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Psychiatric treatment and medication Flashcards

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1
Q

define the dopamine hypothesis for schizophrenia

A

suggest:
1-hyperactivity of the mesolimbic dopamine pathways
-accounts for the positive syx of schizophrenia

2-defifcinecy of dopamine in the mesocrotical dopamine pathway
-accounts for negative and cognitive syx of schizophrenia

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2
Q

examples of first generation antipsychotics 4

A

flupentixol

chlorpromazine hydrochloride

haloperidol

sulpride

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3
Q

examples of second generation antipsychoticvs 6

A

amisulrpide

aripiprazole

clozapine

olanzapine

quetiapine

rispperidone

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4
Q

indications for antipsychotic use 2

A

schizoprhrenia and related disorders

bipolar affective disorder

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5
Q

movement disorder adverse effects of antipsychotis 4

A

acute dystonia
-involuntary contractions of skeletal muscle

pseudo-parkinsonism
-tremor, rigidity and hypokinesia

akathisia
-motor restlessness
-subjective feeling of tension and inability to tilerate inactivity which gives rise to restless movement

tardive dyskinesia
-late onset hyperkinetic, involuntary movement s

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6
Q

autonimic affects of antipsychoics 4

A

anti-adrenergic
-postural hypotension
-ECG chagnes (QTc prolongation) (can cause torsades)

anti-cholinergic
-dry mouth
-blurring of vision
-constipation
-dificultuy with micurtiion and retention

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7
Q

other adverse effects of antipsychotics

A

neuroleptic malgingant syndrome
-potentially fatal
-causes muslce rigidit, extreme EPS, severely elevate body temp and hyperteions and tachycardia

convulsant activity
-antispychotics (esp chlorpromazine) can lower seizure threshold

pigmentation of the skin

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8
Q

metabolic effects of antipsychotics 2

A

weight gain
-occurs with clozapine and olanzapine
-linked to DM

Endocrine
-hyperprolactinaemia
-can cause reduced labido and sexual dysfunction men
-menstrual irregularities and lactation in nonpregnnat females

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9
Q

hypersensitivity reactions to antipsychotics 2

A

cholestatic jaundice
-phenothiazine class (chlorpromazine)

skin reactions
photo seneisivty rahses

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10
Q

what is clozapine licsended for

A

treatment ressitant schizophrenia

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11
Q

why are second generation APs favourable to first generation

A

have fewer extrapyradimal side effects
-dont cause tradive dyskinesia
-not elevate prolactin

have more metabolic effects tho (weight gain)

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12
Q

most important side effect to consider for clozapine
-how is this managed

A

potenially fatal agranulocytosis

occurs in 0.5-2% of ptx

-managed by WBC monitoring initially as inpatient then community
-weekly for 18wks
-then fortnightly for up to one year
-then monthly

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13
Q

describe the link of clozapine and smoking and the risk associated

A

tobacco induces hepatic enzymes
-patients on clozapine will have reduced plasma levels

reduction or cessation in smoking will result in increased clozapine plasma levels
-this can cause dose related adverse effects

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14
Q

define hypomania vs mania

A

Mania and hypomania differ with respect to duration, intensity, and functional impairment:

Duration: In mania, an elevated or irritable mood lasts at least one week. In hypomania, symptoms last for at least 4 days.
Intensity: In mania, symptoms are severe, and in hypomania, they are mild to moderate.
Functional Impairment: In mania, critical life activities such as work and social relationships are impaired. In hypomania, there is no functional impairment.

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15
Q

definition of bipolar disorder

A

repeated (at least two) episodes were patients mood andactivityu levels are significantly disturbed
-on some occasion an elevation of modd and increased energy and acitivyt (hypo(mania))
-on some occasions lowering of moood and decreased energy and activity (depression)

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16
Q

describe the young mania rating scale

A

This is an 11-item instrument used to assess the severity of mania (Young et al 1978). (2)

Elevated Mood
Increased Motor Activity Energy
Sexual Interest
Sleep
Irritability
Speech (rate and Amount)
Language-Thought Disorder
Content
Disruptive-Aggressive Behaviour
Appearance
Insight

