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Psych additional Flashcards

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1
Q

alcohol withdrawal sx and times

A

symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

sx- tremor, tachycardia, sweating, anxiety

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2
Q

Factors associated with poor prognosis of schizophrenia

A
  • strong family history
  • gradual onset
  • low IQ
  • prodromal phase of social withdrawal
  • lack of obvious precipitant
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3
Q

Schneider’s first rank sx for schizophrenia

A
  • Delusions
  • Auditory hallucinations
  • Thought disorder: insertion, withdrawal, broadcasting
  • Passivity phenomena
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4
Q

what is schizoid personality disorder

A

tendency towards solitariness, lack of interest in social relationships, and emotional detachment

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5
Q

what is schizotypal PD

A
  • Ideas of reference (differ from delusions in that some insight is retained)
  • Odd beliefs and magical thinking
  • Unusual perceptual disturbances
  • Paranoid ideation and suspiciousness
  • Odd, eccentric behaviour
  • Lack of close friends other than family members
  • Inappropriate affect
  • Odd speech without being incoherent
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6
Q

difference between schizoid and schizotypal

A

Schizoid = AVOID
Schizotypal = type of schizophrenia (has weird thoughts)

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7
Q

personality disorder clusters

A
  • Cluster A (MAD): - ‘odd or eccentric’ - paranoid, schizoid, schizotypal
  • Cluster B (BAD): ‘dramatic, erratic or emotional’ - histrionic, emotionally unstable(/borderline), dissocial, narcissistic
  • CLuster C (SAD): ‘anxious and fearful’: anankastic, anxious (avoidant) and dependent.
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8
Q

What is Russell’s sign?

A

calluses on the knuckles or back of the hand due to repeated self-induced vomiting
bulimia

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9
Q

purging behaviours

A

vomiting
laxative
exercise
diuretics

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10
Q

schizoaffective disorder

A

combination of psychotic symptoms and prominent mood symptoms (e.g., mania or depression).

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11
Q

What are the main approaches to managing OCD?

A
  • CBT (exposure and response prevention)
  • SSRIs (most commonly fluoxetine)
  • 3rd line: clomipramine (TCA)
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12
Q

discontinuitation sx of SSRIs

A
  • increased mood change
  • restlessness
  • difficulty sleeping
  • unsteadiness
  • sweating
  • GI sxs: pain: cramps, diarrhoea, vomiting, paraesthesia
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13
Q

Duloxetine mechanism of action

A

serotonin and noradrenaline reuptake inhibitor

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14
Q

What is the most appropriate action to take with regards to SSRIs prior to ECT treatment for this patient?

A

Antidepressant medication should be reduced but not stopped when a patient is about to commence ECT treatment

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15
Q

What is Charles Bonnet syndrome?

A

A phenomenon in which patients with severe visual impairment report vivid hallucinations

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16
Q

What is Othello syndrome?

A

Also known as delusional jealousy, is a delusional disorder with male preponderance in which patients hold a firmly held belief that their partner is unfaithful, in the absence of proof.

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17
Q

what is acute dystonia?

A

sudden involuntary muscle contractions and spasms, often affecting the neck (torticollis), jaw, and tongue.

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18
Q

what is tardive dyskinesia?

A

rhythmic involuntary movements e.g. grimace, chewing, sucking movements (mainly facial)

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19
Q

what is parkinsonism?

