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Psychiatry Flashcards

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1
Q

What is delirium?

A

acute confusional state. Fluctuating and impaired consciousness. Onset is over hours/days with a rapid deterioration in preexisting cognitive function

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2
Q

What are the features of delirium?

A

COGNITIVE - low concentration, confused, disorientated in time and space
PERCEPTION - visual and auditory hallucinations
PHYSICAL - reduced mobility and movement, restuless, agitated, appetite changed - fluctuation in behaviours
SOCIAL - reduced cooperation, withdrawal, delusions

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3
Q

name the 2 types of delirium

A

hyperactive and hypoactive

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4
Q

DD for delirium?

A

drug/alcohol withdrawal, mania, psychosis, anxiety

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5
Q

name some causes for delirium

A

SDH, meningitis, sepisis, stroke, encepalopathy, UE deranged, hypoxia, liver/kidney injury, thiamine/B12/folate deficiency

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6
Q

Ix for delirium?

A

Bloods - FBC, UE, LFT, blood glucose, blood gas, blood culture
urine culture
ECG
CT/CXR/LP

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7
Q

Mx for delirium

A

treat precipitating cause
optimise surroundings
1st line Mx = Haloperidol (monitor BP)

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8
Q

what is dementia?

A

progressive and global intellectual deterioration without impaired consciousness. 1st symptom = memory loss

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9
Q

features of dementia?

A

BEHAVIOUR - repetitive, restless, rigid and fixed routines
PERSONALITY - sexual disinhibition, shoplifting, blunting
SPEECH - dysphasia, mutism
THINKING - slow, muddled, reduced memory, confabulation, no insight
PERCEPTION - illusions, hallucinations
MOOD - irritable, depressed, crying

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10
Q

name the 4 As of alzheimers

A

amnesia, aphasia, agnosia, apraxia

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11
Q

irreversible causes of dementia

A

Alzheimers, vascular, lewy body, frontotemporal

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12
Q

Ix for a patient presenting with dementia symptoms?

A

fully history of function and decline/collateral Hx
BLOODS - FBC, UE, LFT, B12, folate, gGT, Ca, TSH, syphyllis, ESR, HIV
CT/MRI head - SD
cognitive examinations

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13
Q

Name some cognitive exams to do on a dementia investigation?

A 
MMSE/AMSE
MOCA
addenbrooks
AMT
FAB
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14
Q

Name a medication and class that you can use in a patient with dementia to improve symptoms?

A

Rivastigmine - Acetylcholinesterase inhibitor

Memantine - NMDA receptor antagonist

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15
Q

what is ECT used for?

A

severe catatonic depression which is non-responsive to medication

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16
Q

what is schizoaffective disorder?

A

schizophrenia + mood disorder

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17
Q

what is section 2 of the MH law?

A

admission for assessment for <28 days. Requires 2 doctors (1 section 12 approved) and you can appeal within 14 days

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18
Q

what is section 3 of the MH law?

A

admission for treatment for <6 months. must have a diagnosis and appropriate management stated

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19
Q

what is section 4 of the MH law?

A

emergency treatment for <72 hours. Could be converted into a section 2 or a section 3.

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20
Q

What is a section 5(2) in the MH law?

A

detention of a patient already in hospital for <72 hours.

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21
Q

What is a section 5(4) in the MH law?

A

detention of a patient already in hospital by an authorized psych nurse for <6 hours.

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22
Q

what is somatisation disorder?

A

patient presents with multiple physical symptoms over 2 years. they refuse to accept reassurance from negative test results

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23
Q

what is anxiety?

A

maladaptive psych symptoms not due to organic cause, and precipitated by stress. can be a normal response but in anxiety disorder this response is exaggerated and lasts >3 weeks

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24
Q

symptoms of anxiety?

