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Phase 3b > Psychiatry > Flashcards

Psychiatry Flashcards

(71 cards)

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1
Q

Define nihilistic delusion

A

Delusion of almost nothingness (e.g. nothing in bank account, insides rotting)

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2
Q

Define grandiose delusion

A

Inflated self-importance (I am God)

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3
Q

Define hypochondriacal delusion

A

Firm belief they have a disease

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4
Q

Define De Clerambaults (ertomanic) delusion

A

Man of higher social standing/everyone in love with her

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5
Q

Define Orthello delusion

A

Sexual partner being unfaithful

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6
Q

Define Capgras delusion

A

Close relative has been replaced by imposter

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7
Q

Define cotard delusion

A

Patient believes they are dead or non-existent

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8
Q

Define Folie a deux delusion

A

Shared delusion with someone else

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9
Q

Define Ekboms delusion

A

Delusion of infestation

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10
Q

Define loosening of association

A

Lack of logical association between thoughts giving rise to incoherent speech

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11
Q

Define circumstantiality

A

Slow, rambling, convoluted but goal direct thinking

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12
Q

Define confabulation

A

Give false account to fill gap in memory (Korsakoffs)

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13
Q

Define tangeliality

A

Wandering off topics

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14
Q

Define flight of ideas

A

Rapid skipping from one thought to distantly related idea, often tentative relation

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15
Q

Define clang associations

A

Ideas that are linked by rhyme or similarity of words alone

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16
Q

Define Munchausen’s syndrome

A

Factitious disorder, intentional production of physical or psychological symptoms of illness

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17
Q

Define malingering

A

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

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18
Q

Define pharmacokinetics

A

What the body does to the drug
Absorption
Distribution
Elimination

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19
Q

Define pharmacodynamics

A

What the drug does to the body

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20
Q

Name 1st generation/typical antipsychotics

A

Haloperidol

Chlorpromazine

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21
Q

Extra pyramidal side effects from 1st generation antipsychotics

A

Acute dystonic reaction (hours) - muscle spasm, acute torticolis, ocular gyrate crisis

Parkinsonism (4 weeks) - tremor, bradykinesia

Akasthesia (6-60 days) - inner restlessness, pacing + agitated

Tardive dyskinesia (months - years i.e. long term use) - grimacing, tongue protrusion, lip smacking

