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PSYCHIATRY Flashcards

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1
Q

SELF-HARM + SUICIDE
What are some risk factors for suicide?

A

SAD PERSONS –
- Sex (M>F)
- Age (peaks in young + old)
- Depression
- Previous attempt
- Ethanol
- Rational thinking loss (psychotic illness)
- Social support lacking (unemployed, homeless)
- Organised plan (avoid discovery, plan, notes, final acts)
- No spouse
- Sickness (physical illness)
0–4 low, 5–6 mod (?hospital), ≥7 high

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2
Q

SELF-HARM + SUICIDE
What are some protective factors for suicide?

A
  • Married men
  • Active religious beliefs
  • Social support
  • Good employment
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3
Q

BIPOLAR DISORDER
What are the 4 types of bipolar?

A
  • Bipolar 1 = mania + depression in equal proportions, M>F
  • Bipolar 2 = more episodes of depression, mild hypomania (easy to miss), F>M
  • Cyclothymia = chronic mood fluctuations over ≥2y (episodes of depression + hypomania, can be subclinical)
  • Rapid cycling = ≥4 episodes of (hypo)mania or depression in 1 year
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4
Q

BIPOLAR DISORDER
What is the difference between mania and hypomania?

A

MANIA
- abnormally elevated mood or irritability
- >7 days duration
- severe functional impairment
- psychotic symptoms e.g. delusions, hallucinations

HYPOMANIA
- abnormally elevated mood or irritability
- >4 days duration
- no significant functional impairment
- no psychotic features

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5
Q

SCHIZOPHRENIA
What are the first rank symptoms of schizophrenia?
What is the relevance?

A
  • Delusional perceptions
  • Auditory hallucinations (3 types)
  • Thought alienation (insertion, withdrawal + broadcasting)
  • Passivity phenomenon, incl. somatic
  • ≥1 for at least 1m is strongly suggestive Dx
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6
Q

SCHIZOPHRENIA
What are the three types of auditory hallucinations that count as a first rank symptom?

A
  • 3rd person = talking about the patient (he/she)
  • Running commentary = often on person’s actions or thoughts
  • Thought echo = thoughts spoken aloud
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7
Q

GAD
What is the ICD criteria of GAD?
What are the groups of symptoms present in GAD?

A
  • Difficulty controlling worry, present for more days than not for ≥6m
  • ≥4 symptoms with ≥1 from autonomic arousal section
  • Autonomic arousal, physical, mental, general, tension, other
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8
Q

GAD
What are the investigations for GAD?

A
  • History, MSE + risk assessment
  • GAD-7 + Hospital Anxiety + Depression Scale (HADS) questionnaire
  • Exclude organic (FBC, U+Es, LFTs, TFTs, fasting glucose, PTH)
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9
Q

GAD
What is the stepwise management for GAD?

A

STEP 1
- education about GAD
- active monitoring

STEP 2
- self-help, individual guided self-help

STEP 3
- CBT or SSRI (sertraline)

STEP 4
- refer for specialist treatment

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10
Q

OCD
What is the biological management of OCD?

A
  • 1st line SSRIs = sertraline
  • 2nd line = clomipramine (TCA) with specific anti-obsessional action
  • ?Psychosurgery (stereotactic cingulotomy if intractable > 2 antidepressants, 3 combination Tx, ECT + behavioural therapy
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11
Q

PTSD
What are the 4 core symptoms of PTSD?
How long do they need to be present for to diagnose?

A

HEAR (≥1m) –
- Hyperarousal
- Emotional numbing
- Avoidance + rumination
- Re-experiencing (involuntary)

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12
Q

PTSD
What is the medical management of PTSD?

A
  • Venlafaxine or SSRI like sertraline
  • Risperidone for severe cases where resistant to treatment or psychotic
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13
Q

ANOREXIA NERVOSA
What is the diagnostic criteria for anorexia?

A

FEED ≥3m with absence of binge eating –
- Fear of fatness
- Endocrine disturbance
- Extreme weight loss
- Deliberate weight loss

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14
Q

ANOREXIA NERVOSA
What screening tool can be used in anorexia?

