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Lectures Flashcards

1
Q

What is the most common group of mental disorders in ICD-10?

A

Mood disorders

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2
Q

What are mood disorders?

A

Disorder of mental status and function where altered mood is the (or a) core feature

Refers to states of depression and of elevated mood-mania

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3
Q

How can mood disorders present?

A

Primary problem or consequence of other disorders or illness e.g cancer, dementia, drug misuse or medical treatment

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4
Q

What symptoms are mood disorders often associated with?

A

Anxiety disorders

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5
Q

What is dysthymia?

A

Below threshold version of depression, carry out normal activities but low mood.

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6
Q

What is depression?

A

Symptom = emotion within the range of normal experience

Syndrome = a constellation of symptoms and signs

Recurrent illness = recurrent depressive disorder

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7
Q

When does depression become a disorder?

A
  1. Persistence of symptoms (at least 2 weeks)
  2. hypervasiveness of symptoms
  3. degree of impairment
  4. presence of specific symptoms or signs
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8
Q

What are the 3 categories for the symptoms of depressive illness?

A

Psychological
Physical
Social

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9
Q

List psychological symptoms of depressive illness.

A

Change in mood: depression, anxiety, perplexity, anhedonia

Change in thought content: built, hopelessness, worthlessness, neurotic (e.g obsessive thoughts, panic attacks), delusions and hallucinations

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10
Q

List physical symptoms of depression.

A

Change in bodily function e.g energy, sleep, appetite, libido, constipation, pain

change in psychomotor functioning e.g agitation, retardation

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11
Q

Give an example of an idea of reference.

A

E.g group of people are laughing and you assume they are laughing at you.

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12
Q

What is a delusion?

A

belief or impression maintained despite being contradicted by reality or rational argument

e.g feel like you are rotting inside

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13
Q

List social symptoms of depressive disorders.

A

Loss of interest
irritability
apathy
withdrawal, loss of confidence, indecisiveness, loss of concentration, registration, memory

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14
Q

How long does a patient need to have symptoms to diagnose a depressive disorder?

A

2 weeks

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15
Q

What is anhedonia?

A

loss of ability to derive pleasure from experience

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16
Q

What is apathy?

A

Loss of interest in own surroundings

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17
Q

According to the ICD-10, what is required to confirm depressive disorder?

A

2 weeks
no hypomanic or manic episodes
not linked to psychoactive substance

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18
Q

What is somatic syndrome.

A

Can occur without feelings of sadness/low mood

Lack of interest/pleasure/emotional reactions.
Depression worst in morning
Loss of appetite, weight loss and loss of libido.

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19
Q

What do you need to diagnose mild depression and moderate depression.

A

2 of……

  • abnormal depressed mode most of day almost everyday for past two weeks
  • loss of interest or pleasure
  • decreased energy/increased fatigue

Mild - 4 out of the list of symptoms. Moderate - 6 out of the list of symptoms

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20
Q

When is there an increased risk of postpartum depression?

A

30 days after childbirth up to 24 months

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21
Q

What are differentials for depressive disorders?

A 
normal reaction to life event 
SAD
Dysthymia
Cyclothymia
Bipolar 
Stroke
Tumour
Dementia
Hypothyroidism
Addison's 
Hyperparathyroidism
Infections e.g influenza, hepatitis, HIV
Drugs
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22
Q

What is the first line treatment for depressive disorders?

A

SSRIs

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23
Q

Apart from SSRIs, what are other antidepressants used for depressive disorders?

A

TCAs, monoamine oxidase inhibitors

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24
Q

Apart from meds, what else can be used to treat depressive disorders?

A

Psychological e.g CBT

Physical e.g ECT, psychosurgery, vagus nerve stimulation

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25
Q

How do you measure depressive disorders?

A

SCID

SCAN

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26
Q

What is mania?

A

Elevated mood often associated with grandiose ideas, disinhibition, loss of judgement, similarities to stimulant drugs e.g cocaine.

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27
Q

What are 4 key points of mania?

