3a Psychiatry Flashcards by Anisa Akbar

triad for wernickes syndrome

ataxia
confusion
opthalmoplegia

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Give 4 Sx of mild-moderate lithium toxicity

abdominal pain
diarrhoea
polyuria/dipsia
coarse tremor

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give 4 Sx of severe lithium toxicity

agitation
slurred speech
seizures
renal failure

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side effects to
lithium use

Leukocytosis
Insipidus
Tremor (fine - therepeutic dose, coarse - toxicity)
Hypothroid
Increased weight
u
Metallic taste

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after trialling 2 atypical antispychotics, whats next best Tx

clozapine; agranulocytosis

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what is the criteria for assisted withdrawal for alcohol

> 15units per day
20 on AUDIT questionnaire

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pathological finding in the brain for Alzheimer’s disease

widespread cerebral atrophy
amyloid plaque
tau protein tangles

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which condition are alpha synuclein cytoplasmic inclusions seen in

Lewy body dementia

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which class of drug in dementia is contraindicated in a patient with QT prolongation

anti-cholinesterase inhibitors

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most significant risk of long term antispychotic use

risk of stroke
Weight gain and abnormal lipid profile –> this increases risk of stroke

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time frame to have postnatal depression

d3epressive Sx within 12months of giving birth

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minimum amount of days required to reinduce methadone for opiate therapy

> 5 days

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2 side-effects of amitriptyline/Imipramine

dry mouth
urinary retention
blurred vision
constipation

Anticholinergic effects

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4 Sx for NMS

sweating
fever
fluctuating BP
rigdity
confusion
tachycardia

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blood marking sugestive of NMS

raised creatinine kinase

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before commencing lithium as a TX which blood test is conducted

TFTs

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Px with post Partum psychosis, what is best first line course of management

organise admission to a mother and baby unit

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which blood result are you most likely to see in a Px with anorexia

hypercholestrolaemia

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which psychiatric medication can cause erectile dysfunction

SSRI

Citalopram

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which dementia would we will not give an antipsychotic in

demntia with lewy body

Parkinsonism

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triad for normal pressure hydrocephalus

Wet, wobbly, weird

urinary incontinence
difficulty mobilising
personality change

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define Pica

eating non-food items / food item in obscene quantities

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side effect / thing that needs monitoring on SNRIs

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ECG change when using TCA

prolonged QRS
QTc interval

Also metabolic acidosis

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which mental health can be used for Involuntary detainment for an assessment

section 2

most common side effect clozapine

constipation *Agranulocytosis is serious SE but its rare*

tx for akathesia

Procyclidine

for heroin withdrawal, best first line management

supportive care and symptomatic Tx

define agnosia

inabvaility to recognise people/objects/place Px once knew

how long should ssri in OCD be continued for once Px feels better

12 months

in bulimia, what initial investigation should be done

U&Es particularly if using diuretics; loss of electrolytes

ECG changes found in haloperidol use

prolonged QT interval

which med can improve cognitive function in alzheimers disease

donepezil *Acetylcholinesterase inhibitor*

what demenetia are patients with down syndrome most likely to get

alzheimers

amphetamines plus SSRIs can lead to what

serotonin syndrome

in refeeding syndrome what electrolyte imblances could you see

hypophosphataemia

Is there an age limit for 1 week follow up after using sertraline

Yeh 30y/o cut off

4 clinical features to NMS

Hyperthermia Altered mental state Autonomic dysregulation Rigidity *A 42-year-old male presents to A&E feeling unwell for the past 48 hours. He feels feverish and is concerned as he has developed a tremor. He was recently diagnosed with schizophrenia and commenced on medication last week, but he cannot remember the name or the dose. On examination, there is evidence of muscle rigidity. His AMTS is 4/10. His vital signs are: HR 103bpm, RR 21 breaths per min, O2 saturations on air 98%, BP 138/82mmHg, temperature of 38.5.*

another name for **nephrogenic** diabetes insipidus and what psychiatric complication is linked to

arginine vasopressin resistance (AVP-R) complication of lithium S/E

define autoimmune encephalitis

non-infectious neuroinflammation altered mental status. **Triggered by * previous viral infection seizures psychosis cognitive impairment*.**

name the phenomenon in Parkinson's disease where Px gets stuck on word in a sentence and repeats it over again

logoclonia

which electrolyte imbalance is seen in a panic disorder

Hypocalcaemia

why is hypocalcaemia seen in panic disorder

panic disorder Px is hyperventilating -> reduced CO2 *(blowing off more)* -> causes alkalosis. alkalosis promotes calcium to bind to albumin therefore more being used up; reducing free calcium

in anorexia if PX has pan-systolic murmur with 'click' what does that suggest

loss of myocardium

what is de clerambault syndrome

delusional disorder that someone is in love with them i.e. erotomania

what class of drug is chlorphenamine and what SE can it cause

H1 antagonist - *has anticholinergic activity* high risk of inducing acute delirium as well as anti-cholinergic effects; dry mouth, constipation, blurred vision, urinary retention

if anorexic Px come in with dizziness and confusion, what blood test is important to conduct

cap blood glucose *need to rule out hypoglycemia*

when are SSRIs contraindicated

**Warfarin** - give 2nd line instead; SNRI

when are SNRIs contraindicated

in uncontrolled hypertension

what would u give if SSRI and SNRI are both contraindicated

give NaSSA Mirtazapine

first line SSRI in patient with anorexia who needs to also gain weight

mirtazapine *Olanzapine isn't 1st line for anorexics because of its other SE*

Triad of Sx for normal pressure hydrocephalus

Dementia Gait disturbance Urinary incontinence

Most common side effect of sertraline.

GI disturbance **Diarrhoea** - *can be constipation in some Px though* Gastric ulcer Sexual dysfunction

Give one predisposing factor for anorexia

Dieting

3 Sx of clozapine toxicity

Confusion Ataxia Drowsiness Tachycardia

If Px s on 2nd gen antipsychotic; Displaying confusion, diaphoresis, rigidity, pyrexia What does he likely have and how do we investigate it

**NMS** Creatinine kinase

2nd line Tx for Alzheimer’s

Add Memantine (NMDA class) *to 1st line; Donepezil/galantamine/rivastigmine*

Area of brain responsible for fight or flight

Amygdala

Side effect of memantine

Constipation *Used in severe Alzheimer’s*

If stem suggests heavy alcohol use in an acute setting what blood would we want to check

Blood glucose Risk of hypoglycaemia

Sodium valproate side effects

Remember as **VALPROATE** Vomiting Alopecia Liver toxicity Pancytopenia Retention of fats (weight gain) Oedema Anorexia Tremor Enzyme inhibition

Lithium levels >3. Prompt what

Consider Haemodialysis - prevent seizure