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psychiatry > DUMS > Flashcards

DUMS Flashcards

1
Q

What are some of the things we are monitoring for in patients taking antipsychotics

A

Fasting blood glucose, prolactin, ECG, FBC

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2
Q

Why do you get raised prolactin when using an antipsychotic?

A

Due to inhibition of the dopaminergic tuberoinfundibular pathway

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3
Q

Do patients on clozapine need to let doctors know when they cut down or begin smoking?

A

Yes – smoking increases the levels of clozapine in the body so if a patient starts smoking increased levels of the drug may be harmful

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4
Q

Which anti-psychotic has the best side effect profile

A

Aripiprazole

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5
Q

A pateint is being started on anti-psychotics and wants to avoid weight gain and T2DM risk – which should be avoided

A

Olanzapine associated with the most weight gain and highest T2DM risk

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6
Q

Which anti-psychotic do you give patients with parkinsons

A

None!!!!!!!
Give lorazepam

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7
Q

Ideas of reference

A

Innocuous or coincidental events will be ascribed significant meaning
Seeing objects arranged in a particular way and thinking someone is sending you a message

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8
Q

Self-referential experience

A

The sense than external events are connected to oneself in some way
TV/Radio are transmitting signals aimed at me

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9
Q

Passivity phenomenon

A

Disconnection between performing an action and having ownership of that action

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10
Q

Delusion

A

A fixed falsely held belief with unshakeable conviction
Impervious to logical argument

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11
Q

Knights move thinking

A

Aka looseing of associations
Unexpected illogical connections between ideas

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12
Q

Flight of ideas

A

Quick erratic speech in which the person jumps between ideas
No apparent association between ideas

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13
Q

Neologisms

A

Made up words

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14
Q

side effects of ECT

A

headache, nausea, short term memory impairment, cardiac arrhythmia

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15
Q

the amygdala processes sensory data and passes information to the?

A

hypothalamus
periaqueductal gray
hippocampus
cingulate cortex

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16
Q

what does the hypothalamus do

A

mediates bodily stress response by releasing cortisol

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17
Q

what does the periaqueductal gray do

A

mediates flight or fight response

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18
Q

what does the hippocampus do

A

responsible for memory and learning

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19
Q

what does the cingulate cortex do

A

mediates emotions of anxiety

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20
Q

short acting benzodiazepine

A

lorazepam

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21
Q

long acting benzodiazepine

A

diazepine

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22
Q

when would you use benzo to treat anxiety

A

only used for rapid relief of severe symptoms
avoid long term use

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23
Q

withdrawal side effects of benzo

A

anxiety, insomnia, depression, perceptual sensitivity

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24
Q

first line antidepressant for anxiety

A

SSRI

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25
Q

why is pregabalin used in anxiety

A

its a calcium channel blocker (indirectly enhances GABA)
consider if unresponsive to others

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26
Q

generalised anxiety disorder

A

6 months of disproportionate anxiety about everything
management: CBT + SSRI

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27
Q

what is the appetitive system

A

promotes seeking behaviours
mediated by dopamine

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28
Q

what is the aversive system

A

promotes survival in event of stress
- loss event= depression
- threat event= anxiety
mediated by serotonin

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29
Q

what is atypical depression

A

reactive mood with anxiety/rejection hypersensitivity
increased appetite/sleep

30
Q

what is cortisol dysregulation

A

stress releases cortisol
chronic stress can cause cortisol dysregulation
excess cortisol may cause depression through
- neuronal damage (low hippocampal volume)
- release of pro-inflammatory cytokines

31
Q

two main mechanisms to increase monamine activity

A

reuptake inhibition: keep monoamine in synaptic cleft
monamine oxidase inhibitor: prevent removal of monoamine from presynaptic neuron

32
Q

what type of antidepressants work through reuptake inhibition

A

tricyclics
SSRI
SNRI

33
Q

how does tricyclics work

A

inhibit reuptake of serotonin + noradrenaline (also 5-HT antagonists, membrane stabilisers)

34
Q

how do SSRIs work

A

inhibit reuptake of serotonin

35
Q

how do SNRIs work

A

inhibit reuptake of serotonin and noradrenaline

36
Q

big side effect of MAO

A

cause hypertensive crisis if taken with substance containing tyramine (cheese, wine, beer)

