Psychiatry Flashcards
(93 cards)
1
Q
Mental State Examination parts
A
Appearance and behaviour Speech- RTV Mood and affect Thoughts Perceptions Insight Cognition Suicidal ideation
2
Q
What is a delusion?
A
Firm, fixed false belief in something that is not in-keeping with cultural or societal views
3
Q
What is an illusion
A
Real stimulus but false perception
Can be normal
4
Q
Types of thoughts in MSE
A
Tangential Circumstantial Knight's move Clanging/ punning Blocking Perseveration Disorganised Neologism Loosened associations
5
Q
Things to comment about appearance in MSE
A
Unkempt Clothing Behaviour- eye contact, expressions Motor symptoms- akathisia, depressive Body habitus Distracted
6
Q
Types of hallucination
A
Auditory Visual Gustatory Olfactory Somatic Tactile
7
Q
One unit of alcohol in grams
A
8g of absolute alcohol
8
Q
Alcohol detoxification withdrawal symptoms/signs
A
Seizures after around 37 hours
Delirium tremens after around 72 hours
1-4 days Nausea and vomiting Tremor Sweats Anxiety Disturbed sleep Hypertension Tachycardia
2+ days Confusion Extreme agitation Dehydration Delirium tremens
9
Q
Symptoms/signs of delirium tremens
A
Severe confusion Agitated behaviour Extreme hyperactivity Global dysfunction LOC Hallucinations Sleep disturbance Fever HTN Tachycardia Hyperhidrosis Dehydration
10
Q
Scoring system used in alcohol withdrawal
A
CIWA-Ar
10 or more then diazepam
Three scores less than 10- stop diazepam
11
Q
ICD-10 definition of dependence syndrome
A
Compulsion to take it and difficulty controlling this
Physiological withdrawal state
Evidence of tolerance
Neglect of alternative pleasures
Continuation of substances despite harming consequences
12
Q
Drugs for alcohol withdrawal
A
Disulfiram- causes acute insensitivity reaction to ethanol- inhibits acetaldehyde dehydrogenase
Naltrexone- opioid receptor antagonist, reduces cravings and euphoria
Acamprosate- GABA analogue, good for maintenance of alcohol abstinence
13
Q
Adverse effects of lithium
A
Nausea and vomiting
Diarrhoea
Fine tremor
Nephrotoxic- diabetes insipidus and secondary polyuria
Hypothyroid secondary to thyroid enlargement
IIH
Weight gain
Leucocytosis
Hyperparathyroidism and secondary hypercalcaemia
14
Q
When should lithium levels be monitored?
A
12 hours post-dose
Weekly after starting or changing dose, until stable levels
Checked every 3 months
Thyroid and renal function assessed every 6 months
15
Q
Features of lithium toxicity
A
Coarse tremor Hyperreflexia Acute confusion Polyuria Seizure Coma
16
Q
Lithium toxicity may be precipitated by
A
Dehydration
Renal failure
Diuretics, ACE-i, ARBs, NSAIDs and metronidazole
17
Q
Lithium toxicity management
A
If low levels then alkalisation of urine may help to excrete more
Fluid resuscitation
If extreme then haemodialysis may be indicated
18
Q
Side effect of Mirtazapine
A
Increase in appetite
19
Q
Conversion disorder
A
Typically motor or sensory options
Patient doesn’t consciously feign symptoms or seek material gain
20
Q
Second generation anti-psychotics
A
Clozapine Olanzapine Risperidone Quetiapine Amisulpride Aripiprazole
21
Q
Monitoring of what with clozapine use is extremely important
A
FBC
Risk of agranulocytosis/ neutropenia
Should only be used in patients resistant to other treatment
Dose adjustment if starting or stopping smoking
22
Q
What is bulimia nervosa?
A
Characterised by episodes of uncontrollable binge eating followed by purgative behaviours to prevent weight gain (such as self-induced vomiting, laxative use, diuretics, exercise)
23
Q
First generation antipsychotics and their side effects
A
Haloperidol, chlorpromazine
Extrapyramidal side effects and hyperprolactinaemia are common
24
Q
Examples of typical antipsychotic extra-pyramidal side effects
A
Parkinsonism
Acute dystonia- sustained muscle contraction (managed with procyclidine)
Akathisia
Tardive dyskinesia
25
Best SSRI post-MI
Sertraline
26
Which SSRI is most likely to cause a prolonged QT?
