1
Q
blood test results in anorexia
A
- The general rule is that most results are low except the G’s and C’s, which are elevated : Growth hormone, Glucose, Cortisol, Cholesterol, Carotinaemia.
- Low levels of sex hormones: FSH, LH, testosterone and oestrogen
- Normal T4, low T3
- Low levels of potassium, calcium and magnesium
- Metabolic alkalosis
- High levels of cortisol
- normocytic anaemia, mild leukopenia and thrombocytopenia due to malnutrition.
2
Q
define panic disorder
A
anxiety disorder, is characterized by the occurrence of recurrent, unexpected panic attacks, each marked by intense fear or discomfort.
3
Q
what causes neuroleptic malignant syndrome
A
- dopamine antagonist medication such as antipsychotics
4
Q
clinical signs and symptoms of NMS
A
- fever,
- muscle rigidity,
- confusion,
- rhabdomyolysis (hence the raised creatine kinase and subsequent electrolyte derangements such as hyperkalaemia and hypocalcaemia),
- metabolic acidosis,
- autonomic lability - characterized by fluctuations in blood pressure, tachycardia, and diaphoresis
- raised white cell count.
5
Q
name some cognitive assessment tests
A
- 10 point screener [10-CS]
- MOCA
- MMSE
- 6-item cognitive impairment test [6-CIT]
- mini-cog
6
Q
minimum duration for depression sx to be diagnosed as depression
A
2 weeks
7
Q
PTSD vs acute stress disorder
A
- PTSD = symptoms > 4 weeks from traumatic event.
- acute stress reaction = sx lasting <4 weeks from traumatic event
8
Q
section 5(2)
A
permits detainment of a voluntary pt in a psych hospital for 72 hours for further assessment
by 1 doctor
9
Q
section 5(4)
A
permits detainment of a voluntary pt in hospital for 6 hours for further assessment
by 1 nurse
10
Q
section 3
A
6 month treatment order and
requires an approved mental health practitioner and 2 doctors.
11
Q
section 135
A
court order that allows police to enter a person’s home and take a person to a Place of Safety
police order
lasts 24 hours
Followed up with an MHA Assessment
12
Q
section 136
A
court order that allows police to take a person to a Place of Safety from a public space
police order
lasts 24 hours
Followed up with an MHA Assessment
13
Q
when can you give activated charcoal for ovredose
A
if pt presents with 1 hour
14
Q
how is N-acetylcysteine dose calculated
A
The dose of N-acetylcysteine is adjusted based on the paracetamol level, nomogram and local guidelines.
15
Q
cholinergic side effects
what drugs cause this
A
- Gastrointestinal issues: Diarrhoea, N+V, abdominal cramping, gastric irritation
- Sweating and salivation: Increased sweating and salivation
- Urination: Increased urinary frequency
- Bradycardia
- acetylcholinesterase inhibitors
16
Q
anticholinergic side effects
A
can’t see cant spit, can’t pee, can’t shit
17
Q
Mx of lithium toxicity
A
- mild tox = fluid resus
- severe / renal impairment = haemodialysis.
- benzos may be used to mx agitation or seizures
18
Q
what is cyclothymia
A
- Chronic mood fluctuations over 2 years with episodes of hypomania and depression
- Cyclothymia has milder symptoms than bipolar and often goes unnoticed and therefore undiagnosed
19
Q
NMS vs serotonin syndrome
A
NMS occurs over a long period of time [days-weeks] whereas serotonin syndrome occurs over a short period of time[24hrs].
20
Q
key Sx of serotonin syndrome
A
- Neuromuscular abnormalities: Tremor, Clonus, hyperreflexia, hypertonis and rigidity
- Altered mental state: anxiety, agitation, delirium
- Autonomic hyperactivity: hyperthermia, HTN, tachycardia, sweating, midriasis
21
Q
serotonin syndrome Mx
A
stop the causative agent
supportive Mx
Benzes for agitation
Cyproheptadine 5HT antagonist for severe cases
22
Q
NMS Mx
A
- stopping the causative agent + supportive care with IV fluids + benzos for sedation.