A

Persistence of symptoms
pervasiveness of symptoms
degree of impairment
presence of specific signs or symptoms

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28
Q

What is hypomania?

A

Lesser degree of mania with no psychotic symptoms (hallucinations, delusions)

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29
Q

List symptoms of mania.

A 
elevated mood
increased energy 
overactivity
pressure of speech 
decreased need for sleep 
disinhibition 
grandiosity 
alteration of senses
extravagant spending 
can be irritable

1 week of symptoms severe enough to disrupt work and social activities

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30
Q

List differential diagnoses for mania.

A 
Mixed affective state
Schizoaffective disorder
Schizophrenia
Cyclothymia
ADHD
Drugs and alcohol
Stroke 
Tumour 
Epilepsy 
AIDS
Neurosyphilis
Cushings
Hyperthyroidism
SLE
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31
Q

What tools can you use to measure mania?

A

SCID, SCAN

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32
Q

What are treatment options for mania?

A

Antipsychotics
Mood stabilisers
Lithium
ECT

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33
Q

List examples of antipsychotics.

A

Olanzapine
Risperidone
Quetiapine

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34
Q

Give examples of mood stabilisers.

A

Sodium valproate
Lamotrigene
Carbamazepine

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35
Q

What is bipolar affective disorder?

A

Repeated (2+) episodes of depression and mania or hypomania

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36
Q

What is the epidemiology of bipolar disorder?

A 
Early onset (15-19) usually with positive FH
M=F
Mean age of onset is 21
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37
Q

What is the epidemiology of depression?

A

Mean age = 27
F:M = 2:1
Less common in those employed and financially independent
Associated with lower educational attainment
First episode can be linked to adverse life event

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38
Q

What is the clinical course and outcome of major depression?

A

4-6 month duration
around half recover in 26 weeks
80+% have further episodes

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39
Q

What is the clinical course and outcome of bipolar/mania?

A

1-3 months
60% recover at 10 weeks
90% have further episodes

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40
Q

What is the most common type of affective disorder?

A

Depression

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41
Q

List three common mental health disorders.

A

Affective/anxiety

Substance misuse

Disorders of reaction to psychological stress

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42
Q

Give examples of affective/anxiety disorders.

A

Major depressive disorder
Generalised anxiety disorder
Panic disorder and phobic anxiety
OCD

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43
Q

Give examples of substance misuse disorders.

A

Due to drugs, tobacco, opioids/benzo/stimulants

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44
Q

Give an example of disorders of reaction to stress.

A

PTSD

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45
Q

What is cognitive behavioural therapy?

A

Show how thoughts affect/are related to feelings and behaviour
Patient centred
Goal orientated
Can involve exposure therapy

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46
Q

What is CBT useful for?

A 
Depression 
Anxiety 
Phobias
OCD 
PTSD
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47
Q

Give examples of ‘thinking errors’.

A 
Automatic negative thoughts 
Unrealistic beliefs 
Cognitive distortions
Catstrophizing
Balck and white/all or nothing thinking 
Perfectionism
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48
Q

What is behavioural activation?

A

Activities function as avoidance and escape from aversion, thoughts, feelings and external situations

Client taught to analyse unintended consequences of the way they are responding

Collaborative/empathic/non-judgemental

Small changes –> long term goals

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49
Q

What is interpersonal psychotherapy?

A

Focussed on present
Time limited
Treatment for depression/anxiety

Depression often follows a disturbing change in or contingent with significant I-P event

Construct interpersonal map and focus area

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50
Q

List 4 therapies used for common mental health disorders.

A

CBT
Behavioural activation
IPT
Motivational interviewing

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51
Q

What are benefits of interpersonal psychotherapy.

A

No homework

Can continue practising skills

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52
Q

What are disadvantages of IPT?

A

Requires reflection

Limited interpersonal support if poor social networks

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53
Q

What is motivational interviewing?

A

Promotes positive behaviour change

Used where behaviour change is being considered when patient may be unmotivated or ambivalent to change

More effective than advice giving

Shows empathy, avoids argument, support self-efficacy

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54
Q

What are the stages of change?

