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psychiatry > DUMS > Flashcards

DUMS Flashcards

1
Q

What are some of the things we are monitoring for in patients taking antipsychotics

A

Fasting blood glucose, prolactin, ECG, FBC

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2
Q

Why do you get raised prolactin when using an antipsychotic?

A

Due to inhibition of the dopaminergic tuberoinfundibular pathway

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3
Q

Do patients on clozapine need to let doctors know when they cut down or begin smoking?

A

Yes – smoking increases the levels of clozapine in the body so if a patient starts smoking increased levels of the drug may be harmful

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4
Q

Which anti-psychotic has the best side effect profile

A

Aripiprazole

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5
Q

A pateint is being started on anti-psychotics and wants to avoid weight gain and T2DM risk – which should be avoided

A

Olanzapine associated with the most weight gain and highest T2DM risk

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6
Q

Which anti-psychotic do you give patients with parkinsons

A

None!!!!!!!
Give lorazepam

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7
Q

Ideas of reference

A

Innocuous or coincidental events will be ascribed significant meaning
Seeing objects arranged in a particular way and thinking someone is sending you a message

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8
Q

Self-referential experience

A

The sense than external events are connected to oneself in some way
TV/Radio are transmitting signals aimed at me

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9
Q

Passivity phenomenon

A

Disconnection between performing an action and having ownership of that action

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10
Q

Delusion

A

A fixed falsely held belief with unshakeable conviction
Impervious to logical argument

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11
Q

Knights move thinking

A

Aka looseing of associations
Unexpected illogical connections between ideas

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12
Q

Flight of ideas

A

Quick erratic speech in which the person jumps between ideas
No apparent association between ideas

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13
Q

Neologisms

A

Made up words

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14
Q

side effects of ECT

A

headache, nausea, short term memory impairment, cardiac arrhythmia

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15
Q

the amygdala processes sensory data and passes information to the?

A

hypothalamus
periaqueductal gray
hippocampus
cingulate cortex

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16
Q

what does the hypothalamus do

A

mediates bodily stress response by releasing cortisol

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17
Q

what does the periaqueductal gray do

A

mediates flight or fight response

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18
Q

what does the hippocampus do

A

responsible for memory and learning

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19
Q

what does the cingulate cortex do

A

mediates emotions of anxiety

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20
Q

short acting benzodiazepine

A

lorazepam

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21
Q

long acting benzodiazepine

A

diazepine

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22
Q

when would you use benzo to treat anxiety

A

only used for rapid relief of severe symptoms
avoid long term use

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23
Q

withdrawal side effects of benzo

A

anxiety, insomnia, depression, perceptual sensitivity

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24
Q

first line antidepressant for anxiety

A

SSRI

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25
why is pregabalin used in anxiety
its a calcium channel blocker (indirectly enhances GABA) consider if unresponsive to others
26
generalised anxiety disorder
6 months of disproportionate anxiety about everything management: CBT + SSRI
27
what is the appetitive system
promotes seeking behaviours mediated by dopamine
28
what is the aversive system
promotes survival in event of stress - loss event= depression - threat event= anxiety mediated by serotonin
29
what is atypical depression
reactive mood with anxiety/rejection hypersensitivity increased appetite/sleep
30
what is cortisol dysregulation
stress releases cortisol chronic stress can cause cortisol dysregulation excess cortisol may cause depression through - neuronal damage (low hippocampal volume) - release of pro-inflammatory cytokines
31
two main mechanisms to increase monamine activity
reuptake inhibition: keep monoamine in synaptic cleft monamine oxidase inhibitor: prevent removal of monoamine from presynaptic neuron
32
what type of antidepressants work through reuptake inhibition
tricyclics SSRI SNRI
33
how does tricyclics work
inhibit reuptake of serotonin + noradrenaline (also 5-HT antagonists, membrane stabilisers)
34
how do SSRIs work
inhibit reuptake of serotonin
35
how do SNRIs work
inhibit reuptake of serotonin and noradrenaline
36
big side effect of MAO
cause hypertensive crisis if taken with substance containing tyramine (cheese, wine, beer)
37
examples of MAOI
phenylzine moblecamide
38
atypical antidepressant
mirtazapine
39
side effect of mirtazapine
massive weight gain sedation
40
when to use an atypical antidepressant
after trial of SSRIs especially useful if they have had trouble sleeping
41
what is serotonin syndrome
caused by an excess of serotonin in the synaptic cleft most often caused by taking combination of SSRI and MAOI
42
presentation of serotonin syndrome
neuromuscular excitation- hyperflexia, clonus, myoclonus altered mental status- agitation, insomnia, delirium autonomic dysregulation- tachycardia, high temperature, shivering, sweating, diarrhoea
43
what can a prolonged fever from serotonin syndrome lead to
rhabdomyolysis metabolic acidosis renal failure DIC
44
treatment of serotonin syndrome
benzodiazepine for agitation if severe ventilation and sedation cyproheptadine may be used- serotonin receptor antagonist
45
when to use ECT in depression
if life threating or rapid response needed
46
management if psychotic depression
SSRI and augment with antipsychotic
47
how long to continue antidepressant treatment
6 months after symptoms stop
48
definition of mania
7 days of manic symptoms- not going to list them all
49
what is hypomania
4 days of less severe symptoms which don't impact on function
50
bipolar 1
one episode of mania
51
bipolar 2
depression with episode of hypomania
52
acute management of mania
antipsychotic + benzodiazepine - antipsychotic- olanzapine, quetiapine or risperidone
53
acute bipolar depression management
antipsychotic- quetiapine, olanzapine or lurasidone
54
signs of toxic lithium levels
D&V ataxia course tremor drowsiness/altered conscious level coma
55
what is the mesolimbic pathway
circuit where dopaminergic inputs from the ventral tegmental area innervate brain regions involved in executive, affective and motivational function
56
recommended amount of alcohol per week
<14 units
57
wernicke's encephalopathy
acute thiamine deficiency - ataxia - nystagmus - confusion
58
korsakoff syndrome
chronic thiamine deficiency - dementia - confabulation
59
detoxification of alcohol
benzodiazepine (gradually withdraw) + vitamin supplementation - choose: chlordiazepoxide or diazepam - lorazepam may be preferable in patients with hepatic failure - carbamazepine also effective
60
mechanism of alcohol addiction
chronic alcohol consumption enhances GABA mediated inhibition in the CNS and inhibits NMDA-type glutamate receptors withdrawal of alcohol causes the opposite
61
how many hours after last drink do symptoms start of alcohol withdrawals
6-12 hours
62
when is the peak incidence of seizure in alcohol withdrawal
36 hours
63
when is the peak incidence of delirium tremens in alcohol withdrawal
48-72 hours
64
presentation of alcohol withdrawal
tremor sweating tachycardia anxiety
65
presentation of delirium tremens
coarse tremor confusion delusions auditory and visual hallucination fever tachycardia
66
disulfram
acetaldehyde dehydrogenase inhibitor causes alcohol intolerance
67
acromprosate
acts centrally (GABA/glutamate) reduces cravings
68
detoxification of opioids
methadone: full agonist buprenorphine: partial
69
opioid reversal
IV naloxone
70
cluster A personality disorders
odd and eccentric - paranoid - schizoid - schizotypal
71
cluster B personality disorders
dramatic and emotional - borderline - histrionic - antisocial
72
cluster C personality disorders
anxious and avoidant - avoidant - dependent - anakastic

psychiatry (6 decks)

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