Psychiatry Flashcards

Question

What makes anxiety pathological

Answer 1

Its extent or context causing significant impairment of social/ occupation/ other functions

Answer 2

Generalised and persistent but not restricted to or event strongly predominating in any particular environmental circumstance i.e. its free floating

Answer 3

Most days for at least 6 months Not controllable Causing significant distress/ impairment in functioning

Answer 4

1. Psychoeducation 2. Self help/ psychoeducation groups 3. High intensity psychological intervention CBT or drug treatment SSRI 4. SNRI 5. Pregablin

Answer 5

Up to 12 weeks

Answer 6

``` Intrusive thoughts Dissociation e.g. gaze Negative mood Avoidance Arousal e.g. hyper vigilance Emotional numbing ```

Answer 7

More than 1 month

Answer 8

LFT derangement is alcohol a problem as a possible coping mechanism

Answer 9

If sub-clinical - period of watchful waiting and arrange regular review If clinically important referral to specialist mental health service 1st line - trauma based psychological therapies - CBT focusing on exposure to. traumatic event in a controlled way and EMDR 2nd line - antidepressants SSRI (paroxetine or sertraline) or venlafaxine

Answer 10

Fear of being fat The person feels they are overweight despite evidence of normal or low body weight Obsessively restricting calorie intake with the intention of losing weight

Answer 11

Personality disorders OCD Anxiety

Answer 12

``` Excessive weight loss Amenorrhoea Lanugo hair - fine, soft hair across most of body Changes in mood, anxiety and depression Solitude Cardiac complications - prolonged QT, cardiac atrophy and sudden cardiac death Hypotension Bradycardia Enlarged salivary glands ```

Answer 13

``` Hypokalaemia Low FSH, LH, oestrogen, testosterone Low T3 Low urea - function of low protein intake Raised cholesterol and growth hormone Impaired glucose tolerance Hypercholesterolaemia Hypercarotenamia ```

Answer 14

Significant impairment of intellectual functioning Significant impairment of adaptive/ social function Age of onset before adulthood

Answer 15

Wechsler Intelligence Scale for Adult WAIS score

Answer 16

Hyperactivity

Answer 17

10 week watch and wait period before referring to CAMHS Parental and child education essential Medication if conservative management failed 1st line - methylphenidate If inadequate 2nd line - lisdexamfetamine Dexamfetamine if benefit from lisdexamfetamine but can't tolerate side effects

Answer 18

ECG as cardiotoxic

Answer 19

Deficit in social interaction, communication and flexible behaviour

Answer 20

No cure but managed via MDT approach

Answer 21

Avoidance and restriction of certain foods and types of food

Answer 22

Tailored to individual needs If anxiety - CBT or SSRI If comorbid ASD - help with sensory problems Dietetic input

Answer 23

Transient lability in mood for around 3 days after birth and usually resolve within 2 week

Answer 24

Irritability Anxiety about parenting Tearfulness

Answer 25

Supportive | reassuring measures

Answer 26

Episodes where person excessively overeats often as an expression of underlying psychological distress Not restrictive and patient likely to be overweight

Answer 27

Binge eating followed by purging by inducing vomiting or taking laxatives to prevent calories being absorbed

Answer 28

``` Alkalosis - due to vomiting HCl acid from the stomach Hypokalaemia Erosion of teeth Swollen salivary glands Mouth ulcers GORD Calluses on knuckles - Russel's signs ``` Presenting complaint may be abdominal pain or reflux

Answer 29

Referral to specialist care Adults - guided self help if ineffective or unacceptable --> CBTED Child --> FBT Pharmacological Tx limited role - high dose fluoxetine

Answer 30

Condition related to continuing pain that is more severe than would be expected and lasts beyond the expected time period following an injury/ trauma

