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4th Year > Psychiatry > Flashcards

Psychiatry Flashcards

(58 cards)

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1
Q

Which allele of Apolipoprotein confers risk of Alzheimer’s Disease?

A

ApoE4

Apo E2 is protective

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2
Q

Duration of symptoms required for Alzheimer’s disease

A

6 months

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3
Q

5 A’s of dementia

A 
Amnesia
Aphasia
Agnosia
Apraxia
Associated symptoms
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4
Q

BPSD

A 
Psychosis
Emotionally labile
Depression/ anxiety
Withdrawal/ apathy
Disinhibition
Sleep cycle disturbances
Altered eating habits
Incontinence
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5
Q

Confusion screen

A

Bloods:

  • FBC
  • U+E
  • LFT
  • TFT
  • Calcium
  • B12
  • Folate
  • Glucose

CXR
Cultures
Urinalysis and drug screen

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6
Q

Side effects of AChEis

A

Mild  D+V, nausea, headache, fatigue, weird dreams, aggression
Moderate  Abdominal pain, loss of appetite, jaundice, dizziness, weight loss, weakness

Parasympathetic effects  Bradycardia, Hypotension, Bronchoconstriction, Increased IOP

SLUDGE Syndrome  Salivation, Lacrimation, Urination, Defaecation, GI problems, Emesis

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7
Q

Contra-indications of AChEis

A

Peptic Ulcer Disease
Conduction problems e.g. Sick Sinus Syndrome
Asthma and COPD

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8
Q

Diagnosis of dementia with Lewy Body (DLB)

A

Presence of dementia-like symptoms, plus 2/3 of:

Fluctuating attention and concentration
  • Recurrent, well-formed visual hallucinations
  • Spontaneous Parkinsonism (Bradykinesia, Rest/ Intention tremor, Rigidity)
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9
Q

Subtypes of Frontotemporal Dementia

A

Behavioural Variant
Progressive Non-Fluent
Semantic

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10
Q

Physical features of Hypoactive delirium

A

More common but also more difficult to detect; Lethargy, reduced mobility and movement, reduced appetite, quiet and withdrawn.

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11
Q

Physical features of hyperactive delirium

A

Agitation, restlessness, sleep disturbance, hypervigilance, restlessness, wandering

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12
Q

First rank symptoms (FRS) in Schizophrenia

A

Thought Disorder (echo, insertion, withdrawal, broadcasting)
Delusional Perceptions
Third Person Auditory Hallucinations
Delusions of Control

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13
Q

Additional symptoms in Schizophrenia

A

Persistent hallucinations in any modality
Breaks in thought
Catatonia (strange, purposeless behaviour)
Negative symptoms

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14
Q

Paranoid Schizophrenia

A

The most common. Dominated by paranoid hallucinations and delusions, with catatonic behaviour and negative symptoms less common.

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15
Q

Hebephrenic schizophrenia

A

Affective changes such as inappropriate mood, disorganised thought and speech. Delusions and hallucinations are rarer.

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16
Q

Catatonic schizophrenia

A

Prominent psychomotor symptoms which may alternate between extremes e.g. hyperkinesis/ stupor, and negativism.

  • Constrained attitudes and positives
  • Violent excitement
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17
Q

Simple schizophrenia

A

Conduct and negative symptoms

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18
Q

Undifferentiated schizophrenia

A

Meets diagnostic criteria but not bound to one disorder

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19
Q

Treatment of Parkinson’s symptoms with Antipsychotics

A

1st Line: Procyclidine

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20
Q

Treatment of Tardive Dyskinesia with antipsychotics

A

1st Line: Procyclidine

2nd Line: IV Benzotropine

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21
Q

Treatment of Akathasia with antipsychotics

A

Procyclidine
Propanolol
Benzodiazepines

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22
Q

Treatment of Tardive Dyskinesia with antipsychotics

A

Tetrabenazine

its irreversible and can’t be reversed if medications stopped- unless treated

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23
Q

Treatment of Neuroleptic Malignant Syndrome

A

Dantrolene or Bromocriptine

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24
Q

Othello Syndrome

Study These Flashcards
A

Morbid jealousy where one believes that the partner is in an affair with someone else, with no evidence or based on minor evidence.