A

SCOFF –
- Do you ever make yourself SICK as too full?
- Do you ever feel you’ve lost CONTROL over eating?
- Have you recently lost more than ONE stone in 3m?
- Do you believe you’re FAT when others say you’re thin?
- Does FOOD dominate your life?

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15
Q

ANOREXIA NERVOSA
What are some investigations for anorexia?

A
  • Sit up squat stand (SUSS) test /3
  • BP (low), temp (low)
  • ECG (brady, T-wave changes, QTc prolongation)
  • FBC (anaemia, dehydrated), LFTs, urinalysis, serum proteins
  • U+Es, Ca2+, Mg2+, phosphate > vomiting, laxatives, diuretics, water loading
  • DEXA scan after 1y of underweight (osteopenia)
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16
Q

ANOREXIA NERVOSA
In anorexia, most things are low apart from what?

A

Gs + Cs –
- GH, Glucose, salivary Glands
- Cortisol, Cholesterol, Carotinaemia

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17
Q

ANOREXIA NERVOSA
What are the MARSIPAN indicators of admission?

A
  • BMI <13, severe malnutrition or dehydration
  • HR <40, ECG changes
  • BP <90 systolic, <70 diastolic esp with postural drop
  • Temp <35
  • Severe electrolyte disturbances (K+, Na+, Mg2+, phosphate = low)
  • SUSS test of 0 or 1
  • Significant suicide or serious self-harm risk
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18
Q

ANOREXIA NERVOSA
What are the biological treatments for anorexia nervosa?

A
  • Fluoxetine, chlorpromazine + TCAs may be used for weight gain
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19
Q

ANOREXIA NERVOSA
What is the pathophysiology of refeeding syndrome?

A
  • Reduced carb consumption leads to reduced insulin secretion so the body switches from carb > fat + protein metabolism
  • Electrolyte stores depleted as needed to convert glucose>energy
  • Reintroducing food causes abrupt shift from fat>carb metabolism + insulin secretion surges, driving electrolytes from serum>cells to help convert glucose>energy causing further serum concentration decrease
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20
Q

ANOREXIA NERVOSA
What is the clinical presentation of refeeding syndrome?

A
  • Fatigue, weakness, confusion, dyspnoea (risk of fluid overload)
  • Abdo pain, vomiting, constipation, infections
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21
Q

ANOREXIA NERVOSA
What are the biochemical features of refeeding syndrome?

A
  • Hypophosphataemia main disturbance due to role of converting glucose>energy
  • Hypokalaemia, hypomagnesaemia + thiamine deficiency too
  • Abnormal fluid balance
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22
Q

BULIMIA NERVOSA
What is the diagnostic criteria for bulimia?

A

BPFO ≥2 a week for ≥3m –
- Behaviours to prevent weight gain
- Preoccupation with eating (compulsion to eat but regret after)
- Fear of fatness
- Overeating ≥2/week

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23
Q

PERSONALITY DISORDERS
What are cluster A personality disorders?

A
  • Characterised by odd, eccentric thinking or behaviour
  • MAD
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24
Q

PERSONALITY DISORDERS
What is paranoid personality disorder?

