Psychiatry Flashcards

Question

Extra pyramidal side effects with antipsychotics

Answer 1

Occur in up to 70% of patients Acute dystonia's, akasthisias, Parkinson symroms and tardive dyskinesia. Beyond a threshold occupancy of 80% of D2 receptor occupancy there is no additional clinical efficacy and significantly incr risk of EPSEs.

Answer 2

Extrapyramidal side effects (dystonia, akathisia, PD like symptoms, tardive dyskinesia) Hyperprolactinaemia Neuroleptic malignant syndrome Weight gain

Answer 3

Anxiety Insomnia Change in appetite leading to weight gain Hypercholesterolaemia Diabetes

Answer 4

Sedation (can be good) Weight gain

Answer 5

Postural hypotension Tachycardia Ejaculatory failure

Answer 6

Dry mouth Blurred vision Constipation Urinary retention

Answer 7

Often painful spastic contraction of muscles commonly affecting the neck, eyes and trunk. Eg tongue protrusion, grimacing, torticollis.. May respond to anticholinergics

Answer 8

Distressing feeling of inner restlessness manifested by fidgety leg movements, shuffling of feet, pacing etc. Mat respond to anticholinergics, propranolol, benzos etc

Answer 9

Involuntary, repetitive, purposeless movements of the tongue, lips, face, trunk and extremities that may be generalized or only affect some muscle groups, typically orofacial muscle group. Typically several months or years after antipsychotic treatment and is often irreversible. No beneficial treatment and mat be exacerbated by anticholinergics.,.

Answer 10

Potentially fatal idiosyncratic reaction to antipsychotic medication, resulting from blockade of dopaminrgic hypothalamospinal tracts which normally tonically inhibit preganglionic sympathetic neurons. Characterized by hyperthermia, muscle rigidity, autonomic instability and altered mental status. Rhabdomyolysis with high CK may lead to renal failure. lso generally possinle complication to respiratory and cardiovascular collapse and DIC. management is stop the drug and support. If left untested then mortality is as high as 20-30%

Answer 11

GI symptoms are the most common. Incr risk of GI bleed in patients taking SSRIs. PPI should be prescribed if patient also taking a NSAID. Patients should be counselled to be vigilant for increased anxiety and agitation after starting SSRI Fluoxetine and paroxetine have higher propensity for drug interactions

Answer 12

Partic with paroxetine, may get: Increased mood change Restlessness Difficulty sleeping Unsteadiness Sweating GI symptoms, pain cramping, diarrhoea, vomiting Paraesthesia

Answer 13

Relatively rare condition where patient has a fixed delusion that they are infested by 'bugs' eg worms, parasotes, mites, bacteria, fungi. May occur in conjunction eith other psychiatric conditions of present alone. Patients may be quite functional tho Also called Ekbom syndrome

Answer 14

Delusional misidentification syndrome where patient believes someone significant I.in their life, eg a spouse or friend, has been replaced by an identical impostor

Answer 15

A delusional misidentification syndrome where the patient believes that multiple people are all in fact the same person, who is constantly changing their appearance.

Answer 16

Drowsiness Dry mouth Blurred vision Constipation Urinary retention Lengthening of QT interval

Answer 17

amitryptyline Clomipramine Dosulepin Trazodone

Answer 18

Imipramine Lofepramine Nortriptyline

Answer 19

Also called erotomania, form of paranoid delusion with an amorous quality. Belief that a famous person is in love with them

Answer 20

The intentional production of physical or psychological symptoms

Answer 21

tremor, sweating, agitation, anxiety, sensitivity tonsound, visual disturbance and delirium

Answer 22

Ataxic gait, fluctuating consciousness and nystagmus

Answer 23

Anterograde amnesia, islands of memory and confabulation

Answer 24

Feedback: About personal risk and impairment Responsibility: Personal responsibility for change Advice: To cut down or abstain Menu: Options to change behaviour and targets Empathic interviwwing: Listen and avoid confrontation Self-efficacy: Interviewing style to promote persons self belief to make changes

Answer 25

Neuroprotective drug when detoxifying from alcohol, start on day 1 and continue while not drinking and 6 weeks after relapse

Answer 26

Reduces drinking in those not abstaining. Good for binge drinkers, recently licensed in UK, reduces imouksivity.

