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Psychiatry > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Principles of psychotherapy

A
  • Develop therapeutic relationship
  • Listen to patient concerns
  • Empathetic approach
  • Provide information support and advice
  • Allow expression of emotion
  • Encourage self-help.
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2
Q

Indications of CBT

A
  • Mild-moderate depression
  • ED
  • Anxiety disorders
  • BPAD
  • Substance misuse
  • Schizophrenia
  • Chronic medical conditions - Fibro, CFS, chronic pain
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3
Q

When to use CBT

A
  • Disorder is not caused by life events but how the pt views / reacts to them.
  • Short term collaborative therapy focused on goals of symptom relief and development of new skills to sustain recovery.
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4
Q

Aim CBT

A

Help individuals to identify and challenge negative self thoughts and abnormal underlying core beliefs.

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5
Q

Delivery CBT

A

Individual, or group or as self help - via books or computer programmes. - 6-20 sessions.

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6
Q

Con CBT

A

Requires active collaboration and understanding. Patients should be motivated, able to link their thoughts and emotions.

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7
Q

Selective abstraction

A

focusing on one minor aspect rather than the bigger picture

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8
Q

All or nothing

A

“if he doesn’t text today it means he hates me”

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9
Q

Magnification or minimisation

A

Over or under estimating the importance of an event

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10
Q

Catastrophic thinking

A
  • ## Anticipating the worst possible outcome of an event
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11
Q

Overgeneralisation

A

If one thing is not going well, everything is going to go wrong

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12
Q

Arbitrary inference

A

Coming to a conclusion in the absence of anything to support it.

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13
Q

Negative thought process

A
  1. “friend didn’t call when she said she would”

(CBT stops things here)

  1. Negative automatic thought - friend hates me
  2. Emotional response
  3. Maladaptive behaviour - attempts to avoid friend
  4. Social isolation
  5. Worsening of mood
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14
Q

Types of thought

A

Selective abstraction
All or nothing
Magnification or minimisation
Catastrophic thinking
Overgeneralisation
Arbitrary reference

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15
Q

Operation conditioning

A

behaviour is reinforced if it has positive consequences for the individual and it prevents any negative consequences.

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16
Q

Relaxation techniques

A

Stress related and anxiety. Used techniques causing muscle relaxation during the stress or anxiety.

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17
Q

Systemic desensitisatiobn

A

Phobic anxiety. Gradual exposure to stimulus.

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18
Q

Flooding

A

Rapidly being exposed to phobic object without attempt to reduce anxiety beforehand. Consistent exposure until anxiety subsides.

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19
Q

Exposure and prevention

A

OCD and phobias. Repeatedly exposed to situation which causes anxiety. Are prevented from performing compulsive actions that lessens anxiety. After initial activity, reexposure anxiety eventually declines.

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20
Q

Behavioural activation

A

depressive illnesses. Patients avoid doing things in fear of failure or not enjoying. Making realistic and achievable plans to carry out activities and then gradually increasing amount of activity.

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21
Q

Types of behavioural therapies

A

Relaxation techniques
Systemic desensitisation
Flooding
Exposure and response prevention
Behavioural activation
Operant conditioning

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22
Q

Indications of psychodynamic therapues

A

Dissociative disorders, psychosexual disorders, somatoform, personality disorders. Chronic dysthymia, recurrent depression.

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23
Q

Rationale of psychodynamic therapies

A

Childhood experiences, past unresolved conflicts and previous relationships

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24
Q

Aim of psychodynamic therapies

A

Unconscious explored using free association and therapist interprets the statement in order for client to gain insight and change their maladaptive behaviour.

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25
Q

Transference

A

pt re-experiences strong positive or negative emotions from early relationships in the relationship with therapist

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26
Q

Counter transference

A

the therapist is affected by powerful emotions felt by the patient and reflects what they are feeling

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27
Q

Mode of delivery for psychodynamic therapies

A

Psychoanalysis - one to one with up to 5 50 minute sessions per week for up to a number of years

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28
Q

Psychoeducation

A
  • Delivery of information to people in order to help them understand and cope with their mental illness.
    1. Name and nature of their illness
    2. Likely causes of the illness
    3. What health services can do to help them
    4. What they can do to help themselves.
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29
Q

Counselling

A
  • Form of relieving distress and is undertaken by means of active dialogue between counsellor and client.

Indications - Adjustment disorder, mild depressive illness, normal and pathological grief, child sexual abuse, other forms of trauma, substance misuse, chronic conditions.

Rationale - Behaviour and emotional life are shaped by previous experience and the current environment and the relationships individuals have.