A
  • pattern of suspiciousness about others
  • tendency to perceive attacks on their character + questions loyalty of friends
  • hypersensitivity + unforgiving when insulted
  • preoccupation with conspiracy beliefs + hidden meaning
  • reluctance to confide in others
  • are less resistant to change their beliefs when challenged compared to a patient with delusions
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25
PERSONALITY DISORDERS What is schizoid personality disorder?
- emotional coldness - lack of desire for companionship - preference for solitary activities - few friends or confidants - lack of interest in sexual interactions
26
PERSONALITY DISORDERS What is schizotypal personality disorder?
- odd, eccentric behaviour or 'magical thinking' - inappropriate behaviour - ideas of reference (applying meaning to coincidences or innocuous events) - peculiar speech, mannerisms or dress code - are not psychotic
27
PERSONALITY DISORDERS What are some features of schizotypal personality disorder?
- Ideas of reference (not delusions as insight) - Excessive social anxiety with lack of close friends + social withdrawal - "Magical thinking" believing you can influence people/events with thoughts - Unusual perceptions (illusions, overvalued ideas) - Odd/eccentric behaviour, beliefs, speech or appearance - Inappropriate affect with paranoid or suspicious ideas
28
PERSONALITY DISORDERS What are cluster B personality disorders?
- Characterised by dramatic, overly emotional or unpredictable thinking or behaviour (BAD)
29
PERSONALITY DISORDERS What is borderline/emotionally unstable personality disorder? What is a big risk factor?
- intense and unstable interpersonal relationships - unstable affect regulation (variable, intense moods) - repeated self-injury and suicidality - Often Hx of childhood sexual abuse
30
PERSONALITY DISORDERS In terms of EUPD, what is the difference between... i) impulsive type? ii) borderline type?
i) Difficulties with impulsive + risky behaviours (unsafe sex, gambling) + anger ii) Difficulties with relationships, self-harm + feelings of emptiness
31
PERSONALITY DISORDERS What is histrionic personality disorder?
- exaggerated dramatic behaviour designed to attract attention - attention seeking - flirtatious, seductive, charming and lively - manipulative and impulsive - uncomfortable when they are not the centre of attention - may embarrass friends/family with public displays of emotion - consider their relationships to be closer than they actually are
32
PERSONALITY DISORDERS What is narcissistic personality disorder?
- grandiose sense of self-importance (e.g. exaggeration of achievements) - sense of entitlement + expectation of favourable treatment - arrogant, haughty behaviour - believes they are special + can only be understood by other special people - lacks empathy + often exhibits envy
33
PERSONALITY DISORDERS What is anxious/avoidant personality disorder?
- avoidance of feared stimuli - major fears include fear of criticism and rejection - views self as inept and inferior - extreme social anxiety - strong desire for intimacy - strongly linked to childhood issues (neglect + abuse)
34
PERSONALITY DISORDERS What is dependent personality disorder?
- difficulty in decision making without excessive reassurance - lack of initiative or extreme passivity - will make effort to encourage others to make decisions regarding their own life - often seen in those with overprotective or authoritarian parents
35
PERSONALITY DISORDERS What is anankastic/obsessive-compulsive personality disorder? What may it be seen in?
- Pervasive pattern of perfectionism + inflexibility lacking insight - Hx of family pressure + wanting approval
36
PERSONALITY DISORDERS What are some investigations for personality disorders?
- Assessed (Hx + MSE) more than once - Minnesota Multiphasic Personality Inventory (MMPI) - Eysenck Personality Inventory + Personality Diagnostic Questionnaire
37
PERSONALITY DISORDERS What are the psychological therapies for personality disorders?
- Dialectical behavioural therapy for EUPD - CBT (change unhelpful ways of thinking) - Cognitive analytical therapy (recognise + change unhelpful patterns in relationships + behaviours) - Psychodynamic therapy (looks at how past experiences affect present behaviour)
38
DELIRIUM TREMENS How does delirium tremens present?
