Psychiatry New Flashcards

Question

First Generation Antipsychotics (3) and AEs *''High Calibre Fking''*

Answer 1

H = Haloperidol → Highest risk for EPS & NMS (falls) C = Chlorpromazine → Causes sedation & hypotension F = Fluphenazine → Fast-acting (long-acting depot), high potency, ↑ EPS risk

Answer 2

Parkinson’s disease QT prolongation

Answer 3

1st Line (SGA) Risperidone, Olanzapine Aripiprazole, Quetiapine 2nd Line (SGA switch) **3rd Line (TRS) Clozapine (life saving)**

Answer 4

Blocks D2 and serotonin receptors

Answer 5

Bone marrow suppression (Clozapine) Metabolic disorders (ROAQ)

Answer 6

Mnemonic for High-Yield SGA Side Effects: "Some Risky Antipsychotics Can Make Weighty Patients Especially Slow" Sedation → Quetiapine, Clozapine, Olanzapine Restlessness (Akathisia) → Aripiprazole Agranulocytosis → Clozapine Cardiotoxicity (Myocarditis) → Clozapine Metabolic Syndrome → Quetiapine, Clozapine, Olanzapine Weight Gain → Olanzapine, Clozapine Prolactin Increase → Risperidone EPS → Risperidone Seizures → Clozapine

Answer 7

1st line: SSRI (e.g. sertraline) 2nd line (if SSRI not tolerated): SNRI (e.g. venlafaxine, duloxetine) non-benzo options: Buspirone – non-sedating, takes 2–4 weeks to work Pregabalin – useful in resistant cases Propranolol – for somatic (e.g. palpitations, tremor) symptoms Hydroxyzine – antihistamine with anxiolytic effect 🛑 Benzodiazepines: Short-term use only (max 2 weeks) for crisis situations

Answer 8

Enhances GABA activity

Answer 9

Sedation, dependence, respiratory depression.

Answer 10

Respiratory failure Chronic alcohol use.

Answer 11

Buspirone takes 2–4 weeks to work (not for acute relief).

Answer 12

Partial agonist of serotonin receptors

Answer 13

Dizziness Headache Nausea

Answer 14

Severe hepatic impairment

Answer 15

1st CBT ERP 2nd SSRI or Clomipramine (TCA) 3rd Refer ============= Fluoxetine (Cardio risks) Sertraline Escitalopram

Answer 16

1st Line Tx (4 hrs): Methylphenidate (Ritalin) Long-acting: Concerta (12 hrs, reduces multiple daily doses) 2nd Line Tx: Dextroamphetamine (long-acting)

Answer 17

Increases dopamine and norepinephrine levels. ADHD+DN

Answer 18

Insomnia appetite suppression increased heart rate

Answer 19

Cardiovascular disease anxiety

Answer 20

Guanfacine ( 2 weeks to work) Atomoxetine (2 months to work)

Answer 21

Selective norepinephrine reuptake inhibitor

Answer 22

Severe hepatic impairment cardiovascular disease

Answer 23

3 weeks 6 days - Acute stress disorder 4 weeks 0 days - PTSD

Answer 24

Unexplained symptoms Somatisation = Symptoms hypoChondria = Cancer

Answer 25

Less than 1 mth = brief psychotic disorder > 1 mth < 6 mth = schizophreniform > 6 mth = schizophrenia

Answer 26

inhibiting the reuptake of dopamine and norepinephrine, ↑ Dop+Nore levels in the brain to reduce cravings

Answer 27

Insomnia dry mouth Seizure Risk weight loss

Answer 28

Seizure Disorder: Bupropion lowers the seizure threshold, so it’s contraindicated in individuals with a history of seizures. Eating Disorders: Conditions like anorexia nervosa and bulimia increase the risk of seizures with bupropion. Alcohol or Benzodiazepine Withdrawal: Both increase seizure risk, making bupropion unsafe in these situations. MAOI Use: Concurrent use with monoamine oxidase inhibitors (MAOIs) can lead to severe interactions; a two-week washout period is required.

Answer 29

Mirtazapine (atypical antidepressant) NaSSAs "Mirtazapine: More Mood, More Food" 🧠🍔 Blocks α2 receptors → More ST + NE (boosts mood) Less anxiety, better sleep, weight gain

Answer 30

Assessment (28 days)

Answer 31

Treatment (6 months)

Answer 32

Doctor’s holding power (72 hours) To detain an informal (voluntary) inpatient who tries to leave suddenly when they are a risk to themselves or others. I.e emergency break

Answer 33

Police removal from a public place (24 hours)

Answer 34

SG Atypical antipsychotics (e.g., Quetiapine, Olanzapine, Risperidone)

Answer 35

Somatoform Disorder: Multiple, chronic physical symptoms with no organic cause. Conversion Disorder: Sudden onset of neurological symptoms (motor or sensory) triggered by psychological stress.

