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Barriers AHHH > Mental health > Flashcards

Mental health Flashcards

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1
Q

Neural pathways involved in psychoses

A

Mesolimbic (+ve symptoms), mesocortical (-ve symptoms), tubulo-infundibular (prolactin secretion), nigrostriatal (coordination of movement- EPSEs)

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2
Q

Management of acute dystonia

A

Benztropine (anti-cholinergic) 1-2mg IV or IM (single dose) - then switch to orals and taper

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3
Q

Acute dystonias that are emergencies

A

Oculogyric crisis
Laryngeal spasm
Opisthotonus

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4
Q

Types of EPSEs

A
  • acute dystonias
  • parkinsonism
  • tardive dyskinesia
  • akathisia
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5
Q

Cardiometabolic R/V of a patient on antipsychotic

A

BMI + waist circumference, BP, fasting BGL, lipid profile. 3/12 first year, then 6/12 every year on treatment

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6
Q

Tetrad of symptoms of Neuroleptic Malignant Syndrome

A
  • Muscle rigidity (severe ++)
  • Hyperthermia
  • Autonomic instability (tachycardia, labile BP, tachypnoea, diaphoresis, arrhythmias)
  • Changed mental status (confusion, delirium, stupor)
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7
Q

Diagnosis of dysthymic disorder

A
  1. Depressed mood for 2 years
  2. at least 2 of “SGECAS”
    sleep disturbance
    guilt/hopelessness
    energy loss/fatigue
    concentration loss
    appetite and weight changes
    self esteem loss
  3. during this time, the person has not been without symptoms for >2 months and there has been no major depressive episode
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8
Q

Clinical features of antidepressant discontinuation syndrome (withdrawal syndrome)

A
  • Flu-like symptoms (fatigue, lethargy, malaise, headaches, sweating, muscle aches)
  • Insomnia
  • Nausea
  • Imbalance
  • Sensory disturbance (paresthesias)
  • Hyperarousal
  • Dysphoria/psychoses
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9
Q

Clinical features of serotonin syndrome (triad)

A
  1. Neuromuscular excitability (hyperreflexia, clonus, shivering, tremor, hypertonia, rigidity)
  2. Autonomic dysfunction (hyperthermia, diaphoresis, flushing, mydriasis, tachycardia)
  3. Altered mental status (agitation, anxiety, confusion)
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10
Q

Contraindications to Lithium

A

Absolute: significant renal impairment, sodium depletion, dehydration, significant CVD
Relative: first trimester pregnancy, psoriasis

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11
Q

Target serum of lithium (for both acute phase and maintenance treatment)

A

0.8-1.2 mmol/L

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12
Q

Pre-treatment Lithium ix

A

Bedside - UA, ECG, beta HCG

Lab - FBC, EUC, TFTs, CMP

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13
Q

Serum lithium monitoring regime

A
  • 5-7 days after dose changes
  • Weekly measurements until stable therapeutic level for 4 weeks
  • Every 6-12 months
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14
Q

Ix regime for lithium monitoring

A
  • Serum lithium 6-12 mthly
  • EUC - 2-3mthly first 6 mths, then 6-12 mthly
  • TFTs - 2-3mthly first 6 mths, then 6-12 mthly
  • CMP yearly
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15
Q

Side effects of lithium (acronym)

A

LITHIUMS
Lethargy/sedation
Increased urination and thirst (polyuria, polydipsia), increased weight
Tremor, teratogenicity
Hypothyroidism, hair thinning
Impaired cognition
Upset stomach - nausea, diarrhoea, vomiting
Muscle weakness
Skin effects - acne, oedema, psoriasis exacerbation

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16
Q

Clinical features of acute lithium toxicity (early, progressing, late)

A

Early: marked coarse tremor, poor appetite, N/V, diarrhoea, lethargy, dehydration
Progressing: restlessness, muscle fasciculations, myoclonic jerks, hypertonia
Further: ataxia, dysarthria, drowsiness, confusion
Late: hypotension, arrhythmias, seizures, coma, death

17
Q

Management of lithium toxicity

A
  1. IVF rehydration
  2. GIT decontamination (if large acute ingestion >50g) - saline whole bowel irrigation via NGT
  3. Haemodialysis (rarely required for patients with normal kidney function
18
Q

Indications for haemodialysis in a patient with lithium toxicity

A
  • Serum lithium conc >2.5
  • Severe clinical manifestations (delirium, coma, seizures, hypotension)
  • Serum lithium conc >1.5 with a) persistent clinical effects, b) little response to IVF c) persistent kidney impairment despite IVF
19
Q

Diagnostic criteria of a manic episode

A 
A period of abnormally or persistently elevated, expansile or irritable mood, lasting at least one week and including 3 of:
Distractability
Insomnia
Grandiosity
Flight of ideas
Activity - goal directed
Speech pressure
Thoughtlessness - high risk activity involvement
20
Q

Differences between mania and hypomania

A

Time: M >7 days, HM >4 days
Functioning: M impairs social/occupation funcitoning, HM does not
Hospital: M may require hospitalisation for safety of self or others, HM does not
Psychosis: M may have psychotic features, HM does not

21
Q

Diagnosis of Bipolar 1 disorder

A

The only criteria is the occurrence of one manic episode or one mixed episode

22
Q

Management of acute manic episode

A
  • olanzapine 5mg PO nocte

Risperidone 0.5mg PO nocte

23
Q

Options for maintenance therapy in Bipolar 1

A
  1. Lithium
  2. Carbamazepine
  3. Sodium valproate
  4. Lamotrigine
24
Q

Diagnosis of Bipolar 2

A

the occurrence of at least one major depressive episode and at least one hypomanic episode
*** if they’ve ever had a full manic episode its B1 not B2

Barriers AHHH (8 decks)

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