- Clouding of consciousness, disorientation + amnesia of recent events - Autonomic = diaphoresis, fever, tachycardia (risk of CV collapse) - Psychomotor agitation, delusions + coarse tremor - Visual, auditory + tactile hallucinations
39
WERNICKE'S What is Wernicke's encephalopathy?
- Atrophy of mammillary bodies due to thiamine deficiency, often alcohol abuse
40
WERNICKE'S How does Wernicke's present?
Triad – - Ataxia - Confusion - Ophthalmoplegia + nystagmus
41
KORSAKOFF'S What are some causes of Korsakoff's?
- Heavy alcohol drinkers - Head injury, post-anaesthesia - Basal or temporal lobe encephalitis - CO poisoning - Other causes of thiamine deficiency (anorexia, starvation, hyperemesis)
42
LITHIUM TOXICITY What is the clinical presentation of lithium toxicity?
- Ataxia, dysarthria, confusion (drunk) - COARSE tremor, blurred vision, hyperreflexia - N+V, diarrhoea - Myoclonus, seizures + coma if severe
43
LITHIUM TOXICITY What are some complications of lithium toxicity?
- Arrhythmias (VT) - Acute renal failure - Syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) after cessation of lithium >2m = truncal ataxia, ataxic gait, scanning speech, incoordination
44
LITHIUM TOXICITY When would you do haemodialysis in lithium toxicity?
- Serum [Li] >5mmol/L OR >4 + renal dysfunction OR severe toxicity (seizures, coma, life-threatening arrhythmias)
45
ACUTE DYSTONIA What is the clinical presentation of acute dystonic reaction?
- Rapid onset after dose given or changed - Spasm of muscles of tongue, face, neck + back - Oculogyric crisis (prolonged involuntary upward deviation of eyes) - Torticollis (twisted neck) - Tongue protrusion
46
ACUTE DYSTONIA What is the management of acute dystonia?
- ABCDE approach as emergency - Anticholinergic – IM procyclidine - Stop antipsychotic (switch to atypical as less EPSEs)
47
NMS What is the clinical presentation?
develops over days to weeks SYMPTOMS - altered mental state - muscle discomfort - confusion - agitation - sweating SIGNS - fever >38 degrees - reduced GCS - generalised muscle rigidity (lead-pipe rigidity) - tachycardia - hyporeflexia
48
NMS What are the complications of NMS?
- Resp failure, CV collapse - Rhabdomyolysis - DIC
49
NMS What is the management of NMS?
- ABCDE approach 1ST LINE - Stop antipsychotic (wait >2w before restarting, consider atypical) - Give L-dopa if dopamine withdrawal in Parkinson's - supportive care (IV rehydration) 2ND LINE - IV dantrolene or lorazepam to reduce rigidity 1st line (amantadine second) - Bromocriptine prophylaxis
50
SEROTONIN SYNDROME What is the clinical presentation of serotonin syndrome?
develops within 24hrs SYMPTOMS - shivering - headache - diarrhoea - agitation - pressured speech - hypervigilance SIGNS - hypertension - tachycardia - mydriasis - myoclonus - hyperreflexia - hyperthermia - muscle rigidity
51
SEROTONIN SYNDROME What is the management of serotonin syndrome?
- ABCDE 1ST LINE - discontinuation of serotonergic agent - supportive care (IV fluids + treatment of hyperthermia) - benzodiazepines (DIAZEPAM) 2ND LINE - cyproheptadine (if symptoms persist)
52
LEARNING DISABILITIES What is the triad in learning disabilities?
- Low intellectual performance (IQ < 70) - Onset during birth or early childhood - Wide range of functional impairment
53
AUTISM SPECTRUM What are some risk factors for autism?
- M>F - Obstetric complications - Perinatal infection (rubella) - Genetic disorders (Fragile X, Down's)
54
AUTISM SPECTRUM What are the 3 areas of impaired functioning that need to be present in autism?
- Social interaction - Communication (speech + language) - Behaviour (imposition of routine with ritualistic or repetitive behaviour)
55
AUTISM SPECTRUM Give some examples of impaired social interaction
- Failure to notice + respond to social cues + others' emotional states - Difficulty establishing friendships - Lack of eye contact - Delay in smiling
56
AUTISM SPECTRUM Give some examples of impaired communication
- Expressive speech + comprehension usually delayed or minimal - Concrete thinking (lack imagination) - Absence of gestures - Later speech consists of monologues, endless questions, echolalia
57
AUTISM SPECTRUM Give some examples of impaired behaviours
- Inability to adapt to new environments (distress) - Tendency to have rigid routine with resistance to change - Greater interest in objects, numbers + patterns than people - Stereotypical repetitive movements which may be self-stimulating movements to comfort themselves (rocking, hand-flapping)
