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BPT Written Prep > Mental health > Flashcards

Mental health Flashcards

1
Q

What facotrs increase risk of completed suicide?

A

Underlying mental health diagnosis, male, access to weapons, substance use (particulary alcohol).

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2
Q

What is the first line treatment for bipolar disorder?

A

Lithium

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3
Q

What is second line treatment?

A

Valproate

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4
Q

In unstable bipolar in pregnant women or women planning to get pregnent, what medication should be used to throughout the pregnancy?

A

Lithium. It carries a small risk of foetal cardiac defects, but on balance is the best strategy.

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5
Q

What are the severe side effects of clozapine?

A

Neutropoenia, agranulocytosis, myocarditis.

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6
Q

What are the less severe side effects of clozapine?

A

Hypotension, sedation, weight gain, exacerbation of diabetesm tachycardia, neuoleptic malignancy syndrome.

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7
Q

What risk is associated with suspending clozapine for greater than 72hrs and then taking the full dose again?

A

Seizures.

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8
Q

If patients haven’t had their clozpine for >48hrs, what is the approach to address this?

A

Recommence at 12.5mg and up-titrate per the clozipine titration schedule. If between 48-72hrs, no additional monitoring requirements. Otherwise you have to do all the monitoring again.

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9
Q

When is it considered safe to continue taking clozapine if a dose has been missed?

A

If it’s less than 48hrs, the full dose can be taken safely without introducing the risk of seizures.

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10
Q

What’s the other name for functional neurological disorder?

A

Conversion disorder

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11
Q

What are the diagnositc features of conversion disorder?

A
  1. Altered vountary motor or sensory function
  2. Clinical findings showing incompaitbility between symptoms and recognised neurological and medical conditions.
  3. Symptoms are not better explained by anything else.
  4. Symptoms cause clinically significant distress or impair social, occupational or other important ares of functioning that warrants medical attention.
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12
Q

What is the first line treatment for depression?

A

Psychotherapy - NNT of 3

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13
Q

What can be used to augment depression treatment?

A

Lithium, antipsychotics or ECT.

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14
Q

What is first line pharmacotherapy for depression?

A

SSRI or SNRIs or mirtazapine

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15
Q

What are the criteria for diagnosing major depression?

A

SIG-E-CAPS. Sleep disorder, interest deficit (anhedonia), Guild (worthlessness, hopelessness, regret), Energy deficit, concentration deficit, appetite disorder (up or down), psychomotor retardation or agitation, suicidality.

If pts have 4 of the above with depressed mood for 2 weeks, they can be diagnosied.

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16
Q

What is ECT used for?

A

Catatonia. Severe major depressive disorder. Treatment resistant mania. Schizophrenia with difficult to control positive symptoms.

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17
Q

What is first line treatment for catatonia?

A

Benzodiazepines, then ECT.

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18
Q

What are the major adverse effects of ECT?

A

Impairment of cognitive function. Retrograde and anterograde amnesia.

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19
Q

Which pre-suicide risky behaviour carries that greatest risk of completion?

A

Alcohol misuse > access to lethal means of death.

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20
Q

What is neuroleptic malignant syndrome?

A

Acute reaction to too much dopamine antagonist (e.g. antipsychotics or antiemetics). OR the result of dopamine agonist withdrawal (sudden cessation of dopmainergic drugs - L-DOPA etc)

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21
Q

What are the clinical features of neuroletpic malignant syndrome?

A

Mental status change (agitation, or hypoactive derlirum), muscular lead pipe rigidity, hyperthermia (38 degrees or higher), autonomic instability (labile BP, tachycardia, tachypnoea, arrhythmias), AKI

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22
Q

What is the treatment for neuroleptic malignant syndrome?

A

Withold medications with dopamine antagonism. Tend to cardiovascular instability (fluid, O2, arrhythmia management, pacing). Cooling equipment. Benzodiazepines for agitation and rigidity. Dantrolene, bromocriptine or amantagine may be added for moderate to severe symptoms.

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23
Q

Which treatment for neuroleptic malignant syndrome could cause problems if the condition is actually serotonin syndreom?

A

Bromocriptine has both dopamine and serotonin activity, so it would worsen serotonin syndrome.

24
Q

What is serotonin syndrome caused by?

A

The result of serotonin excess, e.g. in the setting of overdose of SSRIs or other drugs that increase the amount activity on serotonin receptors.

25
Q

What are the clinical features (triad) of serotonin syndrome?

A

Neuromuscular excitation (rigidity, hyper-reflexia, ankle and occular clonus), autonomic effects (hyperthermia, tachycardia, hypertension, flushing, sweating, dilated pupils) and altered mental status.

26
Q

What are the most common drug groups implicated in serotonin syndrome?

A

SSRIs, SNRIs, TCAs, opioids, St John’s wort, Voritoxetine, Trazodone, MAOIs (some incidental MAOIs - linezolid, methylene blue, isoniazid, lamotrigine), amphetamines, lithium

27
Q

What are the diagnostic criteria for serotonin syndrome?

