Psychiatry Flashcards

Question

Which antipsychotic and which antidepressant is most likely to result in a long QT

Answer 1

Haloperidol Citalopram

Answer 2

Antimuscarinic - Dry mouth, blurred vision, urinary retention, constipation - Sedation and weight gain - Impaired glucose tolerance - Reduced seizure threshold - Neuroleptic malignant syndrome

Answer 3

- Clozapine - Olanzapine (obesity and dyslipidaemia) - Risperidone - Aripiprazole (good side effect profile) Weight gain hyperprolactinaemia Clozapine associated with agranulocytosis Metabolic Syndrome!

Answer 4

- FBC, U&E, LFT at start of therapy and annually - Lipids and weight at start and 3 months - Fasting blood glucose and prolactin: at start of therapy, 6 months and annually - Baseline and frequently while titrating dose - ECG baseline - CVD risk assessment annually

Answer 5

Alcohol withdrawal symptoms: 6-12 hours seizures: 36 hours delirium tremens: 72 hours

Answer 6

A circle comes back around eventually (Circumstantiality) A Tangent goes off forever in another direction (Tangentiality) A derailed train goes off the track after a little while and needs to be nudged back on (Derailment)

Answer 7

Procyclidine (prepare dose just in case)

Answer 8

Chronic periods of depression + episodes of mania (type 1) or hypomania (type 2) Typically develops in late teen/early 20s

Answer 9

Both relate to abnormally elevated mood or irritability - Hypo: Decreased/increased function >4 days, but less than 7 - Mania: Significant functional impairment or psychotic symptoms for at least 7 days Features of mania: - Abnormally elevated mood - Significant irritability - Increased energy - Decreased sleep (sometimes going days without sleeping) - Grandiosity, ambitious plans, excessive spending and risk-taking behaviours - Disinhibition and sexually inappropriate behaviour - Flight of ideas (rapidly generating and jumping between ideas) - Pressured speech (rapid and unrelenting speech) - Psychosis (delusions and hallucinations - more suggestive of mania)

Answer 10

By a specialist using DSM-5 criteria Other differentials: Cyclothymia involves milder symptoms of hypomania and low mood. Unipolar depression is when the person has only 1 episode of depression +- mania

Answer 11

Lithium - Serum lithium levels have to be taken 12 hours after most recent dose, initial target range 0.6-0.8mmol/L. Lithium toxicity if gets too high! Alternatives: Sodium valproate, olanzapine. Dont forget that valproates proper fuckin teratogenic Depression - Talking therapies and SSRI (Fluoxetine antidepressant of choice) Address comorbities (2-3x risk of Diabetes, CVD, COPD)

Answer 12

Hypomania - Routine referral to community mental health(CMHT) Mania or severe depression - Urgent referral

Answer 13

Manic episode - Antipsychotic (e.g. haloperidol) - Lithium/sodium valproate - Taper and stop existing antidepressants Depressive episode - Olanzapine + Fluoxetine - Antipsychotic (olanzapine) - Lamotrigine

Answer 14

- Nausea/vomiting, diarrhoea - Benign leucocytosis - Fine tremor - Nephrotoxicity (polyuria, secondary nephrogenic diabetes insipidus) - Thyroid enlargement (Goitre) causing hypothyroidism - ECG: T wave flattening/inversion - Weight gain - Idiopathic intracranial hypertension - Hyperparathyroidism and hypercalcaemia!

Answer 15

- Sample taken 12 hours post dose - Lithium levels weekly and after each dose change until stable - Once on stable dose, check every 3 months - If dose change, check after 1 week, and weekly again until levels stable - Thyroid and renal function every 6 months

Answer 16

Lithium has narrow therapeutic range (0.4-1 mmol/L) and long plasma half-life, primarily excreted by kidneys. Toxicity normally occurs >1.5mmol/L - Dehydration - Renal failure - Diuretics(thiazides), ACEi/ARB, NSAID, metronidazole

Answer 17

- Coarse tremor (whatever the fuck that is) - Hyperreflexia - Confusion - Polyuria - Seizure - Coma

