TO DO PSYCHIATRY Flashcards

Question

SCHIZOPHRENIA What is the management of schizophrenia?

Answer 1

1ST LINE - atypical antipsychotic - psychological interventions e.g. CBT, art therapy + family interventions 2ND LINE - alternative antipsychotic 3RD LINE - clozapine

Answer 2

- Delusion in which patient (usually single woman) believes another person (typically higher social status) is in love with them

Answer 3

- Delusional jealousy - Patients (typically men) possess fixed belief that their partner has been unfaithful + often try to collect evidence

Answer 4

- Symptoms of muscle + psychic tension - Causes significant distress + functional impairment - No particular stimulus

Answer 5

- Difficulty controlling worry, present for more days than not for ≥6m - ≥4 symptoms with ≥1 from autonomic arousal section - Autonomic arousal, physical, mental, general, tension, other

Answer 6

i) Palpitations, tachycardia, sweating, tremor ii) Breathing issues, choking, CP, nausea, abdo distress iii) Dizzy, derealisation + depersonalisation, fear of losing control, impending death iv) Numbness + tingling, hot flushes + chills, sleep issues (initial insomnia, fatigue on waking) v) Muscle aches + pains, restless, lump in throat vi) Exaggerated responses to minor surprises/startled

Answer 7

- History, MSE + risk assessment - GAD-7 + Hospital Anxiety + Depression Scale (HADS) questionnaire - Exclude organic (FBC, U+Es, LFTs, TFTs, fasting glucose, PTH)

Answer 8

STEP 1 - education about GAD - active monitoring STEP 2 - self-help, individual guided self-help STEP 3 - CBT or SSRI (sertraline) STEP 4 - refer for specialist treatment

Answer 9

- Sertraline first line, if ineffective offer alternative SSRI or SNRI - If SSRI/SNRI not tolerated then pregabalin - Beta-blockers like propranolol for physical Sx sometimes

Answer 10

- Recognition + diagnosis with treatment in primary care - CBT or drug therapy (SSRIs 1st line, if C/I or no response after 12w then imipramine or clomipramine) - Psychodynamic psychotherapy + specialist MH services if severe

Answer 11

- SSRIs as for panic disorder - BDZs for short-term use only (clonazepam)

Answer 12

- Overt = can be observed (checking the door) - Covert = can't be observed (repeating a phrase in their mind) - Obsession > anxiety > compulsion > relief

Answer 13

- 1st line SSRIs = sertraline - 2nd line = clomipramine (TCA) with specific anti-obsessional action - ?Psychosurgery (stereotactic cingulotomy if intractable > 2 antidepressants, 3 combination Tx, ECT + behavioural therapy

Answer 14

HEAR (≥1m) – - Hyperarousal - Emotional numbing - Avoidance + rumination - Re-experiencing (involuntary)

Answer 15

- Venlafaxine or SSRI like sertraline - Risperidone for severe cases where resistant to treatment or psychotic

Answer 16

FEED ≥3m with absence of binge eating – - Fear of fatness - Endocrine disturbance - Extreme weight loss - Deliberate weight loss

Answer 17

- Osteoporosis, thyroid issues, cardiac atrophy - Electrolyte disturbances (hypokalaemia > arrhythmias) - Decrease in WBC > increased infections - Death due to health complications or suicide

Answer 18

SCOFF – - Do you ever make yourself SICK as too full? - Do you ever feel you've lost CONTROL over eating? - Have you recently lost more than ONE stone in 3m? - Do you believe you're FAT when others say you're thin? - Does FOOD dominate your life?

Answer 19

- Sit up squat stand (SUSS) test /3 - BP (low), temp (low) - ECG (brady, T-wave changes, QTc prolongation) - FBC (anaemia, dehydrated), LFTs, urinalysis, serum proteins - U+Es, Ca2+, Mg2+, phosphate > vomiting, laxatives, diuretics, water loading - DEXA scan after 1y of underweight (osteopenia)

Answer 20

Gs + Cs – - GH, Glucose, salivary Glands - Cortisol, Cholesterol, Carotinaemia

Answer 21

Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN)

Answer 22

- BMI <13, severe malnutrition or dehydration - HR <40, ECG changes - BP <90 systolic, <70 diastolic esp with postural drop - Temp <35 - Severe electrolyte disturbances (K+, Na+, Mg2+, phosphate = low) - SUSS test of 0 or 1 - Significant suicide or serious self-harm risk

