From PassMed/Capsule Flashcards
(111 cards)
1
Q
Charles Bonnet syndrome
A
Visual hallucinations in patients with severe visual impairment
2
Q
How long after the last drink does alcohol withdrawl syndrome occur?
A
4-12 hours
3
Q
3 features of Wernicke’s encephalopathy
A
- Nystagmus (ophthalmoplegia)
- Ataxia
- Confusion
(Vomiting without nausea)
4
Q
Treatment for acute dystonia
A
Procyclidine
5
Q
What is echolalia?
A
Repeating words/phrases like a parrot
6
Q
Do antipsychotics work better against positive or negative symptoms?
A
Positive
7
Q
How to differentiate between mania and hypomania
A
Mania - psychotic symptoms including delusions of grandeur, auditory hallucinations. Significant functional impairment for >7 days
Hypomania. No psychotic symptoms. Increased ro decreased functioning for >4 days
8
Q
Examples of though interference
A
Thought insertion
Thought withdrawal
Though broadcasting
9
Q
First line SSRI in patient with history of CVS disease
A
Sertraline
10
Q
How long should antidepressant therapy be continued in second episode of depression?
A
2 years
11
Q
How long do opiate withdrawl symptoms last?
A
5-7 days
12
Q
Side effects of SSRIs taken with NSAIDs
A
Increased risk GI bleeding
13
Q
Two indications for amitriptyline
A
Neuropathic pain
Migraine prophylaxis
14
Q
When is ECT appropriate treatment?
A
Severe depression refractory to medication
15
Q
Schneider’s first rank symptoms
A
Delusional perception
Thought interference
Auditory hallucinations
Passivity
16
Q
When does bipolar usually present?
A
Late teens
17
Q
Side effects of ECT
A
RETROGRADE amnesia
Confusion, headaches, nausea
Reduced emotional response, anhedonia, apathy, reduced concentration
18
Q
What is passivity?
A
Bodily sensations, actions, thoughts, impulses are controlled by external forces
19
Q
What is clozapine normally given with? Why?
A
Sodium valproate. Seizure protective – clozapine lowers the seizure threshold
20
Q
What is perseveration?
A
Repeating the same words over and over
21
Q
When does delirium tremens occur?
A
Within 72 hours of alcohol withdrawl
22
Q
How long after a traumatic event does PTSD usually present?
A
Within 6 months
23
Q
Features of Korsakoff’s syndrome
A
Retrograde and anterograde amnesia (with confabulation to fill in the gaps)
Apathy/lack of insight into difficulties
24
Q
Side effects of TCAs
A
Dry mouth Constipation Blurred vision Sedation Hypotension
25
Which type of antipsychotic has worse EPSEs
Typicals
26
How long should antidepressant therapy be continued in first episode of depression?
6 months
27
Treatment for severe tardive dyskinesia
Tetrabenazine
28
Features of opiate withdrawl
```
RUNS - D&V, rhinorrhoea, lacrimation, sweating
Fever
Cool and clammy
Dilated pupils
Hypertension
Yawning
Piloerection - "cold turkey"
```
29
What is oculogyric crisis?
Prolonged involuntary upward deviation of eyes
30
When does acute dystonia/neuroleptic malignant syndrome present after starting antipsychotics?
First few weeks
31
Positive scz symptoms may be caused by increased DA activity in which pathway?
Mesolimbic
32
Indicators of poor prognosis in schizophrenia
```
Gradual onset
Family history
Low IQ
Premorbid history of social withdrawal
Lack of obvious precipitant
```
33
Examples of EPSEs
Parkinsonism
Tardive dyskinesia
Acute dystonia
Akathisia
34
How long does a normal grief reaction last?
<6 months
35
What is othello syndrome?
Delusional jealousy - often the belief that a partner is cheating
36
Indication for clozapine
If schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs (one of which should be a second-generation antipsychotic drug), each for at least 6–8 weeks.
37
Contraindications amitriptyline
Cardiac arrhythmias (complete heart block)
Recent MI
MAOI use (risk of serotonin syndrome)
Acute porphyrias
38
Treatment for akathisia
Propanolol
39
What is circumstantiality?
