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MH Flashcards

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1
Q

Pharmacology of Alcohol use disorder-NAD

A

Naltrexone
Acamprosate
Disulfiram

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2
Q

Drug and alcohol history- PCWHTA

Also, check their motivation to stop

A

Pattern

Control

Withdrawal

Persistence despite harm

Tolerance + Abstinence

Motivation to stop

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3
Q

Mood in MSE

-SOA

A

Subjective–> I feel like shit too
Objective–> Euthymic, dysthymic and maniac
Affect–> outward manifestation of mood

Is it congruent
Is it reactive
Is it labile

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4
Q

Substance dependence- two things you have to look for if they are dependent on a substance

A

Substance tolerance and withdrawal

A maladaptive change in behaviour, resulting from substance tolerance and substance withdrawal. Namely, the patient perceives a need for the substance to avoid unpleasurable feelings–> Monopolization, loss of control and social changes

Monopolization
Multiple hospitalizations
Loss of control of use
Symptoms of tolerance and withdrawal

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5
Q

Why is ETOH and benzo dangerous

A

Although the extent of respiratory depression differs from one benzodiazepine to another, severe, life-threatening episodes such as those seen in opioid intoxication are uncommon in benzodiazepine monotherapy. However, respiratory depression can be quite severe when benzodiazepines are combined with other respiratory depressants (e.g., alcohol).

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6
Q

The antidote for Benzo overdose

A

Antidote: flumazenil

Indications
Severe respiratory depression
Overdose in benzodiazepine-naive patients (e.g., accidental ingestion in children, periprocedural oversedation with benzodiazepines)
Routine use of flumazenil for benzodiazepine overdose is not recommended.

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7
Q

Why should you be cautious when using flumazenil in Benzo OD in a chronic benzo user

A

Can precipitate seizures

Most cases of benzodiazepine overdose occur in patients who are on chronic benzodiazepine therapy. Flumazenil can precipitate withdrawal symptoms and seizures in patients with benzodiazepine dependence.

Benzodiazepine overdose is very rarely life-threatening unless associated with the co-ingestion of alcohol, opioids, barbiturates, 1st generation antihistamines (e.g., diphenhydramine) or other respiratory or CNS depressants!

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8
Q

ECT electrode placement

A

Unilateral placement- all dependent on the tragus of the ear on non-dominant hemisphere, one goes to the temporal fossa and the other close to the vertex

Bitemporal- Placed on the temporal fossa

Bi-frontal- outer the canthus of the eye

LOOK AT THE PICTURE for electrode placement in ECT

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9
Q

What are the absolute contraindications and relative for ECT

A

No absolute contraindications.

Relative contraindications include:
Elevated intracranial pressure and space-occupying lesions in the brain
Recent myocardial infarction (within the last 3 months)
Severe arterial hypertension
Narcotic intolerance
Acute glaucoma
Changes in the cerebral arteries, e.g., aneurysm, angioma

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10
Q

Pregnancy and pacemakers contraindicated in ECT-True or false

A

False

Pregnancy and pacemakers are not a contraindication for ECT!

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11
Q

What are some side effects of ECT

  • common
  • uncommon
A
  1. Reversible memory loss: retrograde more often than anterograde amnesia
  2. Tension headache
  3. Nausea
  4. Transient muscle pain

Less common
Skin burns
Temporary, short-term functional disorders (such as amnesic aphasia)
Prolonged seizure

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12
Q

Delusion vs illusion vs hallucination

A

Delusion- fixed false belief
Illusion- Misintreparation of an external stimulus
Hallucination- Perception in the absence of an external stimulus

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13
Q

5A of schizophrenia- negative symptoms

A 
Anhedonia 
Affect(Flat)
Avolition 
Alogia- a poverty of speech
Attention(poor)
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14
Q

Positive, negative and cognitive symptoms of schizophrenia

A

Think of positive symptoms as things that are ADDED to normal behaviour

Think of negative symptoms as things that are SUBTRACTED or missing from normal behaviour

cognitive symptoms–> impairment in attention, executive function, and working memory