A

Pre-contemplation -> contemplation -> planning -> action -> maintenance

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55
Q

What is stigma?

A

Devalues people due to distinguishing characteristic

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56
Q

List approaches to reduce stigma in mental illness.

A 
Societal 
Individuals 
Good medication management
CBT
Consider own attitudes and awareness
Influence of celebs
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57
Q

What are controversies in mental health?

A

Diagnosis, social control, treatment without consent, rising rates of antidepressant prescription, security, detention, ECT

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58
Q

List indications for antidepressants.

A

Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders (OCD, panic, social phobia, PTSD)

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59
Q

How long does it take for antidepressants to reach their maximum effect?

A

3-6 weeks

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60
Q

List classifications of antidepressants.

A 
TCAs
MAOIs
SSSRIs
SNRIs
Novel antidepressants
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61
Q

What are the unacceptable side effects of TCA?

A

Antihistaminic (sedation and weight gain)
Anticholinergic (dry mouth, eyes, constipation, memory defects)
Antiandrenergic (orthostatic hypotension, sedation, sexual dysfunction)

QT lengthening

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62
Q

What are tertiary TCAs?

A

Amine side chains

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63
Q

Give examples of tertiary TCAs.

A

Imipramine, amitriptyline

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64
Q

What are the differences between tertiary and secondary TCAs?

A

Tertiary - block serotonin

Secondary - block noradrenaline, less severe side effects

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65
Q

What are side effects of MAOIs?

A

Orthostatic hypotension, weight gain, dry mouth, sedation, sexual dysfunction, sleep disturbance

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66
Q

What can develop when MAOIs are taken with tyramine-rich food or sympathomimetics?

A

CHEESE REACTION - Hypertensive crisis

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67
Q

What can causes serotonin syndrome?

A

If taking MAOI with meds that increase serotonin or have sympathomimetic actions.

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68
Q

What are symptoms of serotonin syndrome?

A

Abdo pain, diarrhoea, sweats, tachycardia, HTN, myoclonus, irritability delirium

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69
Q

How do SSSRIs work?

A

Block serotonin pre-synaptic re-uptake

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70
Q

What are SSRIs used for?

A

Anxiety and depression

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71
Q

What are most common SEs of SSRIs?

A

GI upset, sexual dysfunction, anxiety, restlessness, nervousness, insomnia, fatigue, sedation, dizziness

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72
Q

Give examples of SSRIs.

A 
Paroxetine
Sertraline
Fluoxetine 
Citalopram 
Escitalopram 
Fluvoxamine
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73
Q

What is discontinuous syndrome?

A

Coming of SSRIs - lasts about 1 week - 10 days (agitation, nausea, dysphoria)

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74
Q

What is activation syndrome?

A

Serotonin reuptake inhibitors (SSRI) have been associated with a state of restlessness, lability, agitation, and anxiety termed “activation syndrome”. In some people, this state change can increase suicidal tendencies, especially in those under age 25 and during the initial weeks of treatment.

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75
Q

How do SNRIs work?

A

Inhibit serotonin and noradrenergic reuptake like the TCAS but without anthistamine, antiadrenergic or anticholinergic side effects

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76
Q

Give examples of SNRIs.

A

Venlafaxine
Duloxetine
Mirtazapine

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77
Q

Susie has a non psychotic unipolar depression with no history of hypomania or mania. She has depressed mood, hyperplasia, psychomotor retardation and hyper somnolence. What agent would you use to treat her?

A

SSRI

Citalopram, Fluoxetine or Sertraline
less sedating

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78
Q

55yo DM, mild HTN, painful diabetic neuropathy, previous depressive episodes and one suicide attempt. Treated with paroxetine, sertraline and bupoprion. What would you treat him with?

A

Duel reuptake inhibitor as ge had not achieved remission with two SSRIs.

Don’t give venlafaxine since HTN.

Duloxetine good since indication for neuropathic pain, depression and anxiety.

Don’t give TCA since lethality in overdose.

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79
Q

How do you treat resistant depression?

