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psychiatry Flashcards

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1
Q

what neurotransmitter is deranged in depression

A

5HT (serotonin)

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2
Q

What PHQ-9 score correlates to what levels of depression

A

5-9 > mild depression
10-14 > moderate depression
15-19 > moderately severe depression
20-27 > severe depression

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3
Q

what is the incidence and timeline for postnatal mental health issues

A

Baby Blues > majority of women, first week
Postnatal depression > 1 in 10, 3 months after birth
Puerperal psychosis > 1 in 1000, a few weeks after birth

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4
Q

SSRI mechanisms and examples

A

block the re-uptake of serotonin by the presynaptic membrane on the axon terminal.

sertraline, citalopram, escitalopram, fluoxetine, paroxetine

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5
Q

SNRI mechanism and examples

A

block the reuptake of serotonin and noradrenaline by the presynaptic membrane.

duloxetine, venlafaxine

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6
Q

TCA mechanism and examples

A

block the reuptake of serotonin and noradrenaline by the presynaptic membrane. Also block acetylcholine and histamine receptors = anticholinergic and sedative side effects.

amitriptyline, nortriptyline

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7
Q

Mirtazipine mechanism

A

Mirtazapine is a presynaptic alpha2-adrenoreceptor antagonist which increases central noradrenergic and serotonergic neurotransmission.

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8
Q

how long do antidepressants take to work

A

2-4 weeks

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9
Q

how long should antidepressants be continued

A

at least 6 months

2 years for recurrent depression

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10
Q

when and how does antidepressant discontinuation syndrome present

A

2-3 days after stopping treatment

  • flu-like symptoms
  • electric-shock sensations
  • irritability
  • insomnia
  • vivid dreams
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11
Q

Serotonins syndrome: presentation, severe presentation, management

A
  1. altered mental states
  2. autonomic nervous system hyperactivity
  3. neuromuscular hyperactivity

if severe: confusion, seizures, severe hyperthermia and respiratory failure

supportive care (eg sedation with benzodiazepines) & withdrawal from causative agent

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12
Q

What presenting features inc. risk of suicide

A

Previous suicidal attempts
Escalating self-harm
Impulsiveness
Hopelessness
Feelings of being a burden
Making plans
Writing a suicide note

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13
Q

what background factors increase risk of suicide

A

Mental health conditions
Physical health conditions
History of abuse or trauma
Family history of suicide
Financial difficulties or unemployment
Criminal problems (prisoners have a high rate of suicide)
Lack of social support (e.g., living alone)
Alcohol and drug use
Access to means (e.g., firearms

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14
Q

what are the protective factors to suicide

A

Social support and community
Sense of responsibility to others (e.g., children or family)
Resilience, coping and problem-solving skills
Access to mental health support

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15
Q

What substance can be used within one hour of overdoes

A

activated charcoal

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16
Q

what’s used to treat benzodiazepine overdose

A

flumazenil

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17
Q

whats used to treat beta blocker overdose

A

glucagon for heart failure or cardiogenic shock

atropine for symptomatic bradycardia

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18
Q

whats used to treat cocaine overdose

A

diazepam

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19
Q

whats used to treat cyanide overdose

A

dicobalt edetate

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20
Q

whats used to treat methanol or ethylene glycol poisoning

A

fomepizole or ethanol

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21
Q

whats used to treat carbon monoxide poisoning

A

100% oxygen

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22
Q

Treatment for mania in Bipolar Disorder

A

antipsychotic (e.g. olanazapine, quetiapine, risperidone or haloperidol)
lithium
sodium valproate
stop antidepressants

