Corrections Flashcards
Can ECT cause retrograde or anterograde amnesia?
Retrograde
Mx of symptoms of mania in primary care?
Urgent referral to CMHT
Mx of symptoms of hypomania in primary care?
Routine referral to CMHT
Once levels are stable, how often shoud lithium levels be checked?
Every 3 months, 12h post dose
Is flight of ideas a feature of mania or hypomania?
Mania
1st line intervention for ‘less severe’ depression?
Guided self-help
PHQ-9 score for less severe depression?
<16
Mx of patients with OCD with severe functional impairment?
Referral to 2ary care mental health team for assessment
N.B. - clomipramine should only be considered as an alternative primary pharmacological intervention to SSRIs when the individual expresses a preference for clomipramine based on past positive experiences or if SSRIs are contraindicated
What needs to be co-prescribed alongside SSRI + NSAIDs?
PPI (due to increased bleeding risk)
1st line medication in mx of OCD?
SSRIs
Mx of OCD:
a) mild functional impairment
b) moderate functional impairment
c) severe functional impairment
a) CBT (including ERP)
b) SSRI or more intensive CBT
c) refer to the secondary care mental health team for assessment, offer combined treatment whilst waiting (CBT + SSRI)
When treating OCD copmapred to depression, how long does an SSRI take to work?
The SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response
What is adjustment disorder?
A protracted response to a significant life event or life change characterised by significant emotional distress and disturbance that interferes with normal social functioning.
Symptoms:
- Depressive symptoms
- And/or anxiety symptoms
- Inability to cope
When do symptoms of adjustment disorder occur after the stressor?
Occurs within 1 month of particular stressor
Shouldn’t persist longer than 6 months after
stressor is removed
What is a likely side effect of memantine?
Constipation
Contraindications of AChEIs?
1) QT prolongation
2) 2nd/3rd degree heart block in an unpaced patient
3) Sinus bradycadia <50 bpm
What is an alternative to AChEIs in patients with dementia with a contraindication e.g. QT prolongation?
Cognitive stimulation therapy
What is the most appropriate treatment for patients with SEVERE Alzheimer’s?
Memantine
What is semantic dementia a type of ?
FTD
Why are those with Down’s syndrome more likely to get early onset Alzheimer’s?
The exta copy of APP can lead to early onset beta amyloid plaques
What other side effects is akathisia associated with?
Due to distressing nature:
- Aggression
- Low mood
- Suicidal ideations
What is alogia?
Paucity of speech (a common negative symptom of schizophrenia)
What can clozapine toxicity be precipitated by? Why?
Acute infection e.g. pneumonia
Clozapine is metabolised by P450 system –> downregulation of these enzymes during infection/inflammation can lead to increased clozapine level
How to switch from fluoxetine to another SSRI?
Withdraw fluoxetine, leave a gap of 4-7 days then start low dose sertraline.
Fluoxetine has a long half-life compared with most other SSRIs.
Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI?
Direct switch is possible
What is the only SSRI where a direct switch isn’t possible?
Fluoetine
When should lithium levels be checked (once levels are stable)?
12h post-dose every 3 months
What is in Pabrinex?
B vitamins & vitamin C
Features of Wernicke’s?
- oculomotor dysfunction
- nystagmus (the most common ocular sign)
- ophthalmoplegia: lateral rectus palsy, conjugate gaze palsy - gait ataxia
- encephalopathy
- peripheral sensory neuropathy
1st line pharmacological mx of OCD?
SSRI
Note: When treating OCD, compared to depression, the SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response
If CBT or EMDR therapy are ineffective in PTSD, what are the 1st line drug treatments?
Venlafaxine or an SSRI
What class of medication is dosulepin?
TCA
What is adjustment disorder?
Adjustment disorders are excessive reactions to stress that involve negative thoughts, strong emotions and changes in behaviour.
Occur following a clear external stressor e..g job loss.
The symptoms are relatively mild and short-term, and there is no history of more severe mood disturbances or chronic depression.
Who should all patients with severe functional impairment be referred to?
2ary care mental health team
