Passmedicine Flashcards
What is the only contraindication to ECT
Raised ICP
What are the short term side effects of ECT
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia
What are the long term side effects of ECT
Memory problems
Apathy
Anhedonia
Difficulty concentrating
Loss of emotional responses
Difficulty learning new information
What scale is used for rating the severity of OCD
Y-BOCS scale
What is the treatment for OCD
Mild:
CBT or ERP +/- SSRI
Moderate:
SSRI and more intensive OCD
Any SSRI but fluoxetine for body dysmorphia
Alternative - clomipramine
What are the features of mania
Lasts for at least 7 days
causes severe functional impairment in social and work setting
May require hospitalisation
May present with psychotic symptoms
What are the features of hypomania
Lasts <7 days (usually 3-4)
Can be high functioning - doesn’t impair functional capacity in work or social setting
Unlikely to require hospitalisation
No psychotic symptoms
What is Munchausens syndrome
Purposefully causing symptoms
What is malingering
Faking symptoms for personal (usually financial) gain.
What are examples of typical antipsychotics
Haloperidol
Chlopromazine
What are examples of atypical antipsychotics
Clozapine
Risperidone
Olanzapine
What are the extrapyramidal side effects seen with typical antipsychotics
Parkinsonism
Acute dystonia
Akanthisia
Tardive dyskinesia
What are risks of antipsychotics in the elderly
Increased risk of stroke and VTE
What are other side effects of antipsychotics
Antimuscarinic - dry mouth, urinary retention, constipation
Sedation, weight gain
Raised prolactin (galactorrhoea)
Impaired glucose tolerance
Neuroleptic malignant syndrome
Reduced seizure threshold
Prolonged QT interval
what is used in the treatment of delirium tremens or alcohol withdrawal
Long acting benzodiazepines:
Chlordiazepoxide
Diazepam
Other:
Short acting benzodiazepine - Lorazepam
what are the features of alcohol withdrawal
6-12 hours: tremor, sweating, tachycardia, anxiety
36 hours: Peak incidence of seizures
48-72 hours: Delirium tremens (coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia)
What type of drug is mirtazipine
Noradrenergic and specific serotonergic antidepressants
What are side effects of tricyclic antidepressants
Drowsiness
Dry mouth
Blurred vision
Constipation
Urinary retention
Lengthening of the QT interval
what are poor prognostic factors of schizophrenia
Strong family history
Gradual onset
Lo IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
What are the side effects of clozapine
Agranulocytosis
Neutropenia
Reduced seizure threshold
Myocarditis
Constipation
Hypersalivation
What are examples of atypical antipsychotics
Clozapine
Olanzapine
Risperidone
Quetiapine
Amisulpride
Aripiprazole
What is erotmania
AKA De Clerambaults syndrome
A specific form of delusional disorder where a patient believes a famous actor is involve with them.
What are factors shown to increase the risk of suicide
Male
History of deliberate self harm
Alcohol or drug misuse
History of mental illness
History of chronic disease
Advancing age
Unemployment, social isolation, living alone
Being unmarried, divorced or widowed
what are the risks for completing suicide if a patient has already attempted it
Effort to avoid discovery
Planning
Leaving a written note
Final acts
Voilent method
What are the protective factors for reducing the risk of a patient committing suicide
Family support
Having children at home
religious beliefs
What is the step wise treatment for generalised anxiety disorder
Step 1:
Education about GAD and active monitoring
Step 2:
Low-intensity psychological interventions (non facilitated self-help)
Step 3:
High-intensity psychological interventions (CBT)
Drug treatment
Step 4:
Specialist input
What is the medical management for GAD
First line:
Sertraline
If ineffective:
Offer another SSRI or an SNRI (duloxetine or venlafaxine)
What is the management of bipolar disorder
Psychological intervention
Lithium is still the mood stabilizer of choice.
Antidepressants are not recommended but if needed - fluoxetine is the antidepressant of choice.
Which medications can interact with SSRIs
NSAIDs (if co-prescribed - also give a PPI)
Warfarin/Heparin
Aspirin
Triptans (Increased risk of serotonin syndrome)
MAOI
What are the features of discontinuation symptoms of SSRIs
Should be reduced over 4 weeks (not necessary for fluoxetine)
Increased mood changes
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms
Parasthesia
Electric shock sensations
Dizziness
Anxiety
What are the core symptoms of depression
Low mood
Fatigue
Anhedonia
What is the criteria for bulimia nervosa
- Recurrent episodes of binge eating
- Sense of lack of control over eating during these episodes
- Recurrent compensatory behaviour (vomiting, laxatives, diuretics, excessive exercise)
- Recurrent vomiting (erosion of teeth, Russells sign)
The binge eating and compensatory behaviours both occur at least once a week for 3 months
What is Disulfiram
AKA Antabuse
Causes a build up of acetaldehyde within 20-30 minutes of alcohol consumption.
Causes facial flushing, nausea and vomiting.
Taken once daily and its effect lasts for 7 days.
What is acamprostate
Taken 3 times a day and is used as an anti craving medication. It is safe in combination of alcohol.
It is used to prevent relapse.
What is buprenorphine
Mixed opioid agonist/antagonist.
Given as a sublingual tablet and is an alternative opioid replacement to methadone.
