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4th YR PSYCHIATRY > Core conditions > Flashcards

Core conditions Flashcards

1
Q

Alzheimers Dementia

Treatment

A

Gradual onset, Memory loss, increased ventricles, neurofibrilly tangles,

Treatment: ACh inhibitors Donpenezil

alZheimers donpeneZil

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2
Q

Vascular Dementia

signs

TX

A

Stepwise decrease in function
caused by infarcts and thrombolytic

TX: Aspirin and manage HTN

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3
Q

Fronto-temperal

syx

Treatment

A

Picks - earlier onset
Sx = personality disorder, social disinhibition, intellectual sparing, emotional blunting

SSRIs

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4
Q

Delerium

A

Transient change + acute disorientation

Causes: infection, neurological eg stroke, drugs

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5
Q

Illicit drugs
Key effects + withdrawal

Opiates: heroine, codine, morphine
Cannabinoids: cannabis
Hypnotics: bzs, barbiturates
Stimulants: cocaine, MDMA
Hallucinogens: lsd, shrooms

what brings pupils big vs down?

A

Opiate: Effect-decrease HR and BP + pinpoint pupils
Withdrawal: increase HR and BP and big pupils + runny nose + cravings

Cannabinoids: dry mouth, inc HR + appetite
Withdrawal: anxiety, irritability,, tremor, sweating

Hypnotics: Slurred speech,nystagmus, decreased temp (brings you down)
Withdrawal: tremor, inc HR, headache (brings u up)

Stimulant: increase moood + energy, inc HR + BP
Withdrawal: lethargy, craving, inc appeitie

Hallucinations: anxiety, depersonalisation, inc HR and pupils dialte

heroin and bzs = down and small pupil,
cocaine and lsd = big pupils

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6
Q

Schizophrenia
1st rank syx?

Diagnosis

Types

Treatment

A 
- First rank symptoms 
Auditory hallucinations 3rd person
Broadcasting of thoughts and echo
Control - mood and behaviours
Delusional perception

Diagnosis;: symptoms for 1 month with no drugs

PAranoid: delusions are evident
Catatonic: psychomotor distrubances
Hebephrenic: early onset, inappropriate mood, incongrious giggling

Treatment

  1. Antipsychotic
  2. CBT and family therapy and art therapy
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7
Q

Schizoaffective disorder

A

Affective (depression) and Schizophrenic symptoms occur together with equal prominence

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8
Q

Delusional disorder

A

A fixed delusion with unshakable belief

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9
Q

Depression

Syx

Treatment
Drug order

A

3 Core symptmoms= 2 needed for 2 weeks
1. Anhedonia 2. Low mood 3. Decreased energy
+ appetite, sleep disturbances, hopelessness etc

Mild = 4 syx, moderate = 6 syx, severe = 8syx

Management:

  1. mild = CBT
  2. Moderate CBT + SSRI for 6 months
  3. Severe = CBT + SSRIfor 6 months + ECT if catatonic
Drug order
1. SSRI -fluoxeteine (younger) or citalopram - 6 months 
(will know if working by 4 weeks)
\+ review 1 week
2. Change SSRI to another one
3. Add SNRI eg Venlafaxine or Duloxetine
4. Try Mirtazapine Nassa if insomnia too
5. MAOI
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10
Q

Mania

Features

A

Appearance: flamboyant clothing, hats, heavy makeuup
Behaviour: hyperactive, flirty, disinhibited
Speech: Pressured, neologism
Thoughts: Grandiode, flight of ideas
Mood: euphoric, irritabble

reduced need for sleep

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11
Q

Bipolar affective disorder

Diagnosis

Treatment

  • mainc episodes 1st line and 2nd line
  • longer term
A

At least 2 episodes including at least one hypo/manic episode
type 1 = mani and type 2 = hypomania

Management
1. Manic episodes = 1st line Haloperidol, Risperione, Olanzpoine or Queitapine
2. Lithium or Valproate 2nd line if antipsychotics ineffective
BZs used in acute behavioural disturbance
3. Longterm = LITHIUM or valproate

Or women childbearing age use LAMOTRAGINE long term

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12
Q

GAD

Diagnosis

Management

A
  • At least 6 months with prominent tension, worry and apprehension, irritability, tiredness

Managemnt:
1st line CBT, self help
2nd line SSRI Sertraline 1 year

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13
Q

Panic disorder

A

Severe panic attacks occuring unpredictably lasting 1 month and causing MALADAPTIVE behaviour

SYX: palpitations, sweating, tremor, N+V, last a few mins

TX: CBT + SSRIs

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14
Q

Phobia

  • specific + tx
  • agorophobia + tx
  • social + tx
A 
Specific = Eg heights, spiders
TX = Graded exposure therapy and response prevention. Short term use of BZs eg if flight
Agorphobia = fear of crowds and public places
TX = CBT

Social: most common, fear of social situations
TX = CBT, self help and SSRI if no improvement

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15
Q

PTSD

time frame?

