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Revising Group > Psychiatry > Flashcards

Psychiatry Flashcards

(42 cards)

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1
Q

What is a delusion?

A

A fixed, firm, unshakeable belief held against the evidence, outside of social and cultural norms.

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2
Q

What is the first-line pharmacological management for ADHD?

A

Methylphenidate; a stimulant to stimulate frontal lobes.

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3
Q

With what presentation can you diagnose Tourette’s Syndrome?

A

More than a year’s history of multiple motor and phonic tics.

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4
Q

What will Section 136 of the MHA allow the police to do?

A

Detain a member of the public in a public place who is at risk to themselves or others.

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5
Q

What are tics?

A

Non-rhythmic, semi/involuntary motor or phonic verbalisations with discrete muscle groups.

Profanities as tics are rare.

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6
Q

With what presentation can you diagnose ADHD?

A

Inattention and/or hyperactivity-impulsivity, observable in two settings and onset before the age of seven, interfering with appropriate functioning.

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7
Q

What can antipsychotics in the elderly lead to?

A

Stroke and VTE

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8
Q

What are the core symptoms of depression?

A
  • Persistent low mood, often worse in the morning.
  • Loss of interest or pleasure in most activities.
  • Low energy or persistent fatigue.
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9
Q

What are additional symptoms of depression?

A
  • weight changes
  • insomnia or hypersomnia
  • psychomotor agitation
  • decreased libido
  • feelings of worthlessness
  • concentration issues
  • recurrent thoughts of death or suicide
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10
Q

How long do depressive symptoms have to last to have the diagnosis?

A

2 weeks

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11
Q

What are the categories of depression?

A
  1. Mild: Two core symptoms plus two additional symptoms.
  2. Moderate: Two core symptoms plus three or more additional symptoms.
  3. Severe: All three core symptoms plus four or more additional symptoms, possibly with psychotic features if severe.
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12
Q

What are the different medications available to treat depression?

A
  • First line is self help resources and CBT
  • Medication:
    • 1st line is SSRI - e.g. sertraline
      Other:
    • SNRIs e.g. reboxetine for major depression
    • TCAs e.g. Amitriptyline for depressive disorder
    • MAO e.g mocolbemide or selelgiline for depressive disorder
    • NaSSA e.g. mirtazapine
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13
Q

Give are the side effects of TCAs?

A

-overdose → block Na+ channels → cardiac arrest
-Weight gain
-Sexual dysfunction
-Depersonalisation
-Antimuscarinic effects
-lengthening of QT interval

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14
Q

What are the side effects of SSRIs?

A

ADRs- citalopram
-QT interval prolongation
-sexual dysfunction
-sleep disorders
-GI disturbances
-
Contra
-If poorly controlled epileptic
-pre-existing long QT interval, or manic
- Avoid NSAIDs (or co-prescribe with PPI), avoid warfarin/heparin, avoid triptans and MAOIs (risk of serotonin syndrome)
- Avoid giving <18y as increases risk of suicide. If CBT failed then give fluoxetine

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15
Q

What are the side effects of SNRIs?

A

-Palpitations
-Sexual dysfunction
-Decreased appetite
-Nausea
-dry mouth
-dizziness
-excessive sweating

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16
Q

What are the side effects of MAOI?

A

-Irritability
-Sleep disorder
-Nausea + vomiting
- Can’t eat cheese, liver, wine (increase in tyramine → serotonin syndrome)

ADRs- moclobemide
-Confused states (agitation)
-Dizziness
-Dry mouth
Contra- moclobemide
-if thyrotoxicosis,
-if bipolar

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17
Q

What are the side effects of NaSSA?

Study These Flashcards
A

-5HT3 antagonist: increased appetite
-H1 (histamine) antagonist: drowsiness, weight gain

18
Q

What are the postiive symptoms of schizophrenia?

Study These Flashcards
A
  • Though echo/ insertion/ withdrawal/ broadcast
  • Delusions of control and delusional perception
  • Auditory hallucinations (3rd person, running commentary)
19
Q

What are the negative symptoms of schizophrenia?

Study These Flashcards
A
  • Anhedonia - no pleasure
  • Alogia - poverty of speech
  • Avolition - poor motivation
  • Apathy - lack of interest
  • Blunted Affect - lack of emotion
20
Q

What is the criteria to diagnose schizophrenia?