Aim - To help client or patient to find their own solutions to problems.

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30
Q

Supportive psychotherapy

A
  • Describes psych support given by mental health professionals to patients with chronic and disabling mental illnesses
  • Help people cope with adversity or unsolved problems
  • Key elements include active listening, providing reassurance and providing explanation of the patient illness. Providing guidance and possible solutions
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31
Q

Problem solving therapy

A
  • Structured combinations of counselling and CBT.
  • Individuals to deal actively with their life problems by selecting an option for tackling each one, trailing out and reviewing effects.
  • Indications are mild anxiety, and depressive disorders.
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32
Q

IPT

A
  • Interpersonal therapy
  • Depression and eating disorders
  • Interpersonal problem causing the problem. Overlaps with CBT
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33
Q

EMDR

A
  • Eye movement and desensitisation and reprocessing.
  • Accesses and processes traumatic memories
  • PTSD
  • recalling emotionally traumatic material while focusing on an external stimulus.
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34
Q

DBT

A
  • Dialectical behavioural therapy
  • Borderline PD
  • CBT and provides group training skills with alternative coping strategies
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35
Q

CAT

A
  • Cognitive analytic therapy
  • Cognitive theories and psychoanalytic approaches into a therapy
  • Eating and personality disorders.
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36
Q

Therapy for Adverse life events

A

PE, Counselling
Relaxation training

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37
Q

Therapy for depression

A

PE
counselling
CBT
psychodynamic
IPT
behavioural activation

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38
Q

Therapy for PTSD

A

PE, CBT, EMDR

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39
Q

Therapy for Schizophrenia

A

PE
CBT
Family therapy

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40
Q

Therapy for ED

A

PE
CBT
IPT
family therapy
CAT

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41
Q

Therapy for Anxiety disorders

A

PE
CBT
Behavioural therapies

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42
Q

Therapy for substance

A

PE
CBT
motivational interviewing
group therapy

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43
Q

Therapy for BPD

A

PE
DBT
psychodynamic therapy
CAT

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44
Q

Types of therapy

A

Individual
Couples
Family therapy
Group therapy

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45
Q

Indications for antidepressants

A

Used for moderate to severe depressive episodes and dysthymia.

Can also be used for panic attacks, OCD, chronic pain, ED and PTSD

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46
Q

SSRI

A

Selective serotonin reuptake inhibitor

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47
Q

SNRI

A

Serotonin and noradrenaline reuptake inhibitor

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48
Q

TCA

A

Tricyclic antidepressant

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49
Q

MAOI

A

Monoamine oxidase inhibitor

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50
Q

NARI

A

Noradrenaline reuptake inhibitor

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51
Q

NASSA

A

Noradrenaline serotonin specific antidepressant

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52
Q

SARI

A

Serotonin antagonist and reuptake inhibitor

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53
Q

How do antidepressants work

A

Works on monoamine hypothesis by enhancing monoamine neurotransmitters noradrenaline (NA) and serotonin (5HT).

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54
Q

Why are SSRi first line

A

fewer risks of mania, work quicker and are better tolerated so are usually first line in depression.

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55
Q

How long do antidepressants take

A

Antidepressants take around one week to notice and 4-6 weeks is clinically detectable

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56
Q

Examples SSRI

A

Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Fluvoxamine

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57
Q

Depression SSRI

A

All

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58
Q

Panic disorder SSRI

A

Citalopram, escitalopram, paroxetine

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59
Q

Social phobia SSRI

A

escitalopram paroxetine

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60
Q

BN SSRI

A

fluoxetine

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61
Q

OCD SSRI

A

most

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62
Q

PTSD SSRI

A

paroxetine and sertraline

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63
Q

GAD SSRI

A

paroxetine

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64
Q

Why is fluvoxamine not regularly prescribed

A

it is a cytochrome p450 enzyme inhibitor and therefore commonly interacts with other medications potentiating their effects

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65
Q

Mechanism of action SSRI

A

they work by inhibiting the reuptake of serotonin from the synaptic cleft into the pre-synaptic neurones and therefore SSRI increase the concentration of serotonin in the synaptic cleft

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66
Q

Side effects SSRi

A

STRESS
Sweating
Tremor
Rashes
Extra[yramindal side effects
Sexual dysfunction
Somnolence
Stopping SSRI symptoms - discontinuations

GI - nausea, dyspepsia, bloating, flatulence, diarrhoea and constipation

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67
Q

Contraindications and cautions SSRI

A

History of mania - contra and caution
Cardiac disease
DM
concomitant use with drugs that cause bleeding
History of GI bleeding
Hepatic or renal impairment
Pregnancy or breastfeeding
Young adults - inc suicide risk

