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Psychiatry Flashcards

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1
Q

What are the 3 core symptoms of depression

A

Low mood
Anhedonia
Low energy levels

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2
Q

Cognitive symptoms of depression

A 
Low mood
Feelings of guilt
Feelings of uselessness
Feelings of worthlessness
Suicidal thoughts
Poor concentration
Mood congruent hallucinations and delusions
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3
Q

Functional symptoms of depression

A

Early morning waking - 2 hours before their normal time
Difficulty getting to sleep, waking up multiple times during the night
(Diurnal variation of symptoms - worse in early morning and late at night)
Weight loss - loss of appetite, nausea
Weight gain - comfort eating
Decreased libido
Slow thoughts/actions
Agitated/fidgety
Memory problems

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4
Q

Diagnostic criteria of depression

A

1 core symptoms + 3 others
3 others = mild
4-5 others = moderate
7+ others = severe

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5
Q

What does melancholia mean

A

Emotional numbness

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6
Q

Medications that increase the risk of depression

A 
Steroids
Beta blockers
Statins
Oral contraceptive
Isotretinoin
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7
Q

Risk factors for depression

A 
FH
Female
Stress/trauma
Substance abuse
Previous psychiatric diagnosis
Chronic disease
Unemployed
Single
Post-natal
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8
Q

Differentials for depression

A

Hypothyroidism
Bipolar disorder
Parkinson’s disease
Addison’s disease

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9
Q

Depression screening questionnaire

A

PHQ-9

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10
Q

What is bipolar I disorder

A

One or more manic episodes (lasting 1+ weeks) with or without major depressive episodes

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11
Q

What is bipolar II disorder

A

One episode of hypomania and one major depressive episode but no episodes of mania

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12
Q

What is rapid cycling in bipolar

A

4+ manic/hypomanic/major depressive episodes per year

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13
Q

What is cyclothymia

A

Persistent manic/depressive mood swings over the course of 2 years, which are not sufficiently severe to justify a diagnosis of bipolar disorder

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14
Q

How long do you have to allow before seeing beneficial effects of SSRIs

A

4-6 weeks

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15
Q

Common initial side effects of SSRIs

A 
Dry mouth
Mild nausea
GI upset
Sexual dysfunction
Drowsiness
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16
Q

Side effects of tricyclic antidepressants

A 
Dry mouth
Blurred vision
Constipation
Urinary retention
Sweating
Dizziness
Drowsiness
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17
Q

Venlafaxine and Duloxetine belong to which class of antidepressants

A

SNRIs

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18
Q

What are the 10 main symptoms of depression and how long do you need to have had symptoms for

A

At least 2 over a 2 week period

  1. Persistent low mood
  2. Anhedonia
  3. Fatigue/low energy
  4. Disturbed sleep
  5. Poor concentration/indecisiveness
  6. Low self-confidence
  7. Poor/increased appetite
  8. Suicidal thoughts or acts
  9. Agitation or slowing of movement
  10. Guilt or self-blame
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19
Q

What are the main differences between a manic and hypomanic episode

A

Manic lasts at least 1 week
Hypomanic lasts at least 4 days
Manic results in significant dysfunction (work/school), requires hospitalisation (risk to self or others), or has psychotic features. Whereas hypomanic doesnt result in significant dysfunction, hospitalisation or psychotic features

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20
Q

Features of mania and hypomania

A

Increased goal directed activity - sexually, work, socially
Psychomotor agitation
Increased talkativeness/pressure of speech
Flight of ideas or racing thoughts
Loss of social inhibition, socially inappropriate and reckless behaviour, aggressive/hostile
Decreased need for sleep
Overconfidence
Easily distracted

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21
Q

What is dysthymia

A

A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder

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22
Q

Describe how acute stress reactions present

A

Often initial state of “daze” with lowered field of consciousness, narrowed attention, disorientation. Followed by either further withdrawal or agitation and over-activity (flight reaction). Signs of panic are commonly present. Symptoms usually appear within minutes of the impact of the stressful stimulus or event and disappear within 2-3 days (often within hours). Partial or complete amnesia may be present.

