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Psychiatry Flashcards

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1
Q

What drugs are first line for rapid tranquillisation?

A

IM Haloperidol or IM Lorazepam
(Lorazepam used if cardiac history is unknown)

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2
Q

What is section 136?

A

Section 136 is used by the police to bring people who could be displaying signs of mental illness presenting a risk to themselves or others to place of safety.

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3
Q

What are the features of discontinuation of SSRI?

A

Electric shock pains, sweating, GI symptoms, mood changes, unsteadyness, dizzyness.

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4
Q

When is Clozapine indicated to be used?

A

When 2 or more antipsychotics have been unsuccessful.

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5
Q

What is the major side effect with Clozapine?

A

Agranulocytosis.

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6
Q

How do Benzodiazpines work?

A

Enhance GABA

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7
Q

What does section 3 allow?

A

Treatment for up to 6 months

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8
Q

What does section 4 allow?

A

Assessment order of 72 hours

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9
Q

Treatment resistant schizophrenia - use what drug?

A

Clozapine

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10
Q

What are the side effects with Clozapine?

A

Agranulocytosis, weight gain, neutropenia, myocarditis, arrhythmias

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11
Q

What is first line for panic disorder?

A

Sertraline

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12
Q

What does section 4 of the MH act do?

A

72 hours of assessment

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13
Q

What are the biochemical findings in anorexia.

A

Everything is low apart from the G’s and C’s which are raised. Eg raised cortisol/ raised GH.

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14
Q

What are examples of the atypical antipsychotics?

A

Clozapine/ Olanzapine

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15
Q

What score suggests dementia on the mini mental state exam?

A

Anything less than 24/ 30 suggests dementia.

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16
Q

What scores are recommended by NICE for dementia screening in GP setting?

A

6CIT and 10 CS (10 point cognitive screener)

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17
Q

What drug is first line in GAD?

A

Sertraline SSRI

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18
Q

What is the monitoring after prescribing an SSRI for GAD?

A

Review the effectiveness and side effects of the drug every 2 to 4 weeks during the first 3 months of treatment and every 3 months thereafter.

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19
Q

What are the first rank symptoms for schizophrenia? (4)

A

Auditory hallucinations
Thought disorder
Delusions
Passivity phenomena

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20
Q

What type of drug is Risperidone?

A

Atypical antipsychotic

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21
Q

What are the side effects of atypical antipsychotics?

A

weight gain, hyperprolactiaemia, and agranulocytosis with clozapine

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22
Q

What type of drug is Paroextine?

A

SSRI

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23
Q

What drug is used for the long term management of Bipolar?

A

Lithium

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24
Q

What does section 2 allow?

