1.1. Psychiatry Flashcards
(37 cards)
How is the management of OCD, according to NICE?
CBT/ERP > SSRI > ECT | Step 1: Cognitive Behavioural Therapy, with Exposure and Response Prevention.
Step 2: Add ISRS.
Step 3: If suicidal ideation or severely incapacitated: Electroconvulsive Therapy.
How long does it take for lorazepam IV to start working?
3 to 5 minutes
What is the therapy of choice for PTSD?
Trauma-Based CBT and Eye Movement Desensitization and Reprocessing (EMDR)
What are the drugs of choice for rapid tranquilization?
Lorazepam > Haloperidol > Olanzapine
No: Diazepam IM (erratic)
What are the recommendations for lithium exams?
Perform kidney and thyroid screening before initiating. Wait 12h after the last pill before collecting the sample.
Repeat levels after 7 days from the start.
Repeat levels every 3 months.
What are the symptoms of lithium toxicity?
Blurred vision
Vomiting
Tremors
Polyuria / Hypernatraemia
When should you pick hypomania, mania or bipolar?
Mania: hypomania + grandioseness, hallucination, delusions or hospitalisation.
Bipolar: if mention to depressive episodes.
How to differentiate between pseudodementia and normal grief.
Pseudodementia: abrupt, severe symptoms, memory loss. Normal grief: mild, difficult to define, rarely is the answer.
What antidepressants have less interactions with warfarin?
1st choice: mirtazapine.
2nd choice: sertraline (with caution).
What are the indications of ECT?
• Life-threatening depression (catatonia);
• Refractory severe depression;
• Prolongued or severe mania.
What are the steps in antidepressants?
- Adjust SSRI
- Change SSRI
- Venlafaxine, Mirtazapine
- Amitriptyline, Trazodone
What are the top 3 risk factors for suicide?
Previous attempts or self-harms
Divorce
Alcohol and drug abuse
What should be done with depressed patients on warfarin?
Avoid/change SSRI (risk of GI bleeding). Prefer mirtazapine.
When mirtazapine should be preferred?
Heparin or warfarin
NSAIDS
Insomnia, hyporexia
When should Fluoxetine be preferred?
Under 18yo
When should Sertraline be preferred?
Multiple comorbidities
Epilepsy
Pregnancy and Breastfeeding
When should venlafaxine be preferred?
Failed SSRI
Anxiety
Where to should be refereed the patients with high risk suicide intention?
On-call psychiatry liaison.
What is an hormonal marker of anorexia nervosa?
Oestradiol dreased. FSH normal or decreased.
What is the therapy of choice for Borderline Personality Disorder?
Cognitive Analytic Therapy (CAT) and Dialectical Behavioural Therapy (DBT) (ARTE: attention, regulation, tolerance, effectiveness).
What drug needs to have its dose reduced when one stops smoking or increaded when one starts smoking?
Clozapine.
What is the treatment for acute dystonic syndrome?
IM/EV Procyclidine
EV Diazepam
What is the definition of hypochondriasis?
Persistent belief that has serious disease despite evidence.
What is the difference between Munchausen and Malingering?
Munchausen is faking aiming for medical attention. | Malingering is faking aiming for secondary gains (money, leaves, etc).
