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Random psych Flashcards

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1
Q

Organic causes of psychosis

A

Vascular -cerebrovascular accident
Infection- encephalitis, meningitis, neurosyphilis
Traumtic brain injury
Autoimmune encephalitis (anti-NMDA, anti-VGKC)
Metabolic- B12 deficiency, pellagra (vit B3 deficiency), acute intermittent porphrya, wilsons
Iatrogenic- steroids,
Neoplasms- brain tumor
Endocrine- thyrotoxicosis, cushings
Neurodegenerative disease- Alzheimers, Lewy-body, Parkinsons, huntingtons

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2
Q

what is schizoaffective disorder

A

schizophrina + bipolar disorder(mood disorder)

random episodes of psychosis within mood fluctuations

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3
Q

what prescribed medications can cause psychosis?

A

steroids
anticholinergics eg. TCAs
dopaminergics eg. bromocriptine
thyroxine
antimalarials

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4
Q

what illicit substances are most likely to cause psychosis

A
  1. high THC containing cannabinoids- esp synthetic weed (spice)
  2. amphatamines
  3. hallucinogens (LSD, PCP, psilocybin)
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5
Q

key question to ask with someone presenting with auditory hallucinations

A

do you hear the voices through your ear or inside your head?

(true psychotic pts will try to find an explanation for the auditory hallucinations and put them down to an external stimuli as to not sound as crazy. Pts who want to appear psychotic will say thet hear voices in their head)

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6
Q

according to ICD-11, how long does someone need to have symptoms to be diagnosed with schizoprenia?

A

1 month

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7
Q

what is the first line psychological treatment for borderline personality disorder

A

dialectal behavioural therapy (DBT)

remember its pretty much the only condition where CBT isnt the first line

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8
Q

What are the different personality disorders in cluster A personality type

A

Paranoid
schizoid
schizotypal

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9
Q

What are the different personality disorders in cluster B personality type

A

Antisocial
narcissistic
Histrionic
Borderline

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10
Q

Features of anorexia nervosa

A
  • morbid fear of fatness (overvalued idea)
    -BMI <17.5
  • deliberate measures to lose weight eg. food restriction, excessive exercise
  • endocrine disturbances eg. amenorrhoea in women,
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11
Q

Physical disturbances in anorexia nervosa

A
  • low BMI <17.5
  • bradycardia
  • hypotension
  • lenugo hair
  • cold extremities
  • hypothermia
  • constipation
  • amenorrhoea
  • severe: long QTc
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12
Q

What is refeeding syndrome

A

Happens when there is a significant reintroduction of food after the person has had a substantial period of malnourishment

When glucose is reintroduced, there is a surge in insulin, which draws already depleted K, Mg and phosphate into cells leading to major hypokalaemia, hypomagnesmaeia and hypophosphataemia

clinical features:
nausea
muscle weakness
confusion/ coma
arrhythmias- torsades de pointes
ECG changes- T wave flattening and U waves

+thiamine deficiency –> wernickes encephalopathy

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13
Q

features of bulimia nervosa

A
  • characterised by repeated bouts of binging, feeling of regret followed by purging
    eg. vomiting, laxatives, diuretics
  • excessive preocupation of controlling body weight
  • episodes must happen at least 1/week for 3 months to fit diagnostic criteria

may not be underwight like in anorexia

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14
Q

Physical/ clinical signs in bulimia nervosa

A

signs of excessive vomiting:
erosion of teeth

Russels sign- calluses on the knuckles due to self induced vomiting

swelling of parotid glands

hallitosis- bad breath

mallory weiss tear- haematemesis, pain

electrolyte disturbances- low Na, Cl, Mg, Phos and K
arrhythmias
metabolic alkalosis
dehydration
hypostnsion
tachycardia

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15
Q

what is the PHQ-9 questionnaire and what are the questions

A

assessment of the severity of depression

in the past 2 weeks how often…
1. have you had little interest or pleasure doing things
2. trouble sleeping or sleeping too much
3. loss of appetite or eating too much
4. feeling down, depressed or hopeless
5. lacked energy to do things
6. felt like youve let people around you down
7. trouble concentrating
8. changes in speech
9. had thoughts that youd be better off dead