Answer 31

``` Usually felt in 1 limb Assoc with hyoersensitivity to area of skin affected Area may become stiff Chronic pain Radiating pain Sensitivity to non-noxious stimuli Limb weakness Oedema Radiating pain ```

Answer 32

``` Patient education Self-management Medical pharmacotherapy Physical rehab Psychological support ```

Answer 33

``` Female younger chronic social and family problems May have physical illness or personality disorder Alcohol withdrawal Past DSH Impulsive ```

Answer 34

``` Male Older Living alone Single, divorced, separated Unemployed Major psychiatric illness Physical illness Drug and alcohol abuse Special high risk groups e.g. doctors Planned ```

Answer 35

Previous attempt/ self harm

Answer 36

``` SADPERSONS sex - male age <19 or >45 Depression or hopelessness Previous attempts Excessive alcohol or drug use Rational thinking loss - psychosis Separated/ widowed/ divorced Organised or planned attempt No social support Stated future intent ```

Answer 37

Refer to hospital if considered at risk physically due to consequences of substance or risk of repetition Minimise physical harm e.g. general supportive measures, charcoal, antidotes Assess suicide risk Detect and manage any assoc psychiatric disorder Identify and manage drug/ alcohol problem

Answer 38

2 or more episodes in which the patient's mood and energy levels are significantly disturbed, this consists on some occasions of hypomania or mania and on others depression

Answer 39

Has to meet mania criteria, although previous episodes may have been hypomanic and/ or depressive

Answer 40

Current or past hypomanic episode and current or past depressive episode

Answer 41

Family history - anticipation

Answer 42

``` Early onset Low socioeconomic status Subsyndromal mood symptoms Long duration of illness Rapid mood fluctuation Mixed presentation Psychosis Comorbid disorders Family Psychopathology ```

Answer 43

Mood elevated or irritable to a degree that is definitely abnormal for the individual concerned and sustained for at least 4 consecutive days At least 3 of the following signs must be present leading to some interference with functioning of daily living Increased talkativeness, difficulty concentrating, decreased need for sleep, increased sexual drive, mild spending sprees or reckless behaviour

Answer 44

Mood predominantly elevated, expansive irritable and definitely abnormal - prominent and sustained for at least 1 week (unless hospital admission) 3 of the following at least - increased talkativeness, loss of normal social inhibitions, decreased need for sleep, inflated self esteem, distractibility, constant changing in plans, behaviour reckless, marked sexual energy or sexual indiscretions

Answer 45

Typified by mood congruent content of psychotic symptoms, delusions of grandeur/ special ability, persecution, religiosity Hallucinations - 2nd person and auditory

Answer 46

Maximise antimanic dose if patient already on maintenance Antidepressants discontinued If mania - hospital admission likely

Answer 47

Olanzapine Quetiapine Risperidone

Answer 48

Lithium - gold standard Other options are antipsychotics - lamotrigine (if mainly depression) Valproate (if mainly mania) Psychoeducation

Answer 49

During mania/ hypomania | Rapid cycling

Answer 50

2-3 times increased risk of diabetes, cardiovascular disease and COPD

Answer 51

Acute, transient disturbance from the person's normal cognitive function

Answer 52

Up to 6 months

Answer 53

``` Impaired consciousness Fluctuation of symptoms - worse at night Periods of normality Abnormal perception Agitation, fear Delusions ```

Answer 54

Visual hallucinations +/- auditory hallucinations (often threatening)

Answer 55

Hyperactive - agitation, restlessness, sleep disturbance and hypervigilance Hypoactive - lethargic, reduced mobility and movemnet Mixed - combination of signs and symptoms

Answer 56

History from person and informed observer If possible cognitive screening test Ask about previous intellectual function A full physical exam and infection screen Urinalysis - infections, hyperglycaemia Sputum culture FBC - anaemia, infection U+E's - AKI or electrolyte disturbance (hyponatraemia or hypokalaemia) HbA1c- hyperglycaemia Calcium - hypo or hyper LFTs - hepatic failure and rule out hepatic encephalopathy Inflammatory markers Drug levels Thyroid function test s CXRray ECG

Answer 57

Treat underlying cause Maintain environment with good lighting and frequent reassurance In extremely agitated patients small dose of haloperidol or olanzapine may be considered

Answer 58

Life threatening alcohol withdrawal state

Answer 59

Alcohol stimulates GABA receptors in the brain – GABA relaxing effect – alcohol also inhibits glutamate receptors  further inhibitory effect Chronic alcohol use – GABA down regulated and glutamate up-regulated When alcohol removed – GABA under functions and glutamate over functions  extreme excitability with excess adrenergic activity

Answer 60

