Passmed Flashcards
What side effect is commonly caused more by atypical rather than typical antipsychotics?
Weight gain
clozapine is associated with agranulocytosis
What are symptoms including lip smacking, difficulty swallowing and excessive blinking an example of?
Tardive dyskinesias
Can result from long term antipsychotic use
What neuroleptic drugs cause the tyramine cheese reaction
MOAIs
What is a side effect of antidepressant mirtazapine?
Increased appetite
A 45-year-old man with schizophrenia taking chlorpromazine develops a bilateral resting tremor. What side-effect of antipsychotic medication is this an example of?
Parkinsonism
What is borderline personality disorder?
Boderline personality disorder is associated with a history of recurrent self-harm and intense interpersonal relationships
What is a histrionic personality disorder?
Histrionic personality disorder is characterised by emotional shallowness, egoism, vanity, egocentricity, self-indulgence. An individual with this personality type appears to be playing a part and cannot be themselves.
What is a cyclothymic personality disorder?
Individuals with cyclothymic personality disorders tend to alternate between depression and elation.
What is a narcissistic personality disorder?
Narcissistic personality disorder is described in people with a grandiose sense of self importance or uniqueness, preoccupied with fantasies of unlimited success. There are shared features with borderline states, but this condition is considered more stable.
Over what period of time should SSRI’s be stopped?
4 weeks
Which medication can commonly cause psychosis?
Steroids
What is the SSRI used for children?
Fluoxetine is the SSRI of choice in children and adolescents
When do seizures usually occur following alcohol withdrawl?
36 hours
What is the difference between an acute dystonia and a tardive dyskinesia?
Acute dystonia is a sudden, sustained, involuntary muscle spasm e.g. oculogyric crisis
A tardive dyskinesia is abnoral movements e.g. chewing or pouting mouth
What is the management for OCD?
First line is CBT and exposure response prevention
Next SSRIs can be used followed by clomipramine (TCA) second line
Increased urinary frequency and thirst are common side effects of what psychiatric medication?
Lithium
What is the name for pathological jelousy?
Othello syndrome
What is the difference between flight of ideas and knights move?
Differentiating between Knight’s move and flight of ideas - Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
What is the mechanism by which benzodiazepines work?
Increase the effects of GABA that is an inhibitory neurotransmitter
What is the mechanism of action of duloxetine?
Serotonin and noradrenalin reuptake inhbitor
What is the difference between schizotypal disorder and schizoid disorder?
Schizotypal disorder includes delusional beliefs whereas schizoid disorder is the negative symptoms of schizophrenia such as social withdrawl
How do you differentiate antisocial and borderline personality disorder?
Both have impulsivity
antisocial personality disorder are repeated failure to conform to social norms or rules and reckless disregard for their own safety as well as others with a lack of sense of remorse when these actions are discussed
borderline personality disorder are an unstable affect with fluctuating self image and recurrent suicidal ideation and self harm
What is an indication for admission for anorexia?
Blood pressure below 80/50
What is the biggest risk factor for pychosis?
Family history
When is the peak incidence of delirium tremens following alcohol withdrawal?
72 hours
What happens 6-12 hours after alcohol withdrawl?
Symptoms develp
What happens 36 hours after alcohol withdrawl?
Seizures
Which antipsychotic has the best side effect profile especially for prolactin elevation?
Aripiprazole
Why would a bulimic patient present with first degree heart block, tall p waves and flat t waves?
From hypokalaemia from vomiting it all out
What electrolyte abnormality are SSRIs associated with?
With hyponatremia
What should be prescribed for newly diagnosed moderate depression?
Prescribing a generic selective serotonin reuptake inhibitor (SSRI), such as citalopram, fluoxetine, paroxetine, or sertraline.
What is raised in anorexia?
Anorexia features
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
What is the mechanism of action of venlafaxine?
Venlafaxine mechanism of action = serotonin and noradrenaline reuptake inhibitor
How do you treat seasonal affective disorder?
The same as mild depression. NICE guidelines for mild depression, you would begin with psychological therapies and follow up with the patient in 2 weeks to ensure that there has been no deterioration. Following this an SSRI can be given if needed.
What are the common side effects of tricyclic antidepressants and why do they cause these effects?
drowsiness dry mouth blurred vision constipation urinary retention lengthening of QT interva These are antimuscarinic effects
What type of personality disorder prefer to be alone and dont like relationships?
Schizoid
How can you treat tardive dyskinesias caused by antipsychotics?
tetrabenazine
What is a risk of using zopiclone in the elderly?
Increased risk of falls
What is a common GI side effect of clozapine?
Constipation
If you see symptoms of mania in primary care what is the referral process?
Urgent referral to CMHT
What is the name of the syndrome assocaited with depression in which a patient thinks they are dead or part of them is dead?
Cotard’s syndrome
What is charles-bonnet syndrome and what condition is it assocaited with?
Charles-Bonnet syndrome is characterised by visual hallucinations associated with eye disease. Particularly loss of peripheral vision.
What kind of disorder would be a patient who thinks a celebrity is in love with them?
Delusional disorder
What is the PHQ-9 score?
A questionairre for determining the severity of depression
What is the BNF advice on SSRIs and pregnancy?
BNF says to weigh up benefits and risk when deciding whether to use 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
Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
Which SSRI increases appetite?
Mirtazapine
Before diagnosing anxiety which medical condition should be ruled out?
Hyperthyroidism
What is the first line intervention for mild depression?
Psychosocial intervention
What is the risk to a baby of using SSRIs in the thrid trimester of pregnancy?
Persistent pulmonary hypertension
What type of hallucination is a first rank symptom for schizophrenia?
Just auditory hallucinations
What is first line drug treatment for anxiety and panic disorders?
SSRIs e.g. sertraline
What is catatonia?
Stopping of voluntary movement or staying still in an unusual position