Answer 23

- Fluoxetine, chlorpromazine + TCAs may be used for weight gain

Answer 24

- Individual therapy (eating disorder focussed CBT, CBT-ED) - Maudsley anorexia nervosa treatment for adults (MANTRA) - Specialist supportive clinical management (SSCM)

Answer 25

- Reduced carb consumption leads to reduced insulin secretion so the body switches from carb > fat + protein metabolism - Electrolyte stores depleted as needed to convert glucose>energy - Reintroducing food causes abrupt shift from fat>carb metabolism + insulin secretion surges, driving electrolytes from serum>cells to help convert glucose>energy causing further serum concentration decrease

Answer 26

- Fatigue, weakness, confusion, dyspnoea (risk of fluid overload) - Abdo pain, vomiting, constipation, infections

Answer 27

- Hypophosphataemia main disturbance due to role of converting glucose>energy - Hypokalaemia, hypomagnesaemia + thiamine deficiency too - Abnormal fluid balance

Answer 28

- Start up to 10cal/kg/day + increase to full needs SLOWLY over 4–7d - Start PO thiamine, B vitamins + supplements before + during feeding - K+, phosphate + magnesium replacement

Answer 29

BPFO ≥2 a week for ≥3m – - Behaviours to prevent weight gain - Preoccupation with eating (compulsion to eat but regret after) - Fear of fatness - Overeating ≥2/week

Answer 30

SYMPTOMS - recurrent episodes of binge eating - feelings of loss of control during binges - compensatory behaviours (induced vomiting, laxative use or diuretic abuse, excessive exercise) - preoccupation with body weight and shape - thinking about food a lot SIGNS - erosion of tooth enamel - enlarged salivary glands - Russell's sign (calluses/scars on knuckles from induced vomiting) - weight fluctuations - warning signs (eating very rapidly, goes to bathroom very soon after eating)

Answer 31

- Characterised by odd, eccentric thinking or behaviour - MAD

Answer 32

- pattern of suspiciousness about others - tendency to perceive attacks on their character + questions loyalty of friends - hypersensitivity + unforgiving when insulted - preoccupation with conspiracy beliefs + hidden meaning - reluctance to confide in others - are less resistant to change their beliefs when challenged compared to a patient with delusions

Answer 33

i) Conspiracy ii) Devious, trying to cause harm iii) Always on guard + suspicious of others, emotionally cold/distant iv) Watchfulness v) Trusting (fear others will use information against you) vi) Being discriminated against

Answer 34

- emotional coldness - lack of desire for companionship - preference for solitary activities - few friends or confidants - lack of interest in sexual interactions

Answer 35

i) Uncaring ii) Pointless, replaceable iii) Only person they can depend on iv) Withdrawal, prefer to be alone v) Emotionally available + close vi) Being over-cared for or smothered by others vii) Inability to take pleasure from activities, little interest in sex

Answer 36

- odd, eccentric behaviour or 'magical thinking' - inappropriate behaviour - ideas of reference (applying meaning to coincidences or innocuous events) - peculiar speech, mannerisms or dress code - are not psychotic

Answer 37

- Ideas of reference (not delusions as insight) - Excessive social anxiety with lack of close friends + social withdrawal - "Magical thinking" believing you can influence people/events with thoughts - Unusual perceptions (illusions, overvalued ideas) - Odd/eccentric behaviour, beliefs, speech or appearance - Inappropriate affect with paranoid or suspicious ideas

Answer 38

- Characterised by dramatic, overly emotional or unpredictable thinking or behaviour (BAD)

Answer 39

- Childhood conduct disorder before 15 + pattern of irresponsible + antisocial behaviour after age 15

Answer 40

- When they get in trouble with the law - Same traits but without law involvement

Answer 41

i) Predatory ii) Weak iii) Autonomous + alone iv) Aggressive/violent v) Gentle + sensitive, conform to social norms vi) Perceiving exploitation vii) Disregard for others' needs, feelings, safety, impulsive + lacks remorse

Answer 42

- intense and unstable interpersonal relationships - unstable affect regulation (variable, intense moods) - repeated self-injury and suicidality - Often Hx of childhood sexual abuse

Answer 43

i) Contradictory ii) Untrustworthy iii) Self-harm/suicide (impulsive + unpredictable) iv) Able to show self-compassion v) Abandonment (extreme reactions) vi) Paranoid when stressed, labile mood, unstable + intense relationships