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23
Q

Typical symptoms of PTSD

A 
Flashbacks
Dreams/nightmares
Persisting background sense of emotional blunting
Social detachment
Anhedonia
Avoidance of triggers
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24
Q

What is the difference between somatoform/somatisation disorders and hyochondriacal disorder

A

Somatization disorder more general and changing symptoms whereas hypochondriacal disorder usually preoccupied with the possibility of having one or more serious and progressive disorders.

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25
Describe how acute stress reactions present
Often initial state of “daze” with lowered field of consciousness, narrowed attention, disorientation. Followed by either further withdrawal or agitation and over-activity (flight reaction). Signs of panic are commonly present. Symptoms usually appear within minutes of the impact of the stressful stimulus or event and disappear within 2-3 days (often within hours). Partial or complete amnesia may be present.
26
Typical symptoms of PTSD
``` Flashbacks Dreams/nightmares Persisting background sense of emotional blunting Social detachment Anhedonia Avoidance of triggers ```
27
What is the difference between somatoform/somatisation disorders and hyochondriacal disorder
Somatization disorder more general and changing symptoms whereas hypochondriacal disorder usually preoccupied with the possibility of having one or more serious and progressive disorders.
28
5 screening questions for eating disorders
``` Sick? - do you make yourself sick after meals Control? - do you feel you've lost control over how much you eat One stone (in 3 months)? Fat? - do you believe yourself to be fat when others say you are thin Food? - would you say food dominates your life ```
29
Differentials for eating disorders
``` Anxiety/depression/stress Malignancy Addison's disease Chronic infection Malabsorption syndrome Drug/alcohol dependency ```
30
Physical effects of an eating disorder
``` Tooth damage due to acid Cold Bradycardic Think hair Think skin Amenorrheic ```
31
Differentials for anxiety
``` OCD Hyperthyroidism Psychotic illness Substance abuse Substance withdrawal Phaeochromocytoma ```
32
What are Schneider's first rank symptoms of schizophrenia
``` Thought echo Thought insertion/withdrawal Thought broadcasting 3rd person auditory hallucinations Delusional perceptions Passivity/somatic passivity - belief that movements/emotions/thoughts are being controlled ```
33
What are the positive symptoms of schizophrenia
Delusions Hallucinations Thought disorders Schneider's first rank symptoms
34
What are the negative symptoms of schizophrenia
``` Decline in normal function Affective blunting - lack of facial expression, flat voice, lack of eye contact Social isolation/withdrawal Anhedonia Poverty of speech Avolition - lack of motivation Apathy Poor self-care ```
35
What are delusions
Fixed beliefs that are not reality based and cannot be explained as part of the patients cultural background
36
Types of delusions
``` Persecution Reference Grandeur Control - includes thought broadcasting, insertion, withdrawal Nihilistic ```
37
What is the difference between thought disorders and delusions
Formal thought disorder refers to an impaired capacity to sustain coherent discourse, and occurs in the patient's written or spoken language. Whereas delusions reflect abnormal thought content, formal thought disorder indicates a disturbance of the organization and expression of thought
38
Types of auditory hallucinations
Commands Derogatory Conversing Running commentry
39
Drug-induced psychosis usually causes which type of hallucination
Tactile
40
Types of formal thought disorder
``` Tangentiality/flight of thought Derailment/knights move thinking Word salad - no connection between words Incongruent affect Circumstantiality Pressured speech Distractible speech - cant maintain attention, distracted by irrelevant things Perseveration Neologisms - new word or new meaning to an existing word that is only apparent to them ```
41
Describe the prodromal period before schizophrenia