Citalopram
27
SSRI side effects
Most common is GI
Increased risk of GI bleed (PPI if also on NSAID)
Hyponatraemia
28
Management of Generalised Anxiety Disorder
Education about GAD and active monitoring
Low intensity psychological interventions- self help or psychoeducational groups
CBT or drug treatment
Specialist input
29
PTSD management (symptoms for 4 weeks)
Watchful waiting if <4 weeks
Trauma-focused CBT or Eye Movement Desensitisation and Reprocessing
Venlafaxine or SSRI if pharmacological is necessary
30
Anti-muscarinic side effects of TCAs
```
Blurred vision
Dry mouth
Drowsiness
Constipation
Urinary retention
QT lengthening
```
31
Schneider's first rank symptoms of Schizophrenia
Auditory hallucinations- thought echo, two or more voices discussing in the third person, voices commenting on patients behaviour (running commentary)
Thought disorder- Insertion, withdrawal, broadcasting
Passivity phenomena- body activities being controlled externally, experiences are imposed on the individual- eg actions, impulses or feelings
Delusional perceptions- a two stage process- delusional insight from a normal stimulus
32
How long should SSRIs be prescribed for minimum
6 months- prevents relapse into depression
33
Indications for ECT
Severe depression, catatonic schizophrenia and severe mania
34
Side effects of ECT
Headache, nausea, memory impairment and arrhythmias
| Very few long term effects noted
35
Definition of hypomania
Decreased or increased function for 4 days
| Elevated mood or irritability
36
Definition of mania
Severe functional impairment or psychotic symptoms (delusions of grandeur or hallucinations) for 7 days or more
37
Definition of chronic insomnia
Trouble falling asleep or staying asleep at least 3 nights a week for at least 3 months
38
What should be measured and observed in people starting an SSRI?
U&Es- risk of hyponatraemia
39
Indications for ECT
Treatment resistant depression
Manic episodes
Catatonia (life threatening)
Episode of moderate depression known to respond to ECT in the past
40
Somatisation disorder
Unexplained symptoms persisting for at least 2 years, refusal to accept negative results
41
Erotomania
Delusional disorder that involves the belief that a famous person is in love with you, absence of any other psychotic features
42
Diagnosis of anorexia nervosa
Restriction of energy intake relative to requirements leading to a low body weight
Intense fear of gaining weight, getting fat, even though underweight
Disturbance in the way one's body shape or weight is experienced, denial of the seriousness of underweight, undue influence of body weight on self-image
43
Management of anorexia nervosa
Anorexia focused family therapy first line in children and young people
CBT 2nd line
44
Side effects of ECT
Immediate- drowsiness, confusion, headache, nausea, aching muscles, anorexia, cardiac arrhythmia, retrograde memory loss, short term memory impairment
Long term- apathy, anhedonia, difficulty concentrating, loss of emotional responses, difficulty learning new information
45
Factors associated with a poorer prognosis in schizophrenia
```
Low IQ
Strong FH
Social withdrawal prodrome
Gradual onset
Lack of obvious precipitant
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46
What is an oculogyric crisis?
Spasmodic movements of eyeballs into fixed positions, typically upward deviation
47
Core features of major depressive episode and other features
```
Depressed mood, anhedonia and/or anergia
Weight loss or gain
Anorexia or increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue
Feelings of worthlessness or guilt
Loss of concentration
Suicidal ideation
```
48
Main features of a manic episode
Mood- inappropriate, elevated, excited, irritable
Motor activity/ volition- productive, increased energy, reduced sleep, poor concentration, increased libido
Increased cognition- rapid speech, flight of thoughts, clang associations, rhyming, grandiose ideas
49
Bipolar type 1
At least one manic episode for at least one week
| Significant impairment of functioning
50
Bipolar type 2
Milder episode of hypomania
No severe impairment
Duration of 4 days
51
Management of bipolar affective disorder
Admission
Antipsychotic drugs and lithium
Prophylactic mood stabilisers- lithium, anticonvulsants, atypical anti-psychotics
Psychosocial support
52
Average number of ECT shocks to achieve remission
8
53
Contraindications of ECT
Brain tumour
Increased ICP
Recent MI
Brain aneurysm
54
Memory loss from ECT
Uncommon to have autobiographical memory loss
Increased cognitive testing 4-14 days post-test
Metanalysis shows no cumulative cognitive deficits from successive treatment
55
What is psychosis
'Loss of contact with reality'
| Inability to pick out salient information
56
What is a delusion
Fixed, firm, unshakeable belief in something that is held against the evidence and the social and cultural norms
57
Environmental factors that increase likelihood of developing schizophrenia
Though FH- genetic is greatest risk!
```
Fetal infection and malnutrition
Chronic cannabis consumption
Urbanicity
Social class
Social isolation
Immigrant status
```
58
What is the PANSS scoring system?