Answer 44

i) Difficulties with impulsive + risky behaviours (unsafe sex, gambling) + anger ii) Difficulties with relationships, self-harm + feelings of emptiness

Answer 45

- exaggerated dramatic behaviour designed to attract attention - attention seeking - flirtatious, seductive, charming and lively - manipulative and impulsive - uncomfortable when they are not the centre of attention - may embarrass friends/family with public displays of emotion - consider their relationships to be closer than they actually are

Answer 46

i) Their audience (crave attention) ii) In competition for attention iii) Exhibitionism (provocative for attention) iv) Able to listen to others v) Actively or passively side-lined vi) Vivacious, easily influenced by others, excessive concern with physical appearance vii) Closer than what they really are

Answer 47

- grandiose sense of self-importance (e.g. exaggeration of achievements) - sense of entitlement + expectation of favourable treatment - arrogant, haughty behaviour - believes they are special + can only be understood by other special people - lacks empathy + often exhibits envy

Answer 48

i) Competition ii) Inferior iii) Special + more important than others iv) Competitiveness v) Humble vi) Loss of social rank/status or being embarrassed vii) Failure to recognise other's needs or feelings, arrogance, envy (both ways)

Answer 49

- Characterised by anxious, fearful thinking or behaviour (SAD)

Answer 50

- avoidance of feared stimuli - major fears include fear of criticism and rejection - views self as inept and inferior - extreme social anxiety - strong desire for intimacy - strongly linked to childhood issues (neglect + abuse)

Answer 51

i) Evaluative ii) Judgemental iii) Inept iv) Inhibition (social, avoids this) v) Assertive vi) Exposed, ridicule, criticism or rejection vii) Feeling inadequate or inferior, extreme shyness, fear of disapproval

Answer 52

- difficulty in decision making without excessive reassurance - lack of initiative or extreme passivity - will make effort to encourage others to make decisions regarding their own life - often seen in those with overprotective or authoritarian parents

Answer 53

i) Overwhelming ii) Stronger + more competent than themselves iii) Needy iv) Clinging v) Self-sufficient vi) Making a decision, abandonment vii) Requires excessive advice/reassurance, tolerant of abusive treatment, relationship hops, difficult disagreeing with others

Answer 54

- Pervasive pattern of perfectionism + inflexibility lacking insight - Hx of family pressure + wanting approval

Answer 55

i) Sloppy ii) Irresponsible iii) Responsible iv) Controlling v) Flexible vi) Making a mistake vii) Preoccupied with order, extreme perfectionism, neglect friends due to excessive project commitment, rigid + stubborn

Answer 56

- Assessed (Hx + MSE) more than once - Minnesota Multiphasic Personality Inventory (MMPI) - Eysenck Personality Inventory + Personality Diagnostic Questionnaire

Answer 57

- Dialectical behavioural therapy for EUPD - CBT (change unhelpful ways of thinking) - Cognitive analytical therapy (recognise + change unhelpful patterns in relationships + behaviours) - Psychodynamic therapy (looks at how past experiences affect present behaviour)

Answer 58

- Clouding of consciousness, disorientation + amnesia of recent events - Autonomic = diaphoresis, fever, tachycardia (risk of CV collapse) - Psychomotor agitation, delusions + coarse tremor - Visual, auditory + tactile hallucinations

Answer 59

- Atrophy of mammillary bodies due to thiamine deficiency, often alcohol abuse

Answer 60

Triad – - Ataxia - Confusion - Ophthalmoplegia + nystagmus

Answer 61

- Heavy alcohol drinkers - Head injury, post-anaesthesia - Basal or temporal lobe encephalitis - CO poisoning - Other causes of thiamine deficiency (anorexia, starvation, hyperemesis)

Answer 62

- Ataxia, dysarthria, confusion (drunk) - COARSE tremor, blurred vision, hyperreflexia - N+V, diarrhoea - Myoclonus, seizures + coma if severe

Answer 63

- Arrhythmias (VT) - Acute renal failure - Syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) after cessation of lithium >2m = truncal ataxia, ataxic gait, scanning speech, incoordination

Answer 64

- Serum [Li] >5mmol/L OR >4 + renal dysfunction OR severe toxicity (seizures, coma, life-threatening arrhythmias)

