1
Q
EUPD Symptoms?
A
- Fluctuating mood
- Turbulent relationships
- Self-harm.
- Paranoid thoughts and visual or auditory hallucinations can also occur.
2
Q
Schizophrenia symptoms?
A
- Delusions
- Auditory hallucinations
- Disorders of thought perception.
3
Q
Schizoid Personality disorder?
A
- Difficulties forming close relationships
- Prefer to be alone
4
Q
Mania vs Hypomania
A
Distractability
Impulsivity
Grandiose Delusions
Flight of ideas
Activity increase
Sleep deficit
Talkative
Mania lasts > 7 days, Hypomania less
5
Q
First line for OCD with mild impairment?
Second line?
A
1st: CBT
2nd: SSRI
6
Q
Avoidant Personality Disorder symptoms?
A
- Fear of criticism
- Fear of being unliked
- Fear of rejection/ridicule
- Social isolated but crave social contact
7
Q
Antisocial personality disorder symptoms?
A
- Failure to conform to social norms including illegal activities
- Deception
- Repeated lying
- Lack of remorse
8
Q
What type of drug is Duloxetine?
A
SNRI
9
Q
SSRI discontinuation syndrome symptoms?
A
GI effects including diarrhoea, vomiting and abdominal pain
10
Q
ECT side effects?
A
Memory impairment - retrograde amnesia (events before the therapy)
11
Q
Antipsychotics extra pyramidal side effects?
A
Tardive dyskinesia:
- Lip smacking
- Jaw pouting
- Chewing
- Excessive blinking
12
Q
GAD first line?
second line?
A
1st: CBT
2nd: SSRI
3rd: SNRI
13
Q
What is erotomania? (De Clerambault syndrome)
A
A form of delusional disorder that someone famous is in love with them with no other psychotic symptoms
14
Q
Narcissistic personality disorder symptoms?
A
- Inflated self importance
- Excessive need for admiration
- Lack of empathy
15
Q
Depression vs Alzheimers in elderly?
A
- Can present very similarly
- Loss of appetite
- Early morning waking
- Poor concentration
- On MMS, depressive patients answer with ‘I don’t know’ whereas Alzheimers would try and answer questions
16
Q
MMS scores?
A
24-30 -> no impairment
18-23 -> mild impairment
0-17 -> severe impairment
17
Q
What class of drug is mirtazapine?
A
Noradrenergic and specific serotonergic antidepressant which blocks alpha 2 adrenoreceptors
18
Q
What is delirium tremens?
A
A state of confusion which usually occurs following alcohol withdrawal after dependency
19
Q
Treatment for delirium tremens?
A
10-30mg of Chlordiazepoxide 4 times a day
20
Q
Treatment of paracetamol overdose?
A
Acetylcysteine
21
Q
Psych side effect of corticosteroids?
A
Steroid-induced psychosis
22
Q
Side effects of typical anti-psychotics?
A
- Tardive dyskinesia
- Akathisia (inability to remain still)
- Galactorohoea
- Parkinsonism
23
Q
Tricyclic antidepressant side effects?
A
Antimuscarinic SE:
- Drowsiness
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
24
Q
What is circumstantiality?
A
Inability to answer a question without giving unnecessary detail but will usually return to the point
25
What is flight of ideas?
Thought disorder where there are leaps from one topic to another with limited links between them
26
What is tangentiality?
Speech which wanders from a topic without returning to it
27
What is clang associations?
Ideas being related by rhyme/similar sounding
28
What is echolalia?
Repeating words or phrases of the person you are talking to
29
Which antipsychotic is least likely to cause prolactin elevation?
Aripiprazole
30
What is the SSRI of choice in child/adolescent?
Fluoxetine
31
3 core symptoms of depression?
- Low mood
- Low energy
- Anhedonia
32
Examples of somatic symptoms?
- Early morning waking
- Loss of appetite and weight
- Loss of libido
- Diurnal mood variation
- Psychomotor retardation/agitation
33
Which gender is affected by anti-social PD more?
Which gender is affected by EUPD more?
ASPD - Men
EUPD - Women
34
Schizoid PD symptoms?
- Solitary behaviour
- Anhedonia
35
Management of acute dystonia due to antipsychotic use?
