperidone
Weight gain Sedation
50
List 4 side effects of olanzapine
Weight gain Hypercholesterolemia Hyperglycaemia Hypertriglycerideaemia
51
What is the main dangerous side effect of clozapine? How is this monitored?
Agranulocytosis (destruction of WBC). | Monitored weekly for first 6 months, then 2-weekly for second 6 months)
52
What is the first line antipsychotic used?
Risperidone Then aripiprazole Then clozapine
53
What 3 blood tests must be undertaken before prescription of an antipsychotic?
Fasting BM Fasting lipid profile LFTs
54
``` What is akathisia? What class of drugs cause this side effect? How is it treated? ```
Akathisia - inner restlessness. Caused by antipsychotics. Treat with propranolol or anticholinergic.
55
Define tolerance
Reduced responsiveness to a drug caused by previous administration
56
Name 2 mechanisms of tolerance and a brief description of each
Dispositional tolerance - less drug reaches active site | Pharmacodynamic tolerance - drug has less effect on receptors
57
What are 2 common complications of tolerance?
Withdrawal | + consequent dependence (to avoid withdrawal effect)
58
What causes psychological craving?
Reward centres being activated by drugs
59
What are the main forms of drug dependence?
``` Physical dependence (result of tolerance) Psychological craving (result of reward pathway stimulation) ```
60
What are the 3 components of the reward pathway?
VTA (ventral tegmental area) Nucleus accumbens Prefrontal cortex
61
List 3 'good' and 3 'bad' effects of cocaine
Euphoria Increased energy Increased confidence Damage to URT Hypertension Arrhythmias
62
List 4 opiates
Morphine Heroin Codeine Methadone
63
List 4 effects of heroin
Analgesia Drowsiness Euphoria Respiratory depression
64
List 4 symptoms of opiate withdrawal syndrome
Craving Insomnia Muscle pain Dilated pupils
65
List 4 side effects of ecstasy
Nausea Increased BP Dry mouth Dehydration
66
Define psychosis
Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality.
67
List 3 conditions that may present with psychosis
Schizophrenia Delirium Severe affective disorder
68
List 3 positive and 3 negative symptoms of schizophrenia
Positive: Delusions Hallucinations Disordered thinking Negative: Lack of interest Lack of emotions Apathy
69
What are the ICD-10 criteria for a diagnosis of schizophrenia?
One of: Thought alienation Delusions Hallucinatory voices ``` And two of: Persistent hallucinations Breaks of thought Catatonic behaviour Negative symptoms ```
70
List 5 factors which may predispose someone to schizophrenia
``` Substance misuse Family history Social isolation Obstetric complications Dramatic family ```
71
What is a Cluster A personality disorder? List 3.
Prominent problems are with the perceived safety of interpersonal relationships. Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder
72
What is paranoid personality disorder?
A distrust and suspiciousness of others with motives being interpreted as harmful
73
What is schizoid personality disorder?
A detachment from social relationships and restricted range of interpersonal emotions
74
What is schizotypal personality disorder?
A discomfort with close relationships accompanied by cognitive or perceptual distortions
75
What is a Cluster | B personality disorder? List 4.
``` Prominent problems are with keeping feelings tolerable without acting. Antisocial personality disorder Borderline personality disorder Narcissistic personality disorder Histrionic personality disorder ```
76
What is antisocial personality disorder?
Disregard for and violation of the rights of others
77
What is borderline personality disorder?
Instability of interpersonal relationships, self-image, mood and a marked impulsivity
78
What is narcissistic personality disorder?
Grandiosity, need for admiration and lack of empathy
79
What is histrionic personality disorder?
Excessive emotionality and attention seeking
80
What is a Cluster C personality disorder? List 3.
Prominent problems relate to anxiety and how it is managed. Obsessive-compulsive disorder Dependence personality disorder Avoidant personality disorder
81
What is obsessive-compulsive disorder?
Pre-occupation with orderliness, perfectionism and control
82
What is dependent personality disorder?
Excessive need to be cared for that leads to submissive and clinging behaviour
83
What is avoidant personality disorder?
Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
84
What is stigma?