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22
Q

Treatment for Acute dystonia and Parkinsonism

A

Procycladine

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23
Q

Treatment for akasthesia

A

Propanolol +/- cyproheptadine

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24
Q

Treatment for Tardive dyskinesia

A

Tetrabenazine

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25
Name atypical/new antipsychotics
``` Olanzapine Risperidone Quetiapine Aripiprazole Clozapine ```
26
Side effects of atypical/new antipsychotics
Weight gain Diabetes Mellitus Stroke Most with olanzapine and clozapine Lowest with aripiprazole
27
Side effects of clozapine
``` Agranulocytosis (loss of granulocytes (baso, eoso, neutrophils) Reduced seizure threshold Constipation Myocarditis Cardiomyopathy Arrhythmias Severely reduced consciousness Phaeochromocytoma Parkinson's disease Metabolic syndrome ```
28
Name Selective Serotonin reuptake inhibitors (SSRI)
Sertraline Citalopram Fluoxetine Paroxetine
29
Name Serotonin noradrenaline reuptake inhibitors (SNRI)
Venlafaxine | Duloxetine
30
Name tricyclics
Amytriptyline | Clomipramine
31
Side effects of anti-cholinergics/muscarinics
``` Tachycardia Dry mouth Blurred vision Constipation Urinary retention Drowsiness ```
32
Name tetracyclic/NaSSA (noradrenergic and specific seritonergic antidepressant)
Mirtazepine
33
Side effect of Mirtazepine
Drowsiness | Weight gain
34
Side effects of Lithium
``` Fine tremor Impaired renal function Hypothyroidism Cardiac - T wave flattening/inversion Thirst, polydipsia, polyuria (nephrogenic DI) Weight gain Oedema Leucocytosis Teratogenicity ```
35
Side effects of Lithium toxicity
``` Course tremor Ataxia Muscle weakness Seizures Heart block ```
36
What should you check in someone who has had a lithium overdose?
U&E's and TSH | Thyro and nephrotoxic
37
What is Neuroleptic Malignant Syndrome (NMS)?
Caused by antipsychotic medication -> can be caused by withdrawal of dopaminergic drugs as well Usually in first 10 days of treatment
38
Symptoms of Neuroleptic Malignant Syndrome (NMS)
Reduced activity 'Lead pipe' rigidity Stiff pharyngeal and thoracic muscles - leads to dysphagia and dyspnoea
39
Investigations in Neuroleptic Malignant Syndrome (NMS)
Elevated creatine kinase Elevated WCC Deranged LFTs Metabolic acidosis
40
Treatment for Neuroleptic Malignant Syndrome (NMS)
Bromocriptine - to reduce dopamine blockade (dopamine agonist) Dantrolene - to reduce muscle spasms
41
What causes Serotonin Syndrome?
SSRI MAOIs Ecstasy
42
Symptoms of Serotonin Syndrome
``` Increased activity Clonus/myoclonus Hyperreflexia Tremor Muscular rigidity Dilated pupils Autonomic dysfunction - tachycardia, unstable BP ```
43
Investigations in Serotonin Syndrome
Elevated creatine kinase Elevated WCC Deranged LFTs Metabolic acidosis
44
Treatment for Serotonin Syndrome
Cyproheptadine
45
Causes of delirium
PINCH ME Pain Infection - UTI, pneumonia, meningitis, sepsis, encephalitis Nutrition - B12/folate deficiency Constipation Hypoxia Medications - Benzodiazepines, anticholinergics, anticonvulsants Environment Other: Endocrine - hypo/hyperthyroid, Cushings. Vascular - stroke, HF, SAH, vasculitis, migraines. Head trauma
46
Clinical features of delirium
``` Acute/subacute presentation Fluctuating course Inattention Clouding of consciousness Disorientation in time, place and person Anterograde amnesia Visual hallucinations/illusions Paranoid delusions ```
47
Hypoactive features of delirium
Apathy Withdrawal Quiet confusion
48
Hyperactive features of delirium
Agitation Lack of co-operation Delusions Disorientation
49
Differential diagnosis for delirium
``` Dementia Alcohol/drug withdrawal Mania Post-ictal Psychosis Anxiety ```
50
Investigations for delirium
``` Bloods - FBC - anaemia, WCC infection, MCV U&E LFT Glucose TFT Blood cultures Blood gases ECG CT/LP Chest X-ray ```
51
Management for delirium
``` Treat precipitating cause + exacerbating factors Environmental and supportive measures Adequate lighting Hearing aids Glasses Clocks/calendars Side room Sleep hygiene Consider haloperidol ```
52
Define generalised anxiety disorder
'Excessive worry' and feelings of apprehension about every day events/problems, with symptoms of muscle/psychic tension Anxiety that is 'generalised + persistent'
53
How long must symptoms last for to diagnose generalised anxiety disorder
At least six months history of excessive anxiety and worry
54
Symptoms for generalised anxiety disorder
``` At least three of: Restlessness Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance ``` At least four of: Palpitations, sweating, tachycardia, dry mouth Difficulty breathing, chest pain, nausea/vomiting Hot flushes, numbness, restlessness, lump in throat Dizziness/faint, losing control, fear of dying Sleep disturbance, irritability
55
Risk factors for generalised anxiety disorder
``` 35-54 years old Female Divorced/separated Live alone Unemployed ```
56
Management for generalised anxiety disorder
``` Education Stop smoking and alcohol Exercise Psychological support CBT SSRI's Benzodiazepines (lorazepam, diazepam) ```
57
Define panic attack
Period of intense fear characterised by group of symptoms that develop rapidly, reach peak at 10 mins, and don't last longer than 20-30 mins
58
Define panic disorder
Recurrent panic attacks
59
Symptoms of panic disorder
``` Palpitations Chest pain Choking Dyspnoea Dry mouth Dizziness Blurred vision Sweating Feeling of impending doom Fear of dying Fear of losing control Depersonalisation ```
60
Management for panic disorder
SSRI's - Sertraline CBT TCA - Clomipramide
61
Define agoraphobia
Anxiety and panic symptoms associated with places or situations where escape may be difficult or embarrassing -> leading to avoidance
62
Management for agoraphobia
Behavioural - exposure techniques, relaxation training Cognitive - teach about bodily responses associated with anxiety SSRI's - Citalopram, escitalopram
63
Define obsessive compulsive disorder
Obsessions are unwanted intrusive thoughts, images or urges that repeatedly enter the persons mind Compulsions are repetitive behaviours or mental acts that the person feels drive to perform
64
Examples of obsessions
Often unpleasant = death/sexual Repetitive Intrusive Irrational
65
Examples of compulsive acts
``` Checking Washing Counting Symmetry Repeating certain words/phrases ```
66
Treatment for OCD
Psychological = CBT Exposure + response prevention (ERP) Pharmacological = SSRI's = Fluoxetine, sertraline ECT
67
Define post-traumatic stress disorder
Severe psychological disturbance following a traumatic event Characterised by involuntary reexperiencing of elements of the event, with symptoms of hyperarousal, avoidance and emotional numbing
68
How long must symptoms be present for to diagnose post-traumatic stress disorder
1 month
69
How long must symptoms arise within of the traumatic event to diagnose post-traumatic stress disorder
Arise within 6 months of traumatic event
70
Symptoms of post-traumatic stress disorder
Re-experiencing - Flashbacks, nightmares, increased BP, sweating Avoidance - avoiding people, situations or circumstances Hyperarousal - sleep problems, irritability, poor concentration Emotional numbing - lack of ability to experience feelings
71
Treatment for post-traumatic stress disorder
CBT Eye movement desensitisation and reprocessing Stress movement

Phase 3b (18 decks)

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