Passmed Pysch Flashcards by Simrun Chandale

Onset of symptoms, progression, features of
post concussion syndrome

delayed course and prolonged course
headache
fatigue
anxiety/depression
dizziness

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sx of Korsakoff’s syndrome
(what are Wernicke only symptoms)

triad of confusion, ataxia and ophthalmoplegia, as well as anterograde and retrograde amnesia with confabulation

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which atypical antipsychotic lowers seizure threshold

clozapine

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serious side effects of clozapine

agranulocytosis, neutropenia, reduced seizure threshold, and myocarditis.

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key feature of brief psychotic disorder

lasts <1 mo, then returns to baseline functioning

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SSRI + NSAID causes what risk (+ med)

GI bleeding, give PPI

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OCD vs obsessive-compulsive personality disorder

OCD- repetitive compulsions vs rigid with moral, ethics and values, unwilling to change their mindset, perfectionism

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alcohol withdrawal, hours and their symptoms

symptoms - 6-12 hr
seizures - 36h
delirium tremens - 72h

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how long should you take antidepressants for?

min 6 months after remission of symptoms

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first line meds for alcohol withdrawal

chlordiazepoxide
diazepam
liver issues -> lorazepam

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how are SSRIs stopped?

grad reduce over 4 w

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withdrawal sx of SSRIs

dizziness, sleep disturbances, anxiety and mood changes, esp GI DISTURBANCES

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knight’s move vs flight of ideas

knights - illogical leaps between ideas, random
flight of ideas - some link between ideas

think…. chess is unpredictable, planes link destinations

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obsession vs compulsion

o - THOUGHTS only, images urges etc
c - ACT, performance

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acute stress disorder vs PTSD

ASD - first 4 weeks after trauma
PSTD - AFTER 4 WEEKS

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adult - when do u review patient first put on antidepressants ?

after 2 weeks

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what age is the cut off for more reg checking antidepressant initiation

UNDER 25

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«adult -when do u review patient first put on antidepressants ?

review after 1 week, also if increased risk of suicide

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how do benzos work

enhance effect of GABA, the main inhibitory neurotransmitter, increased frequency of chloride channel opening so hyperpolarisation (becomes more negative) and so less neuronal excitability… so sedation, muscle relax, anti convulsant etc

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which condition is flight of ideas feature of?

mania, bipolar disorder

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what condition is knights move assoc w?

schizophrenia

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Switching from fluoxetine to another SSRI ….I

withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low dose of the alternative SSRI

what is charles bonnet syndrome

persistent hallucinations in clear consciousness, w background of visual impairment

problem with zopiclone in elderly

increased risk of falls

what type of drug is mirtzapine

Noradrenergic and specific serotonergic antidepressants (NaSSAs)

type of urinary incontinence is the most associated with amitriptyline

overflow incont.

fts of PTSD (4)

re-experiencing: flashbacks, nightmares, avoidance hyperarousal emotional numbing

age for personality disorders?

must be over 18 y/o

after a change in dose, lithium levels should be taken ...... later and .... until the levels are stable.

a week later, and weekly until stable

RFs for the development of GAD

- 35-54 - divorced, separated - living alone - lone parent

what is used to manage acute dystonia

procyclidine, anti-cholinergic

most tolerable atyp antipsychotic

aripiprazole, esp for high prolactin

complications of citalopram

QT prolongation, torsades de pointes

Long-term atypical antipsychotics can lead to the development of...

glucose dysregulation and diabetes

most appropriate first-line treatment for PTSD

CBT or EMDR (eye movement desensitisation and reprocessing therapy)

what does EMDR stand for

eye movement desensitisation and reprocessing therapy

A 45-year-old female complains of lower back pain, constipation, headaches, low mood, and difficulty concentrating. What path is causing these symptoms? What psych meds can cause this and how?

Hypercalcaemia, STONES, MOANS ABDO GROANS Lithium causes hyperparathyroidism so high calcium

SSRI interaction drugs and issues

NSAIDs: NICE guidelines advise 'do not normally offer SSRIs', but if given co-prescribe a proton pump inhibitor warfarin / heparin: avoiding SSRIs and considering mirtazapine aspirin triptans - increased risk of serotonin syndrome monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

common examples of MA

1st line tx for panic disorder

SSRIS, (beta blockers are for symptoms)

Best antipsychotic for negative symptoms of schizophrenia

clozapine

What tool do you use to asses for alcohol withdrawal severity?

The revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA)

For more severe OCD, or if unresponsive to CBT/exposure and response prevention then add....

an SSRI

Other than CBT what else can be used to treat OCD

ERP, exposure and response prevention therapy

exmaples of TCAS

Amitriptyline Clomipramine Dosulepin Trazodone Imipramine Lofepramine Nortriptyline

What med is used for alcohol abstinence and makes patient throw up if they have alcohol? How does it work? How often do u take?

Disulfiram (aka Antabuse) (Di - disgusting) How..is an irreversible inhibitor of acetaldehyde dehydrogenase. This inhibition causes the buildup of acetaldehyde. The build-up of acetaldehyde within twenty to thirty minutes of alcohol consumption results in unpleasant symptoms, including facial flushing and nausea and vomiting. Disulfiram is taken once daily and its effects last seven days, working as a deterrent to prevent alcohol relapse.

What med is used for alcohol abstinence as an anti craving? How does it work? How often do u take?

Acamprosate (or Campral) an 'anti-craving' medication and the underlying mechanism of action remains unclear. is taken three times a day + psych support

What med can be used as an alt to methadone?

Buprenorphine is a mixed opioid agonist/antagonist. It is typically given as a sublingual tablet and provides an alternative opiate replacement therapy to methadone.

Sleep disturbance, stress triggers and normal mini-mental test score with global memory loss suggests .....

depression over dementia etc

Symptoms of hypomania in primary care, what do you do....

routine referral to Community mental health team

with OCD... tx if functional impairment is mild

CBT /ERP

with OCD... tx If moderate functional impairment

SSRIs and more intense CBT

with OCD... tx If severe functional impairment

refer to the secondary care mental health team for assessment whilst awaiting assessment - offer combined treatment with an SSRI and CBT (including ERP) or consider clomipramine as an alternative as above