A

COGNITIVE - agitated, impending doom, reduced concentration, insomnia, repetitive thoughts, concern of self image
SOMATIC - tension, trembling, sense of collapse, butterfies, increased HR, headaches, sweating, palpitations
BEHAVIOURS - reassurance seeking, avoidance, dependance on a person
CHILDREN - thumb sucking, nail biting, bed wetting

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25
how do you manage anxiety
GENERAL - listen and explain, exercise, meditation, breathing exercises, relaxation techniques THERAPIES - CBT, hypnosis MEDICATION - 1st line = SSRI SYMPTOMATIC - B blocker
26
what are compulsions and obsessions?
COMPULSION - senseless repeated rituals | OBSESSIONS - purposeless ideas/words, perceived by the patient as intrusive (not like delusions.)
27
How do you manage OCD?
SSRI (e.g. fluoxetine)
28
What is a phobic disorder?
anxiety experienced in a well-defined situation that is not dangerous. This situation is avoided as it causes a lot of distress and impaired function
29
how do you manage a phobic disorder?
need to elicit the stimulus! | CBT + SSRI
30
what is PTSD?
develops after a stressful/life threatening situation
31
symptoms of PTSD?
``` re-experiencing the event - vivid nightmareds/flashbacks in which there is raised BP and HR sleep disturbance reduced concentration drug and alcohol misuse emotional numbing ```
32
Mx for PTSD?
eye movement desensitization and reprocessing CBT SSRI
33
What are the core symptoms of depression?
depressed mood, anhedonia, fatigue
34
more typical symptoms of depression?
reduced appetite, insomnia, reduced concentration, psychomotor retardation, reduced libido, feelings of worthlessness and guilt
35
How do you score Mild/Mod/Sev depression
``` Mild = 2 core + 2 typical Mod = 3 core + 2 typical Sev = 4 core + 3 typical ``` +/- psychosis/manic symptoms
36
name 2 screening tools for depression
HAD scale, PHQ9
37
How do you manage depression?
GENERAL - sleep hygeine, anxiety management, self help books, computorised CBT IF MOD = CBT + SSRI SEVERE = rapid MHA/ECT
38
how do you identify severe depression (SUICIDE)?
``` suicide plan/self harm unexplained guilt/worthlessness impaired function concentration impaired impaired appetite decreased sleep/early waking energy low ```
39
What is the order for antidepressant use in depression?
1st line = SSRI 2nd line = alternative SSRI 3rd line = NaSSA/SNRI 4th line = TCA
40
Give examples of SSRIs and their side effects
Citalopram/Sertriline/Fluoxetine GI symptoms, hyponatraemia, increased anxiety when beginning, increased weight, sexual dysfunction prolonged QT with citalopram
41
Give examples of NaSSA and their side effects
Mirtazipine | sedation, increased appetite
42
Give examples of SNRIs and their side effects
Venlaflaxine | nausea, dry mouth, drowsy, constipation, blurred vision
43
Give examples of TCA and their side effects
Amitryptilline | drowsy, dry mouth, blurred vision, constipation, urinary retention
44
what are the signs of mania?
MOOD - irritable, euphoric COGNITION - grandiosity, distractable, flight of ideas, confusion, lack of insight BEHAVIOUR - rapid speech, hyperactive, reduced sleep, hypersexuality PSYCHOSIS - delusions, hallucinations
45
Name some causes of mania?
Meds - steroids, amphetamines, cocaine, SSRIs | PHYS - infection, stroke, neoplasm, bipolar
46
how do you assess someone who is acutely manic?
ASSESS - infections, drug use, CT head/EEG, screen toxins | EXAMINE - cycling speed, psychosis, suicide Rx
47
How do you manage acute mania?
Olanzipine
48
What medication do you use as prophylaxis of bipolar disease - what screening do you need to do before
Lithium carbonate | UE, T4, ECG
49
what is the therapeutic dose of lithium
0.6 - 1.0
50
causes of lithium toxicity?
dehydration, renal failure, thiazide diuretics, NSAIDS, metronidazole
51
features of lithium toxicity
coarse tremor, hyperreflexia, acute confusion, polyuria, seizure and coma
52
How do you manage lithium toxicity?
Mild - 0.9% normal saline | Severe - haemodialysis
53
how does cocaine act on the body?
blocks uptake of dopamine, noradrenaline and serotonin
54