- Some cases require dantrolene or bromocriptine.
23
Q
opiate withdrawal features
A
- Agitation
- Anxiety and irritability
- Muscle aches or cramps
- Chills
- Runny eyes
- Runny nose
- Sweating
- Hypersalivation
- Yawning
- Insomnia
- Gastrointestinal disturbance such as abdominal cramps, nausea, diarrhoea and vomiting
- Dilated pupils
- Piloerection
- Increased heart rate and blood pressure
24
Q
what causes korsakof syndrome
A
Korsakoff syndrome occurs due to prolonged thiamine deficiency –> degeneration of the mammillary bodies [part of the papez circuit and needed for memory formation] and other brain structures. Often irreversible
25
Classic triad of Wernicke’s
T/F: all signs must be present for Dx
1. Confusion / change in mental status
2. Ataxia
3. Nystagmus / ophthalmoplegia / occulomotor dysfunction.
- false not all signs must be present for Dx
26
what causes wernickes
Wernicke’s is a neurological syndrome caused by thiamine [Vit B1] deficiency, associated with alcohol excess. A medical emergency
Thiamine is poorly absorbed in the presence of alcohol
27
duration of Sx for a formal schizophrenia Dx
1 month
28
female sexual arousal disorder
patients lack the desire to have sex, and also experience vaginal dryness when they try to have sex
29
Sexual aversion disorder
is characterised by disgust at even the thought of sex
30
hypoactive sexual desire disorder
the issue lies with pt interest in sex, not with the physiological response to arousal.
Psychiatric conditions, and their treatments can increase the risk of HSDD
31
N-acetylcysteine MoA
Replenishes body stores of glutathione
- Glutathione is needed to detoxify a toxic intermediary product of paracetamol metabolism (NAPQI).
- Therefore, when excessive paracetamol is ingested, hepatocellular stores of glutathione become depleted. NAPQI stays in its toxic form in the liver and causes hepatocyte death.
- N-acetylcysteine replenishes glutathione stores so that NAPQI can be converted to a less toxic product, preventing hepatocyte damage.
32
opioid withdrawal sx + Mx
constellation of physical and psychological symptoms:
- nausea, vomiting, diarrhoea, dilated pupils, sweating, anxiety, and insomnia.
The initial management of heroin withdrawal typically involves supportive care and symptomatic treatment, which may include:
- hydration, electrolyte replacement, antiemetics, and antidiarrhoeal medications
33
what is refeeding syndrome
- This occurs where there is rapid nutritional intake after a long period of low caloric intake.
- It causes insulin to rise rapidly --> intracellular shift of phosphate, magnesium and potassium from extracellular spaces.
- can be fatal
34
Onset + Sx of refeeding syndrome
Refeeding syndrome usually starts 48-72 hours after refeeding begins:
- oedema
- tachycardia
- confusion
35
postpartum psychosis onset timeframe
usually within 2 weeks after birth
36
T/F antipsychotics can cause infertility
TRUE
- Dopamine antagonists can act upon the posterior hypothalamus causing increased release of prolactin (leading to galactorrhoea) as well as interferring with other pituitary hormones
37
symptoms and blood test result seen in panic disorder/ panic attacks
- A sudden feeling of intense anxiety can cause hyperventilation, which in turn reduces arterial CO2 and increases blood pH.
- Alkalosis promotes calcium binding to albumin, reducing the levels of free calcium and thus causing hypocalcaemia.
- Hypocalcaemia can cause tingling or numbness in the hands, feet or around the mouth.
- severe cases can cause fingers and toes to curl
38
MAOIs used in depression
moclobemide[MAOI-B] and phenelzine [MAOI-A]
39
MAOIs used in Parkinson's
selegiline
rasagiline
40
what is adjustment disorder
less intense than acute stress disorder in terms of the stressor e.g. breakup or redundancy.