A

SSRI –> SNRI
Combine antidepressants e.g SSRI or SNRI + Mirtazepine

Adjunctive Rx with lithium
Adjunctive Rx with atypical antipsychotic]

ECT

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80
Q

Discuss prophylaxis of antidepressants.

A

1st episode - 1 year

2nd episode - 2 years

3rd episode = lifelong

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81
Q

What are indications for mood stabilisers?

A

Bipolar
Cyclothymis
Schizoaffective

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82
Q

List classes of mood stabilisers.

A

Lithium, anticonvulsants, antipsychotics

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83
Q

What is the only medication that has been shown to reduce suicide rate?

A

Lithium

84
Q

What is lithium used for?

A

Long-term prophylaxis of mania and depressive episodes in 70%+ of bad.

85
Q

What do you need to get a baseline of before starting lithium?

A

U&E and TSH

since hypothyroidism and small vessel damage in kidneys

86
Q

Why should you do a pregnancy test before prescribing lithium?

A

Ebstein’s anomaly

87
Q

What are the most common side effects of lithium?

A

GI distress, reduced appetite, N&V, diarrhoea, thyroid abnormalities, nonsignificant leukocytosis, polyuria, hair loss, acne, intention tremor, convulsions

88
Q

Give examples of anticonvulsants used as mood stabilisers.

A

Valproic acid

89
Q

What tests do you need to do before starting valproic acid?

A

Baseline LFTs, FBC and pregnancy test

90
Q

List SEs of valproic acid

A 
N&V
Sedation 
Tremor
Hair loss
Platelet dysfunction 
Thrombocytopenia
91
Q

What is carbamazepine prescribed for in psychiatry?

A

First line for acute mania and mania prophylaxis

92
Q

What tests do you need to carry out before taking carbamazepine?

A

FBC, ECG, LFTs

93
Q

What are SEs of carbamazepine?

A

Rasg
N&V&D
Sedation, dizziness, ataxia, confusion, aplastic anaemia, agranulocytosis, water retention

94
Q

What are SEs of lamotrigine?

A 
N&V
Sedation 
Dizziness
Confusion 
Stevens Johnson's Syndrome
95
Q

What is lamotrigine used for?

A

Bipolar depression

96
Q

What are antipsychotics prescribed for?

A

Bipolar affective disorder

97
Q

Give examples of antipsychotics

A

Ariprazole
Risperdone
Quetiapine
Olanzapine

98
Q

33 year old woman, hospitalised with first episode of mania, no previous history of a depressive episode, no drug or ETOH history and has no medical issues. What medication would you start?

A

Lithium

Remember to check for pregnancy, TFT and U&Es

99
Q

You start Mary on a 800mg dose of lithium when she comes to see you in one week, she I complaining of stomach irritation and diarrhoea. What do you think is going on and what should you do?

A

GI irritation including diarrhoea is common particularly in early treatment

encourage to drink

100
Q

27yo male admitted secondary to manic episode. Review history and find he has 5 to 6 manic or depressive episodes a year. Also struggled on and off with ETOH abuse. What medication would you like to start?

A

Depakote since rapid cycler (4 or more depressive or mani episodes/year) and because of comorbid ETOH abuse

101
Q

A patient on Depakote has raised LFTs, what happened and what do you do?

A

Not unusual for anticonvulsants to increase LFTs and as long as they don’t triple, no change in therapy indicated.

102
Q

What is psychosis?

A

An inability to distinguish between symptoms of delusion, hallucination and disordered thinking form reality

103
Q

What are hallucinations?

A

Have the full force and clarity of true perception, no external stimulus, not willed or controlled, located in external space

Sensory - x5 (auditory/visual, tactile, olfactory and gustatory)

104
Q

What is a delusion?

A

An unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction.

105
Q

What illnesses may have psychotic symptoms?

A

Schizophrenia
Delirium
severe affective disorder (e.g depressive episode with psychosis, manic episode with psychosis)

106
Q

What is schizophrenia?

A

Severe mental illness affecting thinking, emotion and behaviour. Most common cause of psychosis.

107
Q

What are symptoms of schizophrenia?