Answer 18

Mild-Moderate: Fluid resuscitation with saline Haemodialysis if severe Sodium bicarbonate sometimes used, alkalinity of urine promotes lithium excretion

Answer 19

- Circumstantiality: Inability to answer without excessive, unnecessary detail. Go on massive tangent BUT do return to original point. - Tangentiality: Wander from topic without ever returning to point. - Neologisms: New word formations, maybe combining 2 words - Clang associations: Ideas related to each other only because they sound the same or rhyme - Word salad: Completely incoherent speech made up of real words that make no sense together - Knights move thinking: Severe loosening of associations. Unexpected and illogical leaps from one idea to another. - Flight of ideas: Feature of mania, leaps from one idea to another, but with discernable links between the 2. Super fast. - Perseveration: repetition of ideas or words, despite attempting to change subject - Echolalia: repeating someone else's speech, including asked question

Answer 20

The following symptoms are common to both hypomania and mania Mood - predominately elevated - irritable Speech and thought - pressured - flight of ideas: characterised by rapid speech with frequent changes in topic based on associations, distractions or word play - poor attention Behaviour - insomnia - loss of inhibitions: sexual promiscuity, overspending, risk-taking - increased appetite

Answer 21

Mania >7 days, psychotic symptoms, severe impairment in social or work setting, may need admission Hypomania <7 days, 3-4 days usually, high functioning - no significant impairment, unlikely to require hospital, no psychosis

Answer 22

Excessive worry about a number of events associated with heightened tension, that significantly impact patients life. Symptoms persist most days for at least 6 months, with no other cause. - Hyperthyroidism - Cardiac disease - Medication (salbutamol, theophylline, corticosteroids, antidepressants, caffeine) - Phaeochromocytoma - Alcohol, benzodiazepine withdrawal

Answer 23

Emotionally: - Excessive, uncontrollable worrying - Restlessness - Difficulty relaxing and concentrating - Easily/Hard to be tired Physical (sympathetic nervous system overactivity): - Muscle tension - Palpitations - GI symptoms - Headaches - Sleep disturbance - Sweating/tremor

Answer 24

Clinical diagnosis (GAD-7 can help) - 5-9 mild - 10-14 moderate - 15-21 severe

Answer 25

Sudden onset physical/emotion symptoms of anxiety that come on quickly for a short while then gradually fade. Can be isolated events or panic disorder (diagnosed symptoms present for a month) Physical: - Tension - Palpitations - Tremor - Sweating - Dry mouth - Chest pain/SOB - Dizziness/Nausea Emotional: - Panic - Fear/danger - Depersonalisation (detached) - Loss of control

Answer 26

Living alone Early parental loss History of abuse Poor educational history Urban living Family history

Answer 27

Step-wise 1 - Education + monitoring 2 - Self referral to low intensity psych intervention 3 - High intensity intervention (CBT, applied relaxation) or drugs - Sertraline (SSRI) first line - Then, alternative SSRI or SNRI (duloxetine/venlafexine) - Pregabalin if cant manage SSRI/SNRI - If under 30, advise increased risk of suicide/self harm ideation!

Answer 28

Stepwise again, common sense pathway really. Then: - CBT - Drugs (SSRI first line, imipramine or clomipramine if not!)

Answer 29

Enhance inhibitory GABA by increasing frequency of chloride channels. Range of effects: - Sedation, hypnosis, anxiolytic, anticonvulsant, muscle relaxant Side effects: - Tolerance/dependance - only prescribe for short time (2-4 weeks) - Withdrawals, up to 3 weeks after stopping, if they come off abruptly. - Withdrawal symptoms: insomnia, irritability, anxiety, tremors, tinnitus, perceptual disturbance, seizures

Answer 30

non selective beta blocker reduces sympathetic nervous system effects, treating physical symptoms. (Tremors, palpitations, sweating etc). Contraindication is asthma (bronchoconstriction/bronchospasms)

