Psychiatry Flashcards by H JP

Difference between acute stress disorder over PTSD

Mx acute stress disorder (2)

<4 weeks acute stress disorder
>4 weeks PTSD

CBT
Benzos

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What is agoraphobia?

Fear of open spaces e.g presence of crowds

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Peak incidence of:

symptoms
seizures
Delirium tremons

with ETOH withdrawal

6-12 hours
36 hours
48-72 hours

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DSM 5 criteria for anorexia (3)

Restriction of energy intake
Intense fear of gaining weight even though underweight
Disturbance in body weight/ shape experience

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Anorexia mx (3)

In children and young people mx (1)

CBT
MANTRA Maudsley Anorexia Nervosa Treatment for Adults
SSCM specialist supportive clinical management

Anorexia focused family therapy first line

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Features anorexia (4)

Reduced BMI
Bradycardia
Hypotension
Enlarged salivary glands

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Physiological abnormalities in anorexia
K+
FSH, LH, oesetrogen, testosterone
Cortisol
GH
Glucose tolerance
T3

K+ - low
FSH, LH, oesetrogen, testosterone low
Cortisol - high
GH - high
Glucose tolerance - impaired
T3 - low

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Typical antipsychotics (2)
Atypical antipsychotics (3)

Haloperidol
Chlopromazine

Clozapine
Risperidone
Olanzapine

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Extrapyramidal side effects (4)

Parkinsonism
Acute dystonia
Akathisia
Tardive dyskinesia

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Acute dystonia mx

Procyclidine

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Antipsychotics monitoring
FBC,U+E, LFT
Lipids, weight
Fasting blood glucose + prolactin

FBC, U+E, LFT at the start of therapy and annually
Lipids, weight at the start, 3 months and then on annually
Fasting blood glucose + prolactin start, 6 months, then annually

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Antipsychotic monitoring
BP
ECG
CVD assessment

BP baseline, frequently during titration
ECG baseline
CVD assessment annually

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How long should benzos be prescribed for?
How do you withdraw?

2-4 weeks
Withdrawn in steps of 1/8 of the daily dose every fortnight

Switch to diazepam
Reduced dose of diazepam by 2 or 2.5mg every 2-3 weeks

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Benzos veruss barbiturates MOA

Increase frequency of chloride channels - benzos
Barbiturates - increase duration of opening

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Bipolar types
I + II

I mania and depression
II hypomania and depression

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Bipolar
Mania management (2)
Depression
Hypomania versus mania for referral

Olanzapine or haloperidol
Fluoxetine

Routine referral to CMHT
Mania urgent referral

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What is Charles Bonnet syndrome? (4)

Persistent or recurrent complex hallucinations (visual or auditory)
Occurring in clear consciousness
BG of visual impairment (not mandatory)
Insight preserved

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RF for Charles Bonnet syndrome (5)

Advancing age
Peripheral visual impairment
Social isolation
Sensory deprivement
Early cognitive impairment

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What is Cotard syndrome?

Patient believes they are dead or non existent
Associated with severe depression

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What is De Clerambault’s syndrome?

AKA erotomania
Single woman often believes a famous person is in love with her

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What is delusional parasitosis?

Delusion that they are infested by bugs/ worms/ parasites

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Mx subthreshold depression symptoms (4)

Individual guided CBT
Computerised CBT
Group physical activity programme
Group based CBT

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Mx moderate and severe depression
High intensity psychological interventions (3)

Individual CBT
Behavioural activation
Behavioural couples therapy

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What is the Hospital Anxiety and Depression scale

14 questions
7 for anxiety, 7 depression
Each a score is given 0-3

0-7 normal
8-10 borderline
11+ abnormal

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PHQ-9 explained

Over the last two weeks: 9 items 0-3 score 0-4 none 5-9 mild depression 10-14 moderate 15-19 moderately severe 20-27 severe

DSM IV criteria for depression (9)

