Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > 29.04 - the day of the Gnarklebark > Flashcards

29.04 - the day of the Gnarklebark Flashcards

1
Q

When can clozapine be used in schizophrenia?

A

Only after 2 different antipsychotics have been tried

treatment resistant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risks with clozapine

A

Neutropenia and fatal agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Side effects of Clozapine

A

Sedation!
Weight Gain!

Hypersalivation
Raised triglycerides
Cardiomyopathy
DM
Lowers seizure threshold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is clozapine treatment started

A

Dose needs titrating.
Check FBC weekly for 18 weeks. THen 2 weekly for a year. Then 4 weekly.

BP, pulse and weight, Temp is also checked YEARLY (physical health). Ask about smoking and alcohol

Safety netting about high fever, chills, bone aches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Side effects of 1st generation antipsychotics

A 
EXTRAPYRAMIDAL:
Rigidity
Bradykinesia
Dystonias
Akathisia
Tardive dyskinesia

Neuroleptic Malignant syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe neuroleptic malignant syndrome

A

Life threatening

Fever
Altered consciousness
Muscle rigidity
Autonomic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Side effects of 2nd generation antipsychotics

A

Fewer extrapyramidal SE

Metabolic effects:
Increase appetite
Weight gain
DM
Sedation
Hypotension
Dry mouth
Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TCAs side effects (Amitryptiline)

A

Sedation
Weight gain
Dizziness
Hypotension

NOT TERATOGENIC, HOWEVER (used in pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Antidepressants in pregnancy

A

Fluoxetine most commonly prescribed

Amitryptiline is also fine, but high OD risk

NO PAROXETINE!! or SNRIs (venlafaxine, dulexitine) or MAOIs or Mirtazapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long are SSRIs used for?

A

At least 4 wks, to say that treatment has failed.

Continue for 6 months following symptom resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Withdrawal symptoms of SSRIs

A

Anxiety
Dizziness
Sleep disturbance
Nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Antidepressants in Breastfeeding

A

Imiparime and Nortriptyline are prefered

Paroxetine or Sertraline can be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is lithium started?

A

Weight and BP measured annually
Give contraception and folic acid advise.

Check levels weekly and titrate up. Once optimum dose, check every 3 months.
U and E and TFTs every 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SE of lithium

A 
GI upset
Fine tremor
Polyuria
Polydipsia
Metallic taste
Weight gain
Oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Toxic symptoms of lithium

A 
Diarrhoea
Course tremor
Ataxia
Dysarthria
Nystagmus
Confusion
Convulsions

AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which is the only mood stabiliser that can be used in pregancy

A

Lithium
NOT in breastfeeding

still teratogenic, but less than carbamazepine or sodium valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which mood stabiliser may be used in breastfeeding

A

lamotrigine in low dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common symptoms of social phobia

A

Blushing or shaking
Fear of vomiting
Urgency or fear of micturition

Marked feature of being the focus of attention, embarrassment or humiliation.
Restricted to fearful situations.
AVOIDANCE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Questions To distinguish OCD from schizophrenia

A

Thoughts are acknowledged as excessive/unreasonable

NOT due to thought insertion
Compulsions originate in the mind of the patientand are not imposed by outside persons or influences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Medications for anxiety

A

All anti-depressants are anxiolytics (brief increase initially)

Beta blockers for autonomic symptoms: HR, sweating etc

Lorazepam has a short half-life
Diazepam has a long
<4 weeks due to addictive nature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an acute stress reaction

A

<1month after stressful even

For >3 days
Anxiety
Depression
Numbness
Detachment
Derealisation
Insomnia
Restlessness
Anger

Alcohol/drug abuse?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of acute stress reaction

A

Reduce emotional response: talk to friends/family/professionals

Encourage recall to debrief

Teach coping skills

Anxiolytics only used if severe anxiety

Hypnotics if sleep distubrance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is adjustment disorder

A

Psychological reaction to new circumstances

Within 3 months
Proportionate

Anxiety/depression
Irritable
Dramatic?
Aggressive?

Sometimes autonomic arousal

Social functioning is impaired

Usually lasts couple of months

24
Q

Management of Adjustment disorder

A

Support groups to accept change
Prevent avoidance and denial

Encourage problem solving
Encourage talk/express feelings
Consider therapy

25
Q

3 core symptoms of PTSD

A

Hyperarousal: persistent anxiety, irritability, insomnia, poor concentration

Re-experiencing: flashbacks

Avoidance: numbness, loss of interest in activities, avoiding reminders

These symptoms persist beyond 6 MONTHS after event

Substance abuse and guilt common
Can also occur years later, if reactivation

26
Q

Management of PTSD

A

Psychoeducation
Trauma focused CBT

Eye movement desensitisation and Reprocessing (EMDR)

Antidepressants (SSRIs)

Social: family support/education
Reintegration
Avoid alcohol

27
Q

Characteritics of borderline EUPD

A 
Chronic empty feeling
Abandonment fears
Relationships are unstable and intense
Suicide attempts and self-harm
Occasional psychotic features (pseudohallucinations)
28
Q

Impulsive EUPD

A 
Lacks impusle control
Outbursts of violence
Sensitivity to being criticised
Emotional instability
Inability to plan ahead
Thoughtless of consequence
29
Q

Management of EUPD

A

Dialectical behavioral therapy

Group therapies

Admit if danger to self
Help from seniors

Mood stabilisers or antidepressants may be helpful.
Antipsyhcotics for agitation

30
Q

Types of alcohol misuse

A

Acute intoxication
Harmful use
Dependence syndrome
Withdrawal

31
Q

Core features of dependence syndrome

A

Primacy (obtaining drug becomes most important)
Continued use despite negative consequences (eg. loss of family, money)

Loss of control of consumption (early morning start)

Narrowing of repertoire (same drug in same setting with same people)

Rapid reinstatement of dependent use after abstinence

Tolerance and withdrawal

32
Q

how does mild alcohol withdrawal present?