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15
Q

Three phases of schizophrenia

A

Prodromal

Psychotic

Residual

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16
Q

Which pathway responsible in schizophrenia

  • positive symptoms
  • negative symptoms
A

mesolimbic for +

Mesocortical for -

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17
Q

What happens in the blockage of

  • tuberoinfundibular
  • nigrostriatal
A

Tubo–> gynacomastia, galactorrhea, and menstrual irregularities

Nigrostriatal–> EPS–> tremor, slurred speech, akathisia, dystonia and other abnormal movements

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18
Q

What are the difference between delusional and schizophrenia

A

Schizophrenia

  1. Bizzare delusions
  2. Daily functioning impairment
  3. Must have 2 or more of the following
    - Delusions
    - Hallucinations
    - Disorganized speech
    - Disorganized behaviour
    - Negative symptoms

Delusional disorder

  1. Non-bizzare
  2. Not impaired
  3. Does not meet the schizophrenia criterion
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19
Q

Delusion

  • defintion
  • bizzare
  • non-bizzare
A

Delusions: fixed, false beliefs that are not amenable to reason, despite evidence to the contrary

Bizarre: impossibility of being true or not consistent with the patient’s social and cultural norms(having super-powers and all)

Non-bizarre: possibility of being true or consistent with the patient’s social and cultural norms(winning the lottery,when you haven’t)

May be grandiose , ideas of reference , paranoid, or erotomanic

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20
Q

Catatonia

  • definition
  • treatment
  • types
A

A behavioral syndrome characterized by abnormal movements and reactivity to the environment

Treatment- benzo and ECT

Retarded catatonia: immobility, posturing, negativism (resisting external commands), staring, mutism

Excited catatonia: excessive, purposeless movement in both the upper and lower limbs, restlessness, and impulsivity

Malignant catatonia: fever, autonomic instability (e.g., tachycardia, tachypnea, abnormal BP, and sweating), rigidity, and delirium (resembles neuroleptic malignant syndrome)

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21
Q

What will schizophrenia show with brain imaging

A

Brain imaging of schizophrenia patients often shows cortical atrophy and enlargement of the cerebral ventricles.