A

Hallucinations, delusions, disordered thinking

Apathy, lack of interest, lack of emotions

108
Q

According to the ICD-10, what are the symptoms/signs of schizophrenia?

A

For more than a month in the absence of organic or affective disorder, at least one of:

  • Alienation of thought
  • passivity
  • hallucinatory voices
  • persistent delusions

AND/OR 2 of:

  • persistent hallucinations
  • breaks or interpolations in the train of thought
  • catatonic behaviour
  • “negative” symptoms e.g apathy
109
Q

How many types of schizophrenia are there? Give examples of 2.

A

9
Paranoid
Residual

110
Q

What are risk factors for psychosis?

A
  • Biological: genetics, neurochemistry e.g “dopamine hypothesis”, obstetric complications, maternal influenza, substance misuse, malnutrition and female
  • Psychological
  • Social: occupation, social class, migration, social isolation, life event precipitants
  • Evolutionary theories e.g Jung’s concept of collective unconscious
111
Q

What would suggest delirium or acute organic brain syndrome psychosis?

A

Consequence of brain or systemic disease, prominent visual hallucinations and illusions affect of terror, delusions are prosecutors and evanescent, worse at night

112
Q

What would suggest depressive episode psychosis?

A

Delusions of guilt, worthlessness and persecution, derogatory auditor hallucinations

113
Q

What would suggest manic episode psychosis?

A

Delusions of grandeur, special powers or messianic roles, gross overactivity, irritability and behavioural disturbance, manic excitement

114
Q

What are signs of schizoaffective disorder?

A

Mix of affective and schizophrenia like features.

115
Q

What early intervention services should be in place for the diagnosis of the first episode of schizophrenia?

A

Family involvement
Psychological interventions
Vocational/educational interventions
Antipsychotic medication

116
Q

If there is no response to a medication despite dose optimisation, how long should you wait before changing antipsychotics for schizophrenia?

A

4 weeks

117
Q

What medication should be considered first for acute exacerbations or recurrence of schizophrenia??

A

Amisulpride
Olanzapine
Risperidone

alternative = chlorpromazine

118
Q

What should be considered for maintenance treatment of schizophrenia?

A

Amisulpride
Olanzapine
Risperidone

alternative = chlorpromazine

119
Q

How long should maintenance treatment for schizophrenia be offered for?

A

2 years

120
Q

How do you treat treatment resistant schizophrenia (not responded to 2)?

A

Clozapine

Then Clozapine + second SGA

Then dozapine augmentation with lamotrigine

121
Q

What psychological therapies can be used for schizophrenia?

A

CBT
Cognitive remediation
Family intervention
Social skills training

122
Q

Who should not take clozapine?

A

Women who are breast feeding.

Pregnancy

123
Q

List good prognostic factors for schizophrenia.

A

Absence of family history, good premorbid function
acute onset
mood disturbance
prompt treatment

124
Q

What are poor prognostic factors for schizophrenia?

A

Slow onset
Prominent negative symptoms
Comorbidity

125
Q

What are the principles of the mental health (care and treatment) (Scotland) act 2003?

A 
Non-discrimination
Equality 
Respect 
Reciprocity 
Informal care 
Participation 
Child welfare
126
Q

What does section 328 define a mental disorder as?

A

Any mental illness, personality disorder or learning disability, however caused or manifested

127
Q

List four key civil compulsory powers to detain.

A

EDC - 72 hours

STDC - 28 days

CTO - 6 months

Nurses holding power - 3 hours

128
Q

Who can detain with a STDC or EDC?

A

Medical practitioner

129
Q

What is the process for a compulsory treatment order?

A

Application to mental health tribunal made by mental health officer. Mental health report ( GP + approved medical practitioner or 2 medical practitioners)

130
Q

What are the principles for detaining a patient?

A

Mental disorder and as a result patient’s decision making impaired, necessary for Rx that is available, risk to individual and/or others, order necessary

131
Q

Who does the adults with incapacity (Scotland) act 2000 protect?