``` Acute confusion Severe agitation Delusions and hallucinations Tremor Tachycardia Hypertension Hyperthermia Ataxia – difficulties with coordinated movements Arrhythmia ```

Answer 61

Chlordiazepoxide – benzodiazepine used to combat effects of alcohol withdrawal Diazepam – less commonly used alterative Use on reducing regimen – continued for 5-7 days IB high dose B vitamins (pabrinex) – followed by regular lower dose oral thiamine

Answer 62

Progressive irreversible impairment of intellect, memory and personality Difficulties with activity of daily living

Answer 63

cognitive impairment that does not fulfil the diagnostic criteria for dementia, for example, because only 1 cognitive domain is affected or deficits do not significantly affect daily living

Answer 64

Alzheimer's disease

Answer 65

Increasing Age

Answer 66

``` Mild cognitive impairment - 1/3 develop AD within 3 years Learning disability Genetics Cardiovascular risk factors Cerebrovascular PD Smoking Anticholinergic burden ```

Answer 67

Amyloid precursor gene APP or presenilin gene PSEN1 or PSEN2

Answer 68

Apolipoprotein E

Answer 69

Cognitive impairment Behaviour and psychological Difficulties with ADL

Answer 70

impairment in 2 of the following cognitive domains | Memory, language, behaviour, visuospatial or executive function

Answer 71

Diagnosis of exclusion Undertake initial assessment and history ``` Arrange appropriate blood tests to exclude reversible causes of cognitive decline FBC ESR CRP U + E’s Calcium HbA1c LFT TFT Serum B12 and folate ``` Other investigations that may be appropriate if clinically indicated include urine microscopy and culture, chest X-ray, ECG, syphilis serology and HIV testing Various cognitive assessment tools Screening – MMSE, MOCA, Addensbrooke

Answer 72

Refer to a neuro service with access to tests (including CSF) for CJD

Answer 73

Non-pharmacological interventions to promote cognition, independence and well-being for people include Cognitive stimulation therapy Group reminiscence therapy Cognitive rehabilitation or IT

Answer 74

Acetylcholinesterase inhibitors – donepezil, galantamine and rivastigmine – as monotherapies for managing mild to moderate AD

Answer 75

Tricyclic antidepressants – amitriptyline Antiemetics e.g. metoclopramide Analgesics – e.g. pethidine or tramadol Sedatives – long acting benzodiazepines or antipsychotics Antihistamines – e.g. chlorphenamine

Answer 76

Neuroleptic Malignant Syndrome

Answer 77

ECG - contraindictaions - prolonged QT, second or third degree heart block in an unpaced patient, bradycardia <50bpm

Answer 78

Amyloid plaques nad tau proteins

Answer 79

Loss of recent memory first - difficulty with executive function Loss of episodic memory - memory loss for recent events, repeated questions, difficulty with new info Visuospatial and language deficits - moderate to severe stage

Answer 80

Problem with blood flow to brain

Answer 81

Stepwise decline May present insidiously with gait and attention problems, changes in personality, focal neuro signs may be present Memory loss - secondary to impairment in frontal. executive decline

Answer 82

``` Fluctuating cognition Recurrent visual hallucinations REM sleep disorder Symptoms of Parkinsonism Bradykinesia, tremor or rigidity ```

