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AKT > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

Switch fluoxetine to SSRI

A

leave gap of 4-7 days before starting new SSRI

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2
Q

Switch SSRI to TCA

A

cross tapering - slowly reduce SSRI whilst slowly increase TCA

exception Fluoxetine should be withdrawn completely prior to starting TCA

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3
Q

SSRI Interactions

A

NSAIDs - avoid, unless PPI cover
warfarin/ heparin - avoid, consider Mirtazepine instead
Triptans, MAOi - increase risk of serotonin syndrome

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4
Q

OCD Mx

A

1st - CBT

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5
Q

Venlafaxine (SNRI) when starting needs WHAT checking first

A

Blood pressure - associated with hypertension

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6
Q

Citalopram SE

A

Prolonged QT - needs ECG on initiation

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7
Q

SSRI Monitoring

A

UEs - hyponatraemia
ECG - prolonged QTC

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8
Q

Lithium monitoring (lithium levels)

A

weekly until in normal range
then every 3 months once stable

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9
Q

hoovers sign is..

A

Malingering non organic paresis - involuntary contralateral hip extension

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10
Q

Panic disorder Mx

A

1st - Paroxetine
2nd - Imipramine or clomipramine (after 12 weeks)

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11
Q

Lithium monitoring (biochemistry)

A

Renal, Calcium, thyroid and liver function every 6 months

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12
Q

Section 4 is…

A

Emergency detain patient for 72 hours
GP and AMHP

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13
Q

Section 2 is…

A

Admission with assessment up to 28 days
AMHP + one other doctor
treatment can be given against patient wishes

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14
Q

Section 3 is…

A

Admission up to 6 months
AMHP + 2 doctors (both must have seen patient within last 24 hours)
treatment can be given against patient wishes

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15
Q

Section 5(2) is…

A

a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

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16
Q

Section 5(4)

A

similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

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17
Q

Section 17a

A

Supervised Community Treatment (Community Treatment Order)
can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication

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18
Q

Section 135

A

a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety

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19
Q

Section 136

A

someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety

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20
Q

Alcohol deterrent medication (makes them vomit if drink alcohol)

A

Disulfiram (Antabuse)

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21
Q

Clozapine serious side effect

A

Agranulocytosis/ Neutropenia - check FBC

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22
Q

Alcohol withdrawal symptoms

A

symptoms: 6-12 hours - tremor, sweating, tachycardia
seizures: 36 hours
delirium tremens: 72 hours

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23
Q

Acute stress disorder Mx

24
Q

First line medication for Children/ adolescent depression (to be started by psychiatry)

25
Acute stress disorder vs PTSD
AST <4 weeks PTSD symptoms longer than 4 weeks
26
Cotard Syndrome
believing they are dead or non existent
27
OCD Mx
1st- CBT +ERP (exposure and response program) 2nd - SSRI or clomipramine 3rd - secondary care
28
Malingering
lying or exaggerating symptoms for personal gain
29
somatisation disorder
physical symptoms + refused to accept negative results
30
Illness anxiety (hypochondriasis) disorder
belief of serious disease + refused to accept negative results
31
Bipolar DVLA Mx
"unstable" (4+ episodes of mood swings within 12 months) - stop driving 6 months and inform DVLA "stable - stop driving 3 months and inform DVLA
32
Capgras disorder
irrational delusion of misidentification where patients believe that a relative or friend has been replaced by an identical impostor
33
Anxiety Mx
1st- SSRI eg paroxetine, sertraline 2nd - Imipramine or clomipramine
34
Clozapine common side effect
hypersalivation
35
SSRI discontinuation syndrome
dizziness, electric shock sensation, anxiety diarrhoea (GI upset)
36
Benzodiazepine withdrawal Mx
switch to equivalent Diazepam reduce 2mg every 2-3 weeks
37
Clozapine monitoring FBC
weekly first 18 weeks (4 months) fortnightly up to one year monthly for rest of duration risk of agranulocytosis
38
Generalised anxiety disorder Mx
1st - low intensity psychological intervention 2nd - high intensity psychological intervention OR medication Mediation 1 - Sertraline 2nd - alternative SSRI or SNRI 3rd - pregabalin
39
Acute stress disorder Fx
Acute stress reaction in first 4 WEEKS of traumatic event (PTSD is >4 weeks) Mx/ CBT trauma focused Benzodiazepines PRN
40
Alcohol withdrawal Fx
6-12 hours symptoms start - tremor, sweating, palpitations, anxiety 36 hours - Seizures 48-72 hours - Delirium tremens - tremor, confusion, delusions, hallucinations
41
Alcohol withdrawal Mx
1st - Benzodiazepines (eg Chlordiazepoxide, diazepam). - Lorazepam if hepatic failure 2nd - Carbamazepine
42
Typical Antipsychotic SE eg Haloperidol, Chlorpromazine
Extrapyramidal side effects - parkinsonism, dystonia 9sustained muscle contraction), akathisia (restless) Increased risk of VTE, Stroke Other: Antimuscarinic - dry mouth, dry eyes, constipation weight gain, sedation raised prolactin impaired glucose tolerance neuroleptic malignant syndrome prolonged QT reduce seizure threshold
43
Lithium SE
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
44
Lithium monitoring
12 hours post dose Weekly until stable, then 3 monthly TFT, LFT every 6 months
45
Generalised anxiety disorder Mx
1st - SSRI (eg sertraline) 2nd - SNRI (eg venlafaxine) 3rd - Pregabalin
46
Borderline personality disorder Mx
Dialectical Behavioural Therapy (DBT)
47
Antipsychotic monitoring
Bloods (FBC, UE, LFT) - initiation, then annually Lipids, weight - initiation, at 3 months, annually Fasting blood glucose, prolactin - Initiation, at 6 months, annually Blood pressure, ECG - Initiation Cardiovascular risk assessment - Annually
48
acute dystonia means
acute dystonia sustained muscle contraction (e.g. torticollis, oculogyric crisis)
49
akathisia is
severe restlessness
50
Tardive dyskinesia is...
(late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
51
PTSD Mx
1 - trauma focused CBT 2nd - eye movement desensitisation and reprocessing EMDR 3 - Venlafaxine/ SSRI
52
hypermetropia (acute angle closure glaucoma) avoid what anti depressant
Mirtazipine
53
young people (under 18) depression Mx
1st- 2 weeks of watch and wait 2nd - psychological therapies (eg cbt) 3rd - CAMHS
54
Quitiapine monitoring
Lipids, weight, BP, prolactin
55
tourettes Mx
Haloperidol
56

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