3A- Psychiatry Flashcards by Nicholas Prescott

what medications are used to manage alcohol dependance?

acomprosate
disulfiram
naltrexone

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what is the function of acomprosate?

used in alcohol dependance

reduces cravings

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what is the function of disulfiram?

used in alcohol dependance

gives hangover type side effects when alcohol is consumed

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what is the function of naltrexone?

used in alcohol dependance

reduces the pleasure from drinking

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management of alcohol withdrawal

chloridazepoxide

IV Pabrinex 5 days

thiamine 100mg BD

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clinical presentation of delirium tremens

altered conciousness
marked cognitive impairment
vivid hallucinations and illusions (can be in any sensory modality):
1- lilliputian (visual hallucination of small humans/ animals)
2- formication (insects on skin)
paranoid delusions
marked tremor
autonomic arousal- sweating, raised pulse and BP, fever

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what triad is seen in Korsakoff’s syndrome?

anterograde amnesia

confabulation

psychosis (lilliputian/ formication)

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what are the subtypes of schizophrenia (just the names)

paranoid

hebephrenic

catatonic

residual

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subtypes of schizophrenia- paranoid

delusions
auditory hallucinations
NO THOUGHT DISORDER

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subtypes of schizophrenia- hebephrenic

thought disorder and flat affect

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subtypes of schizophrenia- catatonic

subject may be immobile or exhibit agitated, purposeless movement

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subtypes of schizophrenia- residual

positive symptoms present at a low intensity

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pharmaceutical treatment pathway for schizophrenia

1st- atypicals- respiridone, olanzapine, quetiapine, aripiprazole etc

2nd- 1st gens- haloperidol/ chloropromazine

3rd- clozapine (if treatment resistant schizophrenia)

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side effects of Lithium

course tremor
hyperreflexia 
seizures
heart block 
weight gain 
hypothyroidism 
impaired renal function 
hypotension 
impaired consciousness

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treatment pathway in depression

1st- SSRI (fluoxetine, citalopram, sertraline)

2nd- alternative SSRI

3rd- NaSSA- mirtazepine
SNRI- venlafaxine/ duloxetine

4th- TCA (amitryptyline, clomipramine)
anti-cholinergic/muscarinic
MAOI’s- moclobemide

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why is clomipramine used in the management of OCD?

specific non-obsessional action

pharmaceutical management of panic disorder

1st- SRRI (sertraline)

2nd- TCA (clomipramine)

treatment of neuroleptic malignant syndrome

bromocriptine (dopamine agonist)

dantrolene (reduces muscle spasms)

treatment of serotonin syndrome

benzodiazepines

Cyproheptadine- 5HT-2a antagnoist

what blood results are present in patients with neuroleptic malignant syndrome and serotonin syndrome?

raised CK and WCC

deranged LFT’s

metabolic acidosis

what is delusional perception?

delusional belief resulting from a real perception (e.g. red light meaning the police are on the way)

what is an extracampine hallucination?

hallucination that is outside the limits of the sensory field- e.g. hearing voices in another city

what is a hypnagognic hallucination?

hallucination occuring when falling asleep

what is a hypnopompic hallucination?

occurs when waking up

what is CIWAR?

A questionnaire that is used to objectify alcohol withdrawal severity in order to help guide therapy.

what physical illnesses need to be ruled out in a suspected diagnosis of anxiety

- hyperthyroid - pheochromocytoma - hypoglycaemia - anaemia - cardiac disease - withdrawal from alcohol/ benzodiazepines - rule out other psych disorders medication causes- salbutamol, corticosteroids, antidepressants, caffiene

tx of OCD

- exposure and response prevention (ERP) - SSRI's- fluoxetine - TCA- Clomipramine (specific non-obsessional action)

Tx of panic disorder

recognisiton and diagnosis, breathing tips etc CBT SSRI- sertraline TCA- Clomipramine (2nd line)

what is Somatisation disorder?

A long history of multiple and severe physical symptoms that cannot be accounted for by a physical disorder or other psychiatric disorder symptoms are real !!

what is a factitious disorder

symptoms and signs made up- playing the sick role

what is malingering

psychological and physical symptoms that are manufactured or exaggerated for a purpose other than assuming the sick role, e.g. evading the police, obtaining compensation, getting a bed for the night. Malingering is not a psychiatric disorder.

suicide risk assessment and management

Sex (male) Age (young or old) Depression Previous attempts? Ethanol abuse- alcohol ! Rational thinking loss (e.g. Schizophrenia) Supportive network loss Organised plans (notes, alone, avoiding detection) No significant others (no friends/ family) Sickness- physical disease ``` 0-2= send home but signpost 3-4= check ups with GP 5-6= consider hospitalisation (involuntary or voluntary) 7-10= definitely hospitalise- can be involuntary ```

what is section 4 of the MHA

72h emergency- when waiting for the 2nd doctor would cause delay 1 doc 1 AMHP needed reason- mental disorder, detained for own safety and not enough time for 2nd doc to attend

describe a section 5(4)

Section 5(4) - In hospital - The patient is already admitted to hospital but is wanting to leave (NOT A&E- NOT TECHNICALLY ADMITTED) - Nurses’ holding power until doctor can attend - 6 hours long - Cannot be treated coercively whilst under section

describe a section 5(2)

Section 5(2) - For a patient already admitted but wanting to leave - Doctors holding power- 72 hours - Allows time for a section 2 or section 3 assessment - Cannot be coercively treatment

5 principles of the mental health act

- assume capacity - individual supported to make own decisions - unwise decision do not mean lack of capacity - best interests - least restrictive practice

describe the capacity assessment

any impairment of the mind/ brain? is the person able to: - understand - retain - weigh up - communicate their decision TIME AND DECISION DEPENDENT RETENTION ONLY NEEDED FOR TIME TO MAKE DECISION

Differences between bipolar 1, II and cyclothymia

bipolar I= mania + major depression Bipolar II= hypomania + major depression Cyclothymia= hypomania + minor depression (for 2 years)