Psychiatry - general, legal and Ppsychopharmacology Flashcards
(142 cards)
1
Q
What are the ‘5 Ps’ that formulate/ summarise a patients difficulties, what might be causing them and make sense of them?
A
- Predisposing
- Precipitating
- Presenting complain
- Perpetuating
- Protective
2
Q
What model helps summarise/ categorise the risk factors and treatment for a mental health condition?
A
Biopsychosocial model
3
Q
What makes up the biological aspects of the biopsychosocial model (4)?
A
- Genetics
- Birth/ pregnancy complications
- Past medical history
- Medications/ drugs
4
Q
What makes up the psychological aspect of the biopsychosocial model (4)?
A
- Trauma/ abuse
- Self esteem
- Mood
- Personality
5
Q
What makes up the social aspect of the biopsychosocial model (4)?
A
- Relationships
- Finances
- Stress
- Culture
6
Q
What are some extra things to ask about in a psychiatric history (3)?
A
- Personal timeline - childhood, abuse/ trauma, etc
- Suicide + self harm
- Legal involvement
7
Q
What are the important parts of a mental state examination (7)?
A
- Appearance + behaviour
- Speech
- Emotion (mood + affect)
- Perception (delusions…)
- Toughts
- Insight
- Cognition
8
Q
What is psychosis?
A
Loss of touch with reality (often with impaired functioning)
9
Q
What is a hallucination?
A
Perception in the absence of a stimulus that has the sense of reality
10
Q
What is a pseudohallucination?
A
A hallucination that the person is able to determine is not real
11
Q
What is an illusion?
A
Wrong interpretation of a real stimulus e.g. leaves rustling = footsteps
12
Q
What is a delusion?
A
Fixed false unshakable belief out of keeping with social norms
13
Q
What is a delusional perception?
A
A false meaning to a true/ correct perception e.g. the traffic light is red, therefore the martians are landing
14
Q
What are delusional perceptions pathogneomic for?
A
Schizophrenia
15
Q
What are some types of thought disorders (9)?
A
- Circumstantiality
- Tangentiality
- Neologisms
- Clang association
- Word salad
- Knights move thinking
- Flight of ideas
- Perseveration
- Echolalia
16
Q
What is circumstantiality?
A
Answering a question with excessive detail and wandering, however RETURNING to the original question and answering it
17
Q
What is tangentiality?
A
Wandering from a topic WITHOUT returning to it
18
Q
What are neologisms?
A
New word formations e.g. combining two words to create a new one
19
Q
What is clang association?
A
Ideas are related only because they sound similar/ rhyme
20
Q
What is a word salad?
A
Real words strung together in a nonsense sentence
21
Q
What is knights move thinking?
A
Unexpected and illogical leaps from one idea to another
22
Q
What is flight of ideas?
A
Leaps from one topic to another with discernible links
23
Q
What is flight of ideas a feature of?
A
Mania
24
Q
What is perseveration?
A
Repetition of words despite attempt to change the topic
25
What is echolila?
Repeating words/ phrases that the other has said
26
What are two types of speech?
* Pressure = rapid (mania)
* Poverty = lack of (depression, dementia)
27
What is munchausens?
Fabrication of physical or psychological symptoms
28
What is malingering?
Fabrication of symptoms for financial/ personal gain
29
What is an obsession?
Mental preoccupation - pervasive + recurrent
30
What is a compulsion?
An urge and action (physical or mental) to obtain relief
31
What are some common ways peoples thoughts are affected (4)?
* Broadcasting
* Insertion
* Withdrawal
* Passivity - controlled by external source
32
What are the common types of delusions (4)?
* Persecutory (mistreated, trying to harm them, spying)
* Grandiose (one has special powers/ wealth)
* Guilt + worthlessness
* Nihilistic (nothing has value/ meaning)
33
What is capgras delusion?
Close relative replaced with imposter
34
What is cotard delusion?
Belief they are rotting/ dying
35
What is fregoli delusion?
Everyone is one person with masks
36
What is orthello delusion?
Believe partner is cheating on them
37
What is De Clerambault delusion?
Beliefe a high status person is in love with them
38
What is the relationship between the mental capacity and mental health act?
Mental health act can "override" capacity act - if patient has capacity they can still be detained
39
What circumstances can a patient be detained under the mental health act (3)?