Answer 65

- Rapid onset after dose given or changed - Spasm of muscles of tongue, face, neck + back - Oculogyric crisis (prolonged involuntary upward deviation of eyes) - Torticollis (twisted neck) - Tongue protrusion

Answer 66

- ABCDE approach as emergency - Anticholinergic – IM procyclidine - Stop antipsychotic (switch to atypical as less EPSEs)

Answer 67

develops over days to weeks SYMPTOMS - altered mental state - muscle discomfort - confusion - agitation - sweating SIGNS - fever >38 degrees - reduced GCS - generalised muscle rigidity (lead-pipe rigidity) - tachycardia - hyporeflexia

Answer 68

- Resp failure, CV collapse - Rhabdomyolysis - DIC

Answer 69

- ABCDE approach 1ST LINE - Stop antipsychotic (wait >2w before restarting, consider atypical) - Give L-dopa if dopamine withdrawal in Parkinson's - supportive care (IV rehydration) 2ND LINE - IV dantrolene or lorazepam to reduce rigidity 1st line (amantadine second) - Bromocriptine prophylaxis

Answer 70

develops within 24hrs SYMPTOMS - shivering - headache - diarrhoea - agitation - pressured speech - hypervigilance SIGNS - hypertension - tachycardia - mydriasis - myoclonus - hyperreflexia - hyperthermia - muscle rigidity

Answer 71

- ABCDE 1ST LINE - discontinuation of serotonergic agent - supportive care (IV fluids + treatment of hyperthermia) - benzodiazepines (DIAZEPAM) 2ND LINE - cyproheptadine (if symptoms persist)

Answer 72

- Low intellectual performance (IQ < 70) - Onset during birth or early childhood - Wide range of functional impairment

Answer 73

- Genetic = Down's, Fragile X, Prader-Willi, neurofibromatosis - Antenatal = TORCH - Perinatal = asphyxia, intraventricular haemorrhage - Postnatal = meningitis, kernicterus - Environmental = malnutrition, smoking or alcohol in pregnancy

Answer 74

i) 50–69 ii) 9–12 iii) Mobile iv) Mostly adequate v) Difficulties reading + writing vi) Most independent

Answer 75

i) 35–49 ii) 6–9 iii) Mobile iv) Simple-no speech, may sign, reasonable comprehension v) Limited, some learn to read, write + count vi) Lifelong supervision, may need prompting + support

Answer 76

i) 20–34 ii) 3–6 iii) Marked impairment iv) Simple-no speech, may sign, reasonable comprehension v) Limited, some learn to read, write + count vi) Lifelong supervision, may need prompting + support

Answer 77

i) <20 ii) <3 iii) Severe impairment iv) Basic non-verbal comms, understands basic commands v) None vi) Complete dependency

Answer 78

- M>F - Obstetric complications - Perinatal infection (rubella) - Genetic disorders (Fragile X, Down's)

Answer 79

- Social interaction - Communication (speech + language) - Behaviour (imposition of routine with ritualistic or repetitive behaviour)

Answer 80

- Failure to notice + respond to social cues + others' emotional states - Difficulty establishing friendships - Lack of eye contact - Delay in smiling

Answer 81

- Expressive speech + comprehension usually delayed or minimal - Concrete thinking (lack imagination) - Absence of gestures - Later speech consists of monologues, endless questions, echolalia

Answer 82

- Inability to adapt to new environments (distress) - Tendency to have rigid routine with resistance to change - Greater interest in objects, numbers + patterns than people - Stereotypical repetitive movements which may be self-stimulating movements to comfort themselves (rocking, hand-flapping)

Answer 83

- boys and men - history of neurodevelopmental disorder (autism + other learning difficulties) - family history of ADHD or other mental health disorder - premature birth - epilepsy

Answer 84

- Inattention - Impulsivity - Hyperactivity

Answer 85

Conservative initially (watch + wait) – - Family education on ADHD + parenting advice - Establish normal balanced diet, exercise can improve Sx - Food diary to identify any triggers + eliminate with dietician - 1st line = Methylphenidate (“Ritalin“) -2nd line = Lisdexamfetamine - 3rd line = Atomoxetine

Answer 86

- Non-specific + atypical Sx (usually derm, GI) - Discrepancy between subjective + objective findings (S = Sx) - Sx often in one system, may move to another once Dx possibilities exhausted - Often results in multiple needless investigations + operations (pt refuses to accept -ve results)