A

Individuals incapable of acting, making decisions, communicating decisions, understanding decisions, retaining memory of decisions

132
Q

When applying for the adults with incapacity act, what must be considered?

A

Intervention must benefit, least restrictive option, consider past/present wishes of individual, relatives, guardians, attorneys etc.

133
Q

What do you assume with regards to capacity?

A

It is present unless proven otherwise

134
Q

What are the two powers regarding the adults with incapacity act?

A

Intervention order or guardianship order

135
Q

What powers do the police have for mentally disordered offenders according to the criminal procedure (Scotland) act 1995?

A

Removal from public place if an immediate need of care/Rx, removal to safe place

Can detain for 24 hours

136
Q

According to the criminal justice and licensing (Scotland) act 2010, is a person with a mental disorder criminally responsible?

A

No, unless personality disorder with abnormally aggressive or seriously irresponsible conduct.

137
Q

What are the forensic roles according to the criminal justice and licensing (Scotland) act 2010?

A

Restriction, assessment, treatment, interim and compulsion orders

Transfer for treatment

138
Q

What mental health facilities are available in Scotland?

A

State Hospital (Carstairs) - high security on account of dangerous, violent or criminal propensities

Medium secure unit - less security

Low security unit - patients have more access to the community

139
Q

List different types cluster A personality disorders.

A

Paranoid personality disorder
Schizoid personality disorder
Scizotypical personality disorder

140
Q

What is the diagnostic criteria for paranoid personality disorder?

A

Pervasive distrust and suspiciousness of others such as their motives are interpreted as malevolent, beginning in early adulthood and present in different contexts.

  • Suspects
  • Preoccupied with unjustified doubts
  • reluctant to confide in others
  • reads hidden demeaning or threatening meanings
  • persistently bears grudges
  • perceives attacks on his or her character
  • recurrent suspicion of fidelity of sexual partner
141
Q

What is the diagnostic criteria for schizoid personality disorder?

A

Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood.

  • neither desires nor enjoys close relationships (including family)
  • almost always chooses solitary activities
  • Little interest in sexual experiences
  • pleasure from few activities
  • Lacks close friends
  • indifferent to praise/criticism
  • detached
142
Q

What is the diagnostic criteria for schizotypical personality disorder?

A

Pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as cognitive or perceptual distortions and eccentrics of behaviour

  • ideas of reference
  • odd beliefs/magical thinking
  • unusual perceptual experiences
  • odd thinking and speech
  • suspicious/paranoid ideation
143
Q

What are the prominent problems with cluster B personality disorder?

A

With keeping feelings tolerable without criticism

144
Q

List 4 examples of cluster B personality disorders.

A

Antisocial
Narcissistic
Borderline
Histrionic

145
Q

What is antisocial personality disorder?

A

Pattern of disregard for and violation of the rights of others, occurring since 15 years.
At least 18 years old
Antisocial behaviour not exclusive during course of schizophrenia or bipolar disorder

146
Q

What is borderline personality disorder?

A

Pervasive pattern of instability of interpersonal relationships, self image and affects and marked impulsivity, beginning early adulthood, present in various contexts

147
Q

List signs of borderline personality disorder.

A
  • Frantic efforts to avoid real or imagined abandonment
  • unstable/intense interpersonal relationships (extremes of idealisation and devaluation
  • identity disturbance
  • impulsivity in at least 2 areas
  • recurrent suicidal behaviour
  • chronic feelings of emptiness
  • inappropriate intense anger, difficult to control
  • transient stress related paranoid ideation
  • marked reactivity of mood
148
Q

What are signs of narcissistic personality disorder?

A

Pattern of grandiosity, need for admiration and lack of empathy.

Fantasies of unlimited success/power
Sense of entitlement
Envious of others and believes others are envious of him

149
Q

What is histrionic personality disorder?

A

Excessive emotional and attention seeking

Uncomfortable if not centre of attention
Inappropriate sexual seductive or provocative behaviour
Self dramatised/theatrically/exaggerated emotions

150
Q

What are the prominent problems of cluster C personality disorders?