37
Q

examples of MAOI

A

phenylzine
moblecamide

38
Q

atypical antidepressant

A

mirtazapine

39
Q

side effect of mirtazapine

A

massive weight gain
sedation

40
Q

when to use an atypical antidepressant

A

after trial of SSRIs
especially useful if they have had trouble sleeping

41
Q

what is serotonin syndrome

A

caused by an excess of serotonin in the synaptic cleft
most often caused by taking combination of SSRI and MAOI

42
Q

presentation of serotonin syndrome

A

neuromuscular excitation- hyperflexia, clonus, myoclonus
altered mental status- agitation, insomnia, delirium
autonomic dysregulation- tachycardia, high temperature, shivering, sweating, diarrhoea

43
Q

what can a prolonged fever from serotonin syndrome lead to

A

rhabdomyolysis
metabolic acidosis
renal failure
DIC

44
Q

treatment of serotonin syndrome

A

benzodiazepine for agitation
if severe ventilation and sedation
cyproheptadine may be used- serotonin receptor antagonist

45
Q

when to use ECT in depression

A

if life threating or rapid response needed

46
Q

management if psychotic depression

A

SSRI and augment with antipsychotic

47
Q

how long to continue antidepressant treatment

A

6 months after symptoms stop

48
Q

definition of mania

A

7 days of manic symptoms- not going to list them all

49
Q

what is hypomania

A

4 days of less severe symptoms which don’t impact on function

50
Q

bipolar 1

A

one episode of mania

51
Q

bipolar 2

A

depression with episode of hypomania

52
Q

acute management of mania

A

antipsychotic + benzodiazepine
- antipsychotic- olanzapine, quetiapine or risperidone

53
Q

acute bipolar depression management

A

antipsychotic- quetiapine, olanzapine or lurasidone

54
Q

signs of toxic lithium levels

A

D&V
ataxia
course tremor
drowsiness/altered conscious level
coma

55
Q

what is the mesolimbic pathway

A

circuit where dopaminergic inputs from the ventral tegmental area innervate brain regions involved in executive, affective and motivational function

56
Q

recommended amount of alcohol per week

A

<14 units

57
Q

wernicke’s encephalopathy

A

acute thiamine deficiency
- ataxia
- nystagmus
- confusion

58
Q

korsakoff syndrome

A

chronic thiamine deficiency
- dementia
- confabulation

59
Q

detoxification of alcohol

A

benzodiazepine (gradually withdraw) + vitamin supplementation
- choose: chlordiazepoxide or diazepam
- lorazepam may be preferable in patients with hepatic failure
- carbamazepine also effective

60
Q

mechanism of alcohol addiction

A

chronic alcohol consumption enhances GABA mediated inhibition in the CNS and inhibits NMDA-type glutamate receptors
withdrawal of alcohol causes the opposite

61
Q

how many hours after last drink do symptoms start of alcohol withdrawals

A

6-12 hours

62
Q

when is the peak incidence of seizure in alcohol withdrawal

A

36 hours

63
Q

when is the peak incidence of delirium tremens in alcohol withdrawal

A

48-72 hours

64
Q

presentation of alcohol withdrawal

A

tremor
sweating
tachycardia
anxiety

65
Q

presentation of delirium tremens

A

coarse tremor
confusion
delusions
auditory and visual hallucination
fever
tachycardia

66
Q

disulfram

A

acetaldehyde dehydrogenase inhibitor
causes alcohol intolerance

67
Q

acromprosate

A

acts centrally (GABA/glutamate)
reduces cravings

68
Q

detoxification of opioids

A

methadone: full agonist
buprenorphine: partial

69
Q

opioid reversal

A

IV naloxone

70
Q

cluster A personality disorders

A

odd and eccentric
- paranoid
- schizoid
- schizotypal

71
Q

cluster B personality disorders

A

dramatic and emotional
- borderline
- histrionic
- antisocial

72
Q

cluster C personality disorders

A

anxious and avoidant
- avoidant
- dependent
- anakastic

psychiatry (6 decks)

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