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16
Q

how to interpret the PHQ-9 score

A

0-4: normal
5-9: mild depressiom
10-14: moderate
15-19: moderately severe
20-27: severe

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17
Q

management of acute mania

A
  1. risk assess and consider section 5(2)
    - Urine drug screen
    - monitor fluid status
  2. if first presentation:
    • short acting benzo (lorazepam)
      - antipsychotic: olanzepine
  3. if already on medication
    - optimise dose
    - check for any interactions
    - consider adding antipsychotic
  4. ECT if unresponsive to Rx

After:
-check compliance
- enquire for any trigger (eg. drugs, antidepressant)
- prev episodes of depression?

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18
Q

Key questions to ask in a history of a manic pt

A

why do they think they are here?

whats been going on?

MOOD: How do they feel in themselves
Have you ever had something like this before?
Have you ever had a period of time where you felt the complete opposite?

THOUGHT: probs will just come out

PERCEPTION: have you been hearing things when it seems like no one is around?

Do you hear through your ear or in your head

INSIGHT: Do you know why you are seeing a psychiatrist? Do you think there is a problem with your mental health

RISK: have you had any thoughts about harming/ killing yourself. Any thoughts of harming others
Do you feel safe?
been spending more money than usual?

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19
Q

what is the managament of adjustment disorders

A
  • spectrum of reactions as a response to ill health

health psychology
antidepressents
commmunication
counselling
symptom control of medical issues
CBT

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20
Q

Medical emergencies related to psychiatric medication

A

neuroleptic malignant syndrome (anti psychotics)
serotonin syndrome (antidepressants)
long QTc –> torsades de pointes (citalopram)

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21
Q

psychiatric problems from medications

A

Roaccutane (acne) –> depression increased suicidality
steroids –> psychosis, delerium, mania, depression

