MD3 Psych and accidentally some RAPP Flashcards
1
Q
3 pillars of bipolar tx?
A
lithium
anti-convulsant - valporate or lamotrigine
anti-psychotic to bridge lithium efficacy period
2
Q
What psychotropic not to give in bipolar?
A
SSRI/SNRI - risk of mania.
3
Q
Which benzo is best for sleep . eg. to tide an SSRI patient over in waiting period?
A
temazepam
4
Q
PTSD therapy type?
A
EMDR
5
Q
Organic causes of anxiety?
A
- hyperthyroid
- arrythmia
- hyper cortisol
- pheo
6
Q
OCD Mx?
A
CBT + SSRI
7
Q
Community equivalent to glycopyrolate?
A
Hyocine butylbromide
8
Q
The 5 EOL symptoms to treat?
A
Pain and SOB, N+V, agitation, secretions.
9
Q
Metaclopramide class?
A
D2 antagonist
10
Q
Key to diabetic foot disease?
A
OFFLOAD
11
Q
Two classes of medications that may cause incontinence?
A
diuretics and anti-cholinergics.
12
Q
What age can you diagnose a personality disorder?
A
not until 18, the prelude is Conduct Disorder (can only have this prior to 18).
13
Q
Therapy type for BPD?
A
DBT therapy
14
Q
It is important to always take a _________ in mental health assessments where possible.
A
Collateral hx
15
Q
Which observation is key in anorexia?
A
Standing BP
16
Q
Typical Mx for First Episode Psychosis?
A
Inpatient stay (if they refuse, CAT team may be an option)
17
Q
Necessary timeline for GAD?
A
6 months
18
Q
Reasons pts avoid mental health treatment?
A
self-esteem
stigma
worry about employment
19
Q
What is conversion disorder?
A
paralysis or other somatic manifestation of psych disorder
20
Q
What is cyclothymia?
A
chronic mood disorder slightly less than hypomania
21
Q
BMI cutoff for anorexia nervosa?
A
Under 18.5
(both types of anorexia)
22
Q
What is atypical anorexia?
A
Consistent with anorexia but still above 18.5 BMI (usually overweight individuals)
23
Q
What is PICA?
A
Eating things that aren’t food
24
Q
What is rumination?
A
Regurgitating food
25
A systolic of ___ would warrant admission for eating disorder.
Under 80
26
Amennorhea in eating disorder pt's indicates a risk of?
Osteopenia
27
Which allied health member is key in refeeding?
Dietician
28
Which 4x molecules should be given for refeeding?
phosphate, potassium, thiamine, magnesium
29
Therapy mode for young eating disorders:
family based therapy
30
How dangerous is opiate withdrawal?
Not dangerous just unpleasant
31
Key qns for PTSD?
- hypervigilence
- nightmares
- sleep
- flashbacks
32
What is suboxone?
mix of naloxone and buprenorphine for opioid withdrawal.
33
Ix for epilepsy?
24 hr EEG monitoring
34
Recorded seizure but normal EEG suggests?
Pyschogenic seizure
35
Does a good recall of events after a seizure suggest epileptic or psychogenic?
Pyshcogenic. Epileptics usually very confused with amnesia.
36
Length of psychogenic seizures?
Typically longer than one minute (usual epileptic length).
37
Primary vs secondary vs tertiary gain?
Primary gain - immediate gain to improve current situation/safety
Secondary gain - sick role/social benefit
Tertiary gain - gain for another, eg. caregiver.
38
Screening for post-natal depression?
Edinburgh depression score
39
4AT under 4 means?
No delirium
40
Screening tool for first nations dementia?
KICA
41
Best anti-psychotic for FEP?
Aripiprazole/brex (lowest weight impact)
42
Mnemonic for breaking bad news?
SPIKES
Setting
Perception
Initiation
knowledge
emotion
summary
43
4 x dopamine paths and their psychiatric relevance?
Mesolimbic - positive symptoms of schizhophrenia
Mesocortical - negative symptoms of schizophrenia
Niagral striatal - EPSE
Infundibular - prolactin levels
44
HR up and SOB in a patient on clozapine? Which Ix?
Suspect myocarditis.
ECG
Troponin
CK
CRP
Imaging - cardiac MRI (best) or ECHO
45
Aspects of the mental health act:
pt needs immediate tx for psychiatric issue due to risk of harm
pt can be treated under the act
there are no less restrictive measures
46
How long to treat FEP?
At least 2 yrs
47
When to consider clozapine?
Fail to reach effect twice on 8 week trials of other agents.
48
What is chlorpromazine?
First gen anti-psychotic AND anti-epileptic so can be used in bipolar too.
49
Negatives for anti-psychotic depot?
- feels restrictive
- can't change dose quickly
50
What is zuclopenthixol?
ACCUPHASE
2-3 day treatment for agitation.
51
Types of EPSE?
Tardive dyskinesia, akathisia, dystonia, parkinsonism.
52
Which ix would you use to monitor a pt on anti-psychotics long term?
BSL, lipids, BMI etc. Due to metabolic syndrome risk.
53
Lithium serum concentration aim?
Aim under 1 mmol/L
54
Which anti-convulsant for bipolar is best for pregnancy/non-teratogenic?
Lamotrigine.
Valporate is teratogenic.
55
What is acute dystonic reaction and how to Mx?
