PassMed Flashcards
What antipsychotic decreases seizure threshold
Clozapine
what therapy is first line for PTSD
Trauma based CBT
What is another name for hypochondriasis
illness anxiety disorder
what factors are associated with a poor prognosis in schizophrenia
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
what prescribed drug can cause psychotic symptoms
steroids e.g. prednisolone
what conditions is ECT indicated in
catatonia
a prolonged or severe manic episode
severe depression that is life-threatening
how do you withdraw an SSRI
Gradually over 4 weeks
explain risk factors of SSRI in pregnancy
Use during the first trimester gives a small increased risk of congenital heart defects
Use during the third trimester can result in persistent pulmonary hypertension of the newborn\
what medication can you give to stop tardive dyskinesia
Tetrabenazine
what medication can you give to stop akathisia
propanolol
what is the TRIAD that occurs with serotonin syndrome
- altered mental status (e.g. agitation, confusion, coma),
- autonomic dysfunction (e.g. hyperthermia, hypertension, tachycardia)
- neuromuscular abnormalities (e.g. tremor, clonus, hyperreflexia)
How do you treat refeeding syndrome
Phosphate replacement
What cognitive screening tests are you aware of
AMTS = screening tool to assess for cognition
MMSE = usually scored out of 30, cut-off is 23/24 (widely used)
MoCA / Addenbrookes (ACE) = more formally done by specialists
GPCOG / 6 item cognitive impairment test = primary care orientated
How long does prolonged grief disorder last
6+ months
ICD11
What are sx of prolonged grief disorder
longing for deceased, preoccupied with deceased, emotional pain, low mood, emootional numbing
How do you manage MUS
Explain and reassure (symptoms are not serious, but rather common and familiar)
Reattribution model - ensure they feel understood, link ssymptoms and psych factors
Avoid over investigation
Encourage sypport
Encourage normal function (normal physical activities)
Consider antidepressants, CBT, graded exercise
What are somatoform disorders
Somatisation disorder Hypochondriasis Conversion disorder Body dysmorphic disorder Pain disorder
How can you manage lithium toxicity
Supportive - requires specialist input.
AIMS: electrolyte balance, monitoring renal function, control seizures.
CONSIDER:
- IV fluid therapy
- Benzodiazepines ( to treat agitation and seizures)
- Haemodialysis (if the renal function is poor)
how does risk of schizo change if one of the parents has it
increeases form 1% to 10%
Clinical picture of delirium
- sudden onset
- fluctuating symptoms
- worse at night
- changes in mood (depression/ mania-like)
- hallucinations, illusions
- delusions (transient and muddled)
- sleep disturbed (insomnia, reversal of sleep wake cycle)
lewy body dementia 2 key sx
fluctuating confusion
vivid visual hallucinations
what psych disease causes increased lymphocytes (and nothing else) on LP
Autoimmune encephalitis
what are symptoms of autoimmune encephalitis
rapid changes in mental status, mood liabililty
e.g. crying one second, laughing the next
in young people with an acute onset of new neurological or psychiatric symptoms without a past context of mental health problems.
how do you treat autoimmune encephalitis
steroids, IV immunoglobulin
wait 2 weeks –> second line tx: add rituximab/cyclophosphamide
which type of dementia affects the hippocampus
Alzheimer’s
Causes HIPPOCAMPAL ATROPHY
triad of Lewy body dementia
- fluctuating cognition
- hallucinations
- parkinsonism
What is another name for Picks disease
Frontotempoiral dementia
how do you manage somatisation (biopsych?)
Bio: consider SSRI (not first linew)
Psych: CBT, mindfulness (not first line)
What age does Picks / frontotemporal dementia occur in
in younger people than other dementias
explain MANTRA
MANTRA involves talking to a therapist to discover the root cause of the eating
disorder and encouraging a behavioural change to develop a non-anorexic
identity.
explain SSCM
SSCM is similar to MANTRA but is considered to be more practical.
Patients are taught about nutrition and how certain eating habits contribute to physical symptoms.
How can you tell alcoholic hallucinosis and delirium tremens apart?
AH
- resolves within 48 hours max from when they stopped drinking
- patients are AWARE they are hallucinating
- no autonomic dysfunction
What precipitates an Acute Transient Psychotic Episode=?
a very stressful life event (1-2 weeks prior)
episode resolves within max 3 months
what model defines the five stages of grief
Kubler Ross model
What are TWO abnormal forms of grief reaction?
- Delayed grief reaction - onset more than 2 weeks from evenmt
- prolonged grief reactions - last more than 6 months
How is DBT different to CBT?
DBT focuses on validation (i.e. teaching the patient how
to accept who they are) and the relationship between the therapist and the patient, which is used as motivation to change unhelpful behaviours.
benzo withdrawal symptoms
insomnia, agitation, anxiety, tremor, tinnitus, and sweating
what is the first management of paracetamol ovrdose in terms of investigations you should do for the patient?
check serum paractamol levels
this will determine whether they are above the threshold and need acetylcisteine
