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4th year medicine > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

first line medication for anxiety and depression

A

SSRIs (citalopram, sertraline)

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2
Q

ICD-10 vs DSM-V

A

DSM-V more up to date for how to classify disorders

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3
Q

main side effect of clozapine and how to test for it

A

agranulocytosis and neutropenia

test with regular FBC

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4
Q

type 1 vs type 2 bipolar affective disorder

A

type 1: mania

type 2: hypomania

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5
Q

how do you treat agranulocytosis from clozapine

A

stop clozapine

send to A&E

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6
Q

medical emergencies in psych

A

clozapine
NMS
serotonin syndrome

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7
Q

psych emergencies

A
  • acute psychosis
  • suicidal patient
  • acutely unwell and violent
  • eating disorders - more than 1kg weight per week/ regularly making themselves sick/ not eating –> ECG to check postural hypotension + bloods: FBC, U&Es
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8
Q

45yrs
long hx of severe depression with psychotic symptoms
multiple inpatient psychiatric admissions

which type of delusion is most compatible with his diagnosis of severe depression

A

nihilistic delusions
- self/part of self/body ceasing to exist - eg patient believing they are dead or dying –> indicates extreme depression (hopelessness and guilt)

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9
Q

generalised anxiety disorder

characteristic symptoms of generalised anxiety disorder?

A

long periods of worry

persistent anxiety

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10
Q

delusion

A

false unshakeable beliefs that can be present in a range of psychiatric disorders incl severe depression.

in mood disorders delusions are mood congruent

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11
Q

delusions of grandiosity

A

believe they’re someone else, may also have special abilities/ powers

typically seen in manic episodes

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12
Q

persecutory delusions

A

belief that you will be persecuted for something even without any evidence

in psychotic disorders

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13
Q

paranoid delusions

A

feeling that you’re under threat

in psychotic disorders

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14
Q

delusional perception

A

true perception, to which a patient attributes a false meaning.

e.g. a normal event such as the traffic lights turning red may be interpreted by the patient as meaning that the martians are about to land.

in psychotic disorders e.g. schizophrenia

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15
Q

most common psychiatric cause of intermittent chest pain and breathlessness or recurrent unexplained panic attacks?

A

panic disorder

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16
Q

compulsive checking behaviours

A

obsessive compulsive disorder

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17
Q

diagnosis of depression

A

all three of the below for >2weeks

  1. persistant low mood
  2. loss of pleasure

associated symptoms:

  • loss of appetite
  • loss of concentration
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18
Q

I started on an antipsychotic 2-10 days ago

  • fever
  • rigidity
  • altered mental state

diagnosis + signs and symptoms

A

neuroleptic malignant syndrome

FALTER:
FEVER
ARMS 
LEUKOCYTOSIS 
TREMORS 
ELEVATED CPK 
RIGIDITY - lead pipe 
signs :
HR: high 
Temp: high
BP: high or low 
RR: high
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19
Q

serotonin syndrome

A

usually occurs when SSRIs/ SNRIs are taken in conjunction with other serotonin (another antidepressant, st johns wort)

agitation 
confusion
twitching muscles
hypereflexia 
sweating 
shivering 
diarrhoea

seizures
arrhythmia
unconsciousness

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20
Q

neuroleptic malignant syndrome

management

A

stop antipsychotic

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21
Q

extrapyramidal side effects

what do you get them from and what are they

A

get with first generation/ typical antipsychotics
e.g. butyrophenones(haloperidol), phenothiazines (prochlorperazine)

  1. dystonia
  2. parkinsonian symptoms
  3. akathisia
  4. tardive dyskinesia
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22
Q

what is dystonia

A
  • early reaction to 1st gen antipsychotics
  • abnormal face and body movements
  • eyes rolling back
  • arching
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23
Q