Before disease develops tendency as a child to be withdrawn, have loss of interest, self-neglect, depression.anxiety, brief psychotic episodes Periods of stress/intense emotion/significant event can trigger schizophrenia in a susceptible individual
42
What drug class is used to treat schizophrenia
Dopamine (D2) receptor antagonists
43
Examples of typical antipsychotics
``` Haloperidol Chlorpromazine Promethazine Flupenthixol Decanoate (IM) ```
44
Side effects of typical antipsychotics
Extrapyramidal - parkinsonism, akathisia, dytonia, dyskinesia Hyperprolactinaemia - sexual dysfunction, osteoprosis, amenorrhea, galactorrhea, gynaecomastia, hypogonadism Metabolic - weight gain, T2DM risk, hyperlipidaemia, metabolic syndrome Anticholinergic - tachycardia, blurred vision, dry mouth, constipation, urinary retention Neuro - seizures, neuroleptic malignant syndrome Increased QT interval
45
Examples of atypical antipsychotics
``` Clozapine Olanzapine Quetiapine Risperidone Amisulpride ```
46
Life threatening potential side effect of Clozapine
Agranulocytosis
47
Organic causes of psychosis
``` Dementia Temporal lobe epilepsy Infection - encephalitis, AIDS Brain injury Brain tumour Huntington's disease Low B12 Cushings High dose steroids SLE Thyroid disease ```
48
What are the 5 main differentials of psychosis
Schizophrenia Drug induced/withdrawal Severe depression (psychosis would be mood congruent) Manic phase of bipolar disorder (psychosis would be mood congruent) Dementia
49
Describe section 2 of the mental health act
Allows for assessment +/- treatment Lasts 28 days AMHP (approved mental health practitioner) activates it 2 doctors need to approve it, one of whom needs to be section 12 approved
50
Describe section 4 of the mental health act
Allows emergency admission for assessment Lasts 72 hours AMHP or nearest relative can activate it One doctor needed to approve it
51
Describe section 3 of the mental health act
Allows treatment for up to 6 months | Treatment for 1st 3 months then need consent or 2nd opinion application by AMHP or NR, needs 2drs approval
52
Describe section 5 (4) of the mental health act
Can hold a patient for up to 6 hours in an emergency | Can be done by a registered nurse
53
Describe section 5 (2) of the mental health act
Can hold a patient for up to 72 hours in an emergency | Can be done by a doctor or approved clinician in charge of the patients care
54
Describe section 135 of the mental health act
Can be used once to remove a patient from their home
55
Describe section 136 of the mental health act
Can be used once to remove a patient from a public place
56
Clinical features of Alzheimers dementia
Progressive memory loss Struggling with ADLs Reduced executive function - planning, organising Nominal dysphasia - word finding, names, objects, paraphrasing Disorientation to time and place - misplacing objects, getting lost Visuo-spatial deficits Behaviour/personality/affect - aggression, apathy, sleep more, disinhibition, paranoia, delusions, hallucinations, depression Prospopagnosia - cant recognise familiar faces In later stages - incontinence, effects of institutionalisation, loss of spontaneous speech, poor self-care, confusion
57
Does alzheimer's dementia affect men or women more commonly
Women
58
Patho of alzheimers dementia
Deposits of senile plaques, beta amyloid plaques and neurofibrillary tangles Neuronal loss Cortical atrophy
59
Medications used to slow progression of cognitive impairment in alzheimers dementia
Cholinesterase inhibitors - Donepezil NMDA receptor antagonists - Memantine Rivastigmine - inhibits acetylcholinesterase and butyrylcholinesterase
60
Donepezil (cholinesterase inhibitor) slows progression of alzheimers dementia by how long for what % of patients
6-12 month delay for 50% of patients
61
Contraindications to use of Donepezil
Bradycardia LBBB Long QTc interval Need to do an ECG before initiating treatment
62
Side effects of Memantine
Headache Confusion Dizziness Risk of acute renal failure - need to do U+Es before initiating treatment
63
Management of BPSDs (behavioural and psychological symptoms of dementia)