Answer 27

Blocks acetaldehyde dehydrogenase Build up of acetaldehyde leads to: Flush reaction, reduced BP, headache Works by threat of unpleasant consequences need supervision to ensure compliance Warn of hidden sources of alcohol, eg mouthwash or perfume Avoid if vascular disease, psychosis, suicidality.

Answer 28

Is an agonist at the GABA benzo receptor and antagonist at NMDA receptor. Acute intoxification: Increase in GABA and reduction in glutamate Chronically: Reduction in GABA, increase in glutamate Withdrawal: Excess excitation from Imbalance of flu to GABA. Can lead to excitotoxic brzin damsge, Nd damage to hippocampus causing memory loss

Answer 29

mental decline relatively rapid in depression. Dementia: Confused and disorientated, difficulty with short tern memory, writing speaking and motor skills are impaired (whereas slowed in depression but normal). Depression will notice or worry about nenort oroblems

Answer 30

patient holds delusion that they (or part of their body) are dead or non existent. Associated with severe depression/psychotic disorders, and can have significant detrimental effects on patients with self neglect and withdrawal from others,

Answer 31

A psychophysical visual disorder where patients with significant vision loss have vivid, often recurrent visual hallucinations. These hallucinations can be simple (i.e. shapes, patterns) or complex (i.e. detailed objects, people) but patients almost always have insight into the fact that they are not real and do not suffer from any other forms of hallucinations (e.g. auditory) or delusions.

Answer 32

Catatonia A prolonged or severe manic episode Severe depression that is life threatening

Answer 33

Short term: Headache, nausea, short term memory impairment, memory loss of events prior to ECT, cardiac arrhythmia Long term: Some report impaired memory

Answer 34

Loss of emotional reactivity Duiurnal mood variation Anhedonia Early morning waking Psychomotor agitation or retardation Loss of appetite and weight Loss of libido

Answer 35

weight gain Excessive salivation Agranulocytosis' Neutropaenia Myocarditis Arrhythmias

Answer 36

the stopping of voluntary movement or staying still in an unusual position . Believed to occur due to abnormalities in balance of dopamine and other neurotransmitter systems. Most commonly associated with certain types of scz.

Answer 37

Antiemetic and antipsychotic. Selective dopamine receptor antagonist

Answer 38

for neuropathic pain. But is a triptan so needs to be avoided with SSRIs, as both have serptonergic action, so incr risk of serotonin syndrome

Answer 39

deprivation of liberty safeguards Amendment to the Mental Capacity Act. If lacking capacity to consent to their care and treatment, can detain in order to keep them safe from harm.

Answer 40

Section for assessment and treatment. Recommended by two doctorsl and Application made by AMHP. Max 28 days and cannot be extended,

Answer 41

Longer term civil section. AMHP appplies for admission based on recommendation of 2 doctors. Initially 6 months, then renewed for further 6, then for periods of 12 months.

Answer 42

Basically for the GP, admission for emergency treatment for up to 72h. Not commonly used.

Answer 43

Holding powers for up to 72 hours if from F2 up (5.2), ot up to 6 hours if nurse (5.4)

Answer 44

Person convicted of offense punishable with imprisonment instead sentenced to hospital order (by crown or magistrates court). Initially 6 months then renewed for 6, then every 12.

Answer 45

Suffering from mental disorder of nature and/or degree which makes it appropriate for them to be detained in hospital for assessment and or treatment. AND that they ought to be detained in the interests of their own health or safety, or with a view to the protection of other persons. AND the appropriate treatment is available.

Answer 46

Hospital order with restrictions. Risk of committing further offfences or necessary for protection of public, basically means Ministry of Justice consent required for section 17 leave, transfer to another hospital or discharge.

Answer 47

Prisoner can be transferred to hospital,and then treated as if under a 37, and can have 47/49 when then transferred back??

Answer 48

LFTs and macrocytosis (if abnorm = alcohol misus?) Serological tests for syphillis Screen for AIDS Urine screen for recreational drugs CT brain if focal signs

Answer 49

Pre: Family history, female sex, Maintaining: Drugs, avoidance behavioura

Answer 50

must be present for at least 4 weeks, otherwise an acute stress reactiom

Answer 51

Most common cause of clozapine related fatality Constipation in up to 60% of patients Severe has mortality of 20-30% Most severe during first four months Advice: Fluids, fibre, regular exercise, bowel 'awareness', avoid anticholinergics, medical team awareness

Answer 52

polyuria, renal failure, metallic taste, sedation, tremor

Answer 53

0.4-0.9mmol/L

Answer 54

initially coarse tremor, nausea and diarrhoea. Then confusion, ataxia, dysarthria, renal failure, hyperreflexia, progressing to coma and death. Add IV fluids to increase renal excretion, and may need dialysis.