Study These Flashcards
A
  • at least 1 core symptom of thought disorder, delusions or hallucinations
  • and 2 other sympotms
  • All need to be present for at least 1 month
21
Q

What are the 2 types of antipsychotics?

Study These Flashcards
A

typical and atypical

22
Q

What are examples of typical antipsychotics?

Study These Flashcards
A
  • Chlorpromazine
  • Haloperidol
23
Q

What are common side effects of typical antipsychotics?

Study These Flashcards
A
  • Weight gain
    • Movement disorder
    • Extrapyramidal symptoms e.g. Parkinsonism
    • Tardive dyskinseisa (restlessness)
    • Hyperprolactinemia
24
Q

What are examples of atypical antipsychotics?

Study These Flashcards
A
  • Olanzapine
  • Risperidone
  • Aripiprazole
25
What are the side effects of atypical antipsychotics?
- VERY FEW EXTRAPYRAMIDAL SIDE EFFECTS * LESS SIGNIFICANT HYPERPROLACTINEMIA (risperidone) * HIGH RISK OF METABOLIC SYNDROME * PROLONGED QT INTERVAL * SEDATION (anti-H1) * CLOZAPINE: agranulocytosis, myocarditis, cardiomyopathy * RISK OF NEUROLEPTIC MALIGNANT SYNDROME
26
What antipsychotic is known to cause weight gain and insomnia as a side effect?
Olanzapine
27
What are common side effects of olanzapine, clozapine and quetiapine?
- QT prolongations - Weight gain - Sexual dysfunction
28
What is the difference between typical and atypical side effects?
Typical meds target dopamine by decreasing it which decreases positive symptoms but not negative ones. Atypical meds block D2 receptors reduce dopamine in the mesolimbic pathway -> reduces positive symptoms. AND Serotonin release inhibits dopamine release. Inhibiting serotonin receptors increases dopamine release This increases dopamine in the mesocortical pathway This reduces negative symptoms
29
What pathway in the brain is involved in creating positive symptoms in schizophrenia?
Hyperactivation of mesolimbic and nigrostriatal pathways
30
What pathway in the brain is involved in creating negative symptoms in schizophrenia?
Hypoactivation mesocortical pathway
31
What pathway is indirectly targeted by antipsychotic meds which leads to hyperprolactinemia + amenorrhoea + galactorrhoea?
Tuberoinfundibular pathway. When antipsychotics are given, there is an decrease in dopamine in this pathway, which leads to an increase in prolactin causing these symptoms
32
What is the difference between psychosis and schizophrenia?
- Schneider first rank symptoms of schizophrenia. If they have these sympotms then schiz. - In psychosis, they will not have the criteria to diagnose schiz but they will have some symptoms of it.
33
What are the 2 types of psychosis?
- Acute -> a sudden case usually due to a trigger - Chronic -> always has psychosis
34
What are the triggers of psychosis?
- Drug-Induced Psychosis: Substances such as cannabis, amphetamines, cocaine, LSD, and alcohol can trigger psychotic episodes. - Sudden withdrawal of drugs and alcohol - Medications: steroids or anticholinergics
35
What are the symptoms of serotonin syndrome?
- Side effects of antidepressants * Excess serotonergic activity in CNS * Hyperreflexia, autonomic dysfunction, altered mental status - Onset within 24h
36
What bloods are done for serotonin syndrome?
Non-specific bloods
37
What is treatment for serotonin syndrome?
IV cyprohepatadine
38
What are the symptoms of Neuroleptic malignant syndrome?
- Side effect of antipsychotics - Excess D2-blockade in CNS - Muscle rigidity, hyperthermia, akinesia (loss or impairment of the power of voluntary movement), tremor, altered mental status - Onset over days/weeks
39
What bloods are done for Neuroleptic malignant syndrome?
Raised creatine kinase
40
What is management of Neuroleptic malignant syndrome?
dantrolene
41
What are symptoms of Extrapyramidal syndrome?
EXTRAPYRAMIDAL SYMPTOMS: Acute Dystonia (painful spasms), Akathisia (movement disorder- can’t stay still), Parkinsonism, irreversible Tardive dyskinesia “ADAPT” * HYPERPROLACTINEMIA * PROLONGED QT INTERVAL * (block repolarisation of K+ channels in myocardium) * RISK OF NEUROLEPTIC MALIGNANT SYNDROME
42
What anti-depressants can be given during pregnancy?
SSRIs - fluoxetine, sertraline, citalopram and escitalopram can be sued in pregnancy

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