Procyclidine
36
What is a common endocrine disorder that occurs as a result of chronic lithium toxicity?
Hypothyroidism
Hyperparathyroidism -> Hypercalcaemia
37
What should happen if clozapine doses are missed for 48 hours or more?
Dose should be restarted again slowly
38
Psych S/E of levodopa?
Psychosis
39
What is the SSRI of choice post MI?
Setraline
40
What food should someone taking MAO inhibitors be told to avoid?
Tyramine containing foods e.g. cheese, cured meats -> causes HTN and headache
41
What is conversion disorder?
Neurological symptoms with loss of motor/sensory function which may be caused by stress
42
What is a consequence of long-term atypical antipsychotics use?
Glucose dysregulation and Diabetes
43
What is an obsession?
An intrusive, unpleasant thought
44
What is a compulsion?
A senseless action taken to reduce the anxiety caused by the obsession
45
What is the risk of SSRI use during third trimester?
Persistent pulmonary HTN
46
What should be used to treat tardive dyskinesia?
Tetrabenzine
47
What can exacerbate mania?
SSRIs
48
What is a non-reassuring deceleration?
One that lasts between 2-3 minutes
49
What is a abnormal deceleration?
One that lasts longer than 3 minutes
50
What anti-depressant is reccomended for use in OCD after SSRI?
Clomipramine
51
When might neuroleptic malignant syndrome present?
Shortly after starting anti-psychotics
52
What electrolyte abnormality can SSRIs cause?
Hyponatraemia
53
What should you monitor in patients who develop infections whilst taking Clozapine?
FBC to check for neutropenia
54
What is Cotard syndrome?
A type of nihilistic delusion where they believe they are dead/do not exist
55
What is the risk of SSRI use in the first trimester?
Congenital heart defects
56
Management of patients with poor compliance of oral anti-psychotics
Switch to monthly depot injections
57
Management of patients with poor compliance of oral anti-psychotics
Switch to monthly depot injections
58
What scoring system is used to assess alcohol withdrawal severity?
Clinical Institute Withdrawal Assessment
59
What is somatisation disorder?
- Multiple physical symptoms presents for at least 2 years
- Patient refuses to accept reassurance
60
What is factitious disorder/Münchausen syndrome?
Intentional production of physical or psychological symptoms
61
What is malingering?
Fraudulent simulation/exaggeration of symptoms for gain
62
S/E of benzo?
- Antegrade amnesia
- Drowsiness
- Confusion
- Dizziness
- Slurred speech
- Cant see/pee/spit/shit
63
Metabolic S/E of antipsychotics?
hyperlipidemia, hypercholesterolemia, hyperglycemia and weight gain.
64
What is schizoaffective disorder?
Combination of psychotic and bipolar disorder symptoms present most of the time for at least 2 weeks
65
What is the difference between schizoid and schizotypical PD?
Schizoid generally does not have any paranoid ideation
66
What is Pareidolia?
Perceiving a specific objection/meaning in an ambiguous pattern e.g. seeing faces in the clouds
67
What are the first rank symptoms of schizophrenia?
- Delusions
- Auditory Hallucinations
- Thought disorder (withdrawal, insertion and broadcasting)
- Passivity experience
68
What is the ICD-10 criteria for a delusional disorder?
- Delusion present for at least 3 months
- Ruled out schizophrenia
- No persistent hallucinations
69
How do you differentiate between mild, moderate and severe depression?
Severe - all 3 core symptoms + 4 other common
Moderate - 2 core symptoms + 3 other common
Mild - anything less
70
Indications for ECT?
Euphoria
Catatonia
Tearful (treatment resistant depression)
71
What is Charles-Bonnet syndrome?
Persistent or recurrent complex hallucinations associated with visual impairment
72
What medication makes patients feel unwell if they drink any alcohol?
Disulfiram - increases acetyl dehydrogenase
73
Another S/E of clozapine except agranulocytosis?
Constipation
74
2nd line for mood stabilising in bipolar?
Valproate
75
Signs of lithium toxicity?
- Ataxia
- Seizures
- Slurred speech
- Vomiting
- Coarse tremor
76
Lithium side effects
- Fine tremor
- Nausea
- Diarrhoea
- Dry mouth
77
Signs of serotonin syndrome?