Answer 31

Obsessions - unwanted intrusive thought, image, urge, repeatedly entering persons mind Compulsions - repetitive behaviours or mental acts that person feels driven to perform. Can be overt (checking a door is closed) or covert (mentally repeating a phrase) Usually a combination of both

Answer 32

- Family history - Age 10-20 at onset - Pregnancy/postnatal - History of abuse, bullying, neglect

Answer 33

Obsessions Anxiety Compulsion Temporary relief Becomes more ingrained each cycle

Answer 34

DSM-5 and/or ICD 11 scoring Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is used to assess severity of symptoms

Answer 35

Mild: - Low intensity psych treatments (CBT including exposure and response prevention (ERP)) Moderate or mild ineffective: - SSRI (Any fine but fluoxetine specifically for body dysmorphic disorder) or more intense CBT with ERP - Clomipramine (TCA) if SSRI not wanted Severe - Secondary care referral with SSRI and CBT with ERP in meantime. *ERP = Exposing patient to anxiety provoking situation without allowing compulsion.

Answer 36

- Requires longer than depression (at least 12 weeks) for initial response - If effective, continue for at least 12 months to prevent relapse

Answer 37

Mental health condition resulting from traumatic experiences. Affects any age, and increases risk of depression, anxiety, substance misuse, and suicide. Symptoms last longer than 1 month (DSM-5) Can arise from witnessing or experiencing: - Violence (domestic, sexual, abuse or physical attacks) - Major car accidents - Major health events - War - Natural disasters

Answer 38

Re-experiencing: flashbacks, nightmares, repetitive and disturbing intrusive thoughts/images. Avoidance: avoiding people, situations, circumstances associated with the event Hyperarousal: Hypervigilance for threat, exaggerated startle response, sleep problems, irritability, difficulty concentrating Emotional numbing - lack of feeling, feeling detached, derealisation (world isnt real) Also: - Substance misuse - Anger - Depression - Unexplained physical symptoms - Negative beliefs and emotions

Answer 39

Trauma Screening Questionnaire Diagnosis based off: - ICD-11 or - DSM-5

Answer 40

Following a traumatic event, single session intervention probably not great. Watchful waiting if mild/less than 4 weeks Trauma focused CBT or eye movement desensitisation and reprocessing (EMDR) Drug treatment SSRI or venlafaxine, but definitely not first line. Army offers services to military personnel

Answer 41

Acute stress reaction in first 4 weeks following a traumatic event. (PTSD is >4 weeks) - Intrusive thoughts (flashback, nightmare) - Dissociation - Negative mood - Avoidance - Arousal Managed with CBT and Benzodiazepines sometimes used (addictive!!)

Answer 42

An antidepressant that works to block alpha2-adrenergic receptors, increasing release of neurotransmitters. NaSSA (Noradrenergic and Specific Serotonergic Antidepressant) Fewer side effects and interactions, so good in old people, who may be on lots of meds Two main side effects: Sedation and increased appetite, good for old people who are skinny and cant sleep. Take in evening to sleep

Answer 43

Understanding: Patient must understand the information relevant to the decision Retention: Retain the info long enough to make the decision Weighing: Weight up the information, consider both risks and benefits Communicating: Communicate their decision back, verbally or non verbally. Explain the decision, assess their understanding, check their retention sometime later, and assess their ability to weigh it up. If they can communicate all this clearly, respect their decision

Answer 44

1. Appearance/Behaviour 2. Speech 3. Emotion - Mood/affect 4. Perception 5. Thought 6. Insight/Judgement 7. Cognition

Answer 45

Activated charcoal - within an hour of various substances to reduce absorption

Answer 46

- Paracetamol: N-Acetylcysteine - Opiods: Naloxone - Benzodiazepines: Flumazenil - Beta blockers: Glucagon (heart failure/cardiogenic shock) or atropine for bradycardia - CCB: Calcium chloride or gluconate - Cocaine: Diazepam - Cyanide: Dicobalt edetate - Methanol/ethylene (solvents or fuels/antifreeze): Fomepizole or Ethanol (alcohol) - Carbon monoxide: 100% Oxygen