Non pharm – CBT, routine, programmed activities, orientation (large clocks, easy to read calendars), music therapy, aromatherapy, exercise SSRIs for depression Carbamazepine for aggression/agitation
64
Risk factors for vascular dementia
Smoking DM Hyperlipidaemia/hypercholesterolaemia Obesity
65
Describe the typical presentation of vascular dementia
Acute/subacute onset of cognitive impairment Stepwise history - varies between periods of stability followed by acute declines Functional deficits before memory loss Mood changes and emotional lability are common May have psychosis, delusions, hallucinations, paranoia
66
Describe the typical presentation of lewy-body dementia
Age >50 Hallucinations Parkinsonism Fluctuations in cognitive ability Multitasking and cognitive tasks more affected than memory at presentation Sleep disorders common Rapidly progression (death usually within 7 years)
67
Frontotemporal dementia tends to affect people under how old?
<65
68
What are the 3 main presentations of frontotemporal dementia
Behavioural (most common) Semantic Non-fluent
69
Features of behavioural predominant frontotemporal dementia
``` Apathy Disinhibition Impulsivity Decline in interpersonal skills Change in preferences e.g. food Childlike amusements Obsessions/rituals ```
70
Features of semantic predominant frontotermporal dementia
Progressive decline in understanding of word meanings Speech may be fluent but difficulty in name retrieval and use of less precise terms Unable to determine meaning of common words Loss of ability to recognise objects or familiar faces
71
Features of non-fluent predominant frontotemporal dementia
``` Speech takes effort Not fluent Apraxia - poor articulation Disorders of speech sound Impaired sentence comprehension ```
72
Types of dementia in order of how common they are
Alzheimers (60%) Vascular (25%) Lewy body (15%) Frontotemporal
73
Organic diseases you need to rule out before dementia diagnosis
``` Delirium Depression/pseudodementia Stroke SOL B12 deficiency Hypothyroidism Substance abuse Metabolic - e.g. Calcium HIV ```
74
Main points of diagnosing Alzheimer's dementia
Insidious onset Decline in at least 2 cognitive domains Impaired ADLs No other cause
75
Classic triad of normal pressure hydrocephalus features
Gait disturbance Memory problems/dementia Urinary incontinence
76
What are the associated functions of the frontal lobe
``` Problem solving/reasoning/planning Emotion/personality Primary motor cortex Brocas area (motor aspects of speech, usually left) Inhibitory functions ```
77
What are the associated functions of the temporal lobe
Perception/recognition of sound Memory Speech Wernicke's area - formulation/understanding of speech
78
What are the associated functions of the parietal lobe
Recognition Movement Orientation Primary sensory cortex
79
What are the associated functions of the cerebellum
Posture Balance Co-ordination of movement
80
What tool/questionnaire can be used to screen for dementia
Mini mental state examination
81
What are the 4 defining features common to all personality disorders
Distorted thinking patterns Problematic emotional responses Over/under regulated impulse control Interpersonal difficulties
82
Describe the Cluster A personality disorders
Odd/eccentric | Dominated by distorted thinking with common features of social awkwardness and withdrawal
83
3 subtypes of Cluster A personality disorders
Paranoid PD Schizoid PD Schizotypal PD
84
Describe the Cluster B personality disorders
Dramatic, emotional, erratic | Problems with impulse control and emotional regulation
85
4 subtypes of Cluster B personality disorders
Borderline PD Narcissistic PD Histrionic PD Antisocial PD
86
Describe the Cluster C personality disorders
Anxious/fearful
87
3 subtypes of Cluster C personality disorders
Avoidant PD Dependent/Asthenic PD Obsessive-compulsive PD
88
What's the difference between CBT and psychodynamic approach
CBT is shorter than PA CBT looks at how we think and feel affects our behaviour and how changing patterns of thinking can change emotion Whereas PA looks at how the past has shaped the present
89
What is a 'care programme approach'