Beating around the bush
| - Unable to answer questions without excessive and unneccesary detail
40
Risks of zopiclone in the elderly
Increased risk of falls
41
Most common serious infection in IVDU
Hep C
42
Ekbom's syndrome
Delusional (not hallucinatory) belief that animals or
| insects are crawling below the sufferer’s skin
43
Relative contraindications for AChE inhibitors. And drugs to avoid when on
GI disease
Recent pancreatitis
Heart disease (bradycardia, AV block) - ECG prior
Asthma/COPD
Anticholinergics
NSAIDs
B blockers
44
Which SSRI does not need 4 weeks of weaning off?
Fluoxetine
45
Side effects of ECT
Headaches
Memory loss
Muscle aches
46
Teratogenic effects of SSRIs in first semester
Congenital heart defects
47
Side effects of typical antipsychotics
EPSEs
Weight gain
Hyperprolactinaemia
Anti-muscarinic
48
SSRI discontinuation symptoms
```
Flu like symptoms
Insomnia
Vivid dreams
Irritability
Dizziness
```
49
When is sodium valproate an appropriate medication for hypomania?
If antipsychotics have been tried already
50
Examples of auditory hallucinations
Third person
Thought echo
Commentary
51
Signs of zopiclone withdrawal
Convulsions
Tremors
Hyperventilation
52
Four types of schizophrenia
Paranoid
Catatonic
Hebephrenic
Simple
53
What is the difference between knight's move and flight of ideas?
In flight of ideas there is a discernible logical link between the concepts. Associated with mania
In knight's move there is no obvious link between ideas . Associated with schizophrenia
54
Why is clozapine monitored regularly?
Risk of agranulocytosis and mycoarditis
55
When does tardive dyskinesia present after starting antipsychotics?
Years later
56
What can cause a rise in clozapine levels?
Stopping smoking
Alcohol binge
(Increase dosage)
57
Three "phases" of schizophrenia
At risk phase: social withdrawal, loss of interest in work/relations
Acute phase: florid psychotic features (Schneider's). +ve symptoms
Chronic phase: -ve symptoms. Apathy, blunted affect, anhedonia, social withdrawal, catatonia, speech/thought poverty, poor personal care
58
What is the difference between harmful and dependent drinking?
Harmful by definition is non-dependent (no withdrawal symptoms)
59
Teratogenic effects of SSRIs in first semester
Persistent pulmonary hypertension of newborn
60
What can cause a fall in clozapine levels?
```
Alcohol abstinence
(Omitting doses)
```
61
Treatment of Wernicke's encephalopathy
Parenteral thiamine
+ benzodiazepines
Ensure adequate hydration and electrolyte balance
62
What can happen when tyramine containing foods (e.g. cheese) are taken alongside MAOIs?
Hypertensive crisis
63
Four key features of PTSD
Reliving (rather than remembering) - flashbacs, nightmares, intrusive memories
Avoidance
Hyperarousal - inability to relax. Always on red alert. Insomina, increased startle reflex. Poor concentration, irritability.
Emotional detachment - numbing
64
What % of people who experience extreme trauma go on to develop PTSD?
10%
65
How does smoking cessation affect clozapine levels?
Raises them
66
Cotard's syndrome
Usually seen in psychotic depression, and is a
delusional state in which the sufferer believes a part of their body (or their whole being) is rotting away or has ceased to exist.
67
Negative scz symptoms may be caused by reduced DA activity in which pathway?
Mesocortical
68
Indicators of good prognosis in schizophrenia
Rapid onset
Obvious precipitant
(Higher IQ)
Lack of family history
69
Three drugs used to manage opiate withdrawal in outpatient settings
Methadone (full mu-receptor agonist)
Buprenophine (partial opiate agonist)
Lofexidine (alpha adrenergic agonist - symptomatic relief)
70
Side effects of atypical antipschotics
Weight gain (particularly olanzapine)
HyperPRL (not as bad as typicals)
Clozapine --> agranulocytosis
71
When does opiate withdrawal peak?
