extra questions Flashcards
what is the difference between OCD and obsessive compulsive personality disorder
OCD is associated with distress, the action and associated with anxiety
with personality disorder, it is not associated with distress, the actions are pleasurable and desirable
medications safe in liver failure
fluoxetine will cause serotonin syndrome in addition to what medications
Monoamine oxidase inhibitors
clozapine can cause which side effects
agranulocytosis
out of SSRI SNRI TCA which one has the most effect on sexual dysfunction
TCA, SSRI are the best with the least side effects
post MI which drugs should be avoided and which can be given
TCA should be avoided
sertraline can be given
risperidone can cause which side effects
prolactine
sodium valproate moa
increases GABA, so increases calmness and sedation
lithium can cause which side effect
reduced ADH expression so polyuria and nephrogenic diabetes insipidus
which dementia medicine can be given as a patch
rivastigmine
sertraline can cause what affect in the elderly
it can cause an low sodium and can cause SIADH
which medication added can cause serotonin syndrome
tramadol
what are the two common medications used In bipolar
Olanzapine and fluoxetine
This is the best combo to avoid inducing a manic episode
If someone who has depression and bipolar and are having an episode of mania, what would you do with their medication regime
remove their antidepressant immediately
How long does someone with bipolar need to be on their medications for
Antipsychotics should be kept for as long as possible as this is a chronic condition
Is pressure of speech a psychotic symptom
NO, it is seen in many conditions such as anxiety, ADHD, PTSD
what are the two common symptoms of a thought disorder
flight of ideas - jumping between ideas
loosened association - a psychological term that describes a lack of connection between ideas. It’s a type of thought disorder that can manifest in speech as a jumble of words and phrases that jump from one idea to another,
what are the three classes of mood stabilisers and name some examples
- lithium
- anti epileptics - Carbamazepine, sodium valproate
- anti - psychotic - haloperidol
what is lithium toxicity
it is when the concentration of lithium in the blood stream is too high
usually if someone who is on lithium presents as very unwell then assume lithium toxicity until proven otherwise
why would someone be suffering from lithium toxicity?
- due to direct damage to the kidneys they can’t excrete It
- if they are on an diuretic - they are more dehydrated and so there is a higher amount of lithium
- DCT may mistake lithium as sodium as they are both class one metals and so might reabsorb it
some side effect of lithium
- hypothyroidism (goitre )
- weight gain
- avoid NSAIDS and ACEi
- polyuria
- nephrogenic diabetes insipidus
how do we treat lithium toxicity
A-E
stop lithium
fluids via dialysis
AnE
what are the three top main psych emergencies
- lithium toxicity
- serotonin syndrome
- neuro epileptic malignant syndrome
who would you avoid using sodium valproate In
WOMEN who are at a child bearing age !!
due to its teratogenic effects causing deformity in 3/10 babies
what is a side effect of olanzapine
It is a sedative which usually causes weight gain
what is the effect of risperidone on ladies
- It reduces dopamine levels
- increases prolactin
- can cause issues with menstruation
- can cause an increase In breast and uterine cancer
what is the difference between loose associations and tangentiality when considering a thought disorder
loose associations -> Its when the person jumps between different ideas and they are completely different
tangentiality -> the person goes of topic but the thoughts are along the same line, they often dont go back to original thought
what are the key features of lithium toxicity
Its often symptoms of dehydration
* - corse tremor
* - confusion
* -ataxia
* - hyperreflexia
* -N+V
what are the side effects of TCAs such as amitriptyline
urinary retention and dry eyes
what is the first line treatment for delirium tremens
oral lorazepam - benzos are first line
offer vitamin B1 (thiamine) this or pabrinex is usually for wernickers but can give as supportive meds
what is a side effect of haloperidol
akathisia
inner restelessness
urge to constantly move around
can cause significant distress
what is a grid prognostic indicator for improving from schizophrenia
high IQ
along with giving IV fluids as a support for lithium overdose what can also be done
urine alkalisation, it helps with eliminating it
risperidone vs donepezil in dementia
risperidone -> used in BPSD
donepezil -> used to slow down the progression of dementia, along with rivastigamine
donepezil should be avoided in which conditions
by slowing the breakdown of a chemical called acetylcholine in the brain. Higher levels of acetylcholine improves communication between nerve cells in the brain
helps slow the memory loss and confusion
sick sinus syndrome and peptic ulcer disease
alogia
The patient demonstrates alogia, or paucity of speech. This is a common negative symptom of schizophrenia.
side effects of carbamazepine
CARBA MEAN”
Confusion
Ataxia
Rashes
Blurred vision
Aplastic anaemia
Marrow (bone marrow) suppression
Eosinophilia
ADH release
Neutropenia
A 17-year-old boy is brought to the Emergency Department by his parents. He believes that he is an angel and that his parents have been sent by the Devil to kill him. The boy states that he hears the voice of God telling him what to do. The boy demands to leave the emergency department as he has received instructions from God telling him to jump from the roof of a nearby carpark.
What should the doctors in the emergency department do whilst waiting for the psychiatrist to arrive?
can hold him with the capacity act
A 58-year-old woman has been struggling with a severe depressive episode for the last two months. She has been prescribed sertraline for the last 6 weeks with no improvement in her mood. She is struggling to sleep, has no appetite and is losing weight. She is also receiving CBT. A decision is made to stop the sertraline.
What would be an appropriate medication to trial next given her symptom profile?
mirtazipine
covers all bases. It’s a rubbish question, all would be fine. Technically if it’s first presentation Fluoxetine or Citalopram (1st line is SSRI)
A 24-year-old woman presents to her GP with an 8-week history of hearing voices outside her flat talking about her and commenting on everything she does.