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22
Q

Psychotic symptoms lasting > 6 months

A

Schizophrenia

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23
Q

Psychotic symptoms lasting > 1 day but ≤ 1 month

Triggered by stressful situations

A

Brief psychotic disorder

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24
Q

Psychotic and residual symptoms lasting 1–6 months

A

Schizophreniform disorder

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25
Schizoaffective disorder
Features of schizophrenia AND a major mood disorder (depression or bipolar disorder) Remeber that it can happen with any MOOD DISORDER- EVEN BIPOLAR--> so you have maniac epsiode with it haha Psychosis must have been present for at least 2 weeks in the absence of any mood disturbance. Mood symptoms do not appear in the absence of psychosis
26
DDX for psychosis
``` Psychosis secondary to GMC Drug-induced psychosis Delirium/Dementia Bipolar disorder, maniac/mixed episode MDD with psychotic features BPD Schizo ones Delusional disorder ```
27
≥ 1 delusion with a duration of ≥ 1 month and no other psychotic symptoms Functioning is not markedly impaired and behavior is not obviously bizarre or odd
Delusional disorder
28
Mood disorder with psychotic features How is it different to schizoaffective disorder
Meets criteria for a mood disorder (e.g., depression or manic phase of bipolar mood disorder) Psychotic features appear exclusively during manic or depressive episodes. Mood symptoms may be present in the absence of psychosis. Mood symptoms do not appear in the absence of psychosis - this is schizoaffective disorder
29
If delusions and hallucinations are not mood congruent it is If delusions and hallucinations are mood congruent it is likely due to
1. psychotic or schiz etc disorder | 2. Mood disorders
30
Differences between mania vs hypomania
Mania Lasts at least 7days Causes severe impairment in social or occupational functioning May necessitate hospitalization to prevent harm to self for others May have psychotic features Hypomania 1. Lasts at least 4 days 2. No impairment 3. Does not require hospitalization 4. No psychotic features
31
MDD and sleeping patterns
Two most common sleep disturbances are: 1. Difficulty falling asleep 2. Early morning awakening
32
What are the unique types and features of depressive disorder
1. Melancholic 2. Atypical 3. Catatonic 4. Psychotic
33
What if pregnant women comes in with maniac episode
ECT is the best treatment for a maniac woman in pregnancy. It provides a good alternative to antipsychotics and can be used with relative safety in all trimesters
34
Dysthymic disorder
Double depression | -Pt. with MDD with dysthymic disorder during residual periods
35
Adjustment disorder vs PSTD and Define adjustment disorder
In adjustment disorder, the stressful event is not life-threatening(such as a divorce, death of a loved one, or loss of a job). In PTSD it is Adjustment disorder occurs when maladaptive behavioural or emotional symptoms develop after a stressful life event. - symptoms begin 3 months after the event - end within 6 months - cause significant impairment in daily functioning or relationships
36
Obsessions
1. Recurrent and persistent intrusive thoughts or impulses That cause marked anxiety and are not simply excessive worries about real problems 2. The person attempts to suppress the thoughts 3. The person realises thoughts are products of his or her own mind
37
Compulsions
1. Repetitive behaviours that the person feels driven to perform in response to an obsession 2. The behaviours are aimed at reducing distress, but there is no realistic link between the behaviour and the distress
38
Intrusive thoughts, images, and urges that trigger repetitive, compulsive behaviour Time-consuming (E.g., ≥ 1 hour/day), or result in significant distress/impairment (school, work)
Obsessive compulsive disorder
39
Excessive perfectionism and rigid control regarding real-life concerns
Obsessive-compulsive personality disorder
40
Recurrent thoughts revolve around real-life concerns, e.g., work, as opposed to the obsessions in OCD, which tend to be of an irrational nature.
GAD
41
Acute stress disorder vs PTSD
Acute stress disorder - the event occurred < 1 month ago - symptoms last < 1 month PTSD - event occurred at any time in the past - symptoms lasts >1 month
42
What 2 things should you rule out in any anxiety disorder
1. Hyperthyroidism | 2. Caffeine intake
43
Major complaint: anxiety in response to unspecific events or themes (e.g., health, relationships) Impaired memory, sleep disturbances, muscle tension, and/or fatigue Impaired functioning Lasts > 6 months
GAD
44
EtOH withdrawal monitoring scale