A

tremor,rigidity,bradykinesia

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20
Q

mx of parkinsonism

A

change the drug/dose,
sometimes anticholinergics like procyclidine can help

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21
Q

what is akathisia

A

unpleasant feeling of restlessness

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22
Q

mx of akathisia

A

change drug/dose, or give
propranolol, benzos

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23
Q

examples of typical antipsychotics

A

haloperidol
Chlorpromazine

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24
Q

examples of atypical antipsychotics

A

aripiprazole
Clozapine
Risperidone
Olanzapine

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25
examples of EPSEs
- acute dystonia - akathisia - parkinsonism - tardive dyskinesia
26
What is the most appropriate medication choice to prevent further seizures in alcohol withdrawal?
chlordiazepoxide
27
side effects of mirtazapine
- increased appetite - increased sleep
28
first line medication for GAD
sertraline
29
difference between knight's move and flight of ideas
- Knight's move= thinking there are illogical leaps from one idea to another - Flight of ideas there are discernible links between ideas
30
what food to avoid on SSRI
Grapefruit juice is a CYP inhibitor and can increase serum levels of SSRIs
31
what is conversion disorder
loss of motor and sensory function, which typically arises during periods of stress
32
drug itneraction that can cause serotonin syndrome
SSRIs and MAOIs so never co-prescribe
33
what are side effects of clomipramine (TCAs)
Dry mouth (anticholinergic) and weight gain (antihistaminic)
34
what medication can precipitate a benign leucocytosis
lithium
35
Most appropriate antidepressant to start post MI
sertraline
36
features of anorexia
- most things low - G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
37
unexplained sx
Somatisation = Symptoms hypoChondria = Cancer
38
delusional parasitosis
Patient with a fixed, false belief (delusion) that they are infested by 'bugs'
39
side effect of steroid use
steroid-induced psychosis
40
Metabolic side effects of antipsychotics
- dysglycaemia - dyslipidaemia - diabetes mellitus
41
What pattern of memory loss is characteristic for severe depression
global memory loss, can mimic dementia but is pseudodementia
42
most effective antipsychotic for dealing with negative symptoms
clozapine
43
short term side effects of ECT
- headache - nausea - short term memory impairment (retrograde amnesia more common than anterograde amnesia) - memory loss of events prior to ECT - cardiac arrhythmia
44
RF for GAD
- Aged 35- 54 - Being divorced or separated - Living alone - Being a lone parent
45
what happens when a pt takes disulfiram
Within twenty to thirty minutes of alcohol consumption results in unpleasant symptoms, including facial flushing and nausea and vomiting
46
what is korsakoff syndrome
- complication of wernicke's encephalopathy - It's features include: anterograde amnesia, retrograde amnesia, and confabulation
47
triad for wernicke's encephalopathy
- ophthalmoplegia (often a lateral rectus palsy and/or horizontal nystagmus) - confusion - ataxia (though any cerebellar signs can be present)
48
what is Erotomania (De Clerambault's syndrome)
The presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms
49
differing demographic in antisocial PD and borderline PD
Antisocial personality disorder more often affects men than it does women, Borderline personality disorder affects more women than men.
50
What is formication
a type of paraesthesia in which it feels like insects are crawling on the skin
51
where does heroin act in the brain
mu opiate agonist stimulates brain and spinal cord receptors which are normally acted on by endogenous endorphins (reduce pain
52
presentation of heroin use
- pinpoint pupils - Intense rush/buzz, feelings of euphoria - anorexia - decreased libido
53
antidote for opiate overdose
naloxone
54
sx of opiate withdrawal
- peaks 36-48hrs - dysphoria, nausea, insomnia, agitation - flu like sx - 'Everything runs': diarrhoea, vomiting, lacrimation, rhinorrhoea - gooseflesh 'cold turkey'
55
signs of benzo withdrawal
- insomnia - tremor - agitation - loss of appetite - excessive sweating - tinnitus - seizures
56
antidote to benzo overdose
flumazenil
57
medication for alcohol dependence
* Disulfiram (aversive) * Acamprosate (anti-craving) * Naltrexone (anti-craving)
58
antidote to paracetamol overdose
N-acetylcysteine activated charcoal if presenting within the first hour
59
where in the brain is affected by Alzheimer's
- hippocampus affected early: new learning and visuospatial skills - temporal and parietal lobes later
60
What is Alzheimer's
increased B-amyloid F>M Age biggest RF 4As Amnesia Agnosia- recognition problems Aphasia Apraxia- inability to carry out skilled tasks despite normal motor function
61
what is vascular dementia
dementia due to infarcts causes by thromboembolism or atherosclerosis
62
presentation of vascular dementia
Stepwise progression - each step representing a sudden deterioration as an infarct occurs
63
what is lewy body dementia
Lewy bodies - eosinophilic intracytoplasmic neuronal structures composed from a-synuclein with ubiquitin found in cingulate nucleus and neocortex
64
presentation of lewy body dementia
2/3 should alert possibility of DLB: 1. bradykinesia, rigidity, tremor 2. fluctuating confusion with variation in awareness 3. vivid visual hallucination- little men or animals
65
how to diagnose neuroleptic malignant syndrome
Serum creatine kinase (CK), which is a muscle enzyme that can be elevated in NMS.
66
mx of mania
antipsychotic e.g. olanzapine
67
mx of dystonia
anticholinergic e.g. benztropine or diphenydramine
68
mx of alzheimers and lewy body dementia
- 3 acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) for mild to moderate - memantine (NMDA receptor antagonist) 2nd line
69
how to differentiate between delirium and dementia
- One of the main factors favouring delirium is impairment of consciousness, - fluctuating sx and hallucinations = delirium
70
Section 2
- admission for assessment for up to 28 days, not renewable - made by an Approved Mental Health Professional (AMHP) on behalf of 2 doctors - one of the doctors should be 'approved' under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
71
section 3
- for up to 6 months, can be renewed
72
section 4
- 72 hour assessment order used as an emergency - a GP and an AMHP or NR often changed to a section 2 upon arrival at hospital
73
section 5(2)
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours F1 can do
74
section 5(4)
similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
75
section 135
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
76
section 136
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
77
Naltrexone use
similar to acamprosate used for anti-craving in alcohol dependence
78
what is disulfiram
anti-eversive in alcohol dependence. makes you go red and feel hungover
79
mx of acute dystonia
procyclidine (anti-cholinergic)
80
Mx of tardive dyskinesia
tetrabenzine
81
signs of TCA overdose (e.g. amitriptylline)
- dry mouth - dilated pupils - arrhythmias - seizures - metabolic acidosis - coma ECG - sinus tachycardia - widening of QRS - prolongation of QT interval
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