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68
Q

SNRI examples

A

venlafaxine
Duloxetine

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69
Q

NASSA example

A

Mirtazapine

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70
Q

NARI example

A

Reboxetine

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71
Q

SARI example

A

Trazodone

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72
Q

Indication SNRi

A

second or third line in the treatment of depression and anxiety disorders.
More rapid onset of action and are more effective for major depression

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73
Q

NASSA indication

A

Second line for depression who would benefit from weight gain and suffer from insomnia

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74
Q

NARI indications

A

Second or third line for major depression

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75
Q

SARi indications

A

Depression where sedation is required
Anxiety
Dementia with agitation
Insomnia

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76
Q

Mechanism of action SNRI

A

preventing the reuptake of noradrenaline and serotonin but do not block cholinergic receptors and therefore do not have as many anti-cholinergic side effects as TCA

77
Q

Mechanism of action NASSA

A

mirtazapine has a weak noradrenaline reuptake inhibiting effect and has anti-histaminergic properties
A1 and A2 blocker so inc appetitite and is a sedative

78
Q

Mechanism of action NARI

A

highly specific noradrenaline reuptake inhibitor

79
Q

Mechanism of action SARI

A

a serotonin antagonist and reuptake inhibtor

80
Q

SNRI side effects

A

Nausea
dry mouth
headache
dizziness
sexual dysfunction
hypertension

81
Q

NASSA side effects

A

inc apetite
weight gain
dry mouth
postural hypotension
oedema
drowsiness
fatigue
tremor
dizziness
abnormal dreams
confuson
anxiety

82
Q

NARI side effects

A

Nausea
dry mouth
constipation
anorexia
tachycardia
palpitations
vasodilation
postural hypotension
insomnia
dizziness
urinary retention

83
Q

SARI side effects

A

minimal anticholinergic side effects and relatively low cardio toxicity compared wit TCA
May cause dizziness, sedation and GI symptoms

84
Q

Cautions SNRI

A

conditions associated with high risk of cardiac arrhythmia and uncontrolled hypertension

85
Q

Cautions NASSA

A

elderly
cardiac disorders
hypotension
urinary retention
diabetes
angle-closure glaucoma
history of seizures and blood disorders
Pregnancy
Breastfeedingf

86
Q

Cautions NARI

A

history of cardiovascular disease
epilepsy
bipolar disorder
urinary retention
hypertrophy prostatic
pregnancy

87
Q

Cautions SARI

A

similar to TCA

88
Q

How to choose correct antidepressant

A

Overall safety
patient preference
prior treatment
type and severity of depression
suicidal ideation
age and co-morbidities
drug - drug reactions
pregnancy and breast feeding
history of mania

89
Q

What not to do when prescribing SSRi

A

co-prescribe NSAIDS without a PPI
Prescribe heparin or warfarin
stop sari suddenly
prescribe citalopram or escitalopram in long QT syndrome

90
Q

What to prescribe to children with depression

A

fluoxetine

91
Q

When to review pt after antidepressant SSRi

A

2 weeks after
Or younger than 30 or at inc risk suicide after 1 week

92
Q

When should SNRi not be used

A

in pt with cardiac disease and uncontrolled hypertension and BP should be taken and regularly monitored after

93
Q

TCA example

A

Amitriptyline
clomipramine
dosulepin
doxepin
imipramine
lofepramine
nortriptyline
trimipramine

94
Q

indication TCA

A

depression
nocturnal enuresis in children
neuropathic pain
migraine prophylaxis

95
Q

Mechaninsm action TCA

A

inhibiting reuptake of adrenaline and serotonin in the synaptic cleft
Have affinity for cholinergic receptors and 5HT2 receptors and contribute to side efcets

96
Q

Side effets TCA

A

anticholinergic = dry mouth, constipation and urinary retention, blurred vision

Cardio - arrhythmia, postural hypotension, tachycardia, syncope

Amitryptiline - Prolonged QTs interval

Psychiatric - hypomania / mania, confusion or delirium

Metabolic 0 inc apetite and weight gain

endocrine - testicluar enlargement, gynaecomastia, galactorrhea

Neuro - convulsions, movement disorders and dykinesias

Others - headache, sexual dysfunction and tremor

97
Q

Contraindications TCA

A

recent MI
arrythmias
mania
severe liver disease
agranulocytosis
history of epilepsy
pregnancy
elderly