Answer 55

insomnia, flu like symptoms, anxiety and muscle twitfhing

Answer 56

Indic: Mild to moderate AD Mech: Acetylcholinesterase inhibitor SE: Nausea, dizziness, diarrhoea and insomnia

Answer 57

Indic: Mild to moderate AD Mech: Acetylcholinesterase inhibitor SE: Nausea, dizziness, diarrhoea and insomnia

Answer 58

Indic: Mild to moderate AD, dementia assoc w PD Mech: Acetylcholinesterase inhibitor SE: Nausea, dizziness, diarrhoea and insomnia

Answer 59

indic: Moderate-severe AD Mech: Glutamine NMDA receptor antagonist

Answer 60

lack of partner/social support History of abuse/domestic violence Personal history of mental illness Unwanted or unplanned pregnancy High perceived stress Present/past pregnancy complications Pregnancy loss

Answer 61

Impaired reciprocal social interaction Impaired verbal and non verbal communication Restricted repertoire of activities and interests

Answer 62

Executive dysfunction theory: Embedded figures test (eg easier to count triangles in picture than see whole) Weak central coherence theory: The Navon Test (see many small as making up large letter H) Mindblindness theory: Sally Anne Test

Answer 63

epilepsy, developmental disorders, mental health disorders

Answer 64

symptoms 6-12 hours Seizures 36 hours Delirium tremens 72 hours

Answer 65

Most things low, Gs and Cs high: Growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

Answer 66

BMi 17.5 or less, weight at least 15% below expected Food restriction and one of: Excessive exercise, self induced vomiting, laxative use, appetite suppressants Body image distortion Morbid fear of fatness Amenhorrhoea or pubertal delay If lacking some of these = atypical AN

Answer 67

Hypoproteinaemia - oedema, renal damage Vitamin deficiencies Hypercholesterolaemia - cardiovasculae and hepatic damage

Answer 68

Decr sex hormones - infertility Decr growth hormone - restarted growth, esp if prepubertal

Answer 69

Hypotension, heart or valve damage - congestive heart failure

Answer 70

Gastric dilation - dumping syndrome Induced vomiting - peptic ulceration, gastritis Malabsorption - constipation, folate or B12 deficiencies

Answer 71

Renal calculi- acute and chronic renal failure

Answer 72

malnutrition, electrolyte abnormalities - epilepsy, autonomic and peripheral neuropathies

Answer 73

Hypocalcaemia, hormone changes - osteoporosis so broken bones, spinal injury. Myopathies

Answer 74

anaemia, esp iron deficiency

Answer 75

ALL of: Persistent preoccupation with eating and craving for food (patient succumbs to overeating) Morbid dread of fatness - patient sets a sharply defined weight threshold Attempts to counteract the fattening effect of food (purging, alternating starvation, laxatives/diuretic use) If missing some of these = atypical BN

Answer 76

Alopecia Pruritus Nail fragility Russell's sign (callouses on knuckles)

Answer 77

Subconjunctival haemorrhage Recurrent epistaxis

Answer 78

Dental erosion Periodontal erosion Dry mouth

Answer 79

metabolic alkalosis Hypokalaemia (->prolonged QTc,/torsades/ v fib) Peripheral oedema (due to aldosterone upregulation)

Answer 80

GORD Barrett's esophagus Boerrhaave's

Answer 81

effects on GI system and electrolytes Cathartic colon = loss of normal peristalsis due to prolonged use Hypovolaemia and electrolyte abnormalities esp hypokalaemia

Answer 82

regularly eating excessive food over a short period of time until uncomfortably full. Eating when not hungry Eating very fast during binge Eating alone or secretly Felling depressed, guilt, ashamed or disgusted after a binge

Answer 83

Avoiding certain foods or has restricted intake of overall amount consumed, or both because of: Increased sensitivity to taste, smell, temperature or appearance of certain foods Concerns about consequences of food, eg has choked/vomited in the past Low interest in eating, reduced appetite

Answer 84

response to exceptional physical/mental stress Mixed and changing picture Initial state of 'daze', narrowing of attention, disorientation Followed by further withdrawal, or agitation and hyperactivity Subsides over a period of days to weeks