Answer 47

Maladaptive personality traits that cause significant psychosocial distress and interfere with functioning. Patterns of thought behaviour and emotion that inhibit normal relationships, QOL and physical health. Genetic and environmental causes, including history of childhood trauma and difficult circumstances

Answer 48

DSM-5 A - Suspicious B - Emotional/impulsive C - Anxious

Answer 49

DSM-5 Paranoid - Difficulty trusting or revealing personal info. Hypersensitive and unforgiving. Schizoid - Lack of interest or desire to form relationships, with the belief that this is of no benefit to them. Prefer solitary activities. Schizotypal - Unusual beliefs, thoughts and behaviours and social anxiety that makes forming relationships hard. Odd speech, eccentric behaviour, magical thinking.

Answer 50

Antisocial - Reckless, harmful behaviour. Lack of concern for the consequences or impact of their behaviour. Aggression. Criminal. Men>women Borderline - Fluctuating strong emotions and difficulty with identity and maintaining relationships. Recurrent suicidal behaviours. Chronic emptiness etc Histrionic - Needs to be centre of attention and performing for others to maintain this. Sexual seductiveness, rapidly shifting, shallow emotions, self dramatisation. Narcissistic - Feelings that they are special and need this to be recognised, or they get upset. Put self first. Entitled, lack empathy, chronic envy. Arrogant

Answer 51

Avoidant - Severe anxiety about rejection or disapproval, causing avoidance of social situations or relationships. Constantly think theyre being criticised or rejected. Dependent - Heavy reliance on others to make decisions, very passive, cant take responsibility for own life. Need constant support and reassurance Obsessive-Compulsive - Unrealistic expectations of how things should be done, catastrophising about what will happen if needs not met. Stingy spending, meticulous, rigid morals, ethics. Hoarding.

Answer 52

With trait domains Negative affectivity - Wide range of negative emotions, prone to mood swings, insecurity, emotional lability Detachment - Avoidance of interactions, relationships, emotional withdrawal. Limited pleasure Dissociality - Disregard for rights/feelings of others. Lack empathy, impulsive and manipulative Disinhibition - Impulsive, risk taking, difficulty controlling self. Struggle with planning and foresight; reckless and irresponsible Anankastia - Orderliness, control, perfectionism. Rigid and stubborn Borderline pattern - Additional qualifier for those with emotional instability, intense and unstable interpersonal relationships, fluctuating sense of identity, impulsivity.

Answer 53

Mild - Some impairment, limited. Symptoms noticable, but do not cause pervasive distress. Still maintains relationships. Moderate - More significant impairments in multiple areas of life. Struggle with maintaining relationships, but can manage day to day Severe - Impairments to all aspects of life. Pervasive difficulties in interpersonal relationships, significant effect on QOL, dysfunction and distress. - Intense and long term therapeutic intervention may be required

Answer 54

CBT Risk management (self harm, suicide, harm to others - MDT approach) Medication not recommended long term, but may help in crisis. Treat coexisting mental health issues

Answer 55

Self harm - 15-24 and females (but males use more lethal methods) Suicide - Middle aged men highest (40-49) - Men 3-4x more likely to die by suicide, but women attempt more, just less lethal methods usually.

Answer 56

1 Emotional suffering 2 Emotional overload 3 Panic 4 Self harm 5 Temporary relief 6 Shame and guilt

Answer 57

- Social support/community - Sense of responsibility to others - Resilience, coping, problem solving skills - Access to mental health support

Answer 58

MCA 2005 applies to adults over 16 and sets out who can make decisions if they become incapacitated 1. A person must be assumed to have capacity unless it is established that he lacks capacity 2. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 3. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success 4. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests 5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action

Answer 59

1. Whether the person is likely to regain capacity and can the decision wait 2. How to encourage and optimise the participation of the person in the decision 3. The past and present wishes, feelings, beliefs, values of the person and any other relevant factors 4. Views of other relevant people

Answer 60

Written, signed, witnessed. Other advance decisions to deny treatments can be made verbally.