58
ADHD What are some risk factors for ADHD?
- boys and men - history of neurodevelopmental disorder (autism + other learning difficulties) - family history of ADHD or other mental health disorder - premature birth - epilepsy
59
ADHD What is the triad of symptoms in ADHD?
- Inattention - Impulsivity - Hyperactivity
60
ADHD What is the management of ADHD?
Conservative initially (watch + wait) – - Family education on ADHD + parenting advice - Establish normal balanced diet, exercise can improve Sx - Food diary to identify any triggers + eliminate with dietician - 1st line = Methylphenidate (“Ritalin“) -2nd line = Lisdexamfetamine - 3rd line = Atomoxetine
61
SOMATISATION DISORDER What is the clinical presentation of somatisation disorder?
- Non-specific + atypical Sx (usually derm, GI) - Discrepancy between subjective + objective findings (S = Sx) - Sx often in one system, may move to another once Dx possibilities exhausted - Often results in multiple needless investigations + operations (pt refuses to accept -ve results)
62
GENDER DYSPHORIA Define... i) transsexual ii) trans woman iii) trans man
i) Person who emotionally + psychologically feels that they belong to opposite sex ii) Assigned male sex 46XY at birth who later identifies as a woman iii) Assigned female sex 46XX who later identifies as a man
63
GENDER DYSPHORIA What is the management of gender dysphoria in... i) <18? ii) >18?
i) Referral to gender identity development service (GIDS) with MDT (CAMHS, clinical psychologist, social worker, family therapist) ii) Referral to gender dysphoria clinic (GP or self-referral)
64
GENDER DYSPHORIA What are some risks of the hormone therapy?
- Oestrogen = clots, gallstones, high triglycerides - Testosterone = polycythaemia, acne, dyslipidaemia - Both = elevated LFTs, infertility, weight gain
65
SCHIZOAFFECTIVE What are the two types of schizoaffective disorder?
Manic type or depressive type
66
SCHIZOAFFECTIVE How does it differ to schizophrenia?
Psychotic Sx tend to wax + wane, unlike in schizophrenia
67
SCHIZOPHRENIA What area of the brain is most affected?
Temporal lobe
68
PHENOMENOLOGY Define illusion
The false perception of a real external stimulus
69
PHENOMENOLOGY Define hallucination
An internal perception occurring without a corresponding external stimulus. The person experiences it as they would a real perception.
70
PHENOMENOLOGY Define delusion
A fixed, false, unshakable belief which is out of keeping with the patient's educational, cultural + social norms. It's held with extraordinary conviction + certainty (even despite contradictory evidence)
71
PHENOMENOLOGY | What are the 3 delusional misidentification syndromes?
- Capgras = idea someone has been replaced by an imposter. - Fregoli = idea various people are the same person - Intermetamorphosis = one significant relative is replaced by another (father is son).
72
PHENOMENOLOGY Define delusional perception and give an example
A primary delusion of two components – where a normal perception is subject to delusional interpretation E.g. – traffic light changed red so that means I am the son of God
73
PHENOMENOLOGY In terms of thought disorders, what is flight of ideas?
Abrupt leaps between topics as a result of thoughts presenting more rapidly than can be articulated. Each thought = more associations. ?Discernible links between successive ideas. Presents as pressure of speech.
74
PHENOMENOLOGY Define passivity phenomena + somatic passivity
- Delusion that one is a passive recipient of actions from an external agency against their will - The same but sensations are controlled by an external agency
75
PHENOMENOLOGY Define conversion
Development of features suggestive of physical illness but which are attributed to psych illness or emotional disturbance rather than organic pathology
76
PHENOMENOLOGY Define sterotypy
Repetitive + bizarre act which is not goal-directed. Action may have delusional significance to the pt
77
PHENOMENOLOGY What are extracampine hallucinations?
hallucinations which are experienced outside the normal sensory field (seeing something behind them)
78
PHENOMENOLOGY In terms of thought disorders, what is circumstantiality?
irrelevant wandering in conversation (going around the point).
79
PHENOMENOLOGY Define loosening of associations
This is thought disorder denoting a lack of connection between ideas. Links between ideas may be illogical or the speech may wander between trains of thought. It is also known as knight's move thinking