1. Depressed mood 2. Diminished interest/ pleasure 3. Weight loss/ gain 4. Insomnia/ hypersomnia 5. Psychomotor agitation 6. Fatigue 7. Worthlessness 8. Reduced concentration 9. Suicidal ideation

Switching antidepressants Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

Direct switch

Switching antidepressants From fluoxetine to another SSRI

Withdraw then leave a gap of 4-7 days before starting low dose alternative SSRI

Switching from SSRI to TCA

Cross tapering (except fluoxetine which should be withdrawn before TCAs starting)

Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine

Cross taper cautiously

Switching from fluoxetine to venlafaxine

withdraw and then start venlafaxine at 37.5 mg each day and increase very slowly

What is somatisation disorder?

Multiple physical symptoms present for at least 2 years

What is illness anxiety disorder?

Persistent belief in presence of an underlying serious disease e.g cancer Hypochondriasis

What is conversion disorder?

Loss of motor or sensory function Patient doesn't consciously feign the symptoms La belle indifference may be present

What is dissociative disorder?

Separating off certain memories from normal consciousness - involves psychiatric symptoms

What is dissociative identity disorder?

Multiple personality disorder & is most severe form of dissociative disorder

What is factitious disorder?

AKA Munchausen's syndrome Intentional production of physical or psychological symptoms

What is malingering?

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

What is circumstantiality?

Inability to answer a question without giving excessive, unnecessary detail, the person does eventually return to the original point.

What is tangentiality?

Refers to wandering from a topic without returning to it.

What is neologisms? What are clang associations? What is word salad?

Formation of new words Ideas are related to each other only by the fact that they sound similar or rhyme Word salad - completely incoherent speech

What is echolalia?

Repetition of someone else's speech including the question

What is perseveration?

Repetition of ideas or words despite an attempt to change the topic

What is Knight's move?

Severe type of loosening associations, unexpected and illogical leaps from one idea to another

Common SE of SSRIs (3)

GI symptoms GI bleeding (must take PPI if taking NSAID) Hyponatraemia

Which two SSRIs have increased drug interactions

Fluoxetine Paroxetine

Citalopram and escitalopram Investigation to do prior to starting Max dose adults Max dose >65yo Hepatic impairment

ECG Adults 40mg 65yo > 20mg Hepatic impairment 20mg

Interactions of SSRI NSAIDS Warfarin/heparin Triptans

NSAIDS - co-prescribe PPI, but normally do not offer SSRI Warfarin/ heparin - consider mirtazapine instead of SSRI Triptans avoid SSRI

How to stop an SSRI?

Gradually reduce over a four week period

Sleep paralysis mx (1)

Clonazepam

Children and adolescents SSRI of choice

Fluoxetine

SSRIs in pregnancy: Risks during: First trimester Third trimester

Use during first trimester - small increased risk of congenital heart defects Third trimester - can results in persistent pulmonary hypertension of the newborn

Paroxetine in pregnancy risk

Increased risk of congenital malformations in first trimester

Section 2 Section 3 Section 5(2) Section 136

28 days assessment 6 months treatment 72 hours in hospital doctor Police pt found in public place 24 hours Section 2 AMHP OR nearest relative + x2 doctors Section 3 AMPH + x2 doctors seen pt within last 24 hours

Section 135

Police can break into property to remove a person to a Place of Safety

Section 5(4)

Nurse to detain a voluntary pt for 6 hours

What is section 17a

Community Treatment Order Can recall a patient to hospital for treatment if they do not comply with conditions of the order in the community

What is section 4?