Positive and negative syndrome scale
59
Positive symptoms of schizophrenia
Symptoms of psychosis
Delusional perception
Hallucinations (auditory most common)
60
Negative symptoms of schizophrenia
```
Blunted affect
Alogia
Avolition
Anhedonia
Asociality
```
61
Management of schizophrenia
Biopsychosocial approach
Anti-psychotic medication- assess which will be best
Initial benzodiazepines acutely
Psychological- psychoeducation, CBT and/or family therapy
Social- housing and benefits, substance misuse, occupation and employment, lifestyle- smoking, exercise, diet
62
Tests to perform before beginning anti-psychotic medication
Weight and waist circumference
Pulse and BP
Fasting blood glucose, HbA1c, lipid profile and prolactin levels
Assessment of any mood disorders
Nutritional status, diet and level of physical activity
63
Treatment resistant schizophrenia and management
Attempted two different antipsychotics at an adequate dose for an adequate amount of time (6-8 weeks), one has to be a second generation antipsychotic
Clozapine
64
Side effects of clozapine
AGRANULOCYTOSIS
Anti-dopaminergic- tardive dyskinesia, tremor, movement disorders, apathic facial expressions
Anti-cholinergic- constipation, dry mouth
Anti-histamine- weight gain, dizziness, drowsines
Anti-adrenergic- hypotension
Neuroleptic malignant syndrome
Withdrawal
Seizures
65
Section 135
Police can enter your home and remove an individual to a place of safety for assessment by approved mental health care professionals
66
Section 136
Police can detain individuals in a safe place from a public place (usually kept in station or hospital)
67
Section 5(2)
Doctors have the ability to detain an inpatient for up to 72 hours but CAN'T force treatment
68
Section 5(4)
Nurses can detain inpatients for up to 6 hours
69
Section 2 of the mental health act
```
Assessment of mental health disorder
Up to 28 days
Require 2 senior doctors and another health or social worker (AMP)
Can treat
Can be appealed after 14 days
```
70
Section 3 of the mental health act
Long term section for treatment
| Up to 6 months with various appeal processes
71
What class is Mirtazipine?
NaSSA
| Noradrenaline and specific serotonin antidepressant
72
Risk assessment of a failed suicide
```
4Ps to assess degree of intent and seriousness
Planning vs impulsivity
Precautions to remain hidden
Preparations prior to act
Public/ in isolation
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Regret
Future planning
Current MSE
Past Hx and background
Coping mechanisms
Protective factors
```
73
Schizoid personality
Introspective, asociality, emotionally cold, asexual, lack of close relationships
74
Paranoid personality
Bears grudges, possessive, suspicious, combative, excessive self importance
75
Schizotypal personality
Ideas of reference , strange beliefs and thinking, abnormal perceptual experiences, paranoia and social anxiety, inappropriate affect, strange behaviour or appearance
76
Antisocial personality
Impulsive, aggressive, irritable, tendency or violence and aggression, short lived relationships
77
Emotionally unstable personality
Intense unstable relationships, boredom/emptiness, uncertain about identity, fear of abandonment, unstable mood, impulsive
78
Histrionic personality
Dramatic, excessive, exaggerated, shallow, centre of attention, inappropriate, manipulative
79
Narcissistic personality
Need to be admired, egocentric, entitled, lack of empathy, grandiosity
80
Anankastic/ obsessive- compulsive personality
Rigid, requires order, adherence to rules, perfectionist, exclusion of pleasure, intrusive thoughts
81
Anxious personality
Social withdrawal, fear of rejection, low self esteem, inferiority, embarrassment
82
Dependent personality
Requires reassurance, fear of abandonment, insecure, clingy, indecisive
83
Clinical features of ADHD
Inattention
Over activity
Impulsivity
84
Management of ADHD
Bio- medication- methylphenidate or dexamphetamine
Psych- Parenting training programmes, CBT/behavioural therapy
Social- Structure and routine, educational support/ school liaison
85
Side effects of methylphenidate/ dexamphetamine
Headaches, insomnia, anorexia, dizziness, anxiety
| Growth suppression
86
Autism spectrum disorder clinical features
Triad of
Social impairment
Communication impairment
Restrictive/ repetitive behaviours and interests
87
Management of autism
Bio- risperidone, SSRI
Psych- SALT, social skills training, behavioural modification programmes, parental training courses
Social- appropriate educational setting
88
What is a learning disability?
Significant sub-average intellectual functioning
Deficits in adaptive or social functioning
Onset within developmental period
89
Investigating confusion in the elderly
```
Bloods and blood culture
ABG
CXR
MMSE/AMT
Urine and culture
ECG
CT head/ LP/EEG if indicated
```
90
Puerperal psychosis recovery time
Usually 6-8 weeks
91
Management of puerperal psychosis
As per condition outside pregnancy
Bio- benzos, antipsychotics, mood stabilisers, antidepressants, ECT
Psych- CBT, family therapy, psychoeducation
Social- Support for the family, housing, employment, protection of the children
92
Suicide risk assessment questions
```
Current episode
BEFORE
Precipitant
Planned or impulsive
Precautions against discovery
Alcohol
DURING
Method, alone, where, what was going through their mind, did they mean to end their life, what did they do straight after
AFTER
Who were they found by, how did they feel when help arrived, do they regret it, current mood, still feeling suicidal, what would they do if they went home today
```
93
Specific questions to ask about overdose
```
What medication(s) did they take?
Where did they get it
How much of them?
What did they take it with?
How long had they been planning and what made them decide?
What did they do after?
How did they get here?
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