Mental Health Flashcards
What is the therapeutic range for Lithium?
0.4-1.0 mmol/L
Indication of lithium
Bipolar disorder
When do the lithium levels need to be checked when dose changed?
1 week
What are the common features of PTSD?
1) Re-experiencing
2) Avoidance
3) Hyperarousal
4) emotional numbing
What ECG changes does Citalopram cause?
QT prolongation and Torsades de pointes
What are the examples of SSRI?
Citalopram
sertraline
Fluoxetine
Side effect of lorazepam
Anterograde amnesia
What should be monitored when initiating and titrating venlafaxine?
Blood pressure (HTN)
What is 2nd line option for depression?
SNRI - venlafaxine
What signs should be monitored when taking antidepressants?
Hyponatraemia
What is life-threatening side-effect of clozapine?
Agranulocystosis/Neutropenia
What is agranulocystosis?
Decreased WCC, primarily neutrophils
What is the 1st line medication for GAD?
SSRI - specifically Sertraline
What are the side effects of typical antipsychotics?
- Acute dystonia (e.g. torticollis, oculgyric crisis)
- Parkinsonism
- Akathisia (severe restlessness)
- Tardive dyskinesia
- Neuroleptic malignant syndrome
What is torticollis?
- Unilateral pain and deviation of the neck with pain on palpation and restricted range of motion
What is neuroleptic malignant syndrome?
- Altered MSE
- Generalised rigidity
- Fever
- Fluctuating blood pressure
What is tardive dyskinesia?
- uncontrolled facial movements such as lip-smacking
What are examples of typical antipsychotics?
- Haleperidol
- Chlopromazine
What are examples of atypical antipsychotics?
- Clozapine
- Risperidone
- Olanzapine
Why was atypical antipsychotics developed?
Due to problematic extrapyramidal side-effects
What is ESPEs?
- Parkinsonism
- Acute dystonia (sustained muscle contraction)
- akathisia (severe restlessness)
- tardive dyskinesia
MOA of venlafazine
Serotonin and noradrenaline reuptake inhibitor
What are the first rank symptoms of schizophrenia?
1) Auditory hallucinations
2) Thought disorder
3) Passivity phenomena
4) Delusional perceptions
For a diagnosis of PTSD, how long should symptoms be present for?
4 weeks
What is the key difference between mania and hypomania?
Psychotic symptoms
What are the symptoms associated with depression?
DSM-5
5/9 symptoms required for diagnosis (everyday for at least 2 week):
Core symptoms:
- Low mood
- Anhedonia
Associated symptoms:
- Disturbed sleep
- Decreased or increased appetite
- Fatigue /loss of energy
- Agitation or slowing of movements
- Poor concentration
- Feelings of worthlessness
- Suicidal thoughts
What tools can be used to assess the degree of depression?
HAD scale
PHQ-9
What investigations should be carried out for depression?
- Bloods to eliminate other causes
What is seasonal affective disorder?
Depression which occurs predominately around the winter months.
What is dsythmic disorder?
- Chronic depressive state (2 years or more)
- Persistent low mood not meeting depression diagnostic criteria
- Not the consequence of a partly resolved major depression
Define bipolar disorder
Chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of depression.
What are the types of bipolar disorder?
- type I disorder:
mania and depression (most common) - type II disorder:
hypomania and depression
Difference between mania & hypomania
- Hypomania:
• Mild elevation of mood and increased energy / activity
• 4 days of manic symptoms
• Does NOT disrupt life
2. Mania: • Mood change (7 days of persistently high, expansive, or irritable mood) AND 3 manic symptoms: --> Increased activity level --> Talkativeness --> Racing thoughts --> Distractibility --> Reduced need for sleep --> Inflated self esteem --> Faulty judgement
Referral criteria for bipolar disorder?
- if symptoms suggest hypomania = routine referral to the community mental health team (CMHT)
- if there are features of mania or severe depression then an urgent referral to the CMHT should be made
Define obesity
BMI 25-29.9 kg/m2
What is the criteria for anorexia?
A. Restriction of energy intake relative to requirements, leading to a significantly low weight in the context of age, sex, developmental trajectory, and physical health
B. Intense fear of gaining weight or persistent behaviour that interferes with weight gain
C. Disturbance in body image.
What are the physical clinical features for anorexia?
- BMI <85% predicted (<17.5 adults). Often rapid loss
- Amenorrhea 3/12 or longer
- Delayed puberty
- Fatigue, fainting, dizziness
- Intolerance to cold
- GI: constipation, abdo pain
- Appearance: wearing baggy clothes