A social construction that devalues people due to a distinguishing characteristic or mark
85
What are the 2 forms of coping?
Problem focussed | Emotion focussed
86
List 5 symptoms of anxiety
``` Psychological arousal Autonomic arousal Muscle tension Hyperventilation Sleep disturbance ```
87
List 2 forms of anxiety disorder
Phobic anxiety disorder | Generalised anxiety disorder
88
List 3 forms of phobia
Agoraphobia Social phobia Specific phobia
89
List 2 drug classes suitable for treatment of generalised anxiety disorder
Antidepressants (SSRI/TCA) | Sedatives
90
List 4 treatments for generalised anxiety disorder
Medication CBT Counselling Relaxation training
91
List 2 treatments for OCD
SSRIs | CBT
92
What are the 3 key elements of a PTSD reaction?
Hyperarousal Re-experiencing phenomena Avoidance of reminders
93
List 5 factors which may predispose children to psychiatric conditions
``` Parental attachment Abuse Maternal health Co-morbidities Head injury ```
94
What are conduct disorders?
Repetitive patterns of antisocial, aggressive or defiant behaviours
95
List 3 management options for childhood conduct disorders
Parent training programme Family therapy Behavioural support
96
What is ADHD?
Hyperkinetic disorder characterised by abnormal inattention, hyperactivity and impulsivity
97
List 3 treatments for ADHD
Psychoeducation Stimulant medication - methylphenidate Parent training
98
Anxiety disorders in adolescents is associated with suppressed activity of which neurological structure?
Amygdala
99
List 2 treatments for adolescent anxiety disorders
SSRIs | Behavioural (CBT)
100
List 2 classes of synaptic proteins that may be implicated in autism spectrum disorder
GABA | Glutaminergic
101
List 4 distinctive features of autism
Non-verbal communication Repetitive behaviour Obsessions Low IQ
102
What is oppositional defiant disorder?
A childhood psychiatric condition characterised by high temper and refusal to obey adult request
103
What is the main drug treatment for dementia?
Acetylcholinesterase inhibitors
104
What screening tool is used to assess likelihood of an eating disorder?
SCOFF questionnaire
105
What is anorexia nervosa? What is the considered BMI?
Eating disorder characterised by limited food intake and fear of weight gain. Causes amenorrhoea. BMI <17.5
106
List 4 symptoms of anorexia
Amenorrhoea Weakness Hypotension Cold intolerance
107
What is bulimia nervosa?
Eating disorder characterised by episodes of binge eating with a sense of loss of control. Followed by self-induced vomiting, laxative abuse or diuretic abuse. Obsession about body shape and weight.
108
List 4 symptoms of bulimia nervosa
Heartburn Pharyngeal trauma Dental issues Weakness
109
What is binge eating disorder?
Eating disorder characterised by episodes of binge eating without any compensatory mechanism (self-induced vomiting etc)
110
List 4 complications of eating disorders
Fertility problems Increased likelihood of depression Anaemia Reduced immunity
111
List 3 risk factors of developing anorexia nervosa
Stressful life events Genetics Puberty
112
List 5 treatments for anorexia nervosa
``` Re-feeding CBT IPT Family therapy Medication (SSRI or Olanzapine) ```
113
List 4 common features of organic mental disorders
Cognitive impairment Behavioural abnormality Mood changes Psychosis
114
Name 1 acute and 1 chronic organic mental disorder
Acute - delirium | Chronic - dementia
115
List 5 presenting symptoms of delirium
``` Impaired attention Disorientation Mood changes Disordered thinking Hallucinations/illusions ```
116
What is a learning disability?
A condition of incomplete development of the mind
117
List 3 criteria for a diagnosis of learning disability
``` Intellectual impairment (IQ<70) Social dysfunction Early onset (during developmental period) ```
118
What IQ range depicts mild, moderate, severe and profound learning disability?
``` Mild = 50-69 Moderate = 35-49 Severe = 20-34 Profound = <20 ```
119
List 4 causes of learning disability
Genetic Infection (meningitis, rubella) Fetal alcohol syndrome Trauma (head injury)

Psychiatry (14 decks)

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