72 hour assessment order GP + AMHP/NR

Schneider's first rank symptoms classification (4)

Auditory hallucinations Thought disorder Passivity phenomena (belief that thoughts or actions are influenced or controlled by an external agent) Delusional perceptions

Mx schizophrenia First line (2)

Atypical antipsychotics CBT

Schizophrenia poor prognostic factors (5)

FH Gradual onset Low IQ Prodromal phase of social withdrawal Lack of obvious precipitant

Absolute contraindication to ECT

Raised intracranial pressure

Medications that can trigger anxiety (5)

Salbutamol Theophylinne Steroids Antidepressants Caffeine

GAD mx (4) HINT: step wise approach, not specifics

1. Education 2. Low intensity psychological interventions 3. High intensity psychological interventions +/- drug treatment 4. Specialist input

GAD drug treatment: (2) If not tolerated then give

1. SSRI 2. SNRI e.g duloxetine, venlafaxine If they cannot tolerate above then pregabalin

GAD FU if <30yo

Weekly FU for the first month as increased risk of suicidal ideation and self harm

Mx of panic disorder (2) If no response after how long switch to (2)

1. CBT 2. SSRIs If no response after 12 weeks then imipramine or clomipramine

Grief reaction stages (5)

Denial Anger Bargaining Depression Acceptance

Difference between mania and hypomania Length of time

Mania versus Hypomania >7 days <7 days

Lithium Adverse effects (6)

GI effects Fine tremor Nephrotoxicity T wave flattening Hypothyroidism IIH

Lithium monitoring explained What blood tests should be checked and how often?

12 hour post dose Lithium levels should be performed weekly when starting and after each dose change until concentrations are stable TFT + U+E every 6 months

OCD Mx Which SSRI is best for body dysmorphic disorder?

1. Low/high intensity psychological treatments 2. SSRI for at least 12 months Fluoxetine

What is Othello's syndrome?

pathological jealousy where a person is convinced their partner is cheating on them without any real proof

Personality disorders Cluster A Cluster B Cluster C

A - odd/ eccentric B - dramatic, emotional, erratic C - anxious and fearful

Cluster A personality traits (3)

Paranoid Schizoid Schizotypal

Cluster B personality traits (4)

Antisocial Borderline Histrionic Narcissistic

Cluster C personality traits (3)

Obsessive compulsive Avoidant Dependent

Grandiose sense of self importance Preoccupation with fantasies of unlimited success, power, or beauty Sense of entitlement Taking advantage of others to achieve own needs Lack of empathy Excessive need for admiration Chronic envy Arrogant and haughty attitude =

Narcissistic

Inappropriate sexual seductiveness Need to be the centre of attention Rapidly shifting and shallow expression of emotions Suggestibility Physical appearance used for attention seeking purposes Impressionistic speech lacking detail Self dramatization Relationships considered to be more intimate than they are =

Histrionic

Efforts to avoid real or imagined abandonment Unstable interpersonal relationships which alternate between idealization and devaluation Unstable self image Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse) Recurrent suicidal behaviour Affective instability Chronic feelings of emptiness Difficulty controlling temper Quasi psychotic thoughts

Emotionally unstable/ borderline

Failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest; More common in men; Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure; Impulsiveness or failure to plan ahead; Irritability and aggressiveness, as indicated by repeated physical fights or assaults; Reckless disregard for the safety of self or others; Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations; Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another =

Antisocial

Difficulty making everyday decisions without excessive reassurance from others Need for others to assume responsibility for major areas of their life Difficulty in expressing disagreement with others due to fears of losing support Lack of initiative Unrealistic fears of being left to care for themselves Urgent search for another relationship as a source of care and support when a close relationship ends Extensive efforts to obtain support from others Unrealistic feelings that they cannot care for themselves =

Dependent

Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection. Unwillingness to be involved unless certain of being liked Preoccupied with ideas that they are being criticised or rejected in social situations Restraint in intimate relationships due to the fear of being ridiculed Reluctance to take personal risks due to fears of embarrassment Views self as inept and inferior to others Social isolation accompanied by a craving for social contact =

Avoidant

Peak age of first episode psychosis

15-30yo

PTSD Mx (2) Drug treatment (2)

1. Watchful waiting for mild symptoms lasting <4 weeks 2. CBT/ EMDR Venlafaxine or SSRI

Psychiatry Flashcards

(85 cards)