- neuromuscular excitability
- autonomic dysfunction (hypo or hypertension)
- altered mental state
78
Signs of neuroleptic malignant syndrome?
- Change in mental state
- Rigidity
- Fever
- Autonomic dysfunction
79
What is agoraphobia?
fear of public spaces or fear of entering a public space
80
What drugs are stimulants?
Cocaine, methamphetamine, MDMA, khat, nicotine
81
What type of drugs are LSD and ketamine?
Hallucinogens
82
Blood tests seen for Neuroleptic malignant?
● Raised CK (creatine kinase) --> due to muscle rigidity
● Raised white cell count
● Deranged LFT’s
● Acute renal failure --> abnormal U&E’s
● Metabolic acidosis --> low pH, low HCO3
83
What is a phenomenon in which the patient has a fascination with repetitive mechanical tasks or with the ordering of objects
Punding
84
Investigation of choice for bulimia nervosa?
U+E (look for metabolic alkalosis with hypokalaemia)
85
Bloods to check before starting lithium?
- TFTs
- U+E
- eGFR
- FBC
86
What is degenerated in Korsakoff syndrome?
The mammillary bodies
87
Sign of Korsakoff vs Wernickes?
profound anterograde amnesia
88
Pathology of Creutzfled-Jakob disease?
Spongiotic changes and neuronal death
89
Alzheimers vs CJ disease?
CJ will have much more rapid onset deterioration of memory, symptoms etc
90
First line feeding mechanism with anorexia nervosa
NG tube
91
Bulimia vs Anorexia
Bulimia - normal BMI, anorexia - low BMI
92
DSMV criteria for mild depression
5 or more symptoms present nearly every day for 2 weeks
93
What is Munchausen syndrome?
Intentionally faking signs/symptoms
94
OCD vs OCPD?
OCPD activités will be pleasurable rather than distressing
95
Russell sign?
Scarring on fingers from inducing vomiting -> Bulimia
96
Opiate withdrawal symptoms?
sweating, watering eyes, rhinorrhoea, yawning, GI upset, anxiety and irritability as well as general aches and pains
97
Early symptoms of autoimmune encephalitis?
- Fever
- Headaches
- Diarrhoea
- URTI
98
Later symptoms of autoimmune encephalitis?
- Generalised seizures
- Rigidity
- Temperature dysregulation
99
Which medications are associated with causing hyperprolactinaemia?
Dopamine antagonists
100
What abnormality can lithium cause in pregnancy?
Ebsteins anomaly
101
Lithium in pregnancy?
Stop in 1st trimester
102
ECG findings with severe anorexia?
Prolonged QT
103
Is re-feeding treatable under the mental health act?
Yes
104
What is logoclonia?
Repeats last syllable/word of a phrase
105
Symptoms of opiate overdose?
Drowsiness
Confusion
Decreased respiratory rate
Decreased heart rate
Constricted pupils
106
Cannabis overdose?
drowsiness, impaired memory, slowed reflexes and motor skills, bloodshot eyes, increased appetite, dry mouth, increased heart rate and paranoia
107
LSD overdose?
Labile mood
Hallucinations
Increased blood pressure
Increased heart rate
Increased temperature
Sweating
Insomnia
Dry mouth
108
What electrolyte abnormality seen in anorexia?
Hypokalaemia
109
Section 2 of MHA?
- Admission for assessment for upto 28 days
- Requires 2 doctors
110
Section 3 of MHA?
- Admission for treatment upto 6 months
- AMHP and 2 doctors
111
Section 4 of MHA?
- Used in emergencies for OUTPATIENTS
- 1 doctor + AMHP
112
Section 5(2) of MHA?
- Detained for 72 hours by doctor
- Used for INPATIENTS
- Cannot be used in ED
113
Section 5(4) of MHA?
- Detained for 6 hours by a nurse
114
Section 135 of MHA?
- Court order that allows police to enter property to remove person to place of safety (A+E)
115
Section 136 of MHA?
- Bring someone from public place to place of safety
116
What test is used to assess muscle wasting in anorexia?
