Psych (things I forget) Flashcards
(49 cards)
What is the difference between tardive dyskinesia, acute dystonia and akathisia?
Tardive dyskinesia = prolonged use - choreoathetoid movements
Acute dystonia = acute reaction - sustained muscle contraction e.g. torticollis/oculogyric crisis
Akathisia = acute reaction - motor restlessness
What are 4 main side effects of typical antipsychotic use?
- Acute dystonia
- Akathisia
- Parkinsonism
- Tardive dyskinesia
What is used to manage tardive dyskinesia, acute dystonia and akathisia?
Tardive dyskinesia = tetrabenazine
Acute dystonia = procyclidine (2nd line = benzotropine)
Akathisia = propranolol
When should patients new on SSRIs be reviewed?
<25 = 1 week
>25 = 2 weeks
What are the clinical features of SSRI discontinuation syndrome?
- Dizziness
- Electric shock sensations
- Anxiety
- Sweating
- GI symptoms
- Restlessness
What should be done in patients on antidepressants displaying symptoms of mania/hypomania?
Stop antidepressant and start antipsychotic
What are risk factors for schizophrenia?
- Male
- Black
- Family history
- Cannabis use
- Childhood abuse
What are prognostic indicators in schizophrenia?
Good = female/predominance of positive sx
Bad = gradual onset of sx/onset in adolescence
What are the NICS/CKS aspects of management for schizophrenia?
- Assess risk of harm to self and others
- Referral to psychiatric team
- Antipsychotic under specialist supervision
- Signpost to support for self/family
- Offer CBT
- Treat co-existing psychiatric/substance disorders
Which antidepressant commonly causes increased appetite and subsequent weight gain?
Mirtazapine (NaSSAs)
What is clang association?
Ideas related only by rhyme or being similar sounding
What should be done to patients with depression who are about to commence ECT?
Reduce antidepressant medication
What is catatonia?
State in which someone is awake but does not seem to respond to other people and their environment/state of near unconsciousness or insensibility
What is the diagnostic criteria for chronic insomnia?
Trouble falling/staying asleep at least 3 nights per week for >3 months in patients of any age
Describe the PHQ-9 score for depression
- <=4 = minimal
- 5-9 = mild
- 10-14 = moderate (talking therapy)
- 15-19 = moderately severe (pharmacotherapy)
- > =20 = severe (pharmacotherapy + referral)
Describe alcohol withdrawal timeframes
6-12 hours = symptoms
36 hours = seizures
72 hours = delirium tremens
What does acamprosate do?
NMDA receptor antagonist - reduces alcohol cravings
What does disulfiram do?
Acetaldehyde dehydrogenase inhibitor - causes unpleasant symptoms when someone has alcohol
What does naltrexone do?
Reduces the pleasurable effects of alcohol
What medications are used in drug overdoses?
Naloxone
Paracetamol - acetylcysteine
What are investigative features of anorexia?
- Most things low
- Gs and Cs raised = Growth hormone, Glucose, salivary Glands, Cortisol, Cholesterol, Carotinaemia
What is neuroleptic malignant syndrome and what are the causes?
Life-threatening disorder characterised by confusion, rigidity and fever
- Adverse reaction to antipsychotics (dopamine receptor agonists)
- Abrupt withdrawal of dopaminergic medication
What are the investigations for neuroleptic malignant syndrome?
- Raised CK
- Raised WCC
- Deranged LFTs
- Abnormal U&Es
- Metabolic acidosis
What is the difference between conversion disorder and somatisation disorder?
Conversion disorder = loss of motor/sensory function
Somatisation disorder = multiple unexplained symptoms >2 years