Treatment?

A

Must be present for 1 month and onset within 6 months of the trauma

syx - persistent, intrusive thoughtd / flash backs, increase arousal, detatchment

treatment: EYE MOVEMENT DEREALISATION + REPROCESSING THERAPY
+ antidepressant

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16
Q

ADJUSTMENT

A

Depressive symtoms and inability to cope with major life event
Ususually self limiting and resolved by 6 months

TX: may respond to talking therapy

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17
Q

Abnormal bereavement

A

Delayed or unusually prolonged lasting over 6 months of inability to accept or cope with the loss

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18
Q

Somatisation disorder

A

multiple PHYSICAL symtoms present for over 2 years that has no organic cause
- spends excessive tme devoted to concerns
Patient often refuses to accept negative results

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19
Q

Conversion Disorder

A

Voluntary motor/sensory functional deficits that suggest neurologiclal conditions but doesnt fit on medical exam

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20
Q

Anorexia Nervosa

Signs

Management

A

BMI < 18.5

Signs: dry skin, fine hair, anaemia, Amenorrhea, bradycardia, risk of suicide, LOW WHITE CELL COUNT

management:

  1. fix BMI with refeeding 0.5kg/week
  2. FAMILY therapy and guided self help
  3. MARSIPAN guidance
  4. MANTRA = CBT + Motivational therapy

Complications: low K, low Na,
Hypophosphataemia is the hallmark of refeeding syndrome

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21
Q

Bullimia Nervosa

A

BMI > 18.5
Morbid fear of fatness, distorted body image, craving for food, binge and purging, self loathing

Signs: Depression, Low K, renal damage, russels sign = calluses on knuckles, mallory weis tear

Management: guided self help CBT + IPT
Fluoxetine SSRI 60mg

22
Q

SSRI eg Fluoxetieine, Sertraline

SE

CI?

A

1st line for depression (fluoxetine in teens and longer half life)

SE: GI bleed, lowers Na, prolonged QT and increased risk of suicide

CI: epilepsy, peptic ulcer disease, under 24s, renal imparrment

23
Q

SNRI

A

Venlafaxine 2nd line
Used for resistant depression
SE: SSRI Se + hypertension and heart disease

CI = hyptertension and heart disease

SNRI = VENLAFAXINE = HEART DISEASE

24
Q

TCA eg Amitryptilline

noradrenaline AND seretonin

SE

CI

OVerdose TX

A
  • for moderate-severe depression
  • Treatment for neuropathic pain

SE: Antimuscarinic - cant shit, cant spit, cant pee cant see
sedation, hypotension, GI upset, prolonged QT

CI : ovoid in those with high risk of overdose, epilepsy, CVD, and constipation

TX: Iv bicarbonate + gastric lavage

25
Q

MAOI
Example?
when indicated?

SE?

A

Example drug;? Phenelzine
- Given in resistant depression
SE: must adhere to dietary restrictons (low cheese and meat) to prevent TYRAMINE reaction = high BP and SA Haem

hypertensive crisis

MAOI=PHENELZINE=TYRAMINE

26
Q

NASSA eg Mirtazapine

noradrenalnie and seretonin specific

A

SE: Sedating, weight, gain dry mouth

LESS sexual SE

(Picture Miranda going to space in a NaSSa spacee ship falling asleep)

27
Q

1st gen Antipsychotic

D2

A

e.g Haloperidol, Chlorpromazine, Fluphenazine
MESOLIMBIC

Extrapyramidal syx, neurological EPSE

TREAT +ve symtoms only

28
Q

2nd gen antipsychotic

D2 + 5HT2A

A

E.g Aripiprazole, = drowsiness, N+V tiredness
Clozapine = most effective, SE agranulocytosis and myocarditis
Quietapine: Also sedates
Rispiridone: Causes gynaecomastia
Olanzopine: causes weight gain

MESOCORTICAL
Treat +ve and -ve

SE for all: Weight gain, diabetes, metabolic
blurred vision, constipation,

29
Q

Lithium

Therapeutic window?