Answer 61

- Property/financial affairs - Health and welfare decisions - Life-sustaining decision authority must be pre specified. - LPA must be registered with the Office of the Public Guardian

Answer 62

Provides legal framework for keeping patients in hospital against their will (detaining/sectioning) If patient agrees, its called an voluntary or informal admission, doesnt involve mental health act

Answer 63

Detailed evaluation into whether or not to detain someone under MHA. Approved Mental Health Professional (AMHP) is primary person making application and organising admission. Nearest relative can do this too. Decision needs to be recognised by 2 doctors; - A section 12 doc (Qualified doctor who can undertake MHA assessments (usually Psych)) - Another doctor Can result in compulsory admission under Section 2 or 3

Answer 64

2: Compulsory admission for assessment, maximum period of 28 days. Non renewable, must discharge or go onto: Section 3: Compulsory admission for treatment. Max period 6 months, the Responsible Clinician can renew.

Answer 65

4 - detain patients for up to 72 hrs in urgent scenarios. Requires AMHP and a doctor. 5(2) - Used in emergency to detain patient voluntarily in hospital. Up to 72 hours, requires 1 doctor. 5(4) - Same as 5(2) but lasts 6 hours and only needs a nurse 135 - can break into a house to remove someone to Place of Safety 136 - used by police to remove someone that has a mental health disorder from public place to safe place for assessment. Lasts up to 24 hours. ALL are followed by a Mental Health Act Assessment

Answer 66

Volume (ml) x Alcohol Content (%) ÷ 1000 = Units of Alcohol

Answer 67

Stimulates GABA (inhibitory) receptors, having a relaxing effect on the brain. Also inhibits NMDA receptors (usually binded by glutamate - excitatory neurotransmitter), causing further relaxing effect. Chronic alcohol results in GABA system becoming down regulated and glutamate system becoming upregulated. Patient must continue drinking or suffer severe withdrawal symptoms

Answer 68

<14 units/week <5 units/day >6 units for women, or >8 units for men, in a single session classify as binge drinking.

Answer 69

Alcoholic liver disease, cirrhosis, HCC, varices Alcohol dependence/withdrawal Wernicke-Korsakoff Pancreatitis Alcoholic Myopathy/cardiomyopathy Pregnancy: SGA Miscarriage Preterm delivery Fetal alcohol syndrome

Answer 70

AUDIT - WHO. 10 MCQs, >8=harmful use. CAGE Cut down - Do you ever think you should? Annoyed - Do you get annoyed at others commenting on your drinking? Guilty - Do you ever feel guilty about drinking? Eye opener - Do you ever drink in the morning to help hangover or nerves?

Answer 71

Examination - Smelling of it - Slurred speech - Bloodshot eyes - Dilated capillaries on face (telangactasia) - Tremor Bloods - Raised MCV - Raised AST and ALT (AST:ALT >1.5 in particular) - Raised GGT

Answer 72

6-12 hours: Tremor, sweating, headache, cravings, anxiety 12-24 hours: Hallucinosis (aware not real) ~36 hours: Seizures 48-72 hours: Delirium tremens

Answer 73

Medical emergency with high untreated mortality, associated with alcohol withdrawal. Long term alcohol down regulates GABA and upregulates Glutamate systems. When removed, GABA underfunctions and glutamate overfunctions, causing extreme excitability and excessive adrenergic activity.

Answer 74

- Acute confusion - Coarse tremor - Delusions - Tachycardia, Hypertension, Hyperthermia - Ataxia

Answer 75

CIWA-Ar tool to score symptoms and guide treatment Benzodiazepine - Chlordiazepoxide or Diazepam as a reducing dose protocol, over ~7 days.* High dose vitamin B followed by long term Thiamine (B1) to prevent Wernicke Korsakoff *In liver disease use Lorazepam, as chlordiazepoxide is excreted through CYP450 pathway, which is impaired in cirrhosis, increasing risk of accumulation and toxicity. Naltrexone or disulfiram or acamprosate for long term prevention of relapse

Answer 76

Thiamine (vitamin B1) deficiency, commonly seen in alcohol excess. Thiamine deficiency causes Wernicke's and eventually leads to Korsakoff syndrome. Petechial haemorrhages occur in variety of brain structures including mamillary bodies and ventricle walls.