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17
Q

state the three main mood stabilisers used in the UK 3

A

lithium

carbamazepine

valporate

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18
Q

describe the uses of lithium in psychiatry 5

A

acute treatment of hypo(mania)

prophylaxis of bipolar or schizo

prophylaxis of recurrent depressive illness

augmentaiton of antidepressants in acute depressive illness

treatment of depresison in bipolar disorder

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19
Q

goals of acute treatment of mania 3

A

reducing mental and physical overactivity

improving features of psychosis

prevent deterioration in health due to exhaustion, sleep deprivation and poor fluid intake

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20
Q

options for acute treatment of mania 5

A

mood stabilisers
-lithium first line

antipsyhotic drugs

other mood stabilites
-lamotrigine and gabapentin

benzos- lorazepman and clonazepam

ECT

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21
Q

predictors of poor responses to lithium

A

rapid cycling disorders or chornic depresion

mixed affective states

alcohol and drug misuse

mood-incongruent psychotic features

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22
Q

define mixed affective staet

A

simultaneous presenc of features of mania and depression

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23
Q

define rapid cycling disorders

A

4 distinct periods of abnormal mood within the year

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24
Q

lithium use in pregnancy

A

lithium is teratogenic
-causes tricuspid valve deformity and thyroid function of the new born infants