A

4-12 hours after last drink

Coarse tremor
Sweating
Tachycardia
Nausea
Vomiting
Agitation
Insomnia

Intense cravings
Lasts 2-5 days
Transient hallucinations are possible

33
Q

Describe severe alcohol withdrawal

A

Peaks at 4-6 days

Acute confusion
Amnesia
Psychomotor agitation
Psychosis
Delirium tremens

Seizures:
5-15% of cases
Occur 6-48hrs after last drink

34
Q

What is delirium tremens

A

Medical emergency
Occurs 1-7 days post drink in 5%

Disoriented to time, place and person

Recent amnesia
Hallucinations and delusions
Severe psychomotor agitation
Fever
Autonomic disturbance and electrolyte imbalance

40% mortality if left untreated

35
Q

Management of delirium tremens (alcohol withdrawal)

A

Benzodiazepines for symptomatic relief (Chlordiazepoxide)

Nutritional and vitamin supplementation (Thiamine and B vitamins for WErnicke’s)

Close monitoring

Admit if:
past hx of complicated withdrawal, current psychiatric symptoms, severe malnutrition, severe biochemical abnormalities

36
Q

What is Wernicke’s encephalopathy

A

Neuronal degeneration 2° to thiamine deficiency

  1. acute confusional state
  2. Ophthalmoplegia, nystagmus
  3. Ataxic gait

Complete triad only in 10%.
Confusion in 80%

Tx IV Pabrinex (B1 replacement)

If left untreated, 80% progress to Korsakoff’s

37
Q

Korsakoff syndrome

A

Usually due to thiamine deficiency

Can be chronic

anterograde amnesia with some retrograde amnesia

Confabulation (describe false memories)

Apathy

KEEP ON THIAMINE and MULTIVITs for 2 yrs!

38
Q

Management strategies for alcohol misuse

A

Disulfiram (alcohol deterrent. Irreversibly inhibits ADH. Build of ADH causes flushing, headache, tachycardia and vomiting)

Motivational interviewing

CBT

Assertiveness training (learning to say no)

AA
Social support

39
Q

Biological management of opiate detox

A

Methadone (symptomatic tx)
Lofexidine (reduces symptoms)

Anti-emetics

40
Q

Postnatal pinks

A

First 48hrs
Temporary excitement, mild overactive with insomnia

Self-resolves

41
Q

Postnatal blues

A 
50-80%
Day 3-10
Tearfulness
Emotional lability
Anxiety
Lasts 48hrs and self-resolves
42
Q

Postnatal depression

A

Peak onset 2-4 weeks

50% risk of recurrence if previous severe depression or postnatal depression

43
Q

What is used to screen for postnatal depression

A

Edinburgh scale!

44
Q

When does postpartum psychosis present

A

50% present by day 7

Almost all by day 90

50% risk with bipolar or previous psychosis

45
Q

Criteria for delirium

A

Clouding of consciousness
Disturbed cognition

1 of:
variable activity levels, increased reaction time, altered speecn of flow

+1 of: insomnia, daytime drowsiness, nocturnal worsening of symptoms, disturbing dreams

46
Q

Which drug can be used for rapid sedation in a patient with acute behavioral disturbance? (patient becomes aggressive/agitated or psychotic)

A

Lorazepam (quick onset)

Anti-psychotics: olanzapine or haloperidol

47
Q

What is acute dystonia

A

Reversible extrapyramidal side effects that occur due to anti-psychotics

Muscle spasm occurring aywhere in the body. Can be lifethreatening if it affects laryngeal muscles!! IT is a psychiatric emergency

Most common with haloperidol (in 10%)

30% Neck twisting 17% Tongue, 15% Jaw, 6% Oculogyric crisis (neck arched and eye rolled back)

48
Q

Management of acute dystonia

A

Anticholinergics (Procyclidine 5-10mg)

49
Q

When is lithium clearance reduced?

A

It is only renally excreted

Renal impairment
Sodium depletion

Can be with diuretics, NSAIDs and ACEI

50
Q

Symptoms of lithium toxicity

A 
Early:
Tremor
Anorexia
N/V/D
Dehydration and lethargy
Late:
Restlessness
Muscle fasciculations
Myoclonic jerk
Hypertonicity

Ataxia, dysarthria, confusion, hypotension, arrhythmias

51
Q

Treatment of lithium toxicity

A

Stop lithium!
Hydrate
May require haemodialysis

52
Q

What is neuroleptic Malignant syndrome

A

Fever
Diaphoresis
Rigidity
Confusion and fluctuating consciousness

Autonomic instability: tachycardia, salivatin and incontinence

SLOW onset! Days-weeks

53
Q

Management of neurpleptic malignant syndrome

A

withdraw antipsychotics!!

Hydrate

Consider benzos for sedation or bromocriptine

54
Q

What is serotonin syndrome

A

Usually when swithcing an antidepressant or combining

Or when mixing with Triptans for migraines or illicit substances

Various symptoms come on within a few hours:
Restlessness/Agitation/confusion
Hyperthermia
GI upset
Mydriasis
Myoclonus
Rigidity
Tremors/convulsions
Ataxia

Can be fatal if left untreated

55
Q

Management of serotonin syndrome

A

Stop serotonergic meds
Rehydrate
Benzos for severe agitation

Consider gastric lavage if OD

Psychiatry (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions