Passmed wrong questions Flashcards
What is Acute stress disorder
Acute (transient) stress reaction that occurs within the first 4 weeks after a traumatic event
TCA anticholinergic side effects
Anticholinergic: tachycardia, dry mouth, mydriasis and urinary retention
Remember - no cholinergic = no PSNS tf you can’t relax
What is not recommended in PTSD
Single-session interventions/debriefing
PTSD management (mild; severe)
- Watchful waiting for mild symptoms lasting less than 4 weeks
- CBT or eye movement desensitisation and reprocessing (EMDR) = first line
- Venlafaxine/SSRI = 2nd line
- Severe cases = risperidone
SSRI choice post MI
Sertraline - most evidence for safe use
What drug is clozapine
Atypical antipsychotic
Main risk of clozapine - how do we account for this
Agranulocytoisis - FBC monitoring needed
Clozapine side effects
- Agranulocytosis
- Reduced seizure threshold
- Constipation
- Myocarditis - do ECG before starting
- Hypersalivation
C = constipation. lo = low WBC, Zap = myocarditis/seizures. Pine = saliv
Clozapine indication
If the use of 2+ antipsychotics still isn’t working in SCZ
Most likely SSRI to cause tornadoes de pointes
Citalopram - don’t use in patients with long QT
History of recurrent self harm and intense interpersonal relationships that alternate between idealisation and devaluation
Borderline personality disorder
Alcohol withdrawal timeframe
6-12 hours - symptoms
36 hours - seizures
72 hours - delirium tremens
ECT memory loss side effect
Retrograde amnensia
SSRI weaning period
4 week period of dose reduction
SSRI with most discontinuation symptoms
Paroxetine
SSRI discontinuation symptoms
PG DRUMS:
- Paraesthesia
- GIT: pain, cramping, D&V
- Difficulty sleeping
- Restlessness
- Unsteadiness
- Mood changes
- Sweating
What is akathisia
Inner restlessness and inability to keep still
What is acute dystonia
Sustained muscle contraction:
- Spasms of facial muscles
- Torticollis
- Oculogyric crisis
What is tardive dyskinesia
Late onset of abnormal involuntary movements e.g. licking lips or pouting of jaw
How is acute dystonia managed
Procyclidine
Common atypical antipsychotic side effects
Metabolic e.g. weight gain and hyperprolactinaemia
Schizophrenia management
Oral atypical antipsychotics = first line
CBT offered to all patients
SCZ comorbidities
Cardiovascular disease ∴ monitor patients - due to antipsychotics and smoking
Supportive psychotherapy vs CBT
- SP: Enhances self esteem, reduces anxiety and improves adaptive skills
- CBT: Helps patients deal with the way they think and behave
How is OCD severity measured
Yale brown Obsessive compulsive scale
What is mild OCD
Symptoms for less than one hour per day with minimal impact on daily living
Mild OCD management
- CBT including exposure and response prevention (ERP)
- Can then offer additional SSRI or more intense CBT including ERP
Which disorder is associated with a history of recurrent self-harm and intense interpersonal relationships that alternate between idealization and devaluation
BPD/EUPD
SSRI associated with long QT
Citalopram - can cause torsades du pointes - sertraline and fluoxetine may also cause to but citalopram = big boy
It sertainly floxuates but citalopram is causing it…
PSTD first line
- ?Watchful waiting if mild (<4 weeks of symptoms)
- Trauma-focused CBT and EMDR
PSTD second line
Venlafaxine or SSRI
PSTD severe cases management
Risperidone
TCA antimuscarinic effects
Dry mouth
Blurry vision
Constipation
Urinary retention
GAD drug treatment
- Sertraline
- If that doesnt work - offer alternative SSRI or SNRI
- If that doesn’t work - offer pregabilin
Alcohol withdrawal management
Decreasing doses of long-acting benzos: chlordiazepoxide or diazepam
- Offer lorazepam with hepatic failure
- Carbamazepine may also work
SSRI of choice in children
Fluoxetine
Physical findings of anorexia nervosa
- Lanugo hair
- Failure of secondary sexual characteristics
- Bradycardia
- Cold intolderance
- Yellow tinge - hypercarotenemia
- Enlarged salivary glands
Memory loss in depression vs dementia
Severe depression may cause global memory loss whereas dementia causes short-term memory loss
Why should SSRIs never be used with MAOIs
MAOIs prevent serotonin breakdown therefore cause serotonin syndrome
What is illness anxiety disorder (hypochondriasis)
Persistent belief in the presence of an underlying serious disease
Hypochondriasis vs somatisation disorder
Somatisation disorder - focus on unexplained symptoms for at least 2 years and rejection of reassurance
Hypochondriasis - they have symptoms but are convinced of a specific underlying disease e.g. cancer
Soma = Symtpoms
Chrondriasis = Cancer
What is cluster A of personality disorders
Odd or eccentric:
- Paranoid
- Schizoid
- Schizotypal
Schizotypal features
Ideas of reference
Odd beliefs about magical thinking
Unusual perceptual disturbances
Paranoia
Odd/eccentric behaviour
Social pariah
Inappropriate affect
Odd speech with incoherency
Less severe depression management
Guided self help before offering CBT
Patients ≤25 who have been started on an SSRI should be reviewed when?
After 1 week due to increased risk of suicide. Nb/ Normally review after 2 weeks for older people
What is catatonia
Stopping of voluntary movement/staying in an unusual position
Anorexia nervosa biochemistry
Most things are low but Gs and Cs raised:
- GH
- Glucose
- salivary Glands
- Cortisol
- Cholesterol
- Carotinaemia
Important SSRI interactions
- NSAIDs - GI bleeding risk ∴ give PPI
- Warfarin/heparin - offer mirtazapine instead
- Aspirin
- Triptans - risk of serotonin syndrome
- MAOIs
Difference 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 circumstantiality
Inability to answer question without going into excess detail - however the question ends up being answered
Before starting lithium what must be checked
renal (U+Es), cardiac (ECG), and thyroid function (TFTs). BMI and FBC should also be done beforehand.
What antihypertensives interfere with lithium clearance
- Thiazide diuretics
- ACEi
- ARB
What metabolic disturbance is seen in bulimia
Hypochloraemic, hypokalaemia metabolic alkalosis
When and where to admit if anorexic
Admit to AMU for immediate stabilisation if patient has signs of bradycardia, hypotension or physical instability
Features of LSD ingestion
- Mood changes
- Hallucinations
- Hypertension
- Tachycardia
- Hyperthermia
Symptoms of SSRI discontinuation
- increased mood change
- restlessness
- difficulty sleeping
- unsteadiness
- sweating
- gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
- paraesthesia
Switching from fluoxetine to another SSRI
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
PHQ-9 scores for less and more severe depression
<16 = less severe depression
≥16 = more severe depression
FIRM STOP for SSRI discontinuation syndrome
Flu like Sx
Insomnia
Restlessness
Mood swings
Sweating
Tummy problems (pain, cramps, D+V)
Off balance
Parasthaesia
Causes of serotonin syndrome = STEAM
SSRI + St Johns Wart
Tramadol + Triptans
Ecstasy (MDMA)
Amphetamines + Anti-emetics (ondansetron +metoclopramide)
MAOI
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
OCD: all patients with severe functional impairment should be referred to
secondary mental health team - treatment can be initiated during this waiting process
Capgras syndrome
Irrational delusion of misidentification where patients believe that a relative or friend has been replaced by an identical impostor.
- Associated with SCZ, brain trauma, dementia
What is thought preservation
This is where a patient repeats ideas or words despite attempting to change the topic.
For example, if a patient were to be asked to describe a cat, and then describe other things, the patient would continually describe cats and keep the topic on that despite being asked to describe other things.
What is the only absolute contraindication to ECT
Raised ICP
What must be done if clozapine/antipsychotics are missed for 2 days?
Dose should be re-titrated like when they first started. - this is because resuming the regular dose means that effects may be worse eg. BP/dizziness