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23
Q

Treatment for acute depressive episode in Bipolar Disorder

A

olanzapine plus fluoxetine
antipsychotics (olanzapine or quetiapine)
Lamotrigine

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24
Q

Target range for Lithium

A

0.6-0.8mmol/L

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25
Adverse effects of Lithium
fine tremor weight gain CKD hypothyroidism and goitre hyperparathyroidism and hypercalcaemia nephrogenic diabetes insipidus
26
What GAD-7 score correlates to what levels of anxiety
5-9 > mild anxiety 10-14 > moderate anxiety 15-21 > severe anxiety
27
management of PTSD
eye movement desensitisation and reprocessing (EMDR) medication (SSRI, venlafaxine, antipsychotics)
28
management of OCD
CBT SSRI Clomipramine (TCA)
29
what are the 3 clusters of personality disorders
Cluster A > Suspicious Cluster B > Emotional or impulsive Cluster C > Anxious
30
what is capgras syndrome
Capgras syndrome involves the false belief (delusion) that an identical duplicate has replaced someone close to them. This might be their spouse, family member or close friend. The person may be suspicious and aggressive towards the imposter. Capgras syndrome is a delusional misidentification syndrome. It is most often seen in psychotic conditions, such as schizophrenia. It can also occur with dementia and other neurological conditions.
31
what is De Clérambault’s Syndrome
De Clérambault’s syndrome, also called erotomania, involves the false belief (delusion) that a famous or high-social-status individual is in love with the patient. This can lead to inappropriate harassment of the individual by the patient. The patient is most often a young, single woman. The patient usually has little or no contact with the individual and no objective evidence to support their belief. Frequently, it occurs without other psychiatric or neurological disease.
32
how long do symptoms of schizophrenia need to be present for diagnosis
6 months
33
typical and atypical antipsychotics examples
typical - chlorpromazine - haloperidol atypical - quetiapine - aripiprazole - olanazapine - risperidone
34
depot antipsychotics (how often and examples)
2wks - 3mnths - aripiprazole - flupentixol - paliperidone - risperidone
35
Clozapine complications
Agranulocytosis (severely low neutrophil count) myocarditis or cardiomyopathy constipation (Intestinal obstruction) seizures excessive salivation
36
Monitoring requirements for antipsychotics
before & during - weight and waist circumference - BP and HR - Bloods > HbA1c, lipids, prolactin - ECG
37
Side effects of antipsychotics
weight gain diabetes prolonged QT interval raised prolactin extrapyramidal symptoms
38
extrapyramidal side effects of antipsychotics
akathisia > restlessness dystonia > abnormal muscle tone, leading to abnormal postures pseudo-parkinsonism > tremor, rigidity tardive dyskinesia > abnormal movements, particularly the face
39
Neuroleptic Malignant Syndrome : presentation, investigation findings, management
presentation - muscle rigidity - hyperthermia - altered consciousness - autonomic dysfunction blood test findings - raised creatinine kinase - raised white cell count management - stop causative meds - supportive care (IV fluids and sedation with benzodiazepine) - if severe treat with bromocriptine (a dopamine agonist) or dantrolene (muscle relaxant)
40
what is the mechanism of alcohol
Alcohol is a depressant. It stimulates GABA receptors, which have a relaxing effect on the brain. It inhibits glutamate receptors (also known as NMDA receptors), causing a further relaxing effect on the electrical activity of the brain. Long-term alcohol use results in GABA system becoming down-regulated and the glutamate system becoming up-regulated to balance the effects of alcohol. The patient must continue drinking alcohol, or they will experience unpleasant, uncomfortable and potentially dangerous withdrawal symptoms.
41
42
calculation for alcohol units
volume (ml) * alcohol content (%) = units of alcohol
43
recommended alcohol consumption
no more than 14 units a week spread evenly over 3 or more days no more than 5 units in a single day
44
CAGE questions for alcohol consumption