What would be the most appropriate diagnosis?
Paranoid schizophrenia - not paranoid personality disorder because this wouldn’t present with hallucinations or delusions
you need symptoms for at least a month to be diagnosed with schizophrenia
when writing about schizophrenia how to type it
paranoid schizophrenia
A 22-year-old medical student goes to see her GP. She is struggling to deliver presentations to large groups of people. She does not enjoy going to parties and being the focus of attention.
She finds these situations difficult, and they cause her a lot of worry and anxiety, with physical symptoms of anxiety. She states that she is very similar to her mother in this regard. She does enjoy going to London and Birmingham shopping, and she also enjoys going to the cinema.
What would be the most appropriate treatment?
social anxiety disorder - first line is ALWAYS CBT
lady has mania, what do you treat her with
oral quetiapine NOT lamotrigine because that’s first line for bipolar depression and used as an anti-epileptic
what is an overvalued idea
strong belief but when challenged you can change your mind, for example being told there is no evidence
A 39-year-old man who is known to have schizophrenia is admitted to hospital. He stopped taking clozapine (500mg/day) 5 days ago. His full blood count is normal.
What is the most appropriate course of action after talking to the patient and gaining their consent?
Restart clozapine using a 2 week escalation chart.
if clozapine has been stopped for more than 48 hours then you need to start low and re titrate
patient is on lithium, what anti hypertensive is the safest to use
atenolol
A 47-year-old man is admitted to a medical ward with ascites. On the second day of admission, he becomes increasingly irritable with staff and is hot, sweaty, and tremulous. day he has a witnessed 30 second tonic-clonic seizure. He is seen by the crash team and regains consciousness.
What medication might be used to manage his symptoms?
delirium tremens
- you give a high dose of benzodiazepine (Chlordiazepoxide) then work down
delusion of reference
a type of psychotic symptom where a person believes that ordinary events have special meaning and are related to them personally
A 21-year-old man presents to the Emergency Department. He asks for a brain operation to remove the chip from his brain. He is clear that the chip has been inserted by the government to monitor his actions. He feels the chip moving when it is activated. He can also hear government operatives talking through the chip and commenting on his activities.
What symptoms is he describing?
Delusion of persecution, tactile hallucinations, 3rd person auditory hallucinations
what auditory hallucination if that are commentating on the person “shreya is doing this and that”
third person - running commentary about you
2 - they are talking 2 you directly
A 57-year-old woman is admitted to an orthopaedic ward with a fractured wrist following a fall. She has no EPS (extra-pyramidal symptoms) on examination and does not have a history of falls previously. She is diagnosed with osteoporosis. She has a past history of schizophrenia and is on a depot antipsychotic every 2 weeks.
Blockade of dopamine in which pathway in the brain may have contributed to her current presentation?
tubero infundibular - it causes high prolactin, which reduces oestrogen which reduces bone strength
which dopamine pathway causes oestoperosis
tuberoinfundibular
A 60-year-old woman is admitted to hospital with low mood. She has a history of alcohol dependence (drinking 20 units a day). She is noted to have an ataxic gait.
What medication is essential to prescribe from the following list?
Parenteral B vitamins
in wernickers need to make it ask fast
A 37-year-old man is known to be suffering from a bipolar affective disorder. He presents with severe depressive symptoms.
Which antipsychotic medicine would be most suitable?
quetiapine for acute
risperidone for maintenance
what is clozapine reserved for
treatment resistant schizophrenia, due to its high side affects of agranulocytosis.
Offer another atypical antipsychotic first such as risperidone
A 62 year old male presents to the GP with his wife. She is complaining that he has had personality changes over the past year. A more detailed history reveals that he has started gambling, and his social conduct is generally impaired. Over time, his language skills have also deteriorated, and he has difficulty finding the right words.
Selective serotonin reuptake inhibitor
This is correct. The patient’s symptoms suggest frontotemporal dementia (FTD), characterised by personality changes, impulsivity, and language difficulties. SSRIs can help manage behavioural symptoms such as disinhibition, which are common in FTD.
what are the three features in normal pressure hydrocephalus
Wet, Wobbly and Wacky otherwise presenting as urinary incontinence, gait dysfunction and dementia
how long post birth is the cut off for post partum depression
within the first 12 months, if it develops later it will usually just be depression
what is the time frame for post partum psychosis
usually develops 2 weeks post partum
difference between narcissistic and histrionic personality disorder
Histrionic personality disorder is characterised by overly intimate or sexually inappropriate behaviour and excessive displays of emotion.
Narcissistic personality disorder is characterised by entitlement and a lack of empathy for others also shows grandiosity
with children who have eating disorders which is the best form of therapy for them?
family focused therapy
munchausens vs malingering
munchausens is intentionally faking signs and symptoms (i.e. adding blood to urine and complaining of pain) in order to gain attention and play “the patient role”.
malingering is when they do it for secondary gain such as getting money seeking disability
which SSRI can be given during breast feeding
SSRI
what is given to reverse an opioid overdose VS treat withdrawal
- naloxone is used to reverse it
- with withdrawal it is usually supportive if medications ; methadone or buprenorphine
if patient is in warfarin then what antidepressant can he be given
Mirtazapine
with anorexia what biochemistry result will you see
raised serum cholesterol
which medications reduces lithium clearance
thiazide
what blood test is seen in patients with purge bulimia
vs with laxative
- hypokalemia
- metabolic alkalosis
with laxatives they will have metabolic acidosis
how long can post partum depression take to develop
up to a year
which antidepressants are known to cause sexual dysfunction
SSRI along with constipation, gastric ulcers