Answer 87

i) Person who emotionally + psychologically feels that they belong to opposite sex ii) Assigned male sex 46XY at birth who later identifies as a woman iii) Assigned female sex 46XX who later identifies as a man

Answer 88

i) Referral to gender identity development service (GIDS) with MDT (CAMHS, clinical psychologist, social worker, family therapist) ii) Referral to gender dysphoria clinic (GP or self-referral)

Answer 89

- Oestrogen = clots, gallstones, high triglycerides - Testosterone = polycythaemia, acne, dyslipidaemia - Both = elevated LFTs, infertility, weight gain

Answer 90

Manic type or depressive type

Answer 91

Psychotic Sx tend to wax + wane, unlike in schizophrenia

Answer 92

Temporal lobe

Answer 93

- Multiple motor tics + at least 1 phonic tic (coprolalia)

Answer 94

The false perception of a real external stimulus

Answer 95

An internal perception occurring without a corresponding external stimulus. The person experiences it as they would a real perception.

Answer 96

A fixed, false, unshakable belief which is out of keeping with the patient's educational, cultural + social norms. It's held with extraordinary conviction + certainty (even despite contradictory evidence)

Answer 97

- Capgras = idea someone has been replaced by an imposter. - Fregoli = idea various people are the same person - Intermetamorphosis = one significant relative is replaced by another (father is son).

Answer 98

A primary delusion of two components – where a normal perception is subject to delusional interpretation E.g. – traffic light changed red so that means I am the son of God

Answer 99

Abrupt leaps between topics as a result of thoughts presenting more rapidly than can be articulated. Each thought = more associations. ?Discernible links between successive ideas. Presents as pressure of speech.

Answer 100

- Delusion that one is a passive recipient of actions from an external agency against their will - The same but sensations are controlled by an external agency

Answer 101

A surprising lack of concern for, or denial of, apparently severe functional disability (not specific to psych)

Answer 102

Development of features suggestive of physical illness but which are attributed to psych illness or emotional disturbance rather than organic pathology

Answer 103

Repetitive + bizarre act which is not goal-directed. Action may have delusional significance to the pt

Answer 104

Abnormal + occasionally bizarre performance of voluntary, goal-directed activity

Answer 105

hallucinations which are experienced outside the normal sensory field (seeing something behind them)

Answer 106

irrelevant wandering in conversation (going around the point).

Answer 107

This is thought disorder denoting a lack of connection between ideas. Links between ideas may be illogical or the speech may wander between trains of thought. It is also known as knight's move thinking

Answer 108

When someone gets stuck on a topic or an idea There may be repetition of words or phrases

Answer 109

- D2 receptor antagonist - Reduced release of dopamine from dopaminergic neurones + so reduced electrical activity in dopaminergic pathways

Answer 110

Mesolimbic pathway (reduces +ve Sx)

Answer 111

- Antagonists at dopamine D2 receptors but more selective in dopamine blockade + so block serotonin 5-HT2a

Answer 112

- Extra-pyramidal side effects (EPSEs) - Hyperprolactinaemia - Metabolic - Anticholinergic - Neurological

Answer 113

- Acute dystonic reaction - Parkinsonism - Akathisia - Tardive dyskinesia

Answer 114

- Weight gain (esp. olanzapine) - Hyperlipidaemia, risk of stroke + VTE in elderly - T2DM risk + metabolic syndrome

Answer 115

Can't see, pee, spit, shit – - Blurred vision - Urinary retention - Dry mouth - Constipation + tachycardia

Answer 116

- Lipids + BMI at 3m - Fasting glucose + prolactin at 6m - Frequent BP during dose titration - FBC, U+Es, LFTs, lipids, BMI, fasting glucose, prolactin + CV risk yearly

Answer 117

- Prevents reuptake + subsequent degradation of serotonin from synaptic cleft by inhibiting its reuptake transporter on the post-synaptic membrane - Prolonged serotonin in synaptic cleft = prolonged neuronal activity - Citalopram, sertraline, fluoxetine

Answer 118

- GI Sx most common (N+V, hyponatraemia, abdo pain, bowel issues, increased bleed risk) - Sedation + sexual impotence - Citalopram + QTc prolongation (dose-dependent)

Answer 119

- Prevents reuptake + subsequent degradation of serotonin AND noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic membrane

