lecture

Question 1

are voices in head hallucinations / psychosis

Answer 1

voices in head are not hallucinations and therefore not a symptom of psychosis

Question 2

causes to consider for different types of hallucination

Answer 2

2nd person voices - affective
3rd person - schizophrenia, oh he’s walking up and down
olfactory - check frontal lobe
visual - check organic causes such as delirium
auditory - can be normal, other causes temporal lobe epilepsy

Question 3

schneiders 1st rank symptoms

Answer 3

Question 4

parkinson’s and schizophrenia antipsychotics

Answer 4

Question 5

psychiatric history

Question 6

commonly prescribed psychiatric drugs

Answer 6

Question 7

what is an overvalued idea

Answer 7

overvalued idea - high intensity idea that preoccupies a patient, but not quite as intense as a delusion

Question 8

which type of hallucination is a schizophrenia first rank symptom

Answer 8

3rd person auditory hallucinations - shneider first rank symptoms

Question 9

drug classes for neuropathic pain

Answer 9

SNRI and tricyclics for neuropathic pain

Question 10

features of QTc prolongation

Answer 10

QTc prolonged if over 450msec for men or 470 for women —> toursades de point and cardiac arrest

Question 11

all current antipsychotics reduce what

Answer 11

level of dopamine activity at D2 receptors, mesocortical and mesolimbic

Answer 12

The four most common extrapyramidal symptoms (EPS) associated with antipsychotic medications, in order of decreasing prevalence, are: Parkinsonism, Akathisia, Dystonia, and Tardive Dyskinesia.

Question 13

unwanted effects of dopaminergic pathways in antipsychotics

Answer 13

action at nigrostantial (movement) and tuberoinfundibulnar (HPA axis)

Question 14

aripiprazole moa

Answer 14

aripiprazole - D2 partial agonist (not antagonist)

Question 15

Lamotrigine indications and severe SE

Answer 15

lamotrigine - treatment resistant depression, depressive bipolar, can cause SJS

Question 16

NMS presentation, RF, causes of death, and management

Answer 16

Neuroleptic malignant syndrome = fever, confusion, muscle rigidity, sweating, autonomic instability. Death usually to rhabdo, renal failure, seizures. RF = high potency (typical antipsychotics) in naive patient, high doses, young men.

Mx - emergency referral to A and E, stop antipsychotics, give benzodiazepines for acute behvioural disturbances, fluid resuscitation, reduce temperature with cooling blanket, oxygen, rhabdo = alkalise urine, relax muscles 1st line dantrolene or lorazepam, 2nd line bromocriptine

Question 17

acute dystonia management

Answer 17

acute dystonia management = IM or IV anticholinergics, first line is procyclidine

Question 18

dopamine antagonism at what pathway causes EPSE

Answer 18

dopamine antagonism at nigrostiatial pathway causes EPSE

Question 19

3 most common SE of antipsychotics

Answer 19

3 most common SE of antipsychotics are - weight gain, akithisia, sedation

Question 20

are typical or atypical antipsychotics more likely to cause NMS

Answer 20

typical is more likely to cause NMS due to more D2 antagonism

Question 21

Ix in NMS/infection differentials -

Answer 21

CK, CRP, WBC (not Ct or serum medication)

Question 22

what is more addictive lorazepam or diazepam

Answer 22

lorazepam has a shorter half life so is more addictive

Question 23

benzos moa

Answer 23

benzodiazepines bind to GABA receptors to potentiate effects of GABA and reduce excitability

Question 24

SNRI monitoring

Answer 24

SNRI - bp and blood sugar monitoring

Question 25

lithium monitoring, excretion, and effect on suicideality

Answer 25

lithium monitoring - weekly after dose change then 3 monthly once stable, annual Us and Es and TFTs. (renal impairment is usually irreversible)lithium is entirely secreted by kindeys and reduces suicidality

Question 26

Mirtazapine monitoring

Answer 26

Mirtazapine monitoring - FBC or WBC for agranulocytosis or neutropenia, renal and hepatic function, lipid profile and weight gain

Question 27

SJS features

Answer 27

SJS - type 4 hypersensitivity reaction, liver, mouth eyes vagina, blisters, STOP drug