Psychiatry Flashcards
(48 cards)
What organic disorder can look a lot like mania?
Frontal lobe syndrome
What are features of temporal lobe epilepsy?
Depersonalisation
Deja vu
Smell auras
Staring
Lip smacking
Finger movements
Can look like schizophrenia
What systemic diseases and drugs can cause organic mental disorders?
Carcinoma of the pancreas
SLE
Porphyria
Hyperthyroidism
Steroids: mania
Antihypertensives: depression
What are the top 3 drug classes which can cause delirium?
Benzodiazepines
Anticholinergics
Opiates
Examples of tyramine-rich foods (that can precipitate a hypertensive crisis in combo with MAOIs)
Cheese - especially mature
Degraded protein: pickled herring, smoked fish, chicken liver, hung game
Yeast and protein extract: Bovril, Oxo, Marmite
Chianti wine, beer
Broad bean pods
Soya bean extarct
Overripe or unfresh food
Drugs that may precipitate a hypertensive crisis in combination with MAOIs
Adrenaline or noradrenaline
Amphetamines
Cocaine
Ephedrine, pseudoephedrine, phenylpropanolamine (cough mixtures, decongestants)
L-dopa, dopamine
Local anaesthetics containing adrenaline
What is an early warning sign of a hypertensive crisis (e.g. in MAOIs)
throbbing headache
What are some examples of mood stabiliser drugs
Lithium
Valproate
Carbamazepine
Lamotrigine
What can precipitate lithium toxicity
Dehydration
Renal impairment
Diuretics, NSAIDs, ACE inhibitors
Which mood stabiliser can rarely be associated with Stevens-Johnson syndrome?
Lamotrigine
Particularly in the first 8 weeks of use
Which mood stabiliser can interact with lots of drugs
Carbemazepine
It is a potent CYP450 enzyme inducer
What are the main sedative drugs
Benzodiazepines
‘Z’ drugs (zopiclone, zolpidem, zaleplon)
How do benzodiazepines work?
Potentiate the action of GABA (the main inhibitory neurotransmitter in the grain)
Increase the flow of chloride ions into the cell, hyper polarising the post-synaptic membrane, reducing neuronal excitability
In what patients should you use caution with benzodiazepines
Older adults
Patients with chronic respiratory disease (e.g. chronic obstructive pulmonary disease, sleep apnoea)
How does pregabalin and gabapentin work
Reduces the release of a range of neurotransmitters through binding to an auxiliary subunit of voltage-gated calcium channels
How do stimulants like amphetamines work?
Increase the activity of dopamine and norepinephrine
Causes of delirium
D - Drugs and alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes)
(S) - Subdural, Sleep deprivation
What reversible causes of reduced cognitive function should be ruled out?
B12
Folate
Thyroid function
Urine dip
What should you use in an agitated patient with Parkinson’s?
Lorazepam
NOT haloperidol (promotes dopamine blockade causing deterioration)
What syndrome do patients often describe seeing tiny versions of real life objects, often faces or cartoons (visual hallucinations)
Charles Bonet Syndrome
What causes Charles Bonnet syndrome?
Vision loss
Is Charles Bonnet syndrome a psychiatric condition?
No - they often have insight - due to their vision loss not a mental health condition
How do you assess muscle wasting in patients with anorexia?
SUSS (sit up-squat-stand) without using hands
What is the first-line pharmacological therapy for ADHD?
Methylphenidate