Sit-up-squat-stand test - failure to do this is a red flag
117
Management of OCD after 12 week trial of SSRI/EMRD?
Another SSRI / Clomipramine
118
What is a delusion of passivity?
Delusion of passivity is the delusion of being controlled, where someone experiences one’s
feelings/impulses/thoughts/actions as not one’s own, but as being imposed on by some external force
119
Egodystonic?
thoughts that are very different to a persons normal thoughts/beliefs -? OCD
120
What is 6CIT?
Brief cognitive function test
121
Medications associated with delirium?
- Furosemide
- Oxybutynin
- Propranolol
- Ranitidine
122
Symptoms of clozapine toxicity?
- Precipitated by viral infection
- confusion, drowsiness, ataxia and tachycardia
123
2nd/3rd line for ADHD?
Lisdexamfetamine
Atomoxetine
124
Blood tests for someone with anorexia?
Hypokalaemia
Low sex hormone levels (FSH, LH, oestrogen and testosterone)
Raised growth hormone and cortisol levels
Hypercholesterolaemia
125
When is activated charcoal effective for paracetamol overdose?
When given within 1 hour of ingestion
126
How should the first dose of acetylcysteine be given?
Over 1 hour
127
Alcohol withdrawal symptoms?
6-12 hours: sweating, tachycardia. nausea tremor
36 hours - seizures
72 hours - Delirium tremens
128
What are tactile hallucinations associated with?
Delirium tremens
129
What types are in Cluster A?
Odd and Ecentric
- Schizoid
- Schizotypical
- Paranoid
130
What type are in Cluster B?
Dramatic/Emotional/Impulsive
- EUPD
- Anti-social
- Narcissistic
- Histrionic
131
What types are in Cluster C?
Anxious/Fearful
- Avoidant
- Dependent
- Obsessive-Compulsive
132
What is alogia?
Lack of speech
133
What is avolition?
Poor motivation
134
Prognosis of schizophrenia?
- 25% never have another episode
- 25% improve substantially
- 25% improve somewhat
- 25% are resistant to treatment
135
New onset neuro symptoms in a young person with no PMH?
Think autoimmune encephalitis
136
Patient using Risperidone and then gets amenorrhoea, galactorrhoea etc
Think hyperprolactinaemia caused by Risperidone
137
Which drug is often used for patients who are anorexic and need help with weight gain but have anxieties with eating?
Olanzapine
138
PHQ-9 depression scores
5 - 9 - mild
10 - 14 - moderate
15+ - more severe
20+ - very severe
139
What should be done before starting any ADHD medication?
Baseline ECG - cardiotoxic
140
Electrolyte abnormalities of refeeding syndrome?
- Hypophosphatemia
- Hypokalaemia
- Hypomagnesemia
141
What is Ekbom syndrome?
Where you believe you are infested with parasites
142
Indications for hospital admission for anorexia?
Low weight (85% or less of expected weight and/or less than the third percentile for BMI)
Lack of any weight gain
Significant oedema
Physiologic decompensation differential greater than 30/min
Temperature less than 36°C
Pulse below 45 beats per minute
Symptoms refractory to outpatient treatment
143
MAO + SSRI can cause what?
Serotonin syndrome
144
What is la belle indifference?
Feelings of indifference about a symptom/concern
145
disulfiram + alcohol effects?
flushing, headache and anxiety
146
acomprostate mode of action?
enhances GABA
147
C/I to ECT
raised ICP
148
What is dyspraxia?
Clumsiness
149
Why is Fluoxetine the choice of SSRI in teenagers?
- Higher half life -> due to increased risk of non-compliance
150
SSRI to SNRI switch?
Cross taper - except fluoxetine
151
Pathophysiology of GAD?
Over reactivity of noradrenergic neurons
Increased activity of 5HT neurons and decreased GABA
152
CAGE Questions
C - Have people ever told you to CUT down on alcohol intake
A - Do you become ANNOYED if people criticise your alcohol intake?
G - Have you ever felt GUILT about drinking?
E - Do you ever need alcohol when you first open your EYES in the morning?
153
Fregoli delusion
Capgras delusion
Fregoli - same person with different disguises
Capgras - imposter replaced a close friend/family
Phase 3A
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