80
PHENOMENOLOGY define perseveration
When someone gets stuck on a topic or an idea There may be repetition of words or phrases
81
ANTI-PSYCHOTICS What is the mechanism of action of typical (1st generation) anti-psychotics?
- D2 receptor antagonist - Reduced release of dopamine from dopaminergic neurones + so reduced electrical activity in dopaminergic pathways
82
ANTI-PSYCHOTICS What pathway do typical (1st generation) anti-psychotics work on to have anti-psychotic effect?
Mesolimbic pathway (reduces +ve Sx)
83
ANTI-PSYCHOTICS What is the mechanism of action of atypical (2nd generation) anti-psychotics?
- Antagonists at dopamine D2 receptors but more selective in dopamine blockade + so block serotonin 5-HT2a
84
ANTI-PSYCHOTICS What are the 5 broad categories of SEs caused by anti-psychotics?
- Extra-pyramidal side effects (EPSEs) - Hyperprolactinaemia - Metabolic - Anticholinergic - Neurological
85
ANTI-PSYCHOTICS What are the extra-pyramidal side effects (EPSEs) of anti-psychotics?
- Acute dystonic reaction - Parkinsonism - Akathisia - Tardive dyskinesia
86
ANTI-PSYCHOTICS What are the metabolic SEs?
- Weight gain (esp. olanzapine) - Hyperlipidaemia, risk of stroke + VTE in elderly - T2DM risk + metabolic syndrome
87
ANTI-PSYCHOTICS What are the anticholinergic SEs?
Can't see, pee, spit, shit – - Blurred vision - Urinary retention - Dry mouth - Constipation + tachycardia
88
ANTI-PSYCHOTICS What regular investigations are done for people on anti-psychotics?
- Lipids + BMI at 3m - Fasting glucose + prolactin at 6m - Frequent BP during dose titration - FBC, U+Es, LFTs, lipids, BMI, fasting glucose, prolactin + CV risk yearly
89
ANTI-DEPRESSANTS What is the mechanism of action of SSRIs? Give some examples
- Prevents reuptake + subsequent degradation of serotonin from synaptic cleft by inhibiting its reuptake transporter on the post-synaptic membrane - Prolonged serotonin in synaptic cleft = prolonged neuronal activity - Citalopram, sertraline, fluoxetine
90
ANTI-DEPRESSANTS What are the side effects of SSRIs?
- GI Sx most common (N+V, hyponatraemia, abdo pain, bowel issues, increased bleed risk) - Sedation + sexual impotence - Citalopram + QTc prolongation (dose-dependent)
91
ANTI-DEPRESSANTS What is the mechanism of action of SNRIs?
- Prevents reuptake + subsequent degradation of serotonin AND noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic membrane
92
ANTI-DEPRESSANTS What are some side effects of SNRIs?
- GI (N+V, constipation), central/peripheral effects (SIADH, rhabdomyolysis)
93
ANTI-DEPRESSANTS What is the mechanism of action of monoamine oxidase inhibitors (MAOI)?
- Inhibits monoamine oxidase enzyme which reduces breakdown of adrenaline, noradrenaline + serotonin so increases level
94
ANTI-DEPRESSANTS What are some side effects from MAOIs?
- Sexual dysfunction, weight gain + postural hypotension
95
ANTI-DEPRESSANTS What are some cautions with MAOIs?
- Increased risk of serotonin syndrome if used with other serotonergic drugs - Hypertensive crisis with ingestion of foods containing tyramine (aged cheeses, smoked/cured meats, pickled herring, Bovril, Marmite)
96
ANTI-DEPRESSANTS What is the mechanism of action of tricyclic antidepressants (TCAs)?
- Prevents reuptake + subsequent degradation of serotonin + noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic neuronal membrane
97
ANTI-DEPRESSANTS What are the side effects of TCAs?
- Anticholinergic (can't see, pee, spit, shit)
98
ANTI-DEPRESSANTS What is the mechanism of action of mirtazapine?
- Blocks alpha-2 adrenergic receptors > increased release of neurotransmitters
99
MOOD STABILISERS What are the side effects of lithium?
LITHIUM – - Leukocytosis - Insipidus (diabetes, nephrogenic) - Tremors (fine if SE, coarse if toxicity) - Hydration (easily dehydrates, renally cleared) - Increased GI motility (N+V, diarrhoea) - Underactive thyroid - Mums beware (Ebstein's anomaly) Can cause weight gain + derm (acne, psoriasis) long-term too
100
MOOD STABILISERS What drugs does lithium interact with?
- NSAIDs, ACEi, ARBs + diuretics may increase lithium levels - Diuretics = dehydration, NSAIDs = renal damage
101
MOOD STABILISERS What regular monitoring is done for lithium?
- Weekly serum lithium after initiation + dose changes until stable then every 3m for a year, then every 6m (sample taken 12h after dose) - 6m = TFTs, U+Es, eGFR - Annual = BMI