Answer 83

Personality changes and behavioural disturbance (apathy or social/ sexual disinhibition)

Answer 84

Intracellular TAU proteins and atrophy of frontal and temporal lobes

Answer 85

2 core symptoms + 4 others to give a total of at least 6

Answer 86

All 3 core symptoms must be present + 5 additional to give a total of at least 8

Answer 87

Depressed mood Anergia Anhedonia

Answer 88

PHQ-9 HADS BDI-II

Answer 89

Low intensity psychological intervention | exercise, regulation of sleep, diet

Answer 90

Consider suicide risk and toxicity in overdose. Explain that symptoms of anxiety may initially worsen. Explain that antidepressants take time to work.

Answer 91

At least 6 months - 1st time | At least 1 year after that

Answer 92

antidepressant and high intensity psychological intervention (CBT) – better response using combined approach

Answer 93

SSRI for 6-8 weeks at therapeutic dose

Answer 94

Switch to another SSRI for 6-8 weeks at therapeutic dose

Answer 95

``` Refer to psychiatrist Consider different class Consider ECT in treatment resistant cases ```

Answer 96

MADRAS | Montgomery Asberg Depression Rating Scale

Answer 97

1st line - psychological therapy - CBT, non-directive supportive therapy, interpersonal therapy and family theraoy 1st line medication in children fluoxetine

Answer 98

Tricyclic or venlafaxine

Answer 99

Discontinuation symptoms Restlessness Problems sleeping, unsteadiness, sweating, abdo pain, altered sensations e.g. electric shock sensations in the head or altered feelings - irritability, anxiety, confusion

Answer 100

If at increased risk of suicide or person under 30 - initial review within 1 week, review frequently thereafter until risk is no longer considered clinically important For people not considered at an increased risk of suicide - initial review within 2 weeks

Answer 101

A result of low vitamin B1 levels (thiamine) --> brain damage

Answer 102

Typically heavy drinking male over 45 Risk of not treating Wernicke's

Answer 103

Memory impairment Behavioural change Inability to form new memories or learn new information Personality change Making up stories to fill gaps in memory (confabulation) Seeing or hearing things that aren’t really there (hallucinations) Lack of insight into the condition

Answer 104

No treatmnet But give high dose pabrinex Stop drinking

Answer 105

Persistent bodily complaints for which adequate examination does not reveal sufficient explanatory structural or other specified pathology Present for >3 months and assoc with impaired functioning

Answer 106

Sensitive consultation to talk openly about their experiences and worries Screen for underlying health problems e.g. depression and anxiety Psycho-social support and therapies e.g. CBT helpful in reducing symptoms SSRIs and other antidepressants can be used to treat co-morbid depression and/ or anxiety Tricyclic antidepressants e.g. amitriptyline probably have the best established role in management of chronic pain Extensive investigations unlikely to be helpful and may increase patient’s anxiety

Answer 107

Presence of physical symptoms that cannot be described by a medical condition, drug or other mental health disorder – starts in early life, chronic and fluctuating course

Answer 108

presentation of neurological symptoms without any underlying neuro cause e.g. paralysis, pseudoseizures, sensory changes – not intentional and symptoms very much real to patient – linked to emotional stress

Answer 109

patients have excessive concern that they have a serious illness despite a lack of evidence – often demand unnecessary tests and can be quite debilitated as a result of constant worry

Answer 110

intentional production of physical pathology or the feigning of symptoms – does not apparently bring any external reward – Munchausen’s rare and extreme form (want to play patient role)

Answer 111

patients intentionally fake or induce illness for secondary gain e.g. drug seeking, disability benefits, avoiding work or prison time

Answer 112

inappropriate lack of concern over the symptoms they are experiencing

Answer 113

Severe disorder caused by an adverse reaction to medications with dopamine receptor antagonist properties e.g. antipsychotics or rapid withdrawal of dopaminergic medications

Answer 114

Hyperpyrexia Autonomic instability Gradually increasing muscle tone Rhabdomyolysis -_> acute renal failure --> coma --> death

Answer 115

Creatinine Kinase

Answer 116