BUT reaction can be severe e.g. suicide attempt
**reaction is often out of proportion to stressor**
41
what is included in a confusion screen
42
1st line drug for opioid withdrawal
methadone and buprenophine are equally as effective for opioid withdrawal both suitable first line drugs but **methodone** is selected first if no CI for either.
43
Sx of delirium tremens
* **Impaired mental status**: Acute confusion, Severe agitation, Delusions and hallucinations [bugs under skin], psychomotor agitation,
* **Autonomic instability**: Tachycardia, Hypertension, Hyperthermia,
* **Neurological impairment**: coarse Tremor, hyperreflexia. Tonic-clonic seizures.
44
what is Oculogyric crisis and what causes it
Oculogyric crisis is one of the acute dystonias associated with certain antipsychotic medications or metoclopramide
45
details of common side effects of typical antipsychotics
EPSE + QT prolongation
46
Mx of neuroleptic malignant syndrome
Mx = stopping the causative agent + supportive care with IV fluids + benzos for sedation.
Some cases require dantrolene or bromocriptine.
47
diagnostic criteria for anxiety
Duration: At least 6 months of Excessive worry and apprehension + Difficulty controlling worry.
AND
Associated symptoms: Restlessness, muscle tension, fatigue
48
who requires a 1 week follow up after initiating an SSRI
pts under 25 due to increased risk of suicidal ideation or self harm in this age range due to increased motivation
49
antidepressants and antipsychotics that are safe in breastfeeding
- **Sertraline and paroxetine** are the most appropriate SSRIs to be used in breastfeeding as they have the lowest presence in the breast milk
- **olanzapine + quetiapine** are safe in breastfeeding
50
how long do Sx of depression have to be present for Dx of post partum depression
2 weeks
51
Sx of mania
I DIG FAST + **Functional impairment**
* Irritable
* Distractable
* Insomnia: Decreased need for sleep
* Gradndiose: Inflated self-esteem or grandiose delusions
* Flight of ideas: rapid thought processes that leap from topic to topic
* Activity ↑
* Speech ↑ : pressured
* Thoughtless [risky behaviour] ± psychosis: hallucinations or delsuion.
52
Sx of lithium toxicity
CHAVS/ CHAPS
* Coarse tremor
* Hyperreflexia
* Arrhythmias + Acute confusion.
* Visual disturbance // Polyuria 2º to nephrogenic insipidus
* Seizures [+ other CNS disturbance: dysarthria and impaired coordination, ataxia + ↓ GCS].
53
when should a pt with an eating disorder be admitted as an inpatient
immediate medical stabilisation and comprehensive care is indicated in:
- severe malnutrition,
- bradycardia,
- hypotension
- severe or rapid weight loss,
- significant suicide risk, or
- inability to perform the SUSS test (sit-up, squat, and stand).
- proximal muscle weakness suggests weak respiratory muscle
54
fregoli delusion
Fregoli delusion is the fixed, false belief that strangers are familiar to the individual and may even all be the same person
55
a new mum with an 18 month old child present with feelings of anhedonia and low mood lasting 3 months. Dx?
depression
post partum occurs within 12 months of having a baby.
had the symptoms started during the first 12 months it would be classed as postpartum.
56
what is the SCOFF questionnaire and what is it used for
- used for anorexia and bulimia to help guide Dx. ≥2 suggests bulimia or anorexia
57
key features of anorexia for Dx
Restriction of energy intake
- Leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
Intense fear of gaining weight or becoming fat
- Despite being significantly underweight
Disturbance in body image
- Undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
58
clozapine SEs
- Agranulcytosis
- Constipation [MC cause of death related to clozapine, can cause bowel obstruction]
- reduced seizure threshold.
- Myocarditis
- Neutropenia
- Slurred speech due to hyper salivation
Quesmed phase 3a
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