98
Q

Example MAOI

A

Irreversible - phenelzine
isocarboxide

Reversible - moclobemide

99
Q

Indications MAOI

A

third line depression - atypical or treatment resistant

Social phobia

100
Q

Mechanism of action MAOI

A

inactivate monoamine oxidase enzymes that oxidise the monoamine neurotransmitters dopamine, noradrenaline, serotonin and tyramine

101
Q

Two forms of MAOI

A

MAO-A and MAO-B
Moclobemide binds to MAO-A nullifying the need for dietary restrictiosn

102
Q

Side effects MAOI

A

cardio - postural hypotension, arrythmias

Neuropsychiatric - drowsiness, insomnia, headache

Gi - inc appetite and weight gain

Sexual - anorgasmia

Hepatic - inc LFT

Hypertensive reactions with tyramine containing foods

103
Q

Caution of MAOI

A

avoid in agitated or excited patients
thyrotoxicosis
hepatic impairment
bipolar - mania

Contraindications - acute confusional states and phaeochromocytoma

In tyramine containing foods.

104
Q

Types of food to avoid MAOI

A

tyramine rich foods
cheese
pickled herring
liver
bovril
oxo
marmite
red wine
causing hypertensive crisis

105
Q

Clinical features hypertensive crisis

A

headache
palpiatations
fever
convulsions
and coma

106
Q

Drug interactions MAOI

A

insulin
opiates
SSRI
TCA
Anti-epileptics

107
Q

Typical antipsychotics

A
  • Haloperidol
  • Chlorpromazine
  • Flupentixol
  • Fluphenazine
  • Sulpiride
  • Zuclopenthixol
108
Q

Atypical antipsychotics

A
  • Olanzapine
  • Risperidone
  • Quetiapine
  • Amisulpride
  • Aripiprazole
  • Clozapine
109
Q

Difference between first and second generation antipsychotics

A

the extent to which they cause extra-pyramidal side effects

110
Q

When to use clozapine

A

treatment resistant schizophrenia after failing to respond to at least two other antipsychotics

111
Q

Type of antipsychotics first line for schizophrenia

112
Q

Indications for antipsychotics

A
  • Psychotic symptoms such as delusions and hallucinations
  • Schizophrenia
  • Depression, mania, delusional disorders, acute and transient psychotic disorders, delirium, dementia as well as violent or impulsive behaviour
113
Q

Typical antipsychotics mechanism of action

A

reducing abnormal transmission of dopamine, through blocking dopamine receptors in the brain.

114
Q

Atypical antipsychotics mechanism of action

A

Reducing specific dopaminergic action, blocking D2 receptor and sertonergic effects.

115
Q

Antidoperminergic antipsychotics

A

D2/D3 receptors to reduce dopamine. Typical have a higher affinity

116
Q

Serotonergic antipsychotics

A

Mostly atypical antipsychotics. Thought to improve affective and negative symptoms and responsible for metabolic side effects.

117
Q

Why do side effects happen in antipsychotics

A

Block dopamine receptors - also have affinity for muscarinin, 5HT , histaminergic and adrenergic receptors which explains side effects

119
Q

How to stop antipsychotics

A
  • continued for at least 1-2 years after state of psychosis. Some continue for 5 years to prevent relapse
  • If stopping, taper medication over 3 weeks. Relapse risk is much greater after stopping suddenly over gradual withdrawal.
119
Q

Monitoring of antipsychotics

A
  • FBC, U+E and LFT - Monitoring is required at start. Clozapine requires white blood cell monitoring weekly for 18 weeks, then fortnightly for up to a year.
  • Fasting blood glucose at 4-6 months then yearly
  • Blood lipids - baseline, 3 months then yearly
  • ECG - before initiating treatment. - More frequent for haloperidol and pimozide
  • BP
  • Prolactin
  • Weight
  • Physical health
  • Creatine phosphokinase
119
Q

Side effects of antipsychotics

A
  • Extrapyramidal
  • Anti-muscarinic - blurred vision, urinary retention, dry mouth, constipation (cant see, cant wee, cant spit, cant shit)
  • Anti-histaminergic - sedation and weight gain
  • Anti-adrenergic - postural hypotension, tachycardia, ejactulatory failure
  • Endocrine / metabolic - INC prolactin (sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement) impaired glucose tolerance, hypercholesterolaemia
  • Neuroleptic malignant syndrome
  • Prolonged QT interval - pimozide and haloperidol - risk of Torsades de pointes
  • Clozapine - hyper salivation and agranulocytosis
119
Q