A package of care for people with mental health problems Care plan is written down + sets out what support the patient will get day to day and who’ll give it to you – meds, money problems, housing, support at home, help to get out of the house, risks, what should happen in an emergency/crisis, problems with drugs/alcohol. Patients get given a CPA care-coordinator (usually a nurse, social worker or OT) to manage care plan and review it at least annually.
90
Dependency syndrome criteria (7)
Craving Increased tolerance Substance use prioritised Feel like they've lost control Withdrawal symptoms Reinstatement after a period of abstinence despite knowing its harmful Narrowing repertoire (usually to cheapest available)
91
What is the national recommended alcohol limit for men and women
<14 units per week | <3 units per day
92
How do you calculate alcohol units
Volume (L) X % alcohol OR (Volume mL X % alcohol) / 1000
93
Health problems caused by excessive alcohol intake
``` Depression/anxiety HTN Arrhythmias Alcoholic cardiomyopathy Hypoglycaemia Liver cirrhosis Oesophageal varices Hepatitis Altered medication breakdown Gastritis Pancreatitis Thiamine deficiency - peripheral neuropathy Symptoms of withdrawal Sleep disturbances and memory impairment Oral/oesophageal/hepatic cancer risk increased ```
94
Medications used to treat alcoholism by causing bad side effects
Acetaldehyde dehydrogenase inhibitors Disulfiram Metronidazole Chlorporamide
95
Medication used for alcohol withdrawal
Benzos - Chlordiazepoxide or Diazepam. Reduce dose gradually over 7-10 days Clonidine
96
Which medication can be used to reduce alcohol cravings
Acamprosate
97
What are the 5 stages of addiction
``` Pre-contemplation - not thinking about it Contemplation - thinking about it Preparation - planning Action - tries Maintenance ```
98
Early symptoms of alcohol withdrawal
``` Autonomic overactivity: Tremor Nausea Sweating Agitation Tachycardia Palpitations Raised BP ```
99
Late symptoms of alcohol withdrawal
``` Delusions Confusion Diarrhoea Convulsions Auditory hallucinations ```
100
When do the late symptoms of alcohol withdrawal peak
24-48 hours
101
What is delirium tremens
Rapid onset of confusion caused by withdrawal from alcohol. When it occurs, it is often three days into the withdrawal symptoms and lasts for two to three days. Massive autonomic overactivity An emergency
102
What causes Wernickes encephalopathy
Thiamine deficiency
103
Features of Wernickes encephalopathy
Nystagmus Ophthalmoplegia Ataxic gait - wide based, small steps Confusion
104
What is the difference between Wernickes and Korsakoffs
Both cause by thiamine deficiency Wernickes is acute and reversible Korsakoffs is chronic and irreversible
105
Features of Korsakoffs syndrome
``` Confabulation (fabricate memories to fill in the gaps) Anterograde > retrograde amnesia Personality changes Disorientation Hallucinations ```
106
What is anterograde amnesia
Loss of the ability to create new memories after the event that caused amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event may remain intact
107
In Wernickes encephalopathy, do you give glucose or thiamine first and why
Thiamine first Because glucose increases thiamine demand and will worsen encephalopathy, IV glucose infusions must be administered after thiamine
108
Structure of a mental health history
``` PC HPC PMH and past psych history DH, Alcohol/illicit drugs FH Personal hx - birth, milstones, childhood, school, employment, relationships, forensic Present SH - home, financial, work, education, dependents Pre-morbid personality ```
109
What things need to be considered/explored as part of a post-suicide attempt risk assessment
``` Were they along How far away was help/intervention Precautions against discovery - none/passive/active Did they get help during or after Final acts - will, insurance, gifts Any active preparation Suicide notes Overt communication of intent Purpose of attempt Expectation of fatality Seriousness of attempt to end life Attitude towards dying - didnt want to/not sure/wanted to Conception of medical rescuability Degree of premeditation Reaction to attempt - regret/accepts/wishes it was successful Number of previous attempts Whether or not they took drugs/alcohol to facilitate the attempt ```