How often to take

Tests

Side effects

toxicity signs

A
  • Acts as mood stabiliser via second messenger system

Window = 0.4-1 mml/L

Take once daily - takes 2 weeks to kick in

Tests: Before = FBC, U+E, TFT, Bhcg, ECG
Check lithium level after 12 hr post dose, 5 days, then weekly until stable, then every 3 months
Check TFT, Ca and U+E every 6 months
12 hr - 5 day - 7 day- 3 month - 6 month

Side effects: GI- abdo pain, nausea, metalic taste, weight gain, idiopathic intracranial hypertension
Water syx: Thirst, polyuria, odema

Toxicity = Anorexia, diarrhoea, dysarthria + renal complicaitons
tx; re-hydration and stopping lithium until symptoms resolve

CI = 1st trimerster in pregnancy, breastfeeding, renal imairment

30
Q

Valproate

A
  • Mood stabiliers and 2nd line for acute mania

SE: Nausea, gastric irritation, diarrhoea, weight gain, tremor

CI in pregnancy!!! change to lamotrigine

31
Q

Benzodiazepine

Short acting ones
Longer acting ones

SE:

Overdose? Tx?

Glutamate = HYPER
Gaba = chill
A

Increase GABA
Uses: insomnia, muscle relaxant hypnotic, alcohol detoxification, psychosis, anxiety disorders short term

Short acting: Lorazepam
Long acting: Diazepam, Chlordiazepoxide

SE: psychomotor retardation, memory impairment, resp depression, dependenace and withdrawal = anxiety and disturbed sleep

Overdose: over sedation
Antidote = FLUMAZENIL IV

32
Q

Lewy Body
Syx triad

TX

A

Fluctuating cognition, visual hallucinations and fluctuating alterness
TX: Levodopa and Donpenezil

33
Q

extra-pyramidal side effects

  • Dystonia
  • Torticollis
  • Akathesia
  • Parkinsoniansm
  • Tardive dyskinesia
A
  • Dystonia = painful spasms of eye, neck and trunk
  • Torticollis = neck position is wrong
  • Akathesia = inner restlessness of legs
  • Parkinsoniansm = muscluar rigidity bradukinesia and tremor
  • Tardive dyskinesia = involuntatu repetitis meaningless movements of tongue lips and face after years of use and irreversible
34
Q

Neuroleptic malignant syndrome

caused by?

Syx?

A

RARE life threatening side effect of antipsychotics

Rigidity, confusion and pyrexia

35
Q

Clozapine

SE

REgular monitoring?

A

Only use when one typical and atypical has been trialled first
SE: Hypersalivation, tachycardia, myocarditis, cardiomyopathy, convulsions, AGRANULOCYTOSIS = severely low WCC

Needs regular blood monitoring for WCC

  • weekly for 4 months
  • fortnightly for a year
  • monthly

INFORM DOCTOR IF SMOKING HABITS CHANGE

36
Q

Persecutary delusion

A

Being spied on

37
Q

Capgras

A

Friend or family has been replaced by an imoposer

Wearing different caps

38
Q

Fregoli

A

Indiviudal is disguising itself as stragers

perri the platypus evil man

39
Q
  • Dopplegangers
A

-Double of one self

40
Q

Othello

A

partner is cheating

your signigicant OTHER is cheating

41
Q

De Clarembault

A

Being secretly loved by a famous persion

usain Bolt loves me

42
Q

Cotard

A

Delusion of being dead

43
Q

Ekbombs

A

Skin infected with parasites

44
Q

Seretonin syndrome

A 
It is characterised by:
Extremes of temperature (and in life threatening cases this can rise above 41.5°C)
Mental agitation and confusion
Hypertonia
Hyperreflexia
Clonus.
45
Q

Treat tardive dyskinesia

A
  1. change typical to atypical antipsychotic

Give Benztropine or benzhexol = anticholinergic for syx

46
Q

Treat Acute dystonic reactions

A

Procyclidine

47
Q

EUPD - borderline

A
  • self harm + suicide
    unstable relationships
    Chronic feelings of emptiness
48
Q

EUPD - antisocial/ impulsive

A

Disregard for rules

Reckless disregard for safety of self or others

49
Q

Antidepressant order

A 
1. SSRI -fluoxeteine (younger) or citalopram - 6 months 
(will know if working by 4 weeks)
\+ review 1 week
2. Change SSRI to another one
3. Add SNRI eg Venlafaxine or Duloxetine
4. Try Mirtazapine Nassa if insomnia too
5. MAOI
50
Q

Where can you do a 5)2

A

inpatients- not in A&E- here you would have to do seciton 2

51
Q

OCD treatment
Obsessions = thoughts
compulsions = acts

A

SSRIs +

A particular form of CBT called exposure-response prevention (ERP) is used in OCD:

4th YR PSYCHIATRY (5 decks)

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