``` Intensive care unit - medical emergency Stop antipsychotics Rapid cooling Renal support Skeletal muscle relaxants e.g. dantrolene Dopamine agonists e.g. bromocriptine ```

Answer 117

Ego-dystonic (unwanted) Obsessions and compulsions

Answer 118

unwanted and uncontrollable thoughts and intrusive images that the person finds it very difficult to ignore e.g. overwhelming fear of contamination

Answer 119

repetitive actions that person feels they must do, generating anxiety if they are not done – often to handle obsession e.g. checking all electrical equipment is turned off to handle obsession that house will burn down

Answer 120

At least 2 weeks AND be a source of distress and interference with activities

Answer 121

Low intensity CBT

Answer 122

Offer CBT including ERP or SSRI | Consider prescribing clomipramine (tricyclic)

Answer 123

Refer to secondary care mental health team for assessment Consider offering combined treatment with an SSRI and CBT or clomipramine

Answer 124

Guided self help | If unavailable or ineffective refer to CMAHS

Answer 125

Refer to CAMHS

Answer 126

Recurrent attacks of severe anxiety which are not restricted to any particular situations or set of circumstances and are therefore unpredictable

Answer 127

Sudden onset palpitations Chest pain Choking sensations Dizziness Feelings of unreality (depersonalisation (outside yourself) or derealisation (detached from surroundings)) Secondary fear of dying, losing control, going mad

Answer 128

Self help CBT SSRIs/ SNRIs/ Tricyclics – clomipramine, desipramine, imipramine

Answer 129

Significant difference in thoughts, feelings and behaviours compared to social norms Chronic, stable Present from teenage years Pervasive across different domains of life

Answer 130

Paranoid Schizoid Schizotypal

Answer 131

Considerable overlap with conspiracy theory, sensitive to set backs, neutral aspects of others as hostile, bear grudges, strong sense of personal rights, not trusting

Answer 132

Quite cold Indifferent praise or criticism No drive to have relationships with others Enjoy their own company

Answer 133

``` Schizophrenia like but no full blown illness Odd eccentric Poor relationship Odd speech Magical thinking ```

Answer 134

Antipsychotic

Answer 135

Borderline Antisocial Histrionic Narcissistic

Answer 136

Driven around on storm of emotions With emotionally unstable personality changes within minutes unlike bipolar With impulsive type - act without thinking of actions Short term gratification of needs Unstable sense of self Intense but unstable relationships Splitting – individuals wholly good or bad

Answer 137

Perceive neutral things as threatening | Rules don’t apply to them

Answer 138

Conduct disorder

Answer 139

``` Need to be in the spotlight Bring the attention back to them Dramatic, theatrical Shallow Concerned with physical appearance Seductiveness ```

Answer 140

Exaggerated sense of self-importance Envious of others and believe others envy them Belittle look down on others Sense of entitlement Expect to be recognised as superior Inability or unwillingness to recognise the need and feelings of others

Answer 141

Anxious/ avoidant Obsessive compulsive Dependent

Answer 142

Background of apprehension Preoccupied with being criticised/ rejected Only situations they know will be successful

Answer 143

Ego-syntonic need for order and routine | Obsessions and compulsion not undesirable