Answer 36

Hypophosphataemia i.e. ↓ Phosphate Tx dietitian , phospate supplements

Answer 37

Autonomic instability – Sweating tachycardia hypertension Briskreflexes Tx Supportive/fluids Benzos serotonin antagonist - chlorpromazine (1st Gen AP) AND/OR Cyproheptadine

Answer 38

<3 Days Resume regular dose. 3–4 Days Reduce dose and titrate up cautiously. ≥ 5 Days Reinduction protocol: Start at a low dose and increase, based on withdrawal signs.

Answer 39

📟 F.E.V.E.R. Fever (Hyperthermia) Encephalopathy (Confusion) Vitals unstable (Tachycardia, BP changes) Elevated enzymes (CK↑ from rhabdomyolysis) Rigidity (Lead-pipe rigidity)

Answer 40

Drowsiness Increased Appetite/ Weight Gain Dizziness and Orthostatic Hypotension(Elderly)

Answer 41

MAOI Use (2 week washout period) Serotonin Syndrome Risk

Answer 42

Acamprosate (reduces cravings) Naltrexone (blocks pleasure)

Answer 43

Acamprosate MOA: ➡️ Modulates glutamate to reduce alcohol cravings and prevent relapse. **Best for maintaining abstinence, NOT withdrawal.**

Answer 44

Blocks opioid receptors, ↓ Pleasure of Boozing

Answer 45

Nausea Liver issues

Answer 46

Liver issues (Give Acamprosate) Opioids Pregnancy

Answer 47

Pregnancy Severe Renal issues

Answer 48

Depression scale (2 weeks) 5-9 indicates mild depression 20-27 indicates severe depression

Answer 49

Acetylcysteine

Answer 50

Flumazenil

Answer 51

Glucagon for HF/ cardiogenic shock Atropine for bradycardia

Answer 52

Bipolar I is worse ============== Bipolar I Disorder: full mania (often + depression) Bipolar II Disorder: hypomania + severe depressive episode (functioning)

Answer 53

Excessive Worry ≥ 6 months. Restlessness Muscle Tension Sleep Disturbance Impairment in Functioning basically worry doesnt fluctuate

Answer 54

H: Hyperthermia A: Autonomic Instability – Fluctuating blood pressure, tachycardia, sweating. R: Rigidity M: Myoclonus – Sudden, involuntary muscle jerks. F: Fever – Often severe and linked to hyperthermia. U: Unconsciousness L: Loss of Intestinal Control (Diarrhea) –

Answer 55

distrust and suspicion

Answer 56

Antisocial Personality Disorder: social harm Borderline Personality Disorder: emotional instability, impulsivity, fear of abandonment, and relationship difficulties. Narcissistic Personality Disorder: Known for grandiosity

Answer 57

Obsessive-Compulsive Personality Disorder (OCPD): perfectionism and rigidity Avoidant Personality Disorder: pervasive fear of rejection and avoidance of social situations

Answer 58

Immobility or Stupor Mutism Posturing (holding unusual positions)

Answer 59

Self-induced symptoms Attention-seeking Frequent hospital visits

Answer 60

Emotional withdrawal Early neglect Difficulty forming attachments

Answer 61

Psychological stressor Neurological disorder

Answer 62

Imposter delusion Misidentification Psychotic conditions (e.g., schizophrenia)

Answer 63

Detached from body Unreal surroundings Triggered by stress

Answer 64

Memory gaps Trauma-related

Answer 65

Multiple identities Distinct personalities Childhood trauma

Answer 66

Alcohol withdrawal symptoms: 6-12 hours seizures: 36 hours delirium tremens: 72 hours

Answer 67

Euphoric or irritable mood Functional impairment Psychotic features

Answer 68

Elevated mood No major functional impairment No psychotic features

Answer 69

1st CBT+EMDR 2nd SSRI OR Venlafaxine

Answer 70

Persistent Low Mood Physical & Cognitive Symptoms Anhedonia

Answer 71

Gradual progression memory loss irreversible

Answer 72

Personality change behavioral issues language deficits

Answer 73

Fluctuating cognition visual hallucinations Parkinsonism

Answer 74

Eccentric behaviour Magical Thinking Social Anxiety

Answer 75

Detached – Aloof Solitary / avoid

Answer 76

Confusion Tremors Hallucinations

Answer 77

Chlor**Diaz**epoxide Contraindicated for Liver For Liver issue patients Lorazepam /Oxazepam

Answer 78

faking illness, for external gain

Answer 79

Procyclidine muscarinic (M1) receptor antagonist

Answer 80

falls , enderly

Answer 81

GI ISSUES! Dizziness electric shock sensations anxiety

Answer 82

Psychogenic – indicating that the origin is psychological rather than neurological. Dissociative – referring to the disconnection from reality often linked to the episodes. Functional – describing symptoms that occur without structural neurological damage.

Answer 83

fearful of: criticism being unliked rejection

Answer 84

illogical leaps from one idea to another

Answer 85

visible links between ideas

Answer 86

Fluffy stuff > CBT > sertraline > Alternate SSRI/ (SNRI duloxetine and venlafaxine)

Answer 87

Donepezil (reversible ACh inhibitor) Rivastigmine 2nd line : Memantine

Answer 88

Falls (old people)

Answer 89

Psychogenic – indicating that the origin is psychological rather than neurological. Dissociative – referring to the disconnection from reality often linked to the episodes. Functional – describing symptoms that occur without structural neurological damage.