C – CUT DOWN? Do you ever think you should cut down? A – ANNOYED? Do you get annoyed at others commenting on your drinking? G – GUILTY? Do you ever feel guilty about drinking? E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?
45
blood results in alcoholics
Raised mean corpuscular volume (MCV) Raised alanine transaminase (ALT) and aspartate transferase (AST) AST:ALT ratio above 1.5 particularly suggests alcohol-related liver disease Raised gamma-glutamyl transferase (gamma-GT) (particularly notable with alcohol-related liver disease)
46
alcohol withdrawal timeline
6-12 hrs > tremor, sweating headache, craving, anxiety 12-14 hrs > hallucinations 24-48hrs > seizures 24-72hrs > delirium tremens
47
delirium tremens : presentation, mortality rate
presentation: - acute confusion - severe agitation - delusions and hallucinations - tremor - tachycardia - hypertension - hyperthermia - ataxia - arrhythmias mortality rate 35%
48
management of alcohol withdrawal
1. CIWA-Ar tool 2. Chlordiazepoxide (Librium) a benzodiazepine, Diazepam is an alternative. Given orally as a reducing regime over 5-7 days. 3. High-dose B vitamins (Pabrinex) given IM or IV followed by long-term oral Thiamine. To prevent Wernicke-Korsakoff Syndrome
49
what medications can be given to help maintain abstinence
acamprosate > tablets that diminsh cravings naltrexone > blocks opiod receptors so prevents people feeling good when drinking disulfiram > produces unpleasant side effects if you drink alcohol (headache, vomiting etc)
50
wernicke-korsakoff syndrome
due to thiamine (B1) deficiency. Thiamine poorly absorbed in presence of alcohol. Wernicke's encephalopathy (reversible) - confusion - oculomotor disturbances - ataxia Korsakoff syndrome (irreversible) - memory impairment - behavioural changes
51
do you replace B12 or thiamine first
B12
52
medications used in opiod dependence (and MOA)
methadone > binds to opioid receptors buprenorphine > binds to opioid receptors Naltrexone > helps prevent relapse
52
refeeding syndrome mechanism
during prolonged starvation intracellular Potassium, Phosphate and Magnesium are depleted. Electrolytes are moved from inside cell to the blood to maintain normal levels in absence of dietary intake. Cell metabolism redice to conerve energy resultin gin loss of intracellular electrolytes. During refeeding, Magnesium, Potassium and Phosphate are shifted out of the blood and Sodium is shifted into the blood. Carbohydrates cause increase in Insulin which further drives glucose, potassium and phosphate into cells. Insulin also causes extra sodium resorption in the kidneys.
53
Blood findings in refeeding syndrome
hypomagnesaemia hypokalaemia hypophosphataemia fluid overload ( due to water following extra sodium into extracellular space)
54
management of refeeding syndrome
slowly reintroduicing food magnesium, potassium, phosphate and glucose monitoring fluid balance monitoring ECG monitoring in severe cases supplementation with electrolytes and vitamins (particularly B vitamins and Thiamine)
55
pathophysiology of alzheimers dementia
brain atrophy amyloid plaques reduced cholinergic activity neuroinflammation
56
associated symptoms of Dementia with Lewy Bodies
visual hallucinations delusions REM sleep disorders Fluctuating consciousness.
57
Frontotemperal dementia : symptoms and age of onset
abnormalities in behaviour, speech and language Onset 40-60 yrs, can be familial
58
initial blood tests in suspected dementia (for exclusion)
Full blood count Urea and electrolytes Liver function tests Inflammatory markers (e.g., CRP and ESR) Thyroid profile Calcium HbA1c B12 and folate Mid-stream urine (MSU) if infection is suspected Chest x-ray (if lung cancer is suspected) Specialist investigations will include imaging (e.g., MRI brain) to exclude structural pathology.
59
five domains of ACE-III
Attention Memory Language Visuospatial function Verbal fluency
60
medications for alzheimers dementia
Acetylcholinesterase inhibitors (e.g., donepezil, rivastigmine or galantamine) Memantine, which works by blocking N-methyl-D-aspartic acid (NMDA) receptors
61
first-line antipsychotics in dementia
Risperidone

psychiatry (6 decks)

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