110
Components of the mental state examination (9)
``` Appearance Behaviour Speech Mood and Affect Thought form Thought content Perceptions Cognition Insight/Judgement ```
111
How can you describe a persons appearance in the MSE
``` Age Build Clothing Hygiene Grooming Clues about quality of self-care Appropriateness for weather and consultation ```
112
How can you describe someones behaviour in the MSE
``` Facial expression Eye contact Body language Response to the consultation Rapport/social engagement Level of arousal (calm/agitated) Anxious/aggressive Hyper/hypoactive Unusual movements - tremors, slowed, repetitive, involuntary ```
113
How can you describe a persons affect
Range - restricted, blunted, flat, expansive Appropriateness - appropriate, inappropriate, incongruous Stability - stable, labile
114
How can you describe a persons speech in the MSE
Rate - normal, slow, rapid, pressured, reduced Volume - loud, normal, soft Flow - spontaneous, hesitant, slurred, stuttering, mute Tone - monotonous, tremulous, hostile Quantity - minimal, excessive Ease of conversation
115
How can you describe a persons cognition in the MSE
``` Level of consciousness - alert, drowsy, intoxicated Orientation to time/place/person Memory functioning Attention/concentration MMSE ```
116
How can you describe a persons perception in MSE
Dissociative symptoms - derealisation, depersonalisation Illusions Hallucinations - visual, olfactory, tactile, gustatory, somatic, auditory
117
How can you assess insight and judgement in the MSE
Insight - do they acknowledge a possible mental health problem, do they understand treatment options, will they comply with treatment, can they identify hallucinations and suicidal impulses What do they attribute their symptoms to? Judgement - problem solving
118
How can you describe someones thought content
Negative - self worth, helpless, guilt, suicidal Positive - inflated self worth, grand plans, overplanning, risk taking, sexual Anxieties - worries, preoccupations Overvalued ideas Delusions - grandiose, persecutory, referential, bizarre, nihilistic, somatic Passivity - thought insertion/withdrawal/broadcast/echo, feelings, body actions/impulses/urges
119
How can you describe someones thought form
``` Circumstantiality Tangential, loose associations Derailment/knights move thinking Flight of ideas Word salads Metonyms - word approximations e.g. paper holder for book Neologism - new word or known word used in a new/unrecognised way Perseveration Thought racing or blocking ```
120
What questions can you ask about someones auditory hallucinations
``` Internal vs external Single or multiple voices 2nd or 3rd person Is it a voice they recognise Is the voice positive/negative/neither Running commentary Commanding ```
121
Name some mood stabilisers
Lithium Gabapentin Valproate Carbamazepine
122
Symptoms of lithium toxicity
``` Coarse tremor Diarrhoea, nausea, abdo pain, vomiting Dizzy/drowsy/confused Agitated Slurred speech Ataxia Nystagmus Seizures ```
123
Lithium toxicity occurs when serum levels are ?
>1.5 mmol/L
124
Name some extrapyramidal side effects of typical antipsychotics
Acute dystonia Akathisia Tardive dyskinesia
125
What is neuroleptic malignant syndrome
Life threatening reaction to antipsychotics Usually within 2 weeks of the first dose Confusion and EPS High fever, tachycardia, tachypnea, diaphoresis
126
What does FALTER stand for in relation to the clinical features of neuroleptic malignant syndrome
``` Fever Autonomic instability Leukocytosis Tremor Elevated enzymes - CK, transaminases Rigor ```
127
Side effects of tricyclic antidepressants
``` Orthostatic hypotension Sedation, delirium, condusion Arrhythmias, tachycardias Long QT - risk for torsade-de-pointes Constipation Urinary retention ```
128
Features of serotonin syndrome
``` Fever, sweating HTN, tachycardia Agitation, anxiety Hyperreflexia Tremor Ataxia ```

Finals (32 decks)

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