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22
Q

max dose of lorazepam

A

4mg in 24 hrs

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23
Q

Tests to perform in a GP setting for addiction

A

urine drug screen

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24
Q

GABA-A targeting drugs

A
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25
MOA of benzodiazepines
potentiates the affects of GABA which incrreases the flow of chloride ions and hence hyperpolarisation of post synaptic membrane --> reduced excitibility
26
Withdrawal features of benzos
anxiety, irritibility, restlessness, tremor, sweating, insomnia
27
toxicity features of benzos
drowsiness, ataxia, slurred speech, reduced conciousness severe: hypotension, brady cardia OD: respiratory depression
28
Antidote for benzo OD
Flumazenil
29
What drugs can be identified on the urinary drug screen
alcohol amphetamines barbiturates benzodiazepines cocaine cannabis methamphetamine opioids phencyclidine (PCP)
30
how long can cannabis be detected for on UDS after use?
casual use: 2-14 days heavy use: 30 days
31
Criteria for dependence in ICD-10 (6 points)
meeting 3 or more = diagnosis 1. a strong desireor sence of compulsion to take 2. difficulties in controlling 3. physiological withdrawal Sx when stop taking 4. evidence of tolerance leading to increased doses to feel the same affect 5. 6.
32
what are the stages of change in the prohchaska and DiClemente's model
pre-contemplation contemplation preparation action mainatainence relapse
33
Screening tools for alcohol misuse
CAGE FAST AUDIT
34
Key questions to ask in alcohol/ substance misuse history
Type of drink and how much in units when did it start what time of day alone or with people social network how much money are they spending on substances pattern of drinking eg. binging/ steadily any withdrawal sx triggers aware of the problem? any period of abstinence and for how long? Mental health comorbidity Diet any mixing of substances How is it affecting their life forensic history, getting into trouble on substances or to get substances
35
how to calculate units of alcohol
(total vol of drink (mls) x ABV%) /1000
36
features of alcohol dependence syndrome
37
Management options for someone with alcohol dependence
psycho: - motovational interview and discuss evidence for concern eg. deranges LFTs - discussion of a plan and warn not to go cold turkey - referral to specialist alcohol services social: - notify the DVLA - drink diary Bio: - thiamine replacement
38
alcohol effects on the CNS
complex interplay between excitatory and inhibitory systems
39
physical and psychological symptoms of alcohol usage
40
medication to help with cravings
Naltrexone - reduces the pleasure feelings of alcohol Disulfuram - inhibits acetaldehyde dehydrogenase which metabolises alcohol and causes intense symptoms if consume alcohol (even ETOH containing products such as perfumes) - acampostate - reduces hyperglutamatergic state. Anticraving drug
41
symptoms of alcohol withdrawal
tremors sweating N+V anxiety hypertension, tachycardia, dilated pupils 24-48hrs after last drink : seizures (tonic clonic) 24-72hrs after last drink: delerium tremens
42
Management of alcohol withdrawal
alcohol detox: clinical institute assessment for alcohol withdrawal benzos: long acting eg. chlordiazepoxide pabrinex dextrose: NEVER GIVE BEFORE PABRINEX as dextrose can potentiate wernikes in thamine depleted pts
43
risk factors for developing delerium tremens
previous DT co-infeciton pancreatitis, hepatitis older age abnormal liver function
44
What is wernickes encephalopathy
vitamin B1 (thiamine) deficiency confusion opthalmoplesia (eg. nystagus or CN6 palsy) ataxia
45
mechanism for thiamine deficiency in AD
1. poor diet due to alcohol 2. damage to gut from alcohol so poor absorption
46
what is korsakoffs psychosis
irreversible complication of wernickes antegrade and retrograde amnesia change in personality (frontal lobe dysfunction) eg. childlike behaviour confabulation psychotic symptoms
47
clinical features of opiate OD
reduced GCS pinpoint pupils hypotension respiratory depression hypotonia hyporeflexia
48
opioid substitution therapy
methadone: - reduces euphoria - more SEs: resp distress, long QTc, constipation, dry mouth buprenorphine - less sedation, less euphoria, less SEs but more unpleasant feelings
49
differentials for depression
organic- anaemia, low vitamin D, thyroid, cushings cognitive- dementia adjustment disorder insomnia
50
differentials for mania
organic- thyrotoxicosis, steroids, antimalarials acute psychosis delusional disorder, grandiosity
51
differentials for psychosis
organic- porphyrias, pellegra, brain tumour, autoimmune encephalitis, thyrotoxicosis, steroids, antimalarials delirium mania drug induced psychosis/ currently high depression with psychosis
52
differentials for confusion
organic- delerium/ infection, low glucose dementia
53
What questionnaire is used in the investigations for OCD and what are the questions
Yale-Brown obsessive compulsicve scale 5qus for each obsession and compulsion and each qu scored out of 5 (5most severe) Time, interference, distress, resistance, control 1. how much time is spent on the obsessions or compulsions 2. how much do these thoughts/ actions interfere with life 3. how much distress is it causing you 4. how much do you try to resist the obsessions/ compulsions 5. how much control do youe obsessions/ compulsions have over you
54
what are some example themes of typical obsessions
agressive obsessions sexual obsessions contamination obsessions hoarding obsessions religious obsessions obsession for symmetry somatic obsessions
55
what are some example themes of typical compulsions
checking compulsions cleaning/ washing compulsions repeating rituals counting ordering/ arranging sorting compulsions
56
what effects do smoking and alcohol have on clozapine levels
smoking cessation - levels will rise starting smoking/ smoking more will reduce levels alcohol binging - increase levels stopping drinking- reduces levels