A

Relate to anxiety and how it is managed (in relationships)

151
Q

Give examples of cluster C personality disorders?

A

Obsessive-compulsive (Anankastic) personality disorder
Avoidant personality disorder
Dependent personality disorder

152
Q

How do you treat borderline personality disorder?

A

Dialectic behavioural therapy

Mentalization-based treatment

Symptomatic prescribing

Co-occuring mental illness

153
Q

What is dependent personality disorder?

A

excessive need to be taken care if that leads to submissive and clinging behaviour and fears of separation

154
Q

What is obsessive compulsive personality disorder?

A

Preoccupation with orderliness, perfectionism and mental and interpersonal control, at expense of flexibility, openness and efficiency

155
Q

What is avoidant personality disorder?

A

Pattern of social inhibition, feeling of inadequacy and hypersensitivity to negative evaluation

156
Q

List indications for use of antipsychotics?

A

Schizophrenia, schizoaffective disorder, bipolar disorder - for mood stabilisation and/or when psychotic features are present, psychotic depression

157
Q

What pathways ate affected by dopamine?

A

Mesocortical, mesolimbic, nigrostriatal, tuberoinfundibular

158
Q

What can dopamine hypoactivity cause?

A

Parkinsonian movements

159
Q

Blocking dopamine in the tuberoinfundibulnar pathway can cause what?

A

Hyperprolactinameia

160
Q

What are the two main types of antipsychotics?

A

Typicals and atypicals

161
Q

What are typical antipsychotics?

A

D2 dopamine receptor antagonists

162
Q

Which type of antipsychotic cause more side effects?

A

Typicals

163
Q

What extrapyramidal side effects are caused by typical antipsychotics?

A

tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, and bradyphrenia,

164
Q

List typical antipsychotics that have extrapyramidal side effects?

A

Fluphenazine, haloperidol, primozide

165
Q

What are atypical antipsychotics?

A

serotonin-dopamine 2 antagonists

166
Q

List examples of atypical antipsychotics.

A

Risperidone
Olanzapine
Aripiprazole

167
Q

List examples of atypical antipsychotics.

A 
Risperidone
Olanzapine
Aripiprazole
Quietiapine
Clozapine
168
Q

What are side effects of Risperidone?

A

Weight gain, sedation, EPSE

169
Q

What antipsychotic is used for treatment resistance?

A

Clozapine

170
Q

What are serious adverse effects of antipsychotics?

A

Tardive dyskinesia (TD)
Neuroleptic malignant syndrome
Extrapyramidal side effects

171
Q

List Neuroleptic malignant syndrome symptoms.

A

severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and LFTs, fatal

172
Q

What is the inly drug to be beneficial in treatment resistance?

A

Clozapine

173
Q

What agents are used for extrapyramidal side effects?

A

Anticholinergics - benztropine, trihexyoheidyl, diphenhydramine

Dopamine facilitators

Beta blockers

174
Q

What are side effects of clozapine?

A

Weight gain, sedative, agranulocytosis, seizures

175
Q

What prophylaxis is given for schizophrenia.

A

Life long, compliance issues, lack of insight, long acting IM injection, may need to use mental health act.

176
Q

What happens with recurrent episodes of schizophrenia?

A

Negative symptoms develop with recurrent episodes of schizophrenia

177
Q

What is the only neuropsychiatric emergency?

A

Neuroleptic malignant syndrome

178
Q

21 yo male, schizophrenia, admitted for profound psychotic symptoms, treatment naive. What bloods should you take?

A

LFT, Glc, fasting lipid, CBC

179
Q

If a schizophrenic patient has mildly elevated total cholesterol and a low HDL. What meds would you choose?

A

Risperidone, Aripiprazole, Ziprasidone

180
Q

Name two antipsychotics which have an increased risk of dyslipidaemia.

A

Olanzapine, Quetiapine

181
Q

How do you treat akathisia which is a common side effect of risperidone?

A

Propranolol

182
Q

What are anxiolytics used to treat?

A

Panic disorder, generalised anxiety disorder, substance-related, withdrawal, insomnias and parasomnias.