Answer 77

Oculomotor dysfunction - Nystagmus (most common) - Ophthalmoplegia Gait ataxia Confusion Disorientation Peripheral sensory neuropathy Triad is: - Ophthalmoplegia and nystagmus - Ataxia - Encephalopathy

Answer 78

- Decreased red cecll transketolase - MRI Managed with thiamine replacement

Answer 79

Korsakoff syndrome, caused by continued haemorrhage and damage to mamillary bodies in hypothalamus. Features of wernickes with added retro and anterograde amnesia, and confabulation (false memory making). Can be irreversible.

Answer 80

T - Need for increasing drug dosage to achieve same effect over time D - Physical and psychological need to use a drug regularly to avoid withdrawals

Answer 81

Dopamine, released by brain's mesolimbic reward system

Answer 82

Anxiety Tremor Insomnia Seizure

Answer 83

Persistent or recurrent complex hallucinations in clear consciousness. Must occur in absence of any other neuropsychiatric disturbance. Associated with age related macular degeneration, glaucoma and cataracts

Answer 84

When multiple physical symptoms have existed for at least 2 years, with no organic cause and patient refuses to accept reassurance or negative results

Answer 85

AKA Conversion disorder Sensory and motor symptoms unexplained by neurological disorders - Gait disturbance - Weakness - Seizures - Sensory loss - Visual disturbance Symptoms not under patients control, they are not faking nor seeking material gain

Answer 86

Persistent belief in the presence of a serious underlying disease, with no accepting reassurance or negative results

Answer 87

AKA Munchausen's. Intentional production of physical or psychological symptoms

Answer 88

Fraudulent simulation or exaggeration of symptoms for financial or other gain

Answer 89

Delusional belief of parasitic infection (bugs, worms, parasites, mites, bacteria, fungi)

Answer 90

Delusion that they are dead or dying. Most often caused by psychiatric conditions (schizophrenia, depression) but can be due to neurological conditions, such as tumours or migraines.

Answer 91

False belief that a duplicate has replaced someone close to them, possibly causing suspicion or aggression towards them AKA Delusional misidentification syndrome

Answer 92

AKA Erotomania Delusion that high status or famous person is in love with them. Can lead to harassment or stalking. Usually has little/no contact with person

Answer 93

AKA Alice in Wonderland syndrome Incorrectly perceiving size of body parts (too big/small). Also associated with changes to perception of time and symptoms of migraine (e.g. aura and headache). Caused by migraine epilepsy brain tumours

Answer 94

Belief that sex organs are retracting or shrinking and will disappear, killing the patient. Causes anxiety and panic attacks. Mostly seen in asia, especially china and india

Answer 95

Apotemnophilia involves a strong feeling that a body part doesn't belong to them, causing them distress, and wanting to remove it. May have desire to be disabled. No associations

Answer 96

Episodes where patient overeats often as an expression of distress. Typically feels a loss of control, not restrictive like anorexia or bullimia, patients likely to be overweight - Planned binge involving binge foods, eating quickly, unrelated to hunger, becoming uncomfortably full and eating in dazed state

Answer 97

- Anaemia - Leucopenia - Thrombocytopenia - Hypokalaemia (low Hb, WCC, platelets, potassium) Reduced bone marrow activity causes normocytic normochromic anaemia, leukopenia and thrombocytopenia

Answer 98

Occurs when someone with an extended severe nutritional deficit resumes eating. The lower the BMI, and the longer the period of malnutrition, the higher the risk.

Answer 99

During starvation, intracellular potassium, phosphate, magnesium depleted. These electrolytes move from inside cells to blood to maintain serum levels Cell metabolism reduces to conserve energy, causing a loss of intracellular electrolytes. During refeeding, potassium, phosphate and sodium shift into blood. Carbs cause increase in insulin which drives glucose, potassium, phosphate into cells. Na+/K+ pump pumps K+ into cells and Na+ out. Insulin causes sodium reabsorption from kidneys.

