Psychiatry 4 Flashcards by John Darlington

What aspects of care are in a care programme approach?

Social workers
Community psychiatry nurse
Home care assessment
OT to help get the patient back into community

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What is the main management of lithium overdose?

Organ support
- IV fluids to flush the lithium

continual monitoring
dialysis may be needed

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Give some differentials for depression:

Adjustment disorder

Grief reaction

Cyclothymia

Organic causes
- hypothyroidism

Schizophrenia
- negative symptoms

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What is the mnemonic for organic symptoms of depression?

CALS

concentration
Appetite
Libido
Sleep

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What cognitive functions can be tested in delirium?

Orientation
Recall and delayed recall
Language - Naming objects

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What diagnosis would you think if someone is suffering from recurrent panic attacks when out in public places?

Panic disorder with agoraphobia

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What advice would you give when prescribing SSRIs to patients?

They can take 2-6 weeks to work and may increase suicide idealisation at first

*bring back <30’s in one week

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How should changing an fluoxetine to another SSRI be done?

withdraw and leave a gap of 4-7 days before starting the new SSRI
- due to the long half life of the fluoxetine

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What is the management of switching from an SSRI to TCA?

Cross coverage

- slowly reduce the SSRI which slowly increasing the dose of the TCA

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Which antidepressant causes an increase in QTc?

citalopram

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How should switching from fluoxetine I to an SNRI be managed and name an SNRI:

Withdrawal the SSRI and start the SNRI immediately, building up slowly

Venlafaxine is the most commonly used SNRI

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How long should a patient be kept on anti-depressants for following recovery?

6 months

2 years if relapsing

1 year if anxiety

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What blood tests should be conducted for those on SSRIs?

FBC
- for G.I Bleeding

U&Es
- hyponatraemia

ECG
- QTc prolongation

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What is the medication options for anti-depressants?

1st line:

SSRI
ensure adequate dose before moving

2nd line:
- change SSRI

3rd line:
- SNRI
or
- NaSSA

4th line:

TCA
lithium

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How should switching from an SSRI to an SNRI be managed and name an SNRI:

cross coverage

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What are the classification of severity of depression?

Mild:
Core symptoms + 2 symptoms

Moderate:
Core symptoms + 4 symptoms

Severe:
Core symptoms +>4 symptoms
or
Psychotic features

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What are the additional symptoms of depression?

Early morning wakening
Decreased appetite
Low libido
Psychomotor retardation (slow movement, reduce movement)

Poor concentration
Suicidal idealisation
Feelings of guilt

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When starting antidepressants, how long after starting should individuals be followed up?

<25 years old: weekly to begin with and following any increases in dose

> 25 years old: 2 weekly to begin with and following any increase in dose

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What drug is good in a depressed patient if they have poor sleep and/or appetite?

mirtazapine

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What are the indications for ECT?

Catatonic patients

Life threatening depression
- not eating drinking

Severe mania

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How often is ECT given? and what are some side effects?

Typically:
- twice weekly for 6-12 weeks

*>2 treatment tend to see improvement

Side effects:

short term memory loss - retrograde
episodic memory loss of previous memories
complications from GA

*reduce prior antidepressants

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How does the dosage of SSRIs vary between anxiety and depression?

Anxiety a lower dose is started first

Depression higher dosage is started first

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What is the syndrome in which some believes their partner/ lover is having an affair and what is a risk with it?

Study These Flashcards

Othello syndrome

- risk of violence

What is called when a person mimics your behaviour?

Study These Flashcards

Echoprexia
- falls under appearance and behaviour.
typic of cationic behaviour

What test can be done quickly to screen for delirium?

4AT - Alertness - Orientation - marks for making mistakes - Attention - months backwards - noticed change or fluctuation

List some factors which suggest a suicide attempt is more serious:

``` Method of attempt Precautions to be avoided Not seeking help before or after faield attempt Planning of attempt Notes ```

What is the BMI equation?

Weight / (height)2 Weight Kg / Height, meters. squared

What investgiations should you do when you are presented with someone with anorexia nervosa?

Bloods: - FBC/ MCV - B12/ Folate - U&Es (electrolyte abnormalities) - Glucose - Bone profile - Amylase - TFTs ECG: - bradycardia - prolonged QT - Hypokalaemia

What clinical signs may you see with anorexia nervosa?

``` Low BMI Bradycardia/ hypotension Lanugo hair Brittle nails/ dry hair Hyothermia Russels sign Parotid enlargement ```

Why must lithium not be stopped abruptly?

It can induce severe mania.