Answer 120

- GI (N+V, constipation), central/peripheral effects (SIADH, rhabdomyolysis)

Answer 121

- Inhibits monoamine oxidase enzyme which reduces breakdown of adrenaline, noradrenaline + serotonin so increases level

Answer 122

- Sexual dysfunction, weight gain + postural hypotension

Answer 123

- Increased risk of serotonin syndrome if used with other serotonergic drugs - Hypertensive crisis with ingestion of foods containing tyramine (aged cheeses, smoked/cured meats, pickled herring, Bovril, Marmite)

Answer 124

- Prevents reuptake + subsequent degradation of serotonin + noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic neuronal membrane

Answer 125

- Anticholinergic (can't see, pee, spit, shit)

Answer 126

- Blocks alpha-2 adrenergic receptors > increased release of neurotransmitters

Answer 127

LITHIUM – - Leukocytosis - Insipidus (diabetes, nephrogenic) - Tremors (fine if SE, coarse if toxicity) - Hydration (easily dehydrates, renally cleared) - Increased GI motility (N+V, diarrhoea) - Underactive thyroid - Mums beware (Ebstein's anomaly) Can cause weight gain + derm (acne, psoriasis) long-term too

Answer 128

- NSAIDs, ACEi, ARBs + diuretics may increase lithium levels - Diuretics = dehydration, NSAIDs = renal damage

Answer 129

- Weekly serum lithium after initiation + dose changes until stable then every 3m for a year, then every 6m (sample taken 12h after dose) - 6m = TFTs, U+Es, eGFR - Annual = BMI

Answer 130

- GABA agonists on alpha2-subunit of GABA(A)-BDZ receptor/Cl- channel complex

Answer 131

Nigrostriatal (Parkinsonism), tuberoinfundibular (prolactin)

Answer 132

More useful in treating -ve Sx of schizophrenia + less likely to cause EPSEs

Answer 133

Aripiprazole as it is a partial dopamine agonist

Answer 134

- Constipation (big issue in elderly) - Reduced seizure threshold, hypersalivation (Rx hyoscine hydrobromide)

Answer 135

Prevention crucial, switch to atypical anti-psychotic, tetrabenazine used if mod–severe but unlikely to completely resolve

Answer 136

- NSAIDs warfarin (increased risk of bleeding), lower seizure threshold

Answer 137

haloperidol, flupentixol zuclopenthixol (decanoate = depot) chlorpromazine

Answer 138

olanzapine, risperidone (depot), clozapine, aripiprazole (depot), quetiapine

Answer 139

Venlafaxine, duloxetine

Answer 140

- Selegiline is selective MAO-B inhibitor which also increases dopamine - Isocarboxazid, phenelzine

Answer 141

Sinus tachy, wide QRS, prolonged QT interval

Answer 142

Sodium bicarbonate

Answer 143

Increased appetite + weight gain + sedation are big ones, also increased triglyceride levels

Answer 144

Lithium inhibits cAMP production which inhibits monoamines

Answer 145

Zopiclone, zolpidem, BDZs used for hypnotic effect (lorazepam, temazepam)

Answer 146

- Enhance effect of inhibitory GABA by increasing frequency of Cl- channels + flow of Cl- ions causing hyperpolarisation of membrane + so prevention of further excitation

Answer 147

IV flumazenil (danger of inducing status epilepticus or death though)

Answer 148

- Withdrawal - Cravings - Continued use despite harm - Tolerance - Primacy/salience - Loss of control - Narrowed repertoire - Rapid reinstatement

Answer 149

- Health checks + BBV screening - Contraception, smear + sexual health advice - General immunisation status + hep A/B - Information on local drug services (needle exchange)

Answer 150

- Amygdala + nucleus accumbens - Cerebral cortex - Pre-frontal cortex - Cerebellum - Hypothalamus + pituitary - Medulla

Answer 151

i) Euphoria, pleasure + reward centre ii) Slows thinking + speech iii) Slow behavioural inhibition centres (confident + relaxed) iv) Slows movement + impairs coordination v) Alters mood + hormones (libido increases) vi) Decreases breathing, consciousness + body temp

Answer 152

- 6–12h = tremors, sweating, tachycardia, anxiety, irritability + aggression - 36h = seizures - 48–72h = delirium tremens

Answer 153

- Have you ever felt you need to CUT down on your drinking? - Have people ANNOYED you by criticising your drink? - Have you ever felt GUILTY about your drinking? - EYE-opener – ever felt you need drink first thing in morning to steady your nerves?