102
HYPNOTICS What is the mechanism of action of hypnotics?
- GABA agonists on alpha2-subunit of GABA(A)-BDZ receptor/Cl- channel complex
103
ANTI-PSYCHOTICS What pathway do typical anti-psychotics work on to cause side effects?
Nigrostriatal (Parkinsonism), tuberoinfundibular (prolactin)
104
ANTI-PSYCHOTICS How is tardive dyskinesia managed?
Prevention crucial, switch to atypical anti-psychotic, tetrabenazine used if mod–severe but unlikely to completely resolve
105
ANTI-PSYCHOTICS Give an example of a typical (1st generation) anti-psychotic.
haloperidol, flupentixol zuclopenthixol (decanoate = depot) chlorpromazine
106
ANTI-PSYCHOTICS Give examples of atypical (2nd generation) psychotics.
olanzapine, risperidone (depot), clozapine, aripiprazole (depot), quetiapine
107
ANTI-DEPRESSANTS Give some examples of SNRIs?
Venlafaxine, duloxetine
108
ANTI-DEPRESSANTS Give some examples of monoamine oxidase inhibitors (MAOI)? Give some examples.
- Selegiline is selective MAO-B inhibitor which also increases dopamine - Isocarboxazid, phenelzine
109
ANTI-DEPRESSANTS In terms of TCA overdose what are the ECG signs?
Sinus tachy, wide QRS, prolonged QT interval
110
ANTI-DEPRESSANTS What is the management of a TCA overdose?
Sodium bicarbonate
111
ANTI-DEPRESSANTS What are some side effects of mirtazapine?
Increased appetite + weight gain + sedation are big ones, also increased triglyceride levels
112
MOOD STABILISERS What is the mechanism of action of mood stabilisers?
Lithium inhibits cAMP production which inhibits monoamines
113
HYPNOTICS Give some examples
Zopiclone, zolpidem, BDZs used for hypnotic effect (lorazepam, temazepam)
114
BDZs How would you manage an overdose? What is the risk of using this?
IV flumazenil (danger of inducing status epilepticus or death though)
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SUBSTANCE ABUSE List 8 features of dependence
- Withdrawal - Cravings - Continued use despite harm - Tolerance - Primacy/salience - Loss of control - Narrowed repertoire - Rapid reinstatement
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ALCOHOL DEPENDENCE What areas of the brain can alcohol affect?
- Amygdala + nucleus accumbens - Cerebral cortex - Pre-frontal cortex - Cerebellum - Hypothalamus + pituitary - Medulla
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ALCOHOL DEPENDENCE How does alcohol affect... i) amygdala + nucleus accumbens? ii) cerebral cortex? iii) pre-frontal cortex? iv) cerebellum? v) hypothalamus + pituitary? vi) medulla?
i) Euphoria, pleasure + reward centre ii) Slows thinking + speech iii) Slow behavioural inhibition centres (confident + relaxed) iv) Slows movement + impairs coordination v) Alters mood + hormones (libido increases) vi) Decreases breathing, consciousness + body temp
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ALCOHOL DEPENDENCE What are the 3 stages of alcohol withdrawal?
- 6–12h = tremors, sweating, tachycardia, anxiety, irritability + aggression - 36h = seizures - 48–72h = delirium tremens
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ALCOHOL DEPENDENCE What are the CAGE questions?
- Have you ever felt you need to CUT down on your drinking? - Have people ANNOYED you by criticising your drink? - Have you ever felt GUILTY about your drinking? - EYE-opener – ever felt you need drink first thing in morning to steady your nerves?
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ALCOHOL DEPENDENCE What are the AUDIT questions?
- How often do you have a drink containing alcohol? - How many units of alcohol do you drink on a typical day? - How often did you have >6 units on a single occasion in the past year?
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ALCOHOL DEPENDENCE What is the regime for acute detoxification?
- Chlordiazepoxide 1st line (2nd = diazepam, lorazepam is preferred for pts with liver cirrhosis) for withdrawal Sx + preventing seizures - Thiamine (PO or IV) - Rehydrate with fluids (often IV), correct electrolyte disturbance - Reducing regime (slowly reduce doses over days)
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ALCOHOL DEPENDENCE What are the 3 biological treatments used in alcohol dependence?
- Naltrexone - Acamprosate - Disulfiram
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ALCOHOL DEPENDENCE What is the mechanism of action of naltrexone?
- Opioid receptor antagonist - Blocks euphoric effects of alcohol - Helps people stick to detox programme + avoid relapse
