Psychiatry

Question 1

Side effects of SSRIs?

Answer 1

Nausea, headache, GI upset (5-HT3)
Agitation, akathisia, anxiety (5-HT2)
Sexual dysfunction (5-HT2)
Insomnia (5-HT2)
Hyponatraemia (SIADH)

? ^suicide risk <18 yrs

Question 2

List some SSRIs

Answer 2

Fluoxetine
Citalopram
Paroxetine
Sertraline

Question 3

Describe the mechanism of SSRIs and SNRIs?

Answer 3

Inhibits reuptake of certain neurotransmitters from synaptic cleft

Question 4

Describe the mechanism of MAOIs?

Answer 4

Inhibit breakdown of serotonin at synapse by inhibiting the enzyme MAO-A

Question 5

Example of MAOIs?

Answer 5

Moclobemide, phenelzine, tranylcypromine

Question 6

Example of Tricyclics?

Answer 6

Amitriptyline, Dothiepin, Imipramine, Lofepramine

Question 7

Triad of serotonin sydrome?

Answer 7

Neuromuscular abnormalities
Altered mental state
Autonomic dysfunction

Question 8

Positive symptoms of Sz?

Answer 8

Delusions
Hallucinations
Disorganised speech

Question 9

Negative symptoms of Sz?

Answer 9

Flattened affect
Reduced speech
Avolition- loss of motivation
Anhedonia- loss of pleasure

Question 10

What is the mesolimbic pathway involved in?

Answer 10

Dopaminergic patheway central in REWARD and MOTIVATION and PLEASURE

Question 11

What parts of the brain does the mesolimbic pathway involve?

Answer 11

Ventral tegmental area projects dopaminergic ction potentials to the nucleus cumbens

Question 12

What affect does antagonising the D2 receptors in the mesolimbic pathway have in schizophrenia?

Answer 12

Treats the positive symptoms

Question 13

What is the mesocortical pathway involved in?

Answer 13

Thought to be involved in executive function and cognitive control of emotions

Projects from VTA to prefrontal cortex

Question 14

How is the mesolimbic pathway involved in schizophrenia?

Answer 14

Hyperactivity of dopamine mediates positive psychotic symptoms

Question 15

How is mesocortical pathway involved in schizophrenia?

Answer 15

Decreased dopamine is thought to be responsible for negative and depressive symptoms of Sz

Question 16

How is the nigrostriatal pathway involved in Sz?

Answer 16

Responsible for motor mediation. Blocking Dopamine D2 recpeots can lead to dystonia, parkinsonian symptoms and akathisia

Question 17

How is the tuberoinfundibular pathway involved in Sz?

Answer 17

Inhibits prolactin release - blocking D2 receptors can lead to hyperprolactinemia leading to amenorrhoea, galactorrhoea and sexual dysfunction

Question 18

How is salience linked to Sz?

Answer 18

Associated with aberrant attribution of salience
-tendency for irrelevant stimuli to be attributed to have motivational significance

Question 19

Fetaures of neuroleptic malignant syndrome?

Answer 19

Tremors, muscle cramps, fever, autonomic instability, delirium, rigidity
RAISED CK (if not rasied CK not NMS)

Adverse reaction to antipsychotics- medical emergency
Treated with dopamine agonists

Question 20

When is clozapine offered?

Answer 20

Ater 2 or more treatments have been unsuccessful

Only drug to demonstrate superior efficacy to others but potentially dangerous side effects

Question 21

What is the serious side effect of clozapine?

Answer 21

Agranulocytosis - severe neutropenia
Monitoring ++++++++
(also hypersalivation, constipation, weight gain)

Question 22

Example of atypical antipsychotics?

Answer 22

clozapine, risperidone, quetiapine, olanzapine, aripiprazole, ziprasidone

Question 23

Example of typical antipsychotics

Answer 23

chlorpromazine, fluphenazine, trifluoperazine
haloperidol
flupentixol
zuclopenthixol

Question 24

What side effects are seen more in atypical antipsychotics?

Answer 24

Metabolic- weight gain (olanzapine and clozapine), impared glucose tolerance (T2DM), dyslipidemia

Question 25

What side effects are seen more in typical antipsychotics?

Answer 25

Antidopaminergic-parkinsonism, akathisia, dystonia, ^ muscle tone, tardive dyskinesia, hyperprolactinemia

Question 26

General antipsychotic side effects?

Answer 26

Pro-longed QT interval arrythmias (ECGs) Anticholinergic- dry mouth, urinary retention, constipation NMS Antiandrenergoc- postural hypotension, impotence

Question 27

What is dementia?

Answer 27

Umbrella term for generalised decline in cognitive function- loss of memory, ability to perform daily activities, thinking

Question 28

Diagnosing dementia?

Answer 28

Medical history, exclude differentials- bloods, MRI/CT, DaT/SPECT

Question 29

First line medication for treating dementia?

Answer 29

Acetylcholinesterase inhibitors e.g. donepezil, galantine, rivastigmine Contraindicated if bradycardic

Question 30

Example of NMDA receptor antagonist and what does it treat?

Answer 30

Memantine Dementia

Question 31

What is delirium?

Answer 31

An acute, transient and reversible state of confusion. Usually result of other organic processes

Question 32

Causes of delirium?

Answer 32

PINCH ME Pain Infection Nutrition Constipation Hydration Medication Environment

Question 33

What is Section 2 of MHA?

Answer 33

Detaining a patient in hospital for assessment of their mental health disorder for up to 28 days. Non-renewable.

Question 34

What is Section 3 of MHA?

Answer 34

Detaining a patient in hospital for treatment of their mental health disorder for up to 6 months- renewable.

Question 35

What is Section 4 of MHA?

Answer 35

Emergency admission for assessment whilst waiting for Section 2/3 for up to 72 hrs

Question 36

What is Section 5(2) of MHA?

Answer 36

Emergency order on an inpatient detained for up to 72 hrs by one doctor

Question 37

What is Section 5(4) of MHA?

Answer 37

Emergency order on an inpatient detained for up to 72 hrs by a nurse.

Question 38

What is Section 135 of MHA?

Answer 38

Court order allowing police to enter private property by force, to remove a person suffering from a mental health disorder and detain them in a place of safety (ED or psychiatry hosp. suite) for up to 72 hrs.

Question 39

What is Section 136 of MHA?

Answer 39

Allows police officers to detain someone suffering from a mental health disorder from public place to place of safety, without a warrant, for up to 24 hrs waiting for medical assessment.

Question 40

Who needs to be present for a MHA assessment?

Answer 40

A Section 12 approved doctor Responsible clinician of patients care Approved mental health professional (AMHP) Nearest relative can be

Question 41

What is Section 131 of MHA?

Answer 41

Informal, voluntary admission of a patient suffering with a mental health disorder.