Answer 144

``` Struggle with small decisions Right answer in given situations e.g. Heinz or Tesco beans Devolve decision making to others When on own preoccupation with not being able to look after themselves ```

Answer 145

Anytime up to 1 year after birth

Answer 146

Lowering of mood, reduced enjoyment in activities and lowering of energy levels Poor appetite, poor sleep May be assoc concerns from mother about bonding with her baby, caring for her baby or harming herself or baby in extreme circumstances

Answer 147

Depends on severity - tailor to individual Reassurance and support important CBT may be beneficial Certain SSRIs - sertraline and paroxetine may be used if symptoms severe

Answer 148

Within first 2 weeks after birth

Answer 149

previous history of mental illness e.g. schizophrenia or bipolar affective disorder, family history of postpartum psychosis, previous episode of postpartum psychosis monitored by perinatal health team

Answer 150

Paranoia, delusions, hallucinations, mania, depression, confusion

Answer 151

Referral to mother and baby unit particularly important in cases where mother experiencing command hallucinations, has thoughts of self-harm or suicide or has delusional beliefs about the baby’s role or identity Antipsychotics + sometimes mood stabilisers Prescribed in consideration with breast feeding – olanzapine, quetiapine

Answer 152

Thiamine - vitamin B1 deficiency | Normally alcoholics

Answer 153

Confusion Oculomotor disturbance (disturbance of eve movements) Ataxia (difficulties with coordinated movements)

Answer 154

Thiamine Pabrinex Stop drinking

Answer 155

Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation e.g.

Answer 156

Behavioural Therapy – exposure Graded exposure/ systematic desensitisation Add CBT if necessary SSRIs/ SNRIs if required

Answer 157

Persistent fear of 1 or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others Fears he or she will act in a way that is embarrassing and humiliating Typically small social settings

Answer 158

Individual CBT SSRI (escitalopram or sertraline) – review at 12 weeks SSRI plus CBT Alternative SSRI or SNRI

Answer 159

Adverse reaction to high levels of serotonin in body

Answer 160

Anti-depressants (especially using more than 1) Anti-migraine drugs – work on 5HT – triptans Especially irreversible MAOIS (tyrosine containing foods) St John’s Wart Mu receptor opioid agonist – tramadol

Answer 161

Mental state changes Autonomic hyperactivity Tremor

Answer 162

Usually conservatively managed Not necessarily hospital Stop all serotonin medications Supportive, symptomatic treatment

Answer 163

Potentially fatal shifts in fluids and electrolytes On refeeding  increased insulin secretion  Increases protein and glycogen synthesis  increases glucose uptake, thiamine use, uptake of potassium, magnesium and phosphate  hypokalaemia, hypo magnesia, hypophosphatemia, thiamine deficiency, salt and water retention  oedema

Answer 164

Severe nutritional deficit for an extended period of time, when they start to feed again Higher risk if BMI <20 and have had little to eat for past 5 days Lower BMI and longer risk of malnutrition greater risk Risk for anyone who has not been eating well

Answer 165

Cardiac arrhythmias Heart failure Fluid overload

Answer 166

Local protocol | Correct electrolyte and fluid abnormalities – phosphate Sandoz, Sandoz k – IV may be required

Answer 167

Slowly reintroducing foods with restricted calories Start with low energy replacement, with high phosphate content e.g. milk and build up every 2-3 days Supplement with multivitamin e.g. forceval and thiamine for at least 10 days Daily bloods Magnesium, potassium, phosphate and glucose monitoring along with other routine bloods, fluid balance monitoring, ECG monitoring, supplementation with electrolytes and vitamins – particularly B vitamins and thiamine

Answer 168

Perceptions in absence of a stimulus - auditory, visual, smell, taste, tactile

Answer 169

fixed or falsely held beliefs

Answer 170

delusional belief that one is loved by another person of, generally of a higher social status

Answer 171

Spouse infidelity

Answer 172

identical duplicate has replaced someone significant to the patient

Answer 173

mistaken belief that some person currently present in the deluded person's environment (typically a stranger) is a familiar person in disguise

Answer 174

any one of a series of delusions that range from a belief that one has lost organs, blood, or body parts to insisting that one has lost one's soul or is dead.

Answer 175

Never comes back to original point

Answer 176

Come back to the point

Answer 177

Illogical jump between ideas

Answer 178

Thought disorder - connections can be made

Answer 179

Most common psychotic disorder

Answer 180

Shallow and inappropriate emotional response, foolish or bizarre behaviour, delusions and hallucinations

Answer 181

affects movement in extreme ways (lack and lots) with schizophrenia features

Answer 182

schizophrenia and significant mood component (could be classified as bipolar or depression)

Answer 183

Stressful life Childhood adversity Family heritage – South Asian and black communities Migration Urban living Cannabis use Other substances – amphetamines, cocaine, ketamine, LSD or inhaled substances Medication use – high dose corticosteroids Early life actors Paternal age >40 or <20 Exposure to Toxoplasma gondii

Answer 184

Symptoms present most of the time for 1 month

Answer 185

bodily sensation being controlled by external influence, actions/ impulses/ feelings imposed on individual or influenced by others

Answer 186