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25
what is checked before commencement of lithium 3
need TFTs, ECG and kideny function tests before commenced
26
main drug interactions with lithium 2
NSAIDs Thiazide diuretics
27
what physcial state in lithium a danger in
dehydration (diarrhoea or excess sweating) as toxicity can occur
28
common side effects of lithium 7
N+V diarrhoea metalic taste in mouth cognitive dulling tremor muscle weakness weigh gain
29
serious side effects of ltihium 4
hypothyroidism -MAIN hyperparathyroidism renal tubular necorsis- renal failure nephrogenic diabetes inspidius
30
presentation of lithium induced hypothyroidism and managemnt
can occur with a frank goitre (lithium interfere with thyroid function by competing with iodine for absorption into thyroid gland) corrected by giving thyroxine -reversible on stopping lithium
31
renal tubular necrosis in lithium use overview
rare -unlear origin develop renal failure with progressive reduction in renal clearance management: -therapueitc bloods monitoring checked 3/12 allows early detection ie eGFR
32
importantt roles of multidisaplinary memebrs for psychaitric patients 5
1. Community Psychiatric Nurse allocated and their role would be to monitor mental state and adherence with medication. 2. Housing Officer present to monitor and report on state of housing and related issues. 3. Occupational Therapy assessment to assess Activities of Daily Living (ADL) (3 marks) 4. General Practitioner for physical health review. 5. Social Work to perform a Needs Assessment focusing on social functioning.
33
management of lithium overdose 3
prinicple - reduction of ansopriong and increased clearance of lithium -diuresisi via IV fluids -Gastirc lavage -Whole bowel irrigation
34
basic prinicples of prescribing antidepressants
discuss w ptx- choice of drug and utility/vaiblilt discuss w patient likely outcomes- -gradual relief from depressive syx over several weeks pprescibre dose of antidepressants - that is likely to be effective withdraw antidepressants gradually -always inform patients of risk and nature of discontinuation syx for a single episode -contine treatment for 4066months after resolution of syx
35
what is the prinicple theory that underpins use of antidepressants and describe ti
monoamine theory of depression depressive syndrome is due to an absolute or relative decrease in monoamines, or of receptor sensitivity at certain receptor sites in the brain
36
state the monoamine neurotransmitters in the brain 3
noradrenaline (NA) dopamine (D) serotonin (5HT)
37
state the different types of antidepressants and some examples 4
tricyclics -amitryptylin SSRI -sertraline, fluoextine, citalopram SNRI -venlafaxine Monoamine oxidate inhibiotrs (MAOIs) -phenalzine
38
MOA of antidepressants
enhance functional activity of NA and/or 5HT -*wait 6 weeks to evaluate effects of antidepressants on an individual basis
39
first choice antidepressants
SSRIs -safe in overdose and heart disease -good adverse effect profile
40
SSRI side effects 7
GI -Nausea -appeitie loss -dry mouth -diarhoea CNS -insomia -dizziness -anxietry -fatigue other -sweating -delyaed orgasm and anorgasmia
41
worry with St john worts use
if coprescribed with SSRI or other 5-HT potentiating drugs can cause serotonergic syndrome
42
neurological features of serotonin syndrome 6
Neurological -myoclonus -nystagmus -headache -tremor -rigidity -seizures
43
mental state features of serotonin syndroem 4
mental state -irritability -confusion -agitation -hypomania
44
other features of serotonin syndrome
hyperpyrexia sweating diarrhoea cardiac arrhymias death
45
CBT concepts
thoughts feelings physcial sensations and behvaiours interconnected negative thoughts and feelings can trap you in a vicious cycle
46
what is the focus of CBT
dealing with automacitv negative thoughts
47
automatic negative thoughts are a nromal everyday occurrence but why are they worse in anxiety and Depression 3
experieced more frequently harder to challenge helpful/balancing thoughts are crowed out
48
CBT approach 5
here and now problem focused specific strategies homework more directive than other therapies
49
5 areas model of CBT
a life situation, relationship or practical problem -then with the CBT approach you do: -altered thinking -altered physical sensations/syx -altered emotions -altered behaviours
50
what is CBT good for 6
depression anxiety OCD eating disorders phobias panic
51
describe psychodynamic psychotehrapy
past relationships recreated in current relationship: -transference -counter transfernce aims -improve insight (identify unhelpful unconicous processes and defense mechanisms -improve management of distress
52
define defence mechanisms
protect us from emotioal distres by preventing experience of unacceptable feelings/impulses/conflicts can be on spectrum from conscious to unconscious everyone uses them not necessarily pathological
53
regarding defence mechanisms: -define projection
attributing unacceptable feelings/thougths to someone else
54
regarding defence mechanisms: -define splitting
all good/ all bad
55
regarding defence mechanisms: -define displacement
an individual transferring negative feelings from one person or thing to another.
56
regarding defence mechanisms: -define repression and suppression
repression- unconscious suppression- concious both- 'forgetting'
57
regarding defence mechanisms: -define intellectualisation
focusing on facts, ignoring emotional content
58
regarding defence mechanisms: -define rationalisation
rational justifications/ excuses for behaviour
59
regarding defence mechanisms: -define sublimation
unacceptable feelings/thoughts into acceptable channel
60
what is the main principle of family (systemic) therapy
mainly in CAMHS -family seen together based on: -syx is not a problem of the child but a problem of the family system -no one person to blame family is seen as a system of relationships -all contribute to maintaining the system and hence the symptoms
61
method of family therapy
promote effective communication patterns within the family -therapist and team take a 'one-down' position postmodern approach -family are experts and have the answers
62
overview of counselling
most common psychotherapy -mainly promary care and usually short term aim to help person become celare about problems and then come up with own answers -therapist tend to avoid giving answers not aim to bring fundamental change but instead bolster existing coping strategies
63
what is the danger with tricyclic antidepresants
dangerous in overdose -seizures -comas -arrythmias
64
an example of a noradrenaline and specific serotonin antidepressant (NaSSAs)
mirtazapine
65
important info on antidepressants for exams 3
selec drug based on side effect profile -ie poor appetite and poor sleep- mirtazpaine wathc for discontinuation symptoms vs addiction sexual side effects could be hidden agenda
66
info on antipsychotics for exams 3
differences betweeen first generation and second generation monitoring -weight -BP -ECG -glucose/HbA1c -lipids remind patient to wear sunscreen
67
what is the teratongenic effect of valporate
neural tube defects
68
what is the teratogenic effect of lithium
ebsteins anomaly -a rare heart defect that's present at birth (congenital). In this condition, your tricuspid valve is in the wrong position and the valve's flaps (leaflets) are malformed
69
why is ECT one of teh safest psych treatments 2
least side effects fastest acting- life saving
70
what happens in ECT
controlled siezure -improves mood and psychotic syx
71
indications for ECT 3
severe depression- sucidal ideation, psychomotor retardation catatonia treatment resistant psychosis
72
contraindications for ECT
no absolute contraindications
73
how often is ECT usually performed
twice/week up to 12 sessions
74
consent for ECT?
patinet needs to give consent or 2nd opinion from mental welfare commission
75
what is given for ECT 2
general anaesthetic muscle relaxant
76
risks of ECT 4
mainly from anaesthetic dentition headache and muslce pains, vomiting long term: memory can be affected
77
mainstay of psychosurgery
anterior cingulotomy -targets anterior cingulate cortex (part of. limbic system)
78
what is anterior cingulotomy psychosurgery used for 2
treatment resistant mood disorder treatment resistant OCD
79
other psychosurgery exmaples 2
transcranial magentic stimualtion vagal nerve stimulation

Psychiatry (21 decks)

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