Answer 154

- How often do you have a drink containing alcohol? - How many units of alcohol do you drink on a typical day? - How often did you have >6 units on a single occasion in the past year?

Answer 155

- Increasing tax on alcohol + restricting advertisement on alcohol - Drinkaware + know your limits campaign - Keeping alcohol out of site (behind counter + having to ask for it) - School alcohol education to reduce long-term alcohol use + binge drinking

Answer 156

- Chlordiazepoxide 1st line (2nd = diazepam, lorazepam is preferred for pts with liver cirrhosis) for withdrawal Sx + preventing seizures - Thiamine (PO or IV) - Rehydrate with fluids (often IV), correct electrolyte disturbance - Reducing regime (slowly reduce doses over days)

Answer 157

- Naltrexone - Acamprosate - Disulfiram

Answer 158

- Opioid receptor antagonist - Blocks euphoric effects of alcohol - Helps people stick to detox programme + avoid relapse

Answer 159

- NMDA antagonist acts on GABA to reduce cravings + risk of relapse

Answer 160

- Inhibits acetaldehyde dehydrogenase > build-up of acetaldehyde - Produces hangover-like Sx when alcohol is drunk = deterrent (flushing, headaches, anxiety, nausea, reduced BP)

Answer 161

- Bind to m-receptor > endogenous endorphins causing cortical inhibitor effects (analgesia) almost immediately - Addictive as high reward for minimal effort

Answer 162

- Naltrexone - Opiate antagonist which prevents lapse > relapse

Answer 163

- BDZs, barbiturates (increased duration of Cl- channels) often taken for their anxiolytic effects - Rohypnol > intoxicant, aphrodisiac + anterograde amnesia - PO + IV

Answer 164

Sweating, myalgia, tremors, risk of seizures

Answer 165

Cocaine, ecstasy (MDMA), amphetamines (speed)

Answer 166

Psychomotor agitation, dysphoric mood, insomnia bizarre/unpleasant dreams

Answer 167

- Arrhythmias, MI + damage to nasal septum if used chronically

Answer 168

i) Euphoria + disinhibition, hallucinations, paranoid, agitation, time passes slowly ii) Increased appetite, dry mouth, tachycardia

Answer 169

- Hallucinations, illusions, depersonalisation + derealisation, paranoia, impulsivity, anxiety, magic mushrooms > euphoria as serotonin release - Tachycardia, palpitations, sweating, blurred vision

Answer 170

- % ABV x volume (L)

Answer 171

"Goose flesh" (piloerection), raised HR/BP, fever, pupil dilatation, abdo cramps, insomnia, agitation (everything runs > D+V, lacrimation, rhinorrhoea, diaphoresis)

Answer 172

i) Euphoria + disinhibition, hallucinations, paranoid, agitation, time passes slowly ii) Unsteady gait, dysarthria, hypotension, nystagmus iii) Sweating, myalgia, tremors, risk of seizures

Answer 173

- when smoking a higher level of clozapine may be required to get therapeutic dose - if stopping smoking a lower dose of clozapine may be required

Answer 174

- Potentiate mood enhancing neurotransmission (dopamine, serotonin, noradrenaline) by blocking their uptake + increase cortical excitability

Answer 175

i) Euphoria, increased alertness + endurance, grandiosity, hallucinations, aggression, impulsivity ii) Tachycardia, HTN, N+V, pupil dilation, CP + convulsions

Answer 176

- LSD, magic mushrooms (PO)

Answer 177

Very – laryngospasm due to cold temp, brain damage, hypoxia

Answer 178

UNSTABLE SELF IMAGE - low self esteem - recurrent suicidal/self-harming behaviour IMPULSIVITY - self-sabotaging or risk-taking behaviour - difficulty controlling temper POOR INTERPERSONAL RELATIONSHIPS - short romantic relationships - feelings of abandonment - idealisation + devaluation of others PARANOIA - quasi-psychotic thoughts in response to stress (transient psychosis that is not prolonged and does not require medication)

Answer 179

- 1st line = benzodiazepines - chest pain = benzodiazepines + GTN - MI = PCI - HTN = benzodiazepines + sodium nitroprusside

TO DO PSYCHIATRY Flashcards

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