A

It’s a flow chart called thee Hunter Serotonin Toxicity Criteria algorithm. The patient has serotonin syndrome:
-If spontaneous clonus is present OR
-If inducible clonus AND agitation or diaphoresis are present OR
-If ocular clonus AND agitation or diaphoresis are present OR
-If tremor AND hyper-reflexia are present OR
-If hypertonia AND pyrexia (temperature >38°C [>100.4°F]) AND ocular clonus or inducible clonus are present.

28
Q

How is severe serotonin syndreome managed?

A

ICU, rapid cooling, I+V with paralysis (especially if concurrent rhabdomyolysis), actvated charcoal if consumed within the last 2 hrs, IV chlorpromazine (serotonin antagonist). Cyproheptadine may be used (a non-specific 5-HT2 anatgonist and antihistamine).

29
Q

How is moderate serotonin syndreom managed?

A

Cease serotonergic medications. Benzos and cyproheptadine may help (5-HT2 antagonist and antihistamine).

30
Q

Is catatonia a positive or negative symptom of schizophrenia?

A

It’s considered a positive symptom

31
Q

For how long do the features of schizophrenia need to be present in order to make a diagnosis of schizophrenia?

A

Patient’s must have had continuous signs of disturbance for 6 months, with at least one month of frank schizophrenia symptoms for at least 1 month.

32
Q

What can patients be diagnosed with if they have had symptoms of schizophrenia that have not lasted the required 1 month of frank symptoms with 6 months of prodrome?

A

Schizophreniform disorder

33
Q

What is depression with psychotic features?

A

Major depression, but with psychotic episodes during mood distrubrance

34
Q

What is schiazoaffective disorder?

A

Psychosis predominent illness, but with mood disturbance componenets.

35
Q

What strategy should be employed when stopping one SSRI/SNRI and starting another one?

A

Weaning one, then ceasing, then starting another with a lowly increasing dose.

36
Q

Which SSRI has the longest half-life and so must be carefully a tapered and time taken prior to starting another agent?

A

Fluoxetine. Half life is 4-16 days, Washout is recommended for 7 days before starting another SSRI or serotonergic medication.

37
Q

What is ‘idea of reference’ as it relates to psychotic illness?

A

When people misattributed benign actions that don’t concent them to be directed at them.

38
Q

Echolalia is what?

A

Seen in major depression. The person is just repeating the same things that have been said to them over and over.

39
Q

What is a grandiose delusion?

A

Is manic illness, the idea that the patient has super-human abilities or is famous.

40
Q

What is looseness of assocaition as it applies to a psychotic patient?

A

What a patients conversation shifts from seemingly between unconnected topics, but cadence, grammer and fluency are maintained.

41
Q

What is thought broadcasting?

A

It’s when a psychotic patients thinks they can broadcast there thoughts to other people and that those people can hear them.

42
Q

What type of mental illness is word salad associated with?

A

Severe psychosis.

43
Q

What is though blocking and what type of mental illness is it associated with?

A

Stopping mid sentence and being seemingly unable to generate new content. Seen in depressed mood disorders.

44
Q

What are the speech symptoms that indicate thought disorder?

A

Looseness of association (severe), echolalia, word salad, flight of ideas

45
Q

Whats the difference between flight of ideas and looensess of association?

A

Flight of ideas is usually rapid cadence, with tenuous but present links between ideas. Sometimes the link is assoance rather think content based (called a ‘clang associaion’). Loosness of association is nomrally spoken with a normal rate and cadence, and the ideas are entirely unconnected.

46
Q

How does mirtazapine work?

A

Monoamine receptor antagonist

47
Q

How does duloxetine work?

A

Inhibitor of both serotonin and noradrenaline re-uptake

48
Q

What is phenelzine?

A

A monoamine oxidase inhibitor

49
Q

What has limited the wide spread use of TCAs?

A

Anti-cholinergic side effects (dry mouth, constipation, erectile dysunfction - opposite of parasympathetic nervous system actions)

50
Q

What neutrotransmitter effects do tricyclic antidepressents have?

A

Inhibit reuptake of serotonin and noradrenaline like SNRIs.

51
Q

What are the most common SNRIs?

A

Venlafaxine, desvenlafaxine, duloxetine

52
Q

Which class of psyhoactive drugs is most likely to lead to weight gain?

A

The second generation anti-psychotics - olanzapine and clozapine are the worst culprits. However, chlorpromazine, valproate, lithium, TCAs and mirtazpine are also associated with weight gain.

53
Q

Which durgs are most likley assocaited wtih a sexual dysfunction?

A

Lots of psychotropic drugs are, but SSRIs are the most common culprit.

54
Q

Which pyschoactive medications are most likley to implicated in QT prolongation?

A

Antipsychotics. The worst one for QT prolongation is a drug called ziprasidone, however haloperidoal seems to the most likley to cuase a malignant arrhtymia or sudden cardiac death.

55
Q

Which anti-epiletpic/mood stabiliser is most often associated with SJS/TEN? What is the HLA allele that must be tested for before commencing carbemazepine to reduce the risk of SJS/TEN?

A

Carbemazepine. HLA 1502. Most prevent in southeast asian countries.

56
Q

What tends to be different clinically when comparing features of drug induced Parkinson’s disease to idiopathic Parkinson’s disease?

A

In drug induced, tremor is often less prominent, is likely to be postural, bilateral and symmetrical.

BPT Written Prep (18 decks)

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