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psch Flashcards

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1
Q

what is phenelzine?

A

Phenelzine is a non-selective and irreversible monoamine oxidase inhibitor

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2
Q

what is fluoxetine?

A

fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class

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3
Q

what is serotonin syndrome?

A

is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe. Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.

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4
Q

name some SSRIs?

A

fluoxetine
citalopram (risk of QT interval prolongation)
sertaline (good for post MI)

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5
Q

what drugs are used in treating alcohol withdrawal?

A

First-line: benzodiazepines e.g. chlordiazepoxide. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol
carbamazepine also effective in treatment of alcohol withdrawal

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6
Q

mechanisms of alcohol withdrawal?

A

chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)

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7
Q

features of alcohol withdrawal

A

tremor, sweating, chacycardiac, anxiety

delirium, delusion

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8
Q

what is reflex hallucination?

A

Reflex hallucinations are when a normal sensory stimulus, in one modality, precipitates a hallucination in another e.g. the voices are only heard when the lights turn out.

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9
Q

what is an autoscopic hallucination?

A

An autoscopic hallucination is a visual hallucination, which describes the experience of seeing oneself in external space.

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10
Q

what is first person hallucination?

A

First person auditory hallucinations (audible thoughts) are where a person hears their own thoughts aloud.

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11
Q

what is elemtary hallucination?

A

Elementary hallucinations are simple, unstructured sounds e.g. buzzing or whistling.

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12
Q

what is hepatic hallucination?

A

Haptic is another word for tactile hallucinations. It is the feeling of the skin being touched, pricked or pinched. Formication is one type of this, where the patient has a sensation of insects crawling on the skin.

This may be associated with long-term cocaine use, or alcohol withdrawal.

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13
Q

what are Schneider’s 1st rank symptoms?

A

auditory hallucinations,

thought disorders,

somatic hallucinations

passivity phenomena

delusional perceptions:

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14
Q

why the need for ECG when on antipsychotics?

A

because patients on antipsychotic treatment are at risk of developing prolonged QT interval

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15
Q

why do antipsychotics cause galatorrhea?

A

Dopamine has an inhibitory effect on the secretion of prolactin and the inhibition of dopamine by the antipsychotic relieves the inhibitory effect on prolactin release resulting increasing prolactin secretion and hence the galactorrhea.

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16
Q

what are the extra-pyramidal effects of anti-psychotics?

A

Parkinsonism
acute dystonia: sustained muscle contraction (e.g. torticollis, oculogyric crisis)
akathisia (severe restlessness)
tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
EPSEs may be managed with procyclidine

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17
Q

how is extra pyramidal symtoms managed?

A

procyclidine

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18
Q

name some antipsychotics?

A 
risperisone-atypical
olanzapine-atypical
quetiapine-atypical
haloperidol
clozapine-atypical
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19
Q

Which is an established life-threatening side effect of clozapine?

A

Agranulocytosis/neutropenia

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20
Q

what are atypical anti-psychotics?

A

used first-line in patients with schizophrenia, according to 2005 NICE guidelines.

The main advantage of the atypical agents is a significant reduction in extrapyramidal side-effects.

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21
Q

side effefcts of atypical antipsychotics?

A

weight gain
clozapine is associated with agranulocytosis (see below)
hyperprolactinaemia

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22
Q

what are 1st gen typical antipsychotics?

A 
Benperidol (Anquil)
Chlorpromazine (Largactil)
Flupentixol (Depixol)
Fluphenazine (Modecate)
Haloperidol (Haldol)
Levomepromazine (Nozinan)
Pericyazine
Perphenazine (Fentazin)
Pimozide (Orap)
Promazine
Sulpiride (Dolmatil, Sulpor)
Trifluoperazine (Stelazine)
Zuclopenthixol (Clopixol)
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23
Q

what are 2nd generation atypical anti-psychotics? (no extra-pyrimidal)

A 
Amisulpride (Solian)
Aripiprazole (Abilify, Abilify Maintena)
Clozapine (Clozaril, Denzapine, Zaponex)
Risperidone (Risperdal & Risperdal Consta)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Paliperidone
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24
Q

when to use clozapine?

A

Clozapine should be introduced 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.