What are examples of MAOI
Tranylcypromine
Phenelzine
What must be avoided when taking MAOI
Tyramine containing foods: Cheese, pickled herring, bovril, oxo, marmite, broad beans
Can cause hypertensive reactions
What are the symptoms of depression
3 Core symptoms:
Depressed mood
Loss of interest (anhedonia)
Reduced energy levels(anergia)
Other common symptoms:
Decreased self-esteem and confidence
Guilt and worthlessness
Bleak and pessimistic views of the future
Ideas or acts of self harm or suicide
Disturbed sleep
Diminished appetite and weight loss
Psychomotor agitation or retardation
Loss of libido
What is the criteria for a mild depressive episode
At least 2 out of 3 of the core symptoms of depression
2 other symptoms
Minimum duration of 2 weeks
Individuals may be distressed but should be able to function
what is the criteria for a moderate depressive episode
At least 2 out of 3 core symptoms
At least 3 or 4 other symptoms
Minimum duration of 2 weeks
Individuals will have difficulty continuing with normal work and social functioning
What is the criteria for a severe depressive episode
All 3 of the core symptoms
At least 4 of the other symptoms
Minimum of 2 weeks duration (if symptoms are severe, may be appropriate to make an early diagnosis)
Also might be psychotic symptoms
Individuals show severe distress and or agitation
what are the two screening equations for depression
‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’
What are the risks of SSRI use in pregnancy
first trimester - increased risk of congenital heart defects
Third trimester - Persistne pulmonary hypertension of the new born
Paroxetine - increased risk of congenital malformations
which is the preferred antidepressant following an MI
sertraline
what is a side effect of citalopram
Dose dependent QT interval prolongation
What are schneiders first rank symptoms (4)
- Auditory Hallucinations:
- Thought echo
- Voices commenting on patients behaviour
- Two or more voices discussing the patient in third person - Thought disorder:
- Thought insertion
- Thought withdrawal
- Thought broadcasting - Passivity phenomena
- Bodily sensations being controlled by an external influence
- Actions/impulses/feelings - experiences which are imposed on the individual or influenced by others - Delusional perceptions:
- A normal object is perceived then theres a delusional insight into the objects meaning
what are other features of schizophrenia
impaired insight
negative symptoms:
- incongruity or blunting of affect
- anhedonia
- alogia
- avolition
Neoligisms
Catatonia
what are some of the adverse effects of lithium
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity (polyuria - due to diabetes insipidus)
thyroid enlargement (hypothyroidism)
ECG - T wave flattening/inversion
Weight gain
Idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism + Hypercalcaemia
When should lithium levels be checked
12 hours post-dose
Performed weekly and after each dose change until concentrations are stable
Thyroid and renal function should be checked every 6 months
Once levels are stable - they are measured every 3 months.
What is schizotypal personality disorder
Patients lack close friends other than family
Have odd or eccentric beliefs
Have a distorted view of reality, superstitions and unusual behaviours
Odd beliefs and magical thinking
Ideas of reference (some insight retained)
What is the treatment for PTSD
Trauma focused CBT or eye movement desensitisation and reprocessing (EMDR)
Drug treatments:
Not routinely used - venlafaxine or a SSRI like sertraline can be used
Severe - Risperidone
What is coward syndrome
when a person believes they are dead or non existent
what is capgras syndrome
An irrational delusion of misidentification where the patient believes that a relative or friend has been replaced by an identical imposter
What is de clerambault syndrome
AKA erotomania
A delusion disorder where patients believe another individual is infatuated with them.
What is delusional parasitosis
AKA Ekbom syndrome
Patients have a fixed, false belief that they are infested by bugs
What is the treatment for personality disorders
Psychological therapies - dialectical behavioural therapy
Treatment of any coexisting psychiatric conditions
What is schizoid personality disorder
Characterised by a tendency towards solitariness
Lack of interest in social relationships
Emotional detachment
Lack of interest for sexual interactions
Few interests
Indifference to praise and criticism
Which of the atypical antipsychotics has the best side effect profile
Aripiprazole
When is clozapine likely to be trialled in schizophrenia
If it is not controlled despite the sequential use of two or more antipsychotic drugs (one should be a second generation).
Each must have been trialled for at least 6-8 weeks.
What are the rules regarding clozapine monitoring
If doses are missed for more than 48 hours - you will need to restart it slowly.
Restarting clozapine must be done under a psychiatrist.
If its stopped for 72 hours - you may need frequent blood tests for a short period.
What are the signs of serotonin syndrome
Hypertension
Muscle rigidity
Pupillary dilatation
Rapid heart rate
Confusion
Agitation
Loss of muscle coordination
Diarrhoea
Shivering
fever
Seizures
What are the features of a brief psychotic episode
An episode of psychosis that lasts less than a month.
usually a return to baseline functioning
What is the most common side effect of the atypical antipsychotics
Weight gain
Hyperprolactinaemia
What is wernickes encephalopathy
a neurological condition due to longstanding thiamine (vitamin B1) deficiency.
Triad of:
confusion
Ataxia (broad based gait)
Occulomotor dysfunction (CN6 palsy and nystagmus)
What is korsakoffs syndrome
Anterograde and retrograde amnesia
Confabulation
What are examples of tricyclic antidepressants
Amitriptyline
Clomipramine
Dosulepin
Trazodone
Imipramine
Lofepramine
Nortriptyline
What is antisocial personality disorder
Characterised by disregard for others, failure to conform to social norms.
Often results in criminal behaviour and lack of remorse.
Which Scoring system is used to determine the severity of alcohol withdrawal
The revised clinical institute withdrawal assessment for alcohol (CIWA-Ar)
What should be done when switching someone off of fluoxetine
A gap of 4-7 days should be left before starting an alternative SSRI
What is the cardiac side effect associated with Citalopram
Prolonged QT leading to Tornadoes Des Pointes.
When is a grief reaction classed as being abnormal
If present 6+ months following a bereavement.
What are examples of SNRIs
Venlafaxine
Duloxetine