183
Q

What are anxiolytics often combined with?

A

SSRIs or SNRIs

184
Q

What are side effects of benzodiazepines?

A 
Somnolence, cognitive deficits 
Amnesia
Disinhibition 
Tolerance
Dependence
185
Q

Name 3 models of stress.

A

Biomechanical
Medicophysiological
Psychological

186
Q

Name 2 coping mechanisms.

A

Problem focussed

Emotion focussed

187
Q

What are normal “fight or flight” response and symptoms of anxiety?

A 
Psychological arousal 
Autonomic arousal
Muscle tension 
Hyperventilation 
Sleep disturbance
188
Q

List psychological arousal reactions to stress producing anxiety.

A 
Fearful anticipation 
Irritability 
Sensitivity to noise
Poor concentration 
Worrying thoughts
189
Q

List autonomic arousal reactions to stress producing anxiety.

A

GI: dry mouth, swallowing difficulties, dyspepsia, nausea, wind, frequent loose motions

Resp: tight chest, difficulty inhaling

CVS: palpitations, chest pain

GU: frequency/urgency of micturition, amenorrhoea, ED

CNS: dizzy/sweaty

190
Q

What are physiological and psychological reactions to stress?

A

Muscle tension
Hyperventilation
Sleep disturbance

191
Q

What is the difference between phobic anxiety disorders and general anxiety disorder.

A

Phobias (occur in particular circumstance)

GAD = occur persistently

192
Q

List differentials for anxiety disorders.

A

Psychiatric: depression, detention, schizophrenia, substance misuse

Physical: thyrotoxicosis, pheochromocytoma, hypoglycaemia, asthma and/or arrhythmias

193
Q

What is GAD?

A

Persistent (several months)

Psychological arousal, autonomic arousal, muscle tension, hyperventilation, sleep disturbance

194
Q

What is the cause of generalised anxiety disorder?

A

Stressor acting on a personality predisposed to the disorder by a combination of genetic and environmental factors in childhood.

195
Q

How are GADs managed?

A

Counselling
Relaxation training
Medication (sedatives, SSRIs or TCA)
CBT

196
Q

What are the key features of phobic anxiety disorders?

A

Same as core GAD features
Only in specific circumstances
“Phobic avoidance”
Anticipatory anxiety

197
Q

List three clinical important syndromes of phobic anxiety disorders.

A

Specific phobias
Social phobia
Agoraphobia

198
Q

What is agoraphobia?

A

Fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong.

May be scared of: travelling on public transport
visiting a shopping centre
leaving home

199
Q

What is social phobia?

A

Fear of exclusion - inappropriate anxiety in situation where person feels observed or could be criticised - restaurants, shops, public speaking

200
Q

How do you manage social phobia?

A

CBT
Education and advice
Medication - SSRI antidepressants

201
Q

What is OCD?

A

Recurrent obsessional thoughts or compulsive acts

202
Q

What are obsessional thoughts?

A 
Ideas, images, impulses 
Occur repeatedly 
Unpleasant and distressing 
Recognised as own thoughts 
Usual key anxiety symptoms
203
Q

What are risk factors for OCD?

A

Genetic - gene coding for 5HT receptors - abnormalities in serotonin

204
Q

How is OCD managed?

A

Good history and MSE
General measures - education and explanation, involve partner/family
Serotonergic drugs (SSRI - fluoxetine, clomipramine)
CBT
Psychosurgery (if treatment resistant)

205
Q

What is PTSD?

A

Delayed and or protracted reaction to a stressor of exceptional severity e.g combat, natural disaster, rape, assault, torture

206
Q

What are the key elects to PTSD?

A
  1. Hyperarousal cdp
  2. Re-experiencing phenomena
  3. Avoidance of reminders
207
Q

How is PTSD managed?

A

Survivors of disasters screened at one month
Mild symptoms = watchful waiting and reviews further month
Trauma-focussed CBT
Eye-movement desensitisation and reprocessing
Risk of dependence with sedatives but patient may prefer SSRI or TCA

Psychiatry (5 decks)

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