``` Longer duration of untreated psychosis Early or insidious onset of schizophrenia Male sex Negative symptoms Family history of schizophrenia Low IQ No precipitating cause Low socioeconomic status Social isolation Significant psychiatric history Continued substance misuse ```

Answer 187

Premature death Suicide (worse if insight remains_) Increased risk of CVD, type 2 diabetes mellitus, smoking and smoking related illness

Answer 188

Undertake an assessment of risk If at high risk to themselves or others - same day specialist mental health assessment All others - refer without delay Oral antipsychotics are first line CBT should also be offered to all patients

Answer 189

1st line - 2nd generation antipsychotic (6-8 weeks) 2nd line - 1st or 2nd generation antipsychotic If not working Check diagnosis – consider psychological input, optimise social supports, check compliance – depot? Final – clozapine

Answer 190

Auditory Hallucinations Thought abnormalities Delusional perception Passivity

Answer 191

Vitamin B12 deficiency

Answer 192

Usually given twice weekly, majority bilateral | Always under GA with a muscle relaxant

Answer 193

2/3 some memory problem Loss is autobiographical and most accentuated from the time period closest to new information and non-cognitive memory domains not affected

Answer 194

Treatment resistant severe depression Manic episodes An episode of moderate depression known to respond to ECT in the past Catatonia

Answer 195

Non-selectively block D2 receptors Block dopamine pathway Mesolimbic pathway - decrease positive symptoms Mesocortical pathway - increase negative symptoms Nigrostriatal – tardive dyskinesia, parkinsonian features, EPS Tuberoinfundibular – increase prolactin – galactorrhoea, gynaecomastia, sexual dysfunction

Answer 196

Use anti-cholinergics to bring ACh and dopamine back in balance Procyclidine PO/IM

Answer 197

Rapid increase in muscle tone causing sustained contraction

Answer 198

Torticollis - head tilt down Oculogyric crisis - spasmodic position of the eyeballs into a fixed position usually upwards Tongue protrusion

Answer 199

Severe restlessness 1st line - beta blocker 2nd line - longa acting bezodiazepine

Answer 200

bradykinesia, cogwheel rigidity, resting tremor, shuffling gait, deep-pan facial expression Bialteral

Answer 201

long term often permanent, involuntary repetitive oro-facial movements, blinking, grimacing, pouting, lip-smacking, may involve limbs +/or trunk – tetrabenazine

Answer 202

Reduced bone density --> osteoporosis, falls, fractures

Answer 203

Women - galactorrhoea, reduced libido/ arousal, anorgasmia, amenorrhoea, anovulation Men - gynaecomastia, erectile dysfunction, oligospermia, reduced libido

Answer 204

Haloperidol | Chlorpromazine

Answer 205

Risperidone Clozapine Olanzapine Quetiapine

Answer 206

Atypical antipsychotics Block D2 receptors and serotonin receptors Occupy D2 receptors transiently

Psychiatry Flashcards

(248 cards)