  • Associated with alcohol dependence and sexual dysfunction
  • Risk of stalking/ violence to partner
25
De Clerambault's Syndrome
AKA Erotomania; the belief that a famous person is in love with them - Communicates via secret signs as can’t declare love
26
Capgras Syndrome
Delusional misidentification- a spouse/ close friend/ relative is replaced by an identical looking imposter. - Slightly more common in women
27
Fregoli's Syndrome
Patient is being persecuted by a single person | Disguised and changes appearance to look like different people
28
Cotard's Syndrome
Nilhilistic Delusions  Being dead/ non-existent; or missing body parts - Associated with depression
29
Ekbom's Syndrome
Delusional parasitosis, involving the belief that they are infested with parasites with no physical evidence (formication; can be induced by cocaine). Risk of self-harm trying to get rid of them.
30
Folie a deux
Induced delusional disorder shared between two people.
31
When may medications be considered in mild depression
- If depression complicates chronic disease/ physical health - Past history of moderate-severe depression - Persists after other interventions - Subthreshold symptoms present for 2+ years
32
Pharmacological treatment escalation in depression
- 1st Line: SSRI - 2nd Line: SSRI - 3rd Line: SNRI or NaSSA - 4th Line: MAOI or TCA - Adjunct Lithium (if recurrent depression)
33
Serotonin Syndrome
Autonomic Hyperactivity Altered Mental state Neuromuscular excitation
34
Treatment of the serotonin syndrome
Stop the drug Fluids Benzodiazepines Serotonin antagonists (Cyproheptadine, Chlorpromazine)
35
Which antidepressants should be taken at night-time due to their sedatory effects?
NaSSAs e.g. Mirtazapine
36
Important patients to use SNRIs with caution in?
Cardiovascular disease
37
Sedatory effects of Tricyclic antidepressants
More Sedating: Amitriptyline, Clomipramine, Trazodone Less Sedating: Nortriptyline, Imipramine, Clomipramine
38
Important SEs of TCAs
``` Sedation Hypotension Dry mouth Constipation Urinary retention ± overflow incontinence Breast changes Mania Convulsiona ```
39
Important interactions with TCAs
MAOIs
40
Important SE of Monoamine Oxidase Inhibitors e.g. phenelzine, moclobemide
Hypertensive crisis due to reduced breakdown of Tyramine (contained in foods such as cheese, red wine)
41
Which drug is associated with Ebstein's anomaly of the heart? (tricuspid/ RV abnormalities)
Lithium
42
Side effects of Sodium Valproate
GI Upset Hair loss with regrowth of curly hair Thrombocytopaenia Ataxia/ Tremor
43
Important interactions with Sodium valproate
Its a CYP450 inhibitor
44
Charles Bonnet Syndrome
Visual hallucinations associated with eye disease
45
Metabolic changes in Anorexia (decreases)
``` Anaemia Hypoglycaemia Low TSH (Hypothyroidism) Low Oestrogen Hypokalaemia Hypophosphataemia Reduced renal function ```
46
Metabolic changes in Anorexia (increases)
``` Bicarbonate Amylase Growth Hormone Cortisol Cholesterol Carotinaemia CCK ```
47
1st line anorexia treatments in adults
CBT-ED MANTRA SSCM
48
1st line anorexia treatment in children
Family Therapy
49
Re-feeding Syndrome
Caused by Hypophosphataemia during treatment - Rhabdomyolysis - Cardiorespiratory failure - Hypotension - Arrhythmias - Seizures Increase feeding slowly and supplement Thiamine and Vitamin B1
50
Wernicke's Encephalopathy Features
Confusion Ataxia (wide-based gait) Ophthalmoplegia (ocular palsies, nystagmus, rectus palsies)
51
Disulfiram
Antabuse- produces an undesirable effect when alcohol is drank
52
Acamprosate/ Naltrexone
Start after withdrawal and continue for 6 months. Reduces cravings by enhancing GABA transmission
53
Features of Opioid dependence
3 of the following present in the last 12 months - Tolerance - Withdrawal - Use increasing/ prolonged duration - Unsuccessful attempts to reduce usage - Large amount of time spent using/ recovering - Takes priority over other life aspects - Persistent use despite harm
54
Negative symptoms of schizophrenia
``` Apathy Reduced motivation (volition) Anhedonia Alogia (poverty of speech) Asociality Blunt affect ``` Is often a late feature
55
Catatonia
``` Strange purposeless behaviour Sudden excitement Posturing Flexibility Negativism Mutism Echopraxia ```
56
Drug treatment escalation in GAD
``` SSRI SSRI/SNRI Pregabalin Benzodiazepines (not in primary care) Beta blockers can be added for palpitations/ tremor ```
57
Degrees of learning disability
Mild 70 Moderate 50 Severe 35 Profound 20 20-15-15-20
58
Guiding principles of the MHA
1. Least restrictive options should be used, and maximising independence 2. As much as possible, empower service users and involve them 3. Respect and Dignity 4. Use must have a reason/ purpose and be done effectively 5. Efficiency and equity

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