57
features of PTSD
re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images avoidance: avoiding people, situations or circumstances resembling or associated with the event hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating emotional numbing - lack of ability to experience feelings, feeling detached
58
factors associated with poor prognosis of schizophrenia
strong family history gradual onset low IQ prodromal phase of social withdrawal lack of obvious precipitant
59
different classess of medically unexplained symptoms
somatisation - physical SYMPTOMS being present. Not reassured by negative test results hypoChondriasis - believing they have a severe medical condition despite reassurance eg. Cancer conversion disorder - loss of sensory or motor function usually in leg. common for over worked athletes dissociative disorder - separating off certain memories from reality eg. amnesia factitious disorder/ muchaussen syndrome - purposefully causing symptoms eg. causing a hypo by taking insulin malignering - fraudulent exaggeration or making up of symptoms with the intention of gains eg. financial, opioid medication
60
what features support a diagnosis of depression over dementia
short history, rapid onset biological symptoms e.g. weight loss, sleep disturbance patient worried about poor memory reluctant to take tests, disappointed with results mini-mental test score: variable global memory loss (dementia characteristically causes recent memory loss)
61
quick and useful clinical tool to differentiate organic from non-organic leg paresis
Hoovers sign get pr to raise unaffected leg and put hand under the heel of the affected leg. In a non-organic causes you will feel pressure under the heel due to involuntary contralateral hip extension
62
what is Cotard syndrome
Cotard syndrome is a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.
63
what is Charles Bonnet syndrome
is a psychophysical visual disorder where patients with significant vision loss have vivid, often recurrent visual hallucinations. These hallucinations can be simple (i.e. shapes, patterns) or complex (i.e. detailed objects, people) but patients almost always have insight into the fact that they are not real and do not suffer from any other forms of hallucinations (e.g. auditory) or delusions.
64
what is the mechanism of hypocalcaemia in someone who is hyperventilating
hyperventilation leads to low CO2 ad respiratory alkalosis alkalosis promotes albumin binding to calcium in the blood and therefore causes reduces free Ca Sx: tingling or numbness in hands and feet and around the mouth, funny turns
65
particular autoantibody associations with autoimmune encephalitis and paraneoplastic conditions
Anti-Hu: Small cell lung cancer NMDA receptor antibodies: Ovarian teratoma Anti-Yo: breast and ovarian tumours
66
management of paracetamol overdose
if injested <1hr ago - activated charcoal if injested <4hrs ago- wait til 4hrs to take blood sample if dose >150mg/kg- start N-acetylcysteine if staggered dose takene- start N- acetylecystein immediately if injested >24hrs ago - start NAC immediately calculation of paracetamol treatment level done using the NOMOGRAM - blood paracetamol level vs time after injestion. If above line then commence Rx
67
pathophysiology of paracetamol OD and antidote
Paracetamol is metabolised by CyP450 into NAPQI which is toxic glutothione binds to NAPQI into a non toxic conjugate in paracetamol OD the gutathione stores become depleated so you get toxic build up of NAPQI which is hepato and nephrotoxic NAC provides cystine for glutathione synthesis to help remove toxic build up
68
which is the preferred SSRI in breastfeeding women
paroxetine
69
contraindications oto Ach inhibitors in dementia
pre-existing QT prolongation
70
schneiders first rank symptoms
auditory hallucinations: hearing thoughts spoken aloud hearing voices referring to himself / herself, made in the third person auditory hallucinations in the form of a commentary thought withdrawal, insertion and interruption thought broadcasting somatic hallucinations delusional perception feelings or actions experienced as made or influenced by external agents
71
definition of learning disability
significant or resuced ability to understand new or complex information or skills reduce ability to cope independently present from before adulthood with persistent effect
72
tools used to help diagnose LD
weshcler adult intellegence scale to determine IQ Adaptive/Social functioning established via clinical interview and ABAS II (Adaptive Behaviour Assessment System) • Presence in childhood established using clinical interview and school reports
73
values for mild moderate and severe LD in terms of IQ
mild 50-69 moderate 35-49 severe 20-34 profound <20
74
common causes of LD
most common is genetic hypoxia infection
75
genetic diseases with LD
Downs syndrome fragile X prader will/ angelmans lesch nyan syndrome congenital hypothyroidism phenylketouria diGeorge
76
what physical illnesses are common in people with LD
epilepsy obestiy, DM, HPTN- due to poorer lifestyles hearing impairment
77
what psychiatric conditions are common in people with LD
autism schizophrenia mood disorders
78
vulnerability factors in people with LD
rejections/ neglect/ abuse poorer coping stratergies sexual/ emotional vulnerability low self esteem bereavement/ adjustment issues
79
what might challenging behaviour be as result of in someone with LD
physical problems- eg. pain, discomfort, dererium psychological- eg. anxiety, depression, psychosis, dementia social- eg. change in routine, carers, bereavement, ABUSE!!!
80
principles of management of someone with LD
BIO- regular physical health checks at GP treat any co-morbidities PSYCHO- counseling, support groups, CBT, behavioural therapy, family therapy SOCIAL- RISK assessment especially abuse, educational support, support with life skills etc..

Psychiatry (4 decks)

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