what is parkinsonian symptoms

A
  • rigidity
  • bradykinesia
  • tremor

appears gradually

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24
Q

what is akathisia

A
  • restlessness
  • after large initial doses
    resemble an exacerbation of the condition being treated
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25
what is tardive dyskinesia
- rhythmic, involuntary movements of tongue, face, and jaw - e.g. lip smacking - develops on long-term antipsychotics
26
treatment for dystonia
anticholinergic drugs
27
what does risperidone cause to increase as a side effect
prolactin >6mg
28
side effects of aripiprazole
- decreases prolactin | - decreases weight
29
atypical/ 2nd generation antipsychotics
- clozapine - olanzapine - risperidone - quetiapine - aripiprazole
30
what tests need to be taken when on lithium
bloods - kidney/ thyroid function
31
NASSA drugs and helpful side effects
mirtazapine: - increased sedating - increased appetite trazodone: - better sleep NASSAs good in old age for their side effects
32
which SSRI increases QTc interval on ECG?
citalopram
33
which SNRI increases blood pressure
venlafaxine
34
somatisation disorder
multiple physical SYMPTOMS present for at least 2 yrs | patient refuses to accept reassurance or negative test results
35
illness anxiety disorder (hypochondriasis)
persistent belief in presence of underlying serious DISEASE | refuses to accept reassurance or negative test results
36
conversion disorder
loss of motor or sensory function patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering) patients indifferent to disorder (la belle indifference)
37
dissociative disorder
'separating off' certain memories from normal consciousness | involves psychiatric symptoms e,g amnesia, fugur, stupor
38
factitious disorder
also known as Munchausens syndrome | intentional production of physical or psychological symptoms
39
malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
40
generalised anxiety disorder first line mx
SSRI = sertraline | if ineffective then alternative SSRI or SNRI
41
panic disorder mx
CBT or SSRI
42
side effects of tricyclic antidepressants
``` e.g. amitriptyline, clomipramine drowsiness dry mouth blurred vision constipation urinary retention lengthening of QT interval ```
43
mx for personality disorders
dialectical behavioural therapy
44
side effects of lithium
for prophylaxis of bipolar disorder ``` side effects: fine tremor nephrotoxicity: polyuria, can cause nephrogenic diabetes insipidus thyroid enlargement, hypothyroidism weight gain intracranial HTN leucocytosis hyperparathyroidism and resultant hypercalcaemia ```
45
monitoring of lithium therapy
check lithium levels 12hrs post dose lithium levels checked weekly until concentrations stable then checked every 3 months after change in dose, levels checked a week later and weekly until levels stable TFTs and U&Es - every 6 months
46
other side effects of antipsychotics except extra pyramidal
increased risk of STROKE AND VTE in elderly dry mouth, blurred vision, urinary retention, constipation sedation raised prolactin - galactorrhoea neuroleptic malignant syndrome: pyrexia, muscle stiffness reduced seizure threshold prolonged QT interval (haloperiodol)
47
how long can benzodiazepines be prescribed for
2-4 weeks due to tolerance and dependence | slow withdrawal
48
benzodiazepines vs barbiturates for chloride channels
benzos increase freq of Cl channels barbiturates increase duration of Cl channels FREQuently BENd - DUR BARBeque
49
side effect of benzodiazepines
respiratory depression
50
visual impairment + visual or auditory hallucinations | no other psychiatric symptoms
charles - Bonnet syndrome
51
repetition of someone else's speech including the questions being asked
echolalia | feature of schizophrenia
52
the inability to answer a question without giving excessive, unnecessary detail
circumstantiality
53
wondering from a topic without returning to it
tangentiality
54
when ideas are related to each other only by the fact they sound similar or rhyme
clang associations
55
loosening of associations, where there are unexpected and illogical leaps from one idea to another.
knights move thinking | schizophrenia
56
leaps from one topic to another but with discernible (apparent) links between them.
flight of ideas | Mania
57
repetition of ideas or words despite an attempt to change the topic.
preservation
58
antidepressant which causes sedation and increased appetite - can help in elderly
mirtazapine
59
on MMSE depression vs dementia
depression: dont know (dont try with answers) dementia: try but get it wrong
60
how long do symptoms need to be present for for a diagnosis of PTSD
at least 1 month
61
what drugs should be avoided on SSRIs
NSAIDs: take PPI at same time warfarin/heparin: take mirtazapine instead triptans and MAOIs - risk of serotonin syndrome
62
anorexia features
most things low | G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
63
WBC high on lithium mx
safety net if symptoms develop, repeat bloods as per usual under notmal monitoring schedule can cause leucocytosis
64
adverse effects of clozapine
``` agranulocytosis, neuropaenia reduced seizure threshold constipation myocarditis: baseline ECG hypersalivation ``` dose adjustment might be needed if smoking is started and stopped during treatment
65
most likely SSRI leading to long QT and torsades de pointes
citalopram
66
mx for alcohol withdrawal
benzodiazepines e.g. chlordiazepoxide | lorazepam in hepatic failure
67
indications for ECT
treatment resistant severe depression (catatonia) manic episodes episode of moderate depression known to respond to ECT in past life threatening catatonia
68
short term side effects of ECT
short term memory impairment memory loss of events prior to ECT cardiac arrhythmias
69
what is a poor prognostic indicator of schizophrenia
``` gradual onset strong family hx low IQ prodromal phase of social withdrawal lack of obvious precipitant ```
70
schizophrenia mx
first line: oral atypical antipsychotics | CBT to all patients
71
what psychotic more likely to be used in drug resistant schizophrenia
clozapine | should only be tried after at least 2 other antipsychotics for 6-8 wks
72
clozapine + infection
worry about neutropaenia - check FBC
73
scoring system for alcohol withdrawal severity
CIWA (clinical institute withdrawal assessment)
74
mania vs hypomania
mania: psychotic symptoms (delusions of grandeur, auditory hallucinations) hypomania = no psychotic symptoms
75
tardive dyskinesia
chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary movements on typical antipsychotics
76
neuroleptic malignant syndrome
``` started on antipsychotic tetrad: - hyperthermia - muscle rigidity - autonomic instability - altered mental status ```
77
citalopram side effect
long QT syndrome
78
man believes they can/have transformed into an animal
clinical lycanthropy
79
thinking theyre rotting away
Cotard delusion

4th year medicine (8 decks)

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