36-48 hours
72
How much is one unit of alcohol?
Amount of alcohol an adult can metabolise in 1 hour
| = 8mg OR 10ml pure ethanol
73
What is acute dystonia?
Sustained muscle contraction e.g. torticollis, oculogyric crisis
74
What is akathisia?
Restlessness/inability to keep still
75
What is tardive dyskinesia?
Involuntary, abnormal choreiform movements e.g. licking lips
76
Pharmacological target of atypical antipsychotics
DA and 5HT receptors
77
Neuroimaging features of Korsakoff's syndrome
Destruction of mamillary bodies
78
Side effects of SSRIs
Dyspepsia
Insomnia
Suicidal behaviours
Hyponatraemia
79
Risk factors for PTSD
Neurotic traits
Family hx
Childhood abuse
80
Clozapine side effects
```
Agranulocytosis
Myocarditis
Hypersalivation
Constipation
Reduced seizure threshold
```
81
% of patients with mania who will go on to develop depression
90%
82
Side effects of zopiclone
Bitter taste in mouth
Constipation
Dizziness
Increased risk of falls (elderly)
83
What is simple schizophrenia?
Negative symptoms only (chronic phase)
84
Indications for ECT
Severe, life-threatening depression
Catatonic state
Severe manic states
85
Neurotransmission effects of alcohol
Increased dopamine in reward pathway -- nucleus accumbens
Increased GABA-A receptor fx
Reduced NMDA receptor fx (amnesia)
86
Do NSAIDs increase or reduce excretion of lithium?
Reduce (increased risk of toxicity)
87
Lithium toxicity features
Diarrhoea, nausea, anorexia, myalgia, ataxia, muscle twitches, tremors, blurred vision
88
Long term effects of lithium use
Hypothyroidism, irreversible nephrogenic DI, hyperglycaemia
89
Monitoring regime for lithium
Lithium levels after 5 days
Then 3 months
TFT monitoring every 6 months
ECG and weight on initiation
90
What should be measured on initiation of lithium treatment?
Weight
| ECG
91
Side effects of sodium valproate
Hair loss (w curly regrowth)
Weight gain
Nausea
92
First line treatment for depression in bipolar disorder
Olanzapine + fluoxetine
93
First line treatment acute mania
Atypical antipsychotics
94
Three important electrolytes in refeeding syndrome
Magnesium
Potassium
Phosphate
95
Pathophysiology of refeeding syndrome
Body switches from catabolic to anabolic state quickly, leading to sudden changes in gluid and electrolyte balances
96
Risk factors for refeeding syndrome
Sudden, dramatic weight loss
Starvation >5 days
BMI <16
97
Commonest eating disorder in tertiary centre
Anorexia nervosa
98
Commonest eating disorder
Binge eating disorder
99
Frequency of binging for bulimia diagnosis
1x per week for 3 weeks
100
Atypical anorexia nervosa
All the features of AN except low weight
| Somebody who started obese and is currently moving through normal weight in their weight loss
101
Risks of in utero SSRIs to the newborn
Persistent pulmonary hypertension
102
Cardiac abnormality associated with lithium use during pregnancy
Ebstein's anomaly.
103
Which medication (when used during pregnancy) is associated with an increased risk of cleft palate in the newborn?
Benzos
104
When are patients given the Edinburgh Postnatal Depression Scale?
After low mood/anhedonia questions are asked
105
What is the longest time benzos can be used to treat anxiety disorders for?
2-4 weeks
106
How should long term benzo use be discontinued?
Reduce by 1/8th dose every fortnight
107
Which receptors do benzodiazepines potentiate?
GABA-A
108
First line pharm treatment for GAD? What if this doesn't work?
SSRI
Then try another SSRI
Then try SNRI
109
Antipsychotic used in challenging behaviours (in learning disabilities) if appropriate?
Risperidone
110
When is formication seen?
Cocaine intoxication
111
Diagnosis of depressive episode
One core symptom (anergia, anhedonia, low mood) for at least 2 weeks
