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Psychiatry > Management > Flashcards

Management Flashcards

1
Q

What are the indications for ECT?

A
  • catatonia
  • a prolonged or severe manic episode
  • severe depression that is life-threatening
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2
Q

Side effects of antipsychotics in elderly?

A

Stroke

VTE

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3
Q

Common side effect of atypical side effect especially olanzapine?

A

weight gain

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4
Q

Side effects of clozapine?

A 
weight gain
excessive salivation
agranulocytosis
neutropenia
myocarditis
arrhythmias
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5
Q

Following MI, preferred AD?

A

Sertraline

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6
Q

What would you give for acute dystonia due to atypical antipsychotics?

A

benztropine IM/IV

procyclidine

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7
Q

What is NMS? How does it present?

A

Neuroleptic malignant syndrome - condition caused by antipsychotics

more common in young male patients
onset usually in first 10 days of treatment or after increasing dose
pyrexia
rigidity
tachycardia
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8
Q

How would you manage NMS?

A

stop antipsychotic
IV fluids to prevent renal failure
dantrolene* may be useful in selected cases
bromocriptine, dopamine agonist, may also be used

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9
Q

How could you diagnose NMS?

A

Rised creatine kinase

leukocytosis

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10
Q

What is section 2?

A

admission for assessment

AMHP and two doctors

28 days

appeal within 14 days

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11
Q

What is section 3?

A

admission for treatment

AMHP and two doctors

6 months

if renewed within second 6 months, then every year

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12
Q

What is section 4?

A

emergency assessment

AMHP + any doctor

72 hrs

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13
Q

What is section 5(2)?

A

Urgent detention of a voluntary inpatient

doctor in charge

72 hrs

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14
Q

What is section 5(4)?

A

Nurses holding of voluntary inpatient

registered mental health nurse

6 hrs

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15
Q

What is a 135?

A

magistrates

entry of home and removal of patient to safety

72 hrs

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16
Q

What is a 136?

A

police officer

allows patient in public to be removed to a place of safety

72 hrs

17
Q

What class of drugs are anti-psychotics?

A

Block dopamine D2 receptors

18
Q

side effects of antipsychotics?

A

parkinsonism

akathisia

dystonias

tardive dyskinesia

hyperprolactinaemia (gynaecomastia, menstrual disturbance, decreased libido, reduced sperm count)

19
Q

What are the symptoms of neuroleptic malignant syndrome?

A

autonomic : hyperthermia, tachycardia, pallor, sweating

fluctuating level of consciousness

muscular rigidity

urinary incontinence

20
Q

What is a way to give antipsychotics to improve compliance?

A

depots

21
Q

What patients should quetiapine not be used on?

A

ones with cardiac pathology - as it may cause long qt syndrome

22
Q

What can be given to patients who have the parkinsonism side effects of anti-psychotics? What considerations should be taken before this?

A

(procyclidine, orphenadrine)anti-muscarinics/cholinergic

can cause anti-musc side effects

can worsen tardive dyskinesia

23
Q

What tests should be done before prescribing Lithium?

A

renal function - plasma urea, electrolytes and creatinine

tfts

24
Q

How often should plasma lithium levels be checked? What is the optimal range?

A

twice weekly when drug first started

then up to 3 months when in maintenance

25
Q

Lithium side effects?

A

hyper-relexia and hyper extension of limbs

toxic psychoses

convulsions

syncope

oliguria

coma

give patients lithium card

26
Q

Side-effects following long-term lithium treatment?

A

hypothyroid

hyperthyroid

memory impairment

nephrotox
arrythmias

27
Q

Side effects of TCA?

A

anti-musc -urinary retention

sedating

dry mouth
blurred vision

constipation

nausea

postural hypotension

28
Q

side effects of SSRIs?

A

nausea vomiting

diarrhoea

sexual dysfunction (delayed ejaculation)

suicide

safer than TCAs, hard to OD

29
Q

How would SSRI withdrawal syndrome present?

A

somatic

psychological symptoms

dizziness

nausea

lethargy

headache

anxiety

sleep disturbance

within one week of stopping SSRI

30
Q

How often is ECT given? What should patient do?

A

twice per week

nil by mouth

atropine and muscle relaxant given

31
Q

Side effects of ECT?

A

headache

temporary confusion

loss of short-term memory

32
Q

What are CI for ECT?

A

raised ICP

severe cardiovascular

33
Q

What do you give for tardive dyskinesia?

A

tetrabenazine

34
Q

What do you give serotonin syndrome?

A

cyproheptadine

35
Q

What can be given to treat :

I) akathisia
ii) tardive dyskinesia

A

Akathesia - propranolol

Tardiv dyskinesia - tetrabenazine

36
Q

Fluoxetine side effects in pregnancy?

A

third trimester risk of persistent pulmonary hypertension

37
Q

Metabolic side effects of anti-psychotics?

A

dysglycaemia
dyslipidaemia
diabetes mellitus

Psychiatry (3 decks)

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