Answer 90

illogical leaps from one idea to another

Answer 91

illogical leaps from one idea to another

Answer 92

Attention-seeking (excessive need to be the center of attention) Dramatic (exaggerated emotional expression) Seductive (inappropriate or provocative behavior)

Answer 93

Olanzapine

Answer 94

Sertraline (follow up in 1 week <30 years old)

Answer 95

Confabulation Thiamine deficiency (B1) Memory impairment (anterograde and retrograde amnesia)

Answer 96

Fever Rigidity Hypotonia Tx= Stop drug + cool + dantrolene/bromocriptine

Answer 97

lip-smacking tongue protrusion

Answer 98

Rigidity resting tremor resembling Parkinson’s disease Bilateral

Answer 99

Lorazepam (benzos)

Answer 100

📉 Most things are low: Weight BMI Sex hormones (oestrogen/testosterone) → infertility, amenorrhoea FSH/LH → periods stop Bone density → risk of osteoporosis Electrolytes (e.g. potassium) → especially if purging Thyroid hormones (T3) → but TSH often normal G's and C's raised: Growth hormone Glucose (mildly) Glands (salivary glands swollen) Cortisol Stress hormone Cholesterol Carotinaemia

Answer 101

Atypical Antipycotic quentapine or Olazapine + SSRI IF NEEDED

Answer 102

STOP ANTI DEPRESSANTS give quentapine or Olazapine

Answer 103

1st Line= Lithium 2nd Line= Atypical Antipycotic (quentapine or Olazapine) 3rd Line= Valproate (mania prevention) OR Lamotrigine (depression prevention)

Answer 104

12 hours post dose weekly until stable 3 months

Answer 105

Auditory hallucinations (e.g., voices commenting on or commanding thoughts). Thought insertion, withdrawal, broadcasting. Delusions of control (made actions, made feelings). Delusional perception. Passivity phenomena (external control over thoughts, actions, and feelings).

Answer 106

**(High yield) Disorganized speech (e.g., loose associations, tangentiality).** Disorganized behavior (e.g., catatonia, childlike behavior). Affective flattening (lack of emotional response). Social withdrawal. Cognitive dysfunction.

Answer 107

● Positive symptoms ● Negative symptoms ● Psychomotor disturbance

Answer 108

Positive symptoms – Delusions, hallucinations, disordered thought.

Answer 109

Negative symptoms – Flat affect, alogia, apathy, asociality.

Answer 110

Catatonia, agitation, Tx ECT!

Answer 111

tuberoinfundibular pathway issue, Think: Hyperprolactinaemia Galactorrhoea, infertility, osteoporosis Tx: Switch to Aripiprazole (partial D2 agonist)

Answer 112

propranolol and benzodiazepines

Answer 113

BIG= Agranulocytosis ⇒ neutropaenic sepsis ● Myocarditis ● Constipation ⇒ gastric paresis ⇒ obstruction ⇒ perforation ● Weight gain ● Sedation ● Reduces seizure threshold Requires a strict monitoring regime (weekly for first 6 months)

Answer 114

"You must have both mood + psychosis together, and at some point, psychosis alone for minimum 2 weeks."

Answer 115

Circumstantiality - schizophrenia & OCD. Tangentiality - schizophrenia, delerium & dementia. Neolgism - aphasia, stroke, other brain injury, see Trumpisms e.g. covfefe. Clanging - mania, bipolar, shizophrenia. Word salad - dementia, shizophrenia, brain injury. Knight's move thinking - schizophrenia, chess players. Flight of ideas - mania & bipolar. Perseveration - brain injury & aphasia, ADHD & OCD, PTSD Echolalia - Tourette's, brain injury, schizophrenia, dementia, epilepsy.

Answer 116

schizoid pd= social isolation - odd beliefs schizoptypical pd= social isolation + odd beliefs

Answer 117

COAT Confusion Opthalmoplegia Ataxia Thiamine deficiency RACK Retrograde amnesia Anterograde Amnesia Confabulation Korsakoffs syndrome

Answer 118

✅ Give Pabrinex (IV thiamine) BEFORE any glucose ⛔️ If you give glucose first → you can precipitate Wernicke’s encephalopathy

Answer 119

LITHIUM Leukocytosis Idioptahic Intracranial Hypertension Tremor Hypothyroidism/Hyperparathyroidism Insipidus (Nephrogenic DI) Mass increased (weight gain)

Answer 120

Inhibit acetaldehyde dehydrogenase CI: Heart DS, psychosis, pregnancy

Answer 121

Partial agonist of mu-opoid receptor antagonist of kappa opoid

Answer 122

Electric shock sudden stop of drug

Answer 123

Hyperreflexia Recent med change/ drug interation

Answer 124

Lead pipe rigidity Antipsychotic use Raised CK

Answer 125

Sertraline For Breast Feeding: Sertraline

Answer 126

1st CBT 2nd SSRI (Sertaline or Paroxetine)