What is the upper limit of time benzodiazepines can be used for to treat generalised anxiety? and how are they withdrawn off?

2 weeks. if been on for a long time - reduce dose 1/8th every 2 weeks

Which Anti-depressant/ anti-anxiety medication should be avoided in pregnancy?

Paroxetine - congenital malformations Benzodiazepines - causes cleft lip abnormalities in first semester

List two risk factors for post-partum depression:

Previous history of depression Family history of depression

What is the most common cause of death during pregnancy and 1year after pregnancy?

Suicide

Is lithium contraindicated in pregnancy and breast feeding?

Yes | - high concentrations enter pass through both

What are the differences in MMSE scores?

>27 normal 24- 27: mild cognitive impairment 21- 23: Mild dementia 10-20: moderate <10: severe dementia

What are some poor prognostic factors for schizophrenia?

Late onset Drug use Drug resistant Negative symptoms - have a poorer prognosis

List several blood tests you would do in order to try and establish a reversible cause for dementia:

``` FBC - macrocytosis? U&Es - electrolyte abnormaliteis Bone profile - Ca2+? LFTs - alcohol, encephalopathy? Thyroid function Glucose B12 ```

What would be some differentials for first presentation of schizophrenia?

Illicit drug abuse Delirium Personality disorder Temporal lobe epilepsy

What is the definition of dementia?

An acquired loss of higher cerebral functioning in >2 more domains which include: - episodic memory - executive function - visuospatial function - Language - aprexia/ agnosia (poor recognition) It must be severe enough to have a significant impact on the individual and be in the absence of reduced consciousness (separating it from delirium)

What imaging may be conducted into dementia and why?

Head CT - rule out neoplasms - rule out hydrocephalus - rule out sub-durals CT angiogram - assess for vascular status of the brain Brain MRI - establish specific atrophy patterns Amyloid Radio-nuclear scan - picks up amyloid deposits

What are some of the causes of dementia?

Degenerative: - Alzheimer's - Lewy body - Fronto-temporal - Huntington's - vCJD Vascular Metabolic: - Uricemia - Liver failure Toxic: - heavy metal poisoning Endocrine: - Hypothyroidism - Hypoparathyroidism Infections: - HIV - Syphilis - TB Trauma: - subdural

List some investigations you could conduct in a patient with dementia to try and establish the cause:

Bloods: - U&Es (renal) - LFTs - TFTs - Bone profile (Ca2+) - Vitamin B12 - HIV serology - Syphilis serology Imaging <65 years old: - Genetic studies for AD genes and Huntington genes - EEG

Why are those with Down's syndrome at increased risk of Alzheimer's disease?

They have increased copies of Amyloid precursor protein | - APP is found on chromosome 21 therefore they have 3 copies.

What are some risk factors for Alzheimer's disease?

1st degree relative with AD Down's syndrome - 3 copies of APP Homozygosity for ApoE E4 allele Head injuries Smoking

Which two types of dementias should NOT receive acetylcholinesterase inhibitors?

Fronto-temporal Vascular

What are some poor prognostic factors for schizophrenia?

Pre-dromal social withdrawing Prolonged illness Gradual onset Family history Medication resistant

How often are Depot injections given and list a type of anti-psychotic medication typically used for it:

IM injection - once monthly Risperidone

Are pseudo-hallucinations part of a normal grief reaction?

Yes | - even seeing the loved one can be normal

If a patient is going for ECT what should occur to their current anti-depressant medication?

Dose should be reduced

Which antidepressant should be avoided in early pregnancy and why, and list some complications of SSRI use in late pregnancy:

Paroxetine - congenital abnormalites Third trimester - resistant pulmonary hypertension

Highlight some areas where children differ from adults with regard to their presentation of depression:

Difficulty dealing with criticism - low self esteem which is easily damaged Mood variability - periods of crying - anger out bursts - irritability Behavioural issues - can often be mistaken for ADHD - poor school work Somatic symptoms - headaches - stomach aches Self harm - more likely to self harm which may be due to immaturity in dealing with emotions

What is the genetic defect in Huntington's disease and list some features seen with it:

Tri-nucleotide repeat of CAG (>39) - Genetic anticipation is seen - AD inheritance Features: - early dementia - Chorea - dystonic movements - changes in personality

In anorexia nervosa what does the Growth hormone and cortisol levels look like?

Raised.

What are some of the genes linked to ADHD and list some risk factors:

DRD4 DRD5 *dopamine receptors Risk factors: - family history - Low social economic status - Head injury - Brain injury - HIE, meningitis - Spina-bifida

Psychiatry 4 Flashcards

(55 cards)