Extrapyramidal side effects

A

PAD-T

  • Parkinsonism -
    • Akathisia -unplesant feeling of restlessness - treated by reducing dose and temp giving propranolol
  • Dystonia - Acute painful contractions of muscles in the neck, jaw and eyes
  • Tardive dyskinesia - Choreoathetoid movement may occur in 40% pt and is irreversible. Most commonly presents as chewing and pouting of the jaw.
119
Q

Cautions of antipsychotics

A

Cardiovascular disease, Parkinson’s, epilepsy, depression, myasthenia graves, prostatic hypertrophy

119
Q

Contraindications antipsychotics

A

comatose states, CNS depression, phaeochromocytoma

119
Q

Parkinson side effects

A

bradykinesia, inc rigidity, coarse tremor, masked faces, shuffling gait - weeks or months to occur

119
Q

Depot injections antipsychotics

A
  • Long acting slow release medications - flupentixol, fluphenazine, zuclopenthixol.
  • They bypass first pass metabolism
119
Q

What are mood stabilisers

A

Drugs used to prevent depression and mania in bipolar affective disorder and schizoaffective disorder.

120
Q

Benefit of depot injections

A

Improve adherence with medication for patients who may find it difficult to take medication orally.

120
Q

Typical vs Atypical antipsychotics
Extrapyramidal side effects
Tolerability
Efficacy
MEtabolic syndrome
Weight gain
T2DM
Stroke in elderly
Tardive dyskinesia
High prolactin

A

Typical
More
less
dec
less
less
less
less
more
more

Atypical
fewer
greater
inc
more
more
more
more
less
less

120
Q

Mechanism of action lithium

A

decreases activity of sodium-dependent intracellular secondary messenger systems as well as modulation of dopamine and serotonin neurotransmitter pathways, dec activity of protein kinase C. and dec turnover of arachidonic acid.

120
Q

Indications lithium

A

First line prophylaxis in bipolar affective or acute manic episodes and as an adjunctive for depression

120
Q

Lithium levels

A

Normal therapeutic levels = 0.4-1.0mmol/L
Toxic = >1.5

120
Q

Contraindications lithium

A

Pregnancy, renal failure and breastfeeding
Untreated hypothyroidism
Addisons disease
Brugada syndrome

120
Q

Toxicity of lithium

A

TOXIC
Tremor
Oliguric renal failure
ataXia
Increased reflexes
Convulsions / Coma / Consciousness lost

121
Q

Caution of lithium

A

Prolonged QT interval, epilepsy, diuretic therapy

122
Q

Monitoring Lithium

A

Before - U+E, eGFR, TFT, Pregnancy status and baseline ECG

Monitored 12 hours following first dose then weekly until normal therapeutic level reached for 4 weeks. Once stable check every 3 months
U+E should be checked every 6 months
TFT every 12 months

123
Q

Sodium valproate indications

A

If lithium and an atypical antipsychotic is ineffective or unsuitable in acute mania. Used in combination with lithium in bipolar

124
Q

Mechanism of action sodium valproate

A

Inhibit catabolism of GABA and dec turnover or arachidonic acid and activate extracellular signal-regulated kinase
Alters synaptic plasticity and interferes with intracellular signalling.

125
Q

Side effects sodium valproate

A

GI disturbances,
VALPROATE
Very fat
Aggression
LFT inc
Platelets low - thrombocytopenia
Reversible hair loss
Oedema
Ataxia
Tremor / Tiredness / Teratogenic
Emesis

125
Q

Monitoring sodium valproate

A

FBC to check platelets before and after surgery
Monitor LFT and prothrombin time before therapy and during first 6 months
Pregnancy test and Weight BMI

126
Q

Contraindication of sodium valproate

A

Pregnancy, hepatic dysfunction, and porphyria

126
Q

Carbamazepine indications

A

not first line for mania
Prophylaxis of bipolar
alcohol withdrawal

127
Q

Mechanism of action carbamazepine

A

blocks voltage dependent sodium channels and therefore inhibits repetitive neuronal firing
Dec glutamate release and dec turnover of dopamine and noradrenaline

127
Q

Side effects carbamazepine

A

GI disturbances
Dermatitis
Dizziness
Hyponatraemia
Blood disorders - leucopenia, thrombocytopenia

128
Q

Contraindications carbamazepine

A

cardiac disease and blood disorders
AV conduction abnormalities and acute porphyria
Avoid in pregnancy
Potent enzyme inducer so drugs such as COCP will be metabolised fasted (contraceptive)

129
Q

Monitoring Carbamazepien

A

check WCC after a week
Measure plasma carbamazepine levels if sign of toxicity
LFT and U+E

129
Q

Indications of lamotrigine

A

bipolar depression
Less teratogenic than others so more likely yo be used in child bearing age