Answer 100

- Hypomagnesaemia - Hypokalaemia - Hypophosphataemia - Fluid overload

Answer 101

Hypophosphataemia - Main cause of symptoms - Muscle weakness (including cardiac and diaphragm) -> heart and respiratory failure Hypomagnesaemia may cause torsades de pointes

Answer 102

- Cardiac dysfunction - Respiratory failure - Confusion, seizures, coma - Tissue hypoxia and haemolysis - Rhabdomyolysis

Answer 103

If patient hasnt eaten, or high risk, for more than 5 days, aim to refeed at no more than 50% of requirements for first 2 days. High risk if - BMI <16 - Unintentional weight loss >15% over 3-6 months - Little nutritional intake 10+ days - Derranged electrolytes prior to feeding If 2 or more of: - BMI <18.5 - Weight loss >10% - Little intake >5days - History of alcohol abuse, drugs, chemotherapy, diuretics, antacids, insulin

Answer 104

- Hypercholesterolaemia - Hypertension - Impaired glucose tolerance - Central obesity Caused more often by atypical antipsychotics (aripiprazole less so, has less side effects)

Answer 105

Severe, medication resistant or psychotic depression. Course of treatments. Involves triggering a short generalised seizure under anaesthaesia. Side effects: Headache, muscle ache, short term memory loss

Answer 106

SSRI - Block reuptake of serotonin by presynaptic membrane on axon terminal. Hence, more serotonin in synapses throughout CNS, boosting communication between neurones SNRI - Blocks reuptake of serotonin and noradrenaline by presynaptic membrane TCA - Block serotonin reuptake and noradrenaline by presynaptic membrane. Also block ACh and histamine receptors, giving them anticholinergic and sedative effects

Answer 107

Anticholinergics block Ach, which is involved in bodily secretions, having a drying effect around the body. Results in: - Dry mouth - Constipation - Blurred vision - Dizziness - Cognitive impairment "cant see pee or climb a tree" Blurred vision, urinary retention and muscle pain/impaired coordination and balance

Answer 108

- Sertraline - usually safe but associated with diarrhoea - Citalopram - Can prolong QT, which can lead to torsades de pointes. Least safe SSRI in patients with heart disease - Fluoxetine - Long half life (4-7 days) first line in children - Paroxetine causes weight gain Other side effects: - GI symptoms - Headaches - Sexual dysfunction (loss of libido, ED, orgasm difficulty) - Increased risk of bleeding (esp when taken with NSAID, anticoagulant) - SIADH causing hyponatraemia!

Answer 109

Similar to SSRIs. Can increase BP so contraindicated in uncontrolled HTN. Venlafaxine - more likely to cause discontinuation symptoms when stopped. Increased risk of death by OD Duloxetine - Treats neuropathic pain, especially diabetic neuropathy

Answer 110

Amitriptyline - used at low dose to treat neuropathic pain TCA - cardiotoxic!! Cause arrhythmia -> tachycardia, long QT, Bundle branch block. Dose dependent. Very dangerous in overdose, so not used in depression Also have anticholinergic side effects.

Answer 111

Serotonin reuptake inhibitor. 3rd line after inadequate response from 2 others. Stimulates and blocks other serotonin receptors. Good for anti-anxiety. Not many side effects, safe in heart disease. Causes nausea for first few weeks

Answer 112

Can be initial period of agitation, anxiety, suicidal ideation, acts of suicide. Review all patients within 2 weeks of starting (1 week in 18-25 due to high suicide risk) Noticable response 2-4 weeks after starting. Some can be directly switched, others need to be crosstapered. Most SSRI and SNRI are safe to switch between except fluoxetine due to long half life

Answer 113

- continue for at least 6 months (2 years in recurrent) before stopping - Reduce slowly over 4 weeks to prevent discontinuation symptoms Discontinuation symtpoms - Flu like - Electric shock sensations - Insomnia - Irritability - Vivid dreams

Answer 114

- NSAIDs (prescribe with PPI) - Warfarin/heparin (consider mirtazapine instead) - Aspirin - Triptans and MAOIs - increased risk of serotonin syndrome!

