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Flashcards in Psychiatry Deck (209)
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1

What are the three classes of personality disorder?

A - odd (paranoid, schizoid)
B - dramatic (histrionic, emotionally unstable, dissocial)
C - anankastic, dependent, anxious

2

List which antidepressants are associated with the following risks:
• Drug Interaction
• Discontinuation Symptoms
• Death from Overdose
• Overdose
• Stopping treatment due to side-effects
• Blood Pressure Monitoring Needed
• Worsening Hypertension
• Postural Hypotension and Arrhythmia

• Drug Interaction: fluoxetine, fluvoxamine, paroxetine
• Discontinuation Symptoms: paroxetine
• Death from Overdose: venlafaxine
• Overdose: TCAs (except lofepramine)
• Stopping treatment due to side-effects: venlafaxine, duloxetine, TCAs
• Blood Pressure Monitoring Needed: venlafaxine
• Worsening Hypertension: venlafaxine, duloxetine
• Postural Hypotension and Arrhythmia: TCA

3

How often should a patient with newly diagnosed depression be followed-up after starting an antidepressant?

Review after 2 weeks (if no particular risk of suicide), then every 2-4 weeks thereafter for 3 months

4

Which low-intensity psychotherapies may be offered to patient with mild-to-moderate depression?

Individual-guided self-help based on the principles of CBT
Computerised CBT
Structured group physical activity programme

5

Who should be offered group CBT?

Individuals with mild-to-moderate depression who decline low intensity psychological therapies

6

Which high-intensity psychological therapies may be offered to patients with moderate-to-severe depression?

Individual CBT
Interpersonal Therapy

7

Transitions between which antidepressants must you be particularly careful with?

 From fluoxetine to other antidepressants (as fluoxetine has a long half-life)
 From fluoxetine or paroxetine to a TCA (both drugs inhibit TCA metabolism so a lower starting dose may be needed)
 To a new serotoninergic antidepressant or MAOI (because of risk of serotonin syndrome)
 From non-reversible MAOI: a 2-week washout period is required (other antidepressants should not be prescribed during this period)

8

Briefly outline the step by step pharmacological management for depression.

STEP 1: SSRI (e.g. sertraline)
STEP 2: Taper down SSRI, start SNRI (e.g. venlafaxine)
STEP 3: Add augmentation - either atypical antipsychotics (e.g. quetiapine) or another antidepressant (e.g. mirtazapine)
STEP 4: ECT

9

Over what period of time should antidepressants be stopped?

4 weeks

10

What needs to be monitored after a patient is started on lithium and how regularly should this happen?

Lithium levels - at 1 week after starting, then weekly until therapeutic level is reached. Then every 3 months (12 hours post dose).
U&E - every 3 months
TFTs - every 6 months
Creatinine clearance - annually

11

Which mood stabiliser does not need monitoring of drug levels?

Sodium valproate

12

How soon after an episode of self-harm should the patient be followed-up?

1 week

This can be in outpatient clinic, CMHT, GP or counsellor

13

Which psychological therapies for patients who have self-harmed?

CBT
Mentalisation-based therapy
Transference-focused psychotherapy

14

What are some coping strategies that can be used for patients with thoughts of self-harm?

Distraction techniques
Mood-raising activities (e.g. exercise)
Prevention of self-harm (put tablets and sharp objects away, stay in public places with supportive people, call a friend/support line, avoid drugs and alcohol)

15

Which service should be involved in the care of a young person with first episode psychosis?

Early intervention service (EIS)

16

Which receptors are blocked by typical and atypical antipsychotics?

Typical = dopamine (D2)
Atypical = dopamine and 5HT2

17

Which antipsychotics are particularly associated with weight gain?

Olanzapine and clozapine

18

What is the main aim of CBT in schizophrenia?

Emphasis on reality testing
Encourage the patient to think about evidence and alternative explanations

19

Which forms of psychological therapy may be useful in schizophrenia?

CBT (for all patients)
Family therapy (particularly useful if high expressed emotion)
Concordance therapy

20

Which social aspects of a patient with schizophrenia require management?

Social skill training
Education, training and employment
Skills (e.g. cooking, budgeting)
Housing
Accessing social activities
Developing personal skills (e.g. creative writing)

21

What is treatment resistance schizophrenia?

Failure to respond to two or more antipsychotics, at least one of which is atypical, each given at a therapeutic dose for at least 6 weeks

22

How is schizoaffective disorder treated?

Same treatment as schizophrenia
You may add a mood stabiliser or antidepressant for the affective component

23

Which investigations are used in neuroleptic malignant syndrome?

CK (high)
WCC (high)

24

How is neuroleptic malignant syndrome managed?

Stop antipsychotics immediately
Get urgent medical treatment (usually ITU)
Treat hyperthermia (cooling blankets, ice packs)
Dantrolene may be used for muscle rigidity
Benzodiazepines may be necessary for agitation
High myoglobin can cause AKI (IV fluids and dialysis may be required)

25

How should delirium tremens be managed?

Reducing benzodiazepine (chlordiazepoxide) regime
IV pabrinex

NOTE: lorazepam may be used in hepatic failure

26

What are the stages of change model?

Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse

27

Where can detoxification for alcohol be given?

Inpatient detox
Community detox

28

What are some psychological therapy options for alcohol abuse?

CBT
Problem-solving therapies
Group therapy (alcoholics anonymous)

29

What are some medical management options for preventing relapse in alcohol abuse?

Acamprosate (anti-craving)
Disulfiram

30

What do rehabilitation programmes for alcohol-abuse involve?

May be residential or day programmes
Allow a break for people submerged in a drinking community
May be skills-based courses to help find employment