Psychiatry Flashcards
Psychiatry (23 cards)
Differentials for low mood
- Depression
- Depressive episode of bipolar disorder
- Anxiety
- Substance misuse
- Physical: PD, dementia, MS, hypothyroidism, stroke
- Drugs: Steroids, Beta blockers, anticonvulsants, oral contraceptives
Differentials for psychosis
- Severe depression with psychosis
- Schizophrenia
- Mania
- Drug induced psychosis (alcohol, cannabis, LSD)
- Alcohol withdrawal
- Delirium
- Dementia
- Brain injury
- B12 deficiency
- Temporal lobe epilepsy
Management of depression
Mild: Watch and wait
Moderate: CBT and SSRI
Severe: Urgent mental health assessment with possible inpatient admission
Side effects of sertraline and key counselling points
Side effects: Nausea, Dry mouth, drowsiness, decreased sex drive, impotence, anorgasmia
Counselling points: Increased anxiety in first couple weeks of taking
Can take up to 4 weeks to start working
Do not stop taking suddenly
Management of schizophrenia
- CBT and family therapy
- EIS for first episode of psychosis
- Antipsychotics (chosen based on patient medical history and preference)
Side effects of antipsychotics
EPSEs (dystonia, akathisia, parkinsonism, tardive dyskinesia) - typicals Hyperprolactinaemia - Weight gain DIabetes Sedation
Side effects of clozapine
- Sedation
- Weight gain
- Diabetes
- Anti-cholinergic
- Hypersalivation
- Hypotension
- Myocarditis
- Agranulocytosis
Different antipsychotics
Haloperidol (Extra-pyramidal side effects, prolactin)
Risperidone (prolactin)
Olanzapine (weight gain, diabetes)
Aripriprazole (less side effects)
Amisulpride (prolactin)
Quetiapine (same as olanzapine but less so)
Clozapine
Causes of dementia
- Hypothyroidism
- B12 deficiency
- Hypocalcaemia
- Brain tumour
- Delirium due to infection or drugs (morphine)
- Depression
Drug treatment of mania
1: Atypical antipsychotic (Haloperidol, olanzapine, quetiapine, or risperidone)
2: Alternate psychotic from first list
3: Lithium (must be willing to comply to blood monitoring
4: Valproate (absolute contraindication in women of child bearing age)
Symptoms of anxiety
Biological: Poor concentration, insomnia, repetitive thoughts, repetitve thougths
Physical: Dry mouth, sweating, palpitations, hyperventilation, nausea, lump in throat, trembling
Types of anxiety disorders
Generalised Panic disorder Phobia OCD PTSD
Treatment of anxiety
1: SSRI
2: SNRI (venlafaxine or duloxetine)
3: TCA or MAOI (phenelzine)
What are BPSDs
- Agression
- Apathy
- Delusions
- Hallucinations
- Verbal outbursts
- Anxiety
Non-pharmalogical treatment of BPSDs
- routine
- programmed activities
- music therapy
- aromatherapy
- exercise
- orientation aids
- regular and familiar staff in hospital
- individual rooms in hospital
Features of vascular dementia
- Step wise decline
- Associated with vascular risk factors
Features of Lewy body dementia
- Visual hallucinations
- REM sleep disorder
- Parkinsonism
- Fluctuating confusion
Features of frontotemporal dementia
- Under 65s
- Insidious onset
- Change in personalty and behaviour
- Speech and language disorders
Memory loss history
- Ask about memory?
- Difficulty recognising places or familiar routes?
- Difficulty recognising faces?
- Struggling finding the right words when talking?
- Change in behaviour or personality?
- Recent illness or fever?
- Low mood or anxiety?
- Hallucinations or delusions?
- Parkinsonism features?
- RISK ASSESSMENT (driving, falls, wandering, ADLs, self harm)
EPSE’s and their management
Dystonia - Procyclidine
Akathisia - Change drug
Parkinsonism - Procyclidine
Tardive dykinesia - Stop drug
Neuroleptic malignant syndrome
- Reaction to antipsychotic drugs
- Symptoms include: autonomic dysfunction (hyperthermia, hypertension, hyperreflexia, tachycardia, tremor, agitation, irritability, sweating)
muscle rigidity, high fever, confusion elevated WBC and LFTs
Psychosis history
Voices - second or third person, commands, running commentary
Delusions - Out to get out? reference? control? Challenge the delusions
Ask about mood? Previous diagnosis of depression or mania?
RISK ASSESSMENT
Check insight
3 core symptoms of ADHD
- Inattentiveness
- Hyperactivity
- Impulsivity