Answer 115

1st trimester - Small risk of congenital heart defects 3rd trimester - persistent pulmonary HTN of the baby Paroxetine has risk of congenital malformations!

Answer 116

One of the earliest atypical agents, carries risk of agranulocytosis. FBC monitoring ESSENTIAL! - Agranulocytosis, neutropenia - Constipation - Myocarditis - Hypersalivation Dose adjustment if start/stop smoking

Answer 117

Cheese because it contains tyramine whatever the fuck that is

Answer 118

Serotonin syndrome is a potentially life threatening drug reaction. Typically results from the use of serotonergic drugs. Caused by: - MOAI - SSRIs (St John's Wort and tramadol interact with SSRIs to cause serotonin syndrome) - Ecstasy - Amphetamines (ADHD Meds - Lisdex) - Triptans Usually due to interactions, doses that are too high, or a new drug is added without sufficient time to affect levels.

Answer 119

Neuromuscular excitation - Hyperreflexia - Myoclonus - Rigidity Autonomic Nervous System excitation - Hyperthermia - Sweating Altered mental state - Confusion

Answer 120

How is serotonin syndrome managed - IV fluids - Benzodiazepines - Serotonin antagonists, cyproheptadine, chlorpromazine if severe

Answer 121

Condition caused by a sudden dopamine deficiency usually caused by overdoing Gradual 1-3 days after starting or increasing an antipsychotic

Answer 122

MAIN 4: - Fever - Muscle rigidity - Autonomic lability: typical features include HTN, tachycardia, tachypnoea. - Agitated delirium/confusion. FALTER: Fever, Autonomic instability, Leukocytosis, Tremor, Elevated enzymes (creatine kinase, transaminases), and Rigor

Answer 123

- Raised Creatinine Kinase - AKI Secondary to Rhabdomyolysis - Leucocytosis

Answer 124

Stop antipsychotics - IV Fluids - Benzodiazepines Severe cases -Dantrolene

Answer 125

SS - Caused by SSRI, MAOI, ecstasy, novel psychoactive stimulants - Faster onset (hours) - Hyperreflexia, clonus, dilated pupils - Severe treatment: Cyproheptadine, Chlorpromazine NMS - Caused by antipsychotics - Slower onset (hours-days) - Reduced reflexes, lead pipe rigidity, normal pupils - Severe treatment: Dantrolene

Answer 126

Acute short term antipsychotic (quetiapine), mood stabiliser (valproate/lamotrigine) if severe

Answer 127

Serotonin and noradrenaline are metabolised by monoamine oxidase in the presynaptic cell MAOI = Monoamine oxidase inhibitor - Tranylcypromine, phenelzine

Answer 128

- Hypertensive reactions with tyramine containing foods (cheese, pickled herring, Bovril, Oxo, Marmite, broad beans) Anticholinergic effects - Dry mouth - Blurred vision - Constipation - Urinary retention - Confusion - Tachycardia

Answer 129

Stop gradually over 4 weeks Discontinuation symptoms (especially with Paroxetine, Fluoxetine can be stopped whenever) - Increased mood change - Restlessness - Difficulty sleeping - Electric shock sensations - Unsteadiness/dizziness - GI sx - pain, cramping, diarrhoea, vomiting - Paraesthesia

Answer 130

Uncontrolled psychosis following 2 antipsychotic drugs (right dose and timeframe) Treated with clozapine. 48 hr rule: if missed for 48 hrs, must be retitrated. Side effects: - Myocarditis - Constipation (cholinergic receptor block) - Smoking cessation increases levels (smoking increases cytochromic b450 levels in liver) - Increased salivation

Answer 131

Disulfiram - causes vomiting, nausea, facial flushing

Answer 132

Acamprostate

Answer 133

Buprenephorine

Answer 134

G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia Most other things low

Psychiatry Flashcards

(159 cards)