Sudden EPSE to first doses of anti-psychotics.
Mx = do not change or reduce dose of anti-psychotic, commence benzotropine (Parkinsons Tx) and wait.
56
Finding on brain scan for Huntingtons?
box shaped ventricles
57
Best imaging for brain aneurysm?
MRI angiogram
58
Timeline in order to diagnose mania?
episode must be a week or more.
59
Ddx never to forget in suspected mania?
Drug induced mania.
60
2 pharm approaches to GAD?
SSRI and benzos
61
Risks of neurostimulation?
memory loss, headache, anaesthetic risk
62
Big 4 considerations when prescribing a TCA?
- QT enlongation
- sedating/weight gain
- anti-cholinergic
- ORTHOSTATIC HYPOTENSION
63
Best anti-depressant for geris?
Mirtazepine
64
clomipramine is used in which condition?
OCD
65
Best benzo for sleep?
Temazepam
66
agents that contribute to serotonin syndrome?
Anti depressants (SSRIs, SNRIs, TCAs), tryptans, tramadol, LITHIUM, illegal drugs.
67
signs of serotonin syndrome?
sweat, shiver, hyper reflexia, myoclonus, dilated pupils.
68
Receptor for opioids?
mu receptor
69
Which 2 things should be given to drinkers just as they quit?
thiamine and benzos
70
How many manic episodes are needed to Dx BPAD?
1
71
How often to monitor Lithium levels?
every 3 - 6 months
72
Carbonate medications eg. antacids make which psychotropic less effective?
Lithium
73
Which benzo is used for alcohol withdrawal in those with liver disease?
Oxazepam NOT diazepam
74
MOA of thiamine and when in the day to give?
Helps in carb metabolism
Give BEFORE food so it can help out.
75
4 Medications for alc withdrawal?
1. Benzo
2. thiamine
3. naltrexone
4. acamprosate
76
3 typical delusions in geri depression with psychosis?
nihilistic, financial, constipation/continence.
77
8 P's of delirium?
-poo (constipated)
-pee (retention)
-pain
-pills (polypharmacy)
-pus (infection)
-potassium (electrolytes)
-puffed (hypoxia)
-parched (dehydrated)
78
How to differentiate somatic symptom disorder from hypochondriasis?
Somatic symptom disorder has no diagnosis in mind.
Hypochondriasis are fixated on a disease.
79
Factitious disorder is also known as?
Munchausen's
80
immediate symptoms of lithium dose?
N+V, fatigue.
81
2 big groups of meds that cause delirium?
anti-cholinergics (TCAs, benzos, lithium, opioids)
diuretics
AND STEROIDS
82
What is neuroleptic malignant syndrome? Mx?
Sudden fever, sweating, rigidity and confusion after starting an anti-dopamine drug. Mx by withdrawing agent, cooling, hydrating and potentially dialysis for CK level.
83
Ix for neuroleptic malignant syndrome?
FBE for WBC and CK levels
84
Why isn't valporate used in pregnancy? What is the mood stabiliser of choice?
Spinal defects.
Lamotrigine.
85
What is Ebstein's anamoly and which psychotropic causes this?
Congenital displacement of tricuspid valve. Caused by Lithium.
86
Autistic patients may suffer from which type of eating disorder?
ARFID - sensory issues
87
Eating disorder symptoms?
tachycardia, increased body hair, constipation/gastroparesis, dehydration, amenorrhea, leukopenia.
88
Most important vital sign for eating disorder?
Postural BP
89
Ix for Eating disorder?
ECG, BSL, ketones. Height and weight. - for screen.
FBE, iron, UEC, LFT, CMP, albumin, b12, folate, vit D, LH, FSH, TFTs, thiamine, DEXA.
90
Great way to tell Parkinsons apart from EPSE?
Unilateral (Parkinsons) pill rolling tremor vs bilateral pill rolling tremor (EPSE)
91
what is echolalia?
mimicking speech
92
what is coprolalia?
swearing like tourettes
93
What are capgras delusions?
Think people are being replaced by clones/copies.
94
Expressive dysphasia is also known as?
Broca's
95
4 components of speech in MSE?
Volume, rate, rhythym, tone
96
What is most weight safe antidepressant?
agomelatine
97
Which anti-psychotic tends to impact prolactin the most?
Risperidone and paliperidone
98
Parkinson's triad:
cogwheel rigidity
bradykinesia
unilateral pill rolling tremor
99
SSRI efficacy?
50-70%
100
What is paroxetine?
SSRI
101
Classic examples of tardive dyskinesia?
Face movements - blinking, jaw and mouth movements like lip smacking. Tongue darting.
102
Bowel obstruction is a risk with which anti-psychotic?
Clozapine
103
Pharm Mx for acute agitation that is a threat to staff?
Droperidol
104
What is NMS and best mx?
neuroleptic malignant syndrome - withdraw agent
105
Best Pharm mx for catatonia?
lorazepam
106
Which symptom of depression is the most accurate predictor of risk?
Hopelessness
107
Anti-depressant with worst discontinuation symptoms?
Venlafaxine
108
Mood stabiliser of choice in pregnancy?
Lamotrigine
109
Why can eating disorders cause parotidomegaly?
excessive vomiting
110
Smoking cessation pharm mx?
nicotine replacement
buproprion
111