effects of cocaine on the body?
CVS - MI, increased HR and BP, QT prolongation, aortic dissection PSYCH - agitation, psychosis, hallucination NEURO - seizure, mydriasis, hypertonia, hyperreflxive
55
Mx of cocaine toxicity?
benzodiazepene
56
what are the features of dependance on a substance?
strong compulsions/cravings difficulty controlling substance levels of use withdrawal tolerance neglect of other hobbies persisting using despite harmful consequences
57
signs of opioid use?
rhinorrhea, needle tracks, pinpoint pupils, drowsy, yawning
58
complications of opioid addiction
``` HIV/Hep B and C infective endocarditis and sepsis DVT respiratory depression social - prostitution and crime ```
59
how can we reduce harm to opioid addicts?
needle exchange programmes HIV and Hep B and C testing Methodone and buprenorphine
60
how does Naloxone work?
opioid antagonist - blocks euphoria in relapse
61
How do you screen for alcohol overuse?
CAGE - ever felt you should cut down? - have people been annoyed by your drinking? - ever felt guilty about drinking? - ever had an eye opener drink?
62
signs of delerium tremens?
72 hours after stopping drinking alcohol | high heart rate, BP drops, tremor, fits, tactile or visual hallucinations
63
how do you manage delerium tremens?
monitor BP | give chlordiazepoxide
64
list support and 2 medications to help with alcohol abstinence?
``` treat coexisting depression refer to specialists AA Disulfiram - nasty reaction when relapse Naltrexone - reduces the pleasure when drinking (opioid antagonist) ```
65
Long term side effects of alcohol abuse?
LIVER - fatty liver, cirrhosis, hepatitis CNS - memory and cognition, cerebellar atrophy, wernicke and korsakoff GI - D&V, ulcers, varices, pancreatitis CVS - arrhythmia, increased BP
66
what causes wernickes encepalopathy?
longstanding thiamine deficiency (B1)
67
triad of wernickes encepalopathy?
confusion, wide gait ataxia, ophtalmoplegia (nystagmus and conjugate gaze)
68
Mx for wernickes encepalopathy?
IM thiamine
69
what is Korsakoff syndrome?
hypothalamic damage and cerebral atrophy due to longstanding thiamine deficiency
70
features of korsakoff syndrome?
unable to form new memories (confabulation) | no insight and apathy
71
Name the first rank symptoms of schizophrenia
auditory hallucinations - thought echo, 3rd person, 2 people discussing in 3rd person thought disorder - thought insertion/withdrawal/broadcast passivity phenomena - body sensations externally controlled delusional perception - object normal but leads to a delusion (traffic light green, therefore I am a god)
72
what is required for the diagnosis of schizophrenia?
a clear 1st rank symptom lasting >6 months, with all other causes ruled out
73
DD for schizophrenia?
head injury, tumour, bipolar, drugs, alcohol
74
Main RF for schizophrenia?
genetics
75
Name some psych interventions for patients with schizophrenia?
CBT - target hallucinations/delusions Work with family Social support Early interventions service - supports people in their first psychotic episode (reduce time of untreated pschosis, quick effective care, increase return to education/employment, maintain life trajectory)
76
What advice/monitoring do you do before starting an antipsychotic?
Hx/Fam Hx of diabetes/HTN/CVD advice on diet/exercise/weight control MONITOR: BP/weight/BG/lipids/FBC/ECG for clozapine
77
how do first generation antipsychotics work? name a few and the side effects
D2 antagonists e.g. Haloperidol SE = EPSE - tremor, slurred speech, akathesia, dystonia, tardive dyskinesia
78
how do you manage dystonia and tardive dyskinesia?
Dystonia - Procyclidine | Tardive dyskinesia - tetrabenazine
79
How do second generation antipsychotics work? name a few and the SE
5HT2A and D2 antagonist e.g. Risperidone/Olanzapine/Quetiapine SE = hyperprolactinaemia, sexual dysfunction, increased weight, DM, CVS SE, daytime drowsiness
80
Name SE of clozapine - what additional baseline Ix are needed
Agranulocytosis and myocarditis | FBC and ECG
81
Different personality disorders - discuss the clusters and types
look in notes

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