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ALCOHOL DEPENDENCE What is the mechanism of action of acamprosate?
- NMDA antagonist acts on GABA to reduce cravings + risk of relapse
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ALCOHOL DEPENDENCE What is the mechanism of action of disulfiram? What affects does it have?
- Inhibits acetaldehyde dehydrogenase > build-up of acetaldehyde - Produces hangover-like Sx when alcohol is drunk = deterrent (flushing, headaches, anxiety, nausea, reduced BP)
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OPIATES/OPIOIDS What drug can be used to prevent relapses?
- Naltrexone - Opiate antagonist which prevents lapse > relapse
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SEDATIVES What are the withdrawal effects of sedatives?
Sweating, myalgia, tremors, risk of seizures
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STIMULANTS What are some examples?
Cocaine, ecstasy (MDMA), amphetamines (speed)
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STIMULANTS What are the withdrawal effects of stimulants?
Psychomotor agitation, dysphoric mood, insomnia bizarre/unpleasant dreams
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STIMULANTS What are some other adverse effects of cocaine?
- Arrhythmias, MI + damage to nasal septum if used chronically
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CANNABINOIDS What are the... i) psych ii) physical effects of cannabinoids?
i) Euphoria + disinhibition, hallucinations, paranoid, agitation, time passes slowly ii) Increased appetite, dry mouth, tachycardia
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HALLUCINOGENS What are some psych + physical effects of hallucinogens?
- Hallucinations, illusions, depersonalisation + derealisation, paranoia, impulsivity, anxiety, magic mushrooms > euphoria as serotonin release - Tachycardia, palpitations, sweating, blurred vision
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OPIATES/OPIOIDS With opioids, what are the symptoms of withdrawal
"Goose flesh" (piloerection), raised HR/BP, fever, pupil dilatation, abdo cramps, insomnia, agitation (everything runs > D+V, lacrimation, rhinorrhoea, diaphoresis)
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SEDATIVES What are the... i) psych ii) physical effects of sedatives?
i) Euphoria + disinhibition, hallucinations, paranoid, agitation, time passes slowly ii) Unsteady gait, dysarthria, hypotension, nystagmus iii) Sweating, myalgia, tremors, risk of seizures
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STIMULANTS What is the action of stimulants?
- Potentiate mood enhancing neurotransmission (dopamine, serotonin, noradrenaline) by blocking their uptake + increase cortical excitability
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STIMULANTS What are the... i) psych ii) physical effects of stimulants?
i) Euphoria, increased alertness + endurance, grandiosity, hallucinations, aggression, impulsivity ii) Tachycardia, HTN, N+V, pupil dilation, CP + convulsions
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HALLUCINOGENS Give some examples of hallucinogens
- LSD, magic mushrooms (PO)
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PERSONALITY DISORDERS what are the clinical features of EUPD?
UNSTABLE SELF IMAGE - low self esteem - recurrent suicidal/self-harming behaviour IMPULSIVITY - self-sabotaging or risk-taking behaviour - difficulty controlling temper POOR INTERPERSONAL RELATIONSHIPS - short romantic relationships - feelings of abandonment - idealisation + devaluation of others PARANOIA - quasi-psychotic thoughts in response to stress (transient psychosis that is not prolonged and does not require medication)
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STIMULANTS what is the management of cocaine toxicity?
- 1st line = benzodiazepines - chest pain = benzodiazepines + GTN - MI = PCI - HTN = benzodiazepines + sodium nitroprusside
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DEPRESSION what is the threshold for different levels of treatment?
less severe depression = PHQ-9 <16 - 1st line = guided self-help - 2nd line = group CBT - 3rd line = individual CBT - 4th line = SSRI more severe depression = PHQ-9 >16 - 1st line = individual CBT + SSRI - 2nd line = individual CBT - 3rd line = SSRI

MY REVISION - ALL TO DO 2 (24 decks)

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