* Evidence of mental health illness
* Risk to society or themselves
* Will benefit from admission
40
What are the principles of detention under the mental health act (3)?
* Least restrictive
* Patient safety protected
* Effective treatment available + given
41
What are the different sections of the mental health act that are important to know?
* Section 2
* Section 3
* Section 5(2)
* Section 5(4)
* Section 135
* Section 136
42
What does section 5(2) allow for?
Doctors holding power - detention for **72 hours**
43
What does section 5(4) allow for?
Nurses holding power - detention for **6 hours**
44
What does section 2 of the MHA allow for?
Admission for **investigations** for **28 days**
45
Can section 2 of MHA be renewed?
No
46
What does section 3 of the MHA allow for?
Admission for **treatment** for **6 months**
47
Can section 3 of MHA be renewed?
Yes first of all for another 6 months, then for 1 year each time
48
Who is required for detention under section 2 and 3 of MHA (3)?
* Approved mental health professional (usually a social worker)
* A section 12 doctor (usually a psychiatrist)
* Another doctor (ST4< - usually their GP)
49
What are the classes of antidepressants (5)?
* Selective serotonin reuptake inhibitors (SSRIS)
* Serotonin noradrenaline reuptake inhibitors (SNRIs)
* Monoamine oxidase inhibitors (MAOI)
* Tricyclic antidepressants (TCAs)
* Noradrenergic and specific serotonergic antidepressants (NaSSA)
50
How long do antidepressants typically take to start working?
4-6 weeks
51
When should a follow up be arranged for those starting antidepressants (2)?
* Within 2 weeks (if over 25)
* Within 1 week (if under 25)
52
How long should antidepressants be continued for after making a good recovery?
At least 6 months
53
How quickly should antidepressants (SSRIs) be discontinued?
Over period of 4 weeks
*fluoxetine immediately*
54
What are some signs/ symptoms of discontinuation syndrome (6)?
* Electric shocks
* Sweating
* Unsteady
* Diarrhoea
* Mood changes
* Restless
55
What is a particular risk of starting antidepressants for those under 30?
High suicide risk in first few weeks
56
What is the mechanism of SSRIs?
5HT (serotonin) presynaptic reuptake inhibitors
57
What are some examples of SSRIs?
* Sertraline
* Fluoxetine
* Paroxetine
* Citalopram
58
What are some specific features of each of these SSRIs (4)?
* Sertraline = good for GAD, OCD, PTSD, breastfeeding
* Fluoxetine = for **children** (only licensed SSRI
* Paroxetine = for **breastfeeders**, high risk of discontinuation syndrome
* Citalopram = QT prolongation --> torsades de points
59
What are some side effects of SSRIs (8)?
* Impotence
* Headaches
* GI Sx (N+V, pain, GI bleeds)
* Reduced libido
* Serotonin syndrome
* Anxiety/ agitation
* Reduce seizure threshold
* Increase risk of bleeding
60
What is a key drug interaction of SSRIs?
NSAIDs - both increase risk of bleeding
*caution when prescribing - use a PPI*
61
What is a blood finding of those raking SSRIs?
Hyponatraemia (due to SIADH)
62
What are some effects of SSRI use in the first trimester (2)?
* **CHD**
* Cleft lip/ pallate
63
What are some effects of SSRI use in the third trimester?
Persistent pulmonary hypertension of the newborn
64
Which antidepressant has been most linked to defects during pregnancy?
Paroxetine
65
What is the mechanism of SNRIs
NAd + 5HT (serotonin) reuptake inhibitor presynaptically
66
What are two examples of SNRIs?
* Venlafaxine
* Duloxetine
67
What is duloxetine specifically good for treating?
When nerve pain is associated
68
What is the mechanism of action of TCA (2)?
* Serotonin, noradrenaline presynaptic reuptake inhibitors
* Antagonises Ach + histamine
69
What are three examples of TCAs?
* Amitriptyline (sedative)
* Imipramine (non-sedative)
* Clomipramine
70
What are some side effects of TCAs (4)?
* Anticholinergic properties (can't see, pee, shit, spit - dry eyes, urinary retention, constipation, dry mouth)
* Impotence
* Sedation
* Arrhythmias (tachycardia, long QT, L/RBBB)
71
What are the signs/ symptoms of TCA overdose (4)?