Answer 85

Significant life change or stressful event, eg bereavement, becoming a patent Variable symptoms between anxious, depressed, mixed, inability to cope/plam ahead, continued to interfere with function Less than six months

Answer 86

1st line: CBT 2nd line: Pharmacotherapy - Benzos for 2-4wk if severe disabling anxiety TCAs:clopiramine can be used for OCD and panic disorder Beta blockers - reduce autonomic symptoms eg palpitation, tremor Antipsychotics at low dose for long term severe anxiety

Answer 87

Severe depression refractory to medication (eg catatonia), those with psychotic symptoms Typically in older patients 67% female Raised intracranial pressure = the only absolute contraindication

Answer 88

Short term: Headache, nausea, short term memory impairment, cardiac arrhythmia (need ECG before) Long term: Plss memory impairment, partic anterograde

Answer 89

mania At least 7 days Severe functional impairment in social and work situations May require hospitalization due to risks to self or others Often psychotic features. Hypomania: Lesser version, typically 3-4 days, does not impair function in same way. Unlikely to require hospitalization Does not exhibit any psychotic symptoms

Answer 90

<1% of people given benzo. Become aggressive, impulsive and hyperactive. More common at extremes of age or with neurodisability. Mark in notes and avoid in future

Answer 91

if prescribed for more than a few weeks. Typical sympt: Apprehension and anxiety, flu like symptoms, insomnia, tremor, heightened sensitivity to stimuli, muscle twitching, very rarely seizures if withdrawing rapidly from large dose.

Answer 92

use sparingly Brief treatment, max 3 weeks Withdraw gradually and warn patients Short acting fof intermittent anxiety, long acting for lasting Consider alternatives

Answer 93

at 6-12 hours Tremor, sweating, tachycardia, anxiety Peak incidence of seizures at 36 hours

Answer 94

48-72 hours Coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

Answer 95

1. Education about GAD and active monitoring 2. Low intensity psychological interventions 3, high intensity psychological interventions, or drug treatment: 1st line = sertraline, if not offer alternative SSRI or SNRI (duloxetine, venlafaxine). If not tolerated, consider pregabalin

Answer 96

CBT and SSRIs are first lime If contraindicated or no response after 12 weeks, should offer imipramine or clomipramine

Answer 97

strong family histoey Slow inset Low IQ Prodromal phase of social withdrawal Lack of obvious precipitant

Answer 98

multiple physical symptoms present for at least 2 years Patient doesn't accept reassurance or negative teest results

Answer 99

persistent belief in presence of an underlying serious disease, eg cancer Patient doesn't accept reassurance or negative test results

Answer 100

typically loss of motor or sensory function Not consciously feigned Patients may be indifferent to their apparent disorder??

Answer 101

trouble falling asleep or stating asleep at least 3 nights a week for 3 months or longer Typically reduced daytime functioning, decreased periods of sleep or incteadrf accidents due to poor concentration

Answer 102

Identify any possible causes, eg mental or physical health or poor sleep hygiene Advise not to drive whilst sleepy Good sleep hygiene Only consider use of hypnotics if daytime impairment severe

Answer 103

Marked memory disorder in alcoholics Thiamine deficiency over long term causes damage and haemorrhage to mamillary bodies of hypothalamus and medial thalamus Often following untreated Wernicke's encephalopathy

Answer 104

anterograde amnesia - inability to acquire new memories retrograde amnesia Confabulation

Answer 105

Confusion Ataxia (broad based gait) Oculomotor dysfunction (eg CN 6 palsies and nystagmus)

Answer 106

warfarin/heparin/aspirin: NICE recommend mirtazapine instead due to GI effects Triptans and MAOIs incr risk of serotonin syndrome

Answer 107

reexperiencing: 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, feelings detached Symptoms present >1 month

Answer 108

GI side effects common Incr risk of gastro bleeding, should hVe PPI if also taking NSAID Hyponatraemia Increased anxiety and agitation esp in first 2 weeks - patients under 30 should be reviewed a week after starting,

Answer 109

NICE says consider benefits and risks Use during first trimester gives small incr risk of congenital heart defects - BUMP says this is no longer latest evidence Use during third trimester can result in persistent pulmonary hypertension of newborn (around 1/300 babies whose mother takes SSRI) Neonatal abstinence syndrome

Answer 110

check BP as associated with development of hypertension

Psychiatry Flashcards

(134 cards)