CIWA-Ar
45
Withdrawal from which 2 substances are lethal
Alcohol and benzo In general, withdrawal from drugs that are sedating is life-threatening, while withdrawal from stimulants is not.
46
Pharmacotherapy to promote alcohol cessation
Block positive effects of alcohol: Naltrexone (first-line agent), acamprosate, or topiramate. Create a toxic reaction when alcohol is ingested: Disulfiram.
47
Nose bleeding and history of drug use think
Cocaine The complication of using cocaine--> Cocaine-induced vasospasm ↓ Reuptake of norepinephrine → ↑ α- and β1‑stimulation → vasoconstriction and vasospasm → myocardial infarction, cerebrovascular accident, or ischemic colitis
48
Amphetamine use clinical features
↑ libido, constipation, tachycardia with arrhythmias, mydriasis, ↑ body temperature, ↑ perspiration, ↓ appetite, weight loss, grinding teeth
49
What is the treatment of choice for opiate overdose
Naloxone
50
Naloxone
immediate acute opioid antagonist--> used in Opioid OD
51
Methadone
full opioid AGONIST--> used to wean off the opioid tolerance without going into withdrawal Helps with weaning off
52
Buprenorphine
partial opioid agonist --> opioid withdrawal in patients with opioid dependence similar to methadone but partial
53
Naltrexone | -what are the 2 uses
opioid antagonist --> used to help people maintain their opioid abstinence. Keep them not going back to using opioids 2 uses-> 1. help people get off alcohol 2. help people stay off opioids(heroin)
54
Treat associated comorbidities of IV opioid addiction
HIV, hepatitis C, endocarditis
55
Clinical features of opioid intoxication
Altered mental status Bilateral miosis (pinpoint pupils) Respiratory depression (decreased respiratory rate and tidal volume) and hemorrhagic lung edema Seizures Decreased bowel sounds Decreased heart rate and blood pressure, hypothermia
56
Naloxone vs naltrexone
Naloxone: rapid onset, short duration (1–2 hours) → preferred for treatment of acute opioid intoxication Naltrexone: long duration (24–48 hours) → used for withdrawal treatment after acute detoxification
57
What is suboxone
Combination drug Buprenorphine+naloxone
58
Triad of an opioid overdose-RAM
Respiratory depression, ALOC and Miosis Altered mental status, respiratory depression, and miosis are the classic triad of opioid intoxication! However, the absence of miosis does not rule out opioid intoxication!
59
How do you monitor withdrawal from opioids
COWS- clinical opioid withdrawal scale--> 1. SOWS- subjective opioid withdrawal scale 2. OOWS- objective opioid withdrawal scale
60
Drug history always ask- if they said they had used drugs in the past
When was the last time you took said drug? like how long has it been
61
Can opioid withdrawal kill you
Opioid withdrawal causes severe discomfort, but is not life threatening!
62
Treatment options for nictoine
Varenicline- Champix (alpha-4-beta-2 nACHR partial agonist): reduces positive symptoms and prevents withdrawal Bupropion: reduces craving and withdrawal symptoms Nicotine replacement therapy (inhaler, lozenges, transdermal patch, nasal spray, or gum)
63
What are 2 typical symptoms of delirium
Visual hallucinations and short attention span Impairment in recent memory is the most finding in delirium
64
What is the workup for dementia
1. FBC 2. Electrolytes 3. TFTs 4. VDRL/RPR 5. B12 and folate levels 6. Brain CT and MRI
65
Fact-Dementia due to Parkinson's disease is exacerbated by antipsychotic medication
Visual hallucinations early in dementia suggest a diagnosis of dementia with Lewy bodies. DO NOT GIVE THESE patients antipsychotics
66
EPS- grimacing and tongue protrusion
Tardive dyskinesia
67
EPS- twisting and abnormal postures
Acute dystonia
68
EPS-characterized by the inability to sit still
Akathisia
69
EPS-characterized by a decrease or slow body movement
Bradykinesia
70
Hypertensive crises with MAOI
Caused bt a build-up of stored catecholamines, MAOIs plus food with tyramine(red wine, cheese, chicken liver, cured meats) or plus sympathomimetics
71
What is the black box warning with SSRIs
increased suicidal thinking and behaviour
72
PTSD- which drug can help with nightmares
Nightmares: Prazosin is effective for improving sleep.
73
Anorexia nervosa-AN- what are 2 management
1) Medical management- this is the 1st priority | 2) Psychiatric management
74
What is the mainstay treatment for TCA OD
IV sodium bicarbonate
75
Major complications of TCAs- 3Cs
Cardiotoxicity Convulsions Coma
76
What are the anti-HAM effects of typical antipsychotics