A

28 days assessment

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25
What does section 3 allow?
Treatment for 6 months
26
What does section 4 allow?
Emergency assessment - 72 hours
27
What does section 5(2) allow?
Pt already in hospital- 72 hours assessment
28
What does section 136 allow?
Police to bring someone to hospital from a public space.
29
What are the first line drugs for Alzheimers?
Any of the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
30
What are the features of Neuroleptic malignant syndrome?
Fever, Autonomic instability, Rigidity and altered mental state. RAISED CK *Starts 2-10 days after starting the antipsychotic**
31
Management of Neuroleptic malignant syndrome?
IV Fluids Dantrolene if severe
32
What are some examples of atypical antipsychotics?
Clozapine, Olanzapine, Arirpiprazole, Quietapine, Risperidone
33
What is important to know about Fluoxetine?
Long half life. If switching to another SSRI. Need to stop Fluoxetine and restart next one in 5-7 days.
34
Switching SSRIs- general principles
Most SSRIs can switch between (direct switch). APART from fluoxetine which needs to be stopped and allow 5-7 days before starting next SSRI.
35
Examples of SSRIs
Sertraline, Fluexoetine, Paroxetine, Citalopram, Escitolapram
36
What is - Delirium tremens - Wernickes encephalopathy - Korsakoffs
Delirium tremens- acute alcohol withdrawal. Wernickes- COAT (confusion, opthalmoplegia, ataxia, thiamine deficiency) Korsafkoffs - RACK (retrograde amnesia, anterograde amnesia, confabulation)
37
How is Delirium tremens treated ?
Benzodiazepines (chlordiazepoxide or diazepam)
38
How does Delirium tremens present?
tremor, sweating, tachycardia, anxiety Seizures!
39
What PHQ 9 indicates less severe/ more severe depression? and management ?
score of 16= less severe = behavioural therapies Score >16= more severe= CBT + antidepressant
40
What are the features of lithium toxicity?
Tremors, Polyuria Confusion Seizures Increased reflexes
41
What is Cotard Syndrome?
Delusion that part of the body is rotten or dead. Cotard = Corpse
42
What is Capers Syndrome?
A familiar person has been replaced with an identical imposter! Closely Associated Person Got Replaced And Switched
43
What is Fregoli Syndrome?
Different people they see are actually the same person in lots of disguises.
44
What is De Clerambault Syndrome?
Someone who is a celebrity is secretly in love with them.
45
What is Otello syndrome?
Pathological delusions that your partner is cheating
46
What is the treatment of depression in Bipolar disorder?
Quetiapine (atypical antipsychotic) alone, or Fluoxetine (SSRI) combined with olanzapine (antipsychotic), or Olanzapine alone, or Lamotrigine alone.
47
Acamprosate, Disulfram, Naltrexone are used how?
Alcohol excess- "problem drinking" Mild Alchohol dependence Disulfram- promotes absistance Acamprosate- reduces cravings. NMDA antagonist Naltrexone- opiod antagonist
48
Adverse effects of Cocaine
Coronary artery spasm Hypertension Tachycardia/ bradycardia Seizures Hyper-reflexia Agitation Psychosis Bugs crawling under the skin
49
Management of cocaine toxicity?
Benzodiazepines are first line in most examples of cocaine toxicity
50
What are the symptoms of discontinuation of a SSRI? - Which SSRI has the highest risk of discontinuation syndrome?
increased mood change restlessness DIFFICULTY SLEEPING! unsteadiness sweating gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting **paraesthesia** Paroxetine is the highest risk!
51
Treatment of ADHD in children?
Methylphenidate AGED OVER 5 (six week trial)
52
What needs to be done before starting ADHD medication?
ECG prior
53
What tests need to be done prior to starting an antipsychotic?
Bloods: Full blood count (FBC), urea and electrolytes (U&E), liver function tests (LFT) Lipids, WEIGHT Fasting blood glucose, prolactin Blood pressure ECG CVS risk assessment
54
Mania vs Hypomania in Bipolar- how long do symptoms need to last for to classify as an episode?
Hypomania- 4 days Mania- 7 days
55
Which antipsychotic is exclusively monitored by secondary care?
Clozapine (risk of agranulocytosis)
56
Ecstasy (MDMA) toxicity? and mangement
Hyponatraemia Tachycardia Hypertension Neurological- anxiety/ sweating Mx) supportive but Dantrolene if required
57
Side effects of Lithium?
nausea/vomiting, diarrhoea fine tremor nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus thyroid enlargement, may lead to hypothyroidism ECG: T wave flattening/inversion weight gain idiopathic intracranial hypertension leucocytosis hyperparathyroidism and resultant hypercalcaemia
58
What are the tools for screening for depression?
HAD PHQ-9
59
What SSRI for breastfeeding mothers (if initiating)?
Paroextine or Sertraline
60
Amitryptilline overdose presents with?
Anticholinergic side effects Dry mouth/ blurred vision/ Prolonged QRS interval
61
Aspirin overdose- does what to do the ABG?
Initially respiratory alkalosis followed by metabolic acidosis
62
What are the risk factors for Schizophrenia?
Black Urban populations Migrants Exposure to Toxoplasmosis
63
Malingering vs Facticious disorder?
Malingering- external reward eg disability payments Factious disorder- internal gains 'sick role'
64
What are the extrapyramidal side effects of antipsychotics?
Acute dystonia (torticillis/oculogyral crisis) Akathesia - restlessness Tardive dyskinesia Parkinsonism
65
What is the difference between Akathesia and Restless leg syndrome?
Akathesia is in response to antipsychotic Restless leg syndrome - Inability to sleep
66
What drug is contraindicated with prescription of SSRI?
MAO inhbitors are contraindicated. Increased the risk of serotonin syndrome Triad of autonomic instability/
67
Tamoxifen cannot be co prescribed with which SSRIs?
Fluoxetine and Paroextine
68
Features of borderline personality disorder
Frequent episodes of self harm Unstable/ intense relationships (Most common type of personality disorder)
69
What is an example of a TCA antidepressant? and how does it present in overdose? and what is the antidote?
Amitriptylline Overdose: antimusclarnic effects - dry mouth/ blurred vision/ ARRYTHMIAS! IV Bicarbonate and need ECG monitoring
70
What is the 6 monthly monitoring for Lithium?
Thyroid and Renal tests every 6 months
71
What is a "brief psychotic disorder"
Episode of psychosis Less than a month NOT substance related/ induced
72

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