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25
side effects of clozpine?
agranulocytosis (1%), neutropaenia (3%) reduced seizure threshold - can induce seizures in up to 3% of patients constipation myocarditis: a baseline ECG should be taken before starting treatment hypersalivation
26
what is obsession and compulsion?
An obsession is an intrusive, unpleasant and unwanted thought. A compulsion is a senseless action taken to reduce the anxiety caused by the obsession
27
what is Eye Movement Desensitization and Reprocessing Therapy (EMDR) used for?
EMDR is used for patients suffering with Post-Traumatic Stress Disorder (PTSD)
28
what is Trauma-focused CBT used for?
rauma-focussed CBT is also used for patients suffering with Post-Traumatic Stress Disorder (PTSD)
29
what is Dialectical behaviour therapy (DBT) used for?
DBT is a psychological intervention for patients with borderline personality disorder.
30
what are the first line treatment for obsessive compulsury disorder (OCD)?
Exposure-response prevention (ERP) therapy as well as cognitive behavioural therapy,
31
what is the pathophysiology of OCD?
some research suggest childhood group A beta-haemolytic streptococcal infection may have a role
32
what is reaction formation?
Acting in the opposite way to the thought or feeling
33
what to prescribe to reverse the effect of extra prymidal effcts of anti-psychotics?
procyclidine (anticholinergic)
34
what risk increase are seen in the elderly when on anti-psychotics?
increased risk of strok increased risk of thromboembolism
35
ADHD medication atomoxetine, what is it's mechamism?
norepinerphrine reuptake inhibitor
36
what is body dysmorphic disorder?
Preoccupation with an imagine defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)
37
suicide risk factors?
male sex (hazard history of deliberate self-harm alcohol or drug misuse history of mental illness depression schizophrenia: history of chronic disease advancing age unemployment or social isolation/living alone being unmarried, divorced or widowed
38
protective factors in suicide?
family support having children at home religious belief
39
what is anterograde amnesia?
the inability to form new memories
40
what is retrograde amnesia?
inability to recall past memories
41
what is wernicke's encephalopathy?
thiamine deficiency disorder characterised by the triad – ophthalmoplegia, ataxia, and confusion.
42
what is Korsakoff's syndrome? (irreversible only affect the limbic system)
marked memory disorder often seen in alcoholics thiamine deficiency causes damage and haemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus in often follows on from untreated Wernicke's encephalopathy anterograde amnesia: inability to acquire new memories retrograde amnesia confabulation
43
what is pseudo-hallucination?
Flashbacks in PTSD are a form of pseudo-hallucination
44
what is elental hallucination?
simple, unstructured sounds- such as buzzing or whistling. It is a type of perceptual disturbance which may be associated with psychosis.
45
what are features of PTSD?
re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images avoidance: avoiding people, situations or circumstances resembling or associated with the event hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating emotional numbing - lack of ability to experience feelings, feeling detached
46
management of PTSD?
cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then venlafaxine(SSNRIs) or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used
47
What may be seen in patient following the administration of lorazepam (benzodiazepines)?
respiratory depression (hypoventilation)
48
what are the features of Benzodiazepine withdrawal syndrome?
tremor, anxiety, perspiration and seizures
49
GABA drugs?
GABAA drugs benzodiazipines increase the frequency of chloride channels barbiturates increase the duration of chloride channel opening Frequently Bend - During Barbeque
50
what causes ADHD?
low levels of dopamine and norepinephrine
51
mediciation used in treating ADHD?
Methylphenidate or lisdexamfetamine
52
side effects of anti-psychotics?
dystonia, dyskinesia, antiemetic effects, and hyperprolactinaemia. Another common side effect is the metabolic syndrome. Care must be taken with antipsychotics as they can also cause a prolonged QT interval.
53
what is mirtazapine?
tetracyclic antidepressants preferred in patients with anorexia nervosa as it also elevates the appetite and produces weight gain.
54
what is amitriptyline?
tetracyclic antidepressants It has a worse side-effect profile than selective serotonin reuptake inhibitors.
55
name od SSRIs?
citalopram (although see below re: QT interval) and fluoxetine are currently the preferred SSRIs sertraline is useful post myocardial infarction as there is more evidence for its safe use in this situation than other antidepressants SSRIs should be used with caution in children and adolescents. Fluoxetine is the drug of choice when an antidepressant is indicated
56
what is cataonia?
a state of unresponsiveness that may include repetitive movements or abnormal postures
57
what is a primary delusion?
are those which cannot be described by any previous psychopathological state, such as a mood disorder
58
what are delusions?
unshakeable, false belief that is not accepted by other members of the patient's culture. To the patient, there is no difference between a delusional belief and a true belief
59
what kind of delusions are common in mania and depression?
Mania and severe depression are more likely to cause secondary delusions, which relate to the patient's underlying mood.
60
what causes tardive dyskinesia?
result from long-term use of antipsychotic drugs. It is suggested that blockade of the dopamine receptor promotes hypersensitivity of the D2 receptor in the nigrostriatal pathway, thus giving rise to excessive movements.
61
what causes dystonia?
Dopamine antagonism in the chemoreceptor trigger zone is the mechanism utilised in some anti emetic medications
62
what is an adverse effect of lithium?
weight gain nausea/vomiting, diarrhoea fine tremor nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus thyroid enlargement, may lead to hypothyroidism ECG: T wave flattening/inversion intracranial hypertension
63
characteristic adverse effect of tricyclic antidepressants?
``` drowsiness dry mouth blurred vision constipation urinary retention lengthening of QT interval ```
64
adverse effect if benzodiazepine?
``` respiratory depression insomnia irritability anxiety tremor loss of appetite tinnitus perspiration perceptual disturbances seizures ```

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