Caused by the action of Histamine Adrenegeric Muscarinic Anti-histamine--> results in sedation and weight gain Anti-alpha Adrenergic--> results in orthostatic hypotension, cardiac abnormalities and sexual dysfunction Anti-muscarinic--> anticholinergic effects: results in dry mouth, tachycardia, urinary retention, blurry vision, constipation, and precipitation of narrow-angle glaucoma
77
Neuroleptic malignant syndrome-FALTERED
``` Fever Autonomic instability(tachycardia, labile hypertension and diaphoresis) Leukocytosis Tremor Elevated CPK Rigidity--> lead pipe rigidity Excessive rigidity Delirium ```
78
Atypical antipsychotic/SGA-increase in prolactin
Risperidione
79
Atypical antipsychotic/SGA-sedation
Quetiapine
80
Atypical antipsychotic/SGA-olanzapine
O-o--> weight gain
81
Atypical antipsychotic/SGA-unqiue partial D2 agonism
Aripiprazole
82
Atypical antipsychotic/SGA-Depo from
Paliperidone
83
Lithium and suicide tendencies
Lithium is the only mood stabilizer shown to decrease suicidality
84
Mnemonic for suicide risk assessment- modified SADPERSONS --> how do you assess for low moderate increased
S: Male sex → 1 A: Age 15-25 or 59+ years → 1 D: Depression or hopelessness → 2 P: Previous suicidal attempts or psychiatric care → 1 E: Excessive ethanol or drug use → 1 R: Rational thinking loss (psychotic or organic illness) → 2 S: Single, widowed or divorced → 1 O: Organized or serious attempt → 2 N: No social support → 1 S: Stated future intent (determined to repeat or ambivalent) → 2 0–5: Maybe safe to discharge (depending upon circumstances) 6-8: Probably requires psychiatric consultation >8: Probably requires hospital admission The 2 point ones are DR.SO
85
Lithium toxicity- tell me the main points
May occur at any Li toxicity(>1.5) Nausea, vomiting, slurred speech, ataxia and incoordination, myoclonus, hyperreflexia, seizures, delirium, coma and nephrogenic diabetes insipidus Discontinue Li Hydrate aggressively Consider dialysis with acute kidney impairment
86
Suicide risk assessment
KIR(pip)E Kill Ideation R(risk)- PIP--> plan, intent and previous Hx E-explore ideation 1) Ask every patient 2) Classify ideation--> passive and active 3) Assess risk- plan, intent and past attempts
87
Mental health-admission blood(8)
1.UEC 2.LFT 3.CMP 4.TFT 5FBC 6.UDS 7.ECG 8.beta-HCG 9.Syphilis serology
88
If you are starting a pt. an antipsychotic what are the levels in the body are you worried about
1. Prolactin 2. Fasting lipids 3. B12 4. Folate 5. Vitamin D
89
For Bipolar depression which medication should not be used alone
Do not use antidepressants alone in the treatment of bipolar depression.
90
What is the treatment for bipolar depression-eTG
an antidepressant + a drug recommended for prophylaxis of bipolar disorder OR quetiapine
91
After last dose when should lithium levels be checked
When monitored, the serum lithium concentration should be measured 8 to 12 hours after the last dose.
92
What is the therapeutic level of lithium
The therapeutic range for lithium has previously been established at 0.6 - 1.2 mmol/L but recent studies have suggested a range of 0.6 - 1.0 mmol/L. 0.6-1 is a good answer For most patients, the therapeutic serum lithium concentration for prophylaxis of bipolar disorder is 0.6 to 0.8 mmol/L Some may need 0.8-1 YOU NEED TO PSYCHOEDUCATE them about the early warning signs of lithium toxicity
93
At which level does lithium toxicity occur at
Toxicity usually occurs at concentrations more than 1.5 mmol/L, but may develop at lower concentrations,
94
Which 4 drugs interact with Lithium
1) NSAIDs 2) Diuretics 3) ACEI Other medications: tetracyclines, cyclosporine(immunosuppressant- similar to tacrolimus)
95
The most common side effect of lithium
Fine tremor
96
Nephrogenic diabetes insipidus with lithium, what is the treatment
Treatment: amiloride
97
Which organ does lithium get excreted by
Kidneys
98
LITHIUM mneomic
Leukocytosis I-->inspidius--> polyuria, polydipsia, decrease GFR and AKI T--> tremor and ataxia H-Hypothyroidism I- increase weight U- underactive mind M--> mother--> Tetratogenic--> tricuspid atresia GIT-->Nausea, vomiting and diarrhea Lithium induced arrhythmias Lithium induced nephropathy
99
What are some early/mild lithium toxicity signs
Gastrointestinal symptoms dominate in acute poisoning. ``` Nausea, vomiting Tremor Agitation Proximal weakness Vision changes was a bit thing that the reg told us- double vision ``` Dehydrated
100
Late signs of lithium toxicity
Altered mental status: confusion, delirium, somnolence, encephalopathy Coarse tremor Dysarthria Disorientation
101
VALRPOATE
``` Vomiting and nausea Anorexia Liver toxicity(hepatically excreted) Pancreatitis Retention of weight Odema Alopecia Teratogen, tremors E ```
102
CPL causes Steven-johnson syndrome
Carbamazepine Phenytoin Lamotrigine

MED 5 (23 decks)

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