* Confused
* Dry skin, mouth
* Dilated pupils + blurred vision
* Drowsiness
72
How is TCA overdose investigated?
ECG = wide QRS, long QT,
73
How is TCA overdose treated?
IV sodium bicarbonate
74
What is the mechanism of MAOI?
Prevents NAd, Ad and serotonin breakdown in CNS
75
What are some complications of MAOI use (2)?
* Hypertensive crisis due to interaction with cheese (tyramine cheese reaction)
* High risk of serotonin syndrome
76
What is an example of an NaSSA?
Mirtazipine
77
What are some side effects of mirtazipine (2)?
* Weight gain
* Sedation
78
What specific circumstances is mirtazipine often used for?
* Patient has insomnia
* Patient underweight
* Patient on LMWH/ warfarin
79
What drugs increases the risk of serotonin syndrome (5)?
SSRIs with:
* **MAOIs**
* Tramadol
* St johns warts
* Ecstasy
* Amphetamines
80
What are the signs/ symptoms of serotonin syndrome (7)?
* Hyperreflexia
* Clonus
* Dilated pupils
* Hyperthermia
* Tachycardia
* Sweating
* Altered mental state
81
How quickly do symptoms of serotonin syndrome develop?
Over hours
82
How is serotonin syndrome investigated (2)?
* Toxicology
* Raised creatinine kinase
83
How is serotonin syndrome managed (2)?
* Supportive
* Chlorpromazine (typical antipsychotic, serotonin antagonist)
84
What is the mechanism of antipsychotics?
D2 receptor antagonist blocking transmission in the mesolimbic pathway
*atypical antipsychotics have more mechanisms*
85
How should antipsychotics be stopped?
Gradual stopping over more than **3 months**
*prevents relapse*
86
What should be monitored for antipsychotics and how frequently should these be monitored (7)?
* FBC
* U&E
* LFTs
* BMI
* Prolactin
* HBA1C
* BP + ECG
*baseline measurements should be taken, then monitored more frequently during first year, then **annually***
87
What are the two classes of antipsychotics?
* Atypical
* Typical
88
What are some examples of typical antipsychotics (2)?
* Haloperidol
* Chlorpromazine
89
What is the name for the side effects that commonly occur with typical antipsychotics?
Extrapyramidal side effects (EPSEs)
90
What is the cause of the extrapyramidal side effects with antipsychotic use?
Decreased dopaminergic activity in the **nigrostriatal** pathway
91
What are some examples of EPSEs (4)?
* Acute dystonia
* Parkinsonism
* Akathisia
* Tardive dyskinesia
92
What is the presentation of acute dystonia from antipsychotic use?
Rapid onset sustained muscle contractions e.g. torticollis
93
What is the treatment of dystonia?
Procyclidine
94
You know what Parkinsonism is so I am not going to ask you what that is!!
HAHA you fucking idiot you had to look it up
95
What is the treatment for Parkinsonism?
Procyclidine
96
What is the presentation of akathisia from antipsychotic use?
Rapid onset severe motor restlessness
97
How is akathisia treated?
Propranolol
98
What is the presentation of tardive dyskinesia from antipsychotic use?
Irregular disco-ordinated involuntary movements (like chorea) years after antipsychotic use
*usually affects jaw*
99
What is the treatment of tardive dyskinesia?
Tetrabenazine
100
What are some other side effects of typical antipsychotics (5)?
* Anticholinergic (can't see, pee, shit or spit)
* Weight gain
* Sedation
* Impaired glucose tolerance
* Reduced seizure threshold
101
What causes raised prolactin levels with antipsychotic use?
Dopamine blockage in the tuberoinfundibular pathway, dopamine surprises prolactin, therefore less dopamine = more prolactin
102
What are the symptoms of high prolactin (3)?
* Lactation
* Reduced libido
* Infertility
103
What are some examples of atypical antipsychotics (5)?
* Risperidone
* Olanzapine
* Quetiapine
* Aripiprazole
* Clozapine
104
What are atypical antipsychotics associated with?
Metabolic syndrome
105
When is clozapine prescribed?
For treatment resistant schizophrenia (after 2 different antipsychotics have been tried)
106
What are some complications of clozapine (4)?
* **Agranulocytosis**
* Hypersalivation
* Weight gain
* Constipation
107
How is clozapine monitored (3)?
* Weekly for first 18 weeks
* Next 16 weeks = biweekly
* Then monthly
*FBC, BP, BMI...*
108
When should the dose of those taking clozapine be retitrated (2)?
* Not taken for > 48 hours
* Smoking status changed
109
What is a major complication of antipsychotic use?
Neuroleptic malignant syndrome
110
What are the signs/ symptoms of neuroleptic malignant syndrome (3)?
* HYPOreflexia
* Rigidity
* Normal pupils
111
How quickly do symptoms of neuroleptic malignant syndrome come on?
Days
112
What are blood test finding in neuroleptic malignant syndrome (2)?
* **Raised creatinine kinase**
* Raised WCC
113
How is neruoleptic malignant syndrome managed?
Bromocriptine (dopamine agonist)
114
What are some complications of neuroleptic malignant syndrome (2)?
* Rhabdomyolisis
* AKI
115
What are some risks associated with antipsychotic use in the elderly (2)?
* Increased VTE risk
* Increased stroke risk
116
What are some examples of mood stabilisers (4)?
* **Lithium**
* Carbamazepine
* Sodium valproate
* Olanzapine
117
What is a theory for the mechanism of lithium?
Interferes/ inhibits with cAMP
118
What are two features of lithium in terms of pharmacokinetics (3)?
* Long half life
* Excreted by the kidneys
* **Narrow therapeutic range** - 0.4-1 mmol/l
119
What are some important drug interactions to know about for lithium (3)?
* NSAIDs --> AKI
* Diuretics --> dehydration
* ACE-i --> AKI + dehydration
120
What are some adverse effects of lithium (7)?
* Leukocytosis
* Fine tremor
* Dehydration + increased thirst (diabetes insipidus)
* Weight gain
* Nephrotoxicity + oedema
* Hyperparathyroid + hypercalcaemia
* Hypothyroid
121
What is the effect of taking lithium during pregnancy?
Ebsteins anomaly
122
What is a rare complication of lithium years after stopping taking it (3)?
SILENT (syndrome of irreversible lithium effectuated neurotoxicity)
Neurological Sx:
* Cerebellar symptoms
* EPSEs
* Dementia
123
What are some symptoms of lithium toxicity (3)?
* N+V
* **Course** tremor
* Fatigue
124
When should lithium concentrations be monitored (2)?
* **12 hours** after dose
* **Weekly** until stable then every **3 months**
125
What should be monitored when taking lithium (4)?
* FBC, U&E, TFTs
* eGFR
* BMI
* ECG
126
How do benzodiazepines work?
GABA agonists
127
What are benzodiazepines used for (3)?
* Sedation
* Anxiolytics
* Anticonvulsants
128
What are 3 examples of benzodiazepines and what is their duration?
* Diazepam = longer acting
* Chlordiazepoxide = longer acting
* Lorazepam = shorter acting
129
What are some side effects of benzodiazepines (3)?
* Resp depression
* Sedation
* Amnesia (anterograde)
130
How can an overdose of benzodiazepines be treated?
Supportive, resp support
*IV flumenazil can be used*
131
What is another type of anxiolytic other than benzodiazepines?
Pregabalin
132
What drug is similar to benzodiazepines and helps with sleep?
Zopiclone
*and other "Z" drugs*
133
What is the mechanism of zopiclone?
GABA agonist
134
What is a side effect of zopiclone in the elderly?
Increased risk of falls
135
What is ECT?
Electroconvulsive therapy - electric currents passed through brain under general anaesthetic, inducing muscle jerks/ seizures
136
What are some side effects of ECT (4)?
* **Amnesia**
* Nausea
* Headaches
* Arrhythmias
137
What are some contraindication for ECT (4)?
* **Raised intracranial pressure** = absolute
* Recent MI
* Severe hypertension
* <12 years
138
What are some examples of talking therapies (4)?
* CBT
* DBT (dialectical behaviour therapy)
* IPT (interpersonal psychotherapy)
* Couple therapy
139
What is the approach to CBT (5)?
* **S**ituation
* **T**oughts
* **E**motions
* **A**ctions
* **P**physical feelings
140
What is dialectical behaviour therapy?
Changing negative thinking + promoting **acceptance**
141
What is IPT?
Resolving relationship problems
142
What is couples therapy (3 principles)?
* Improve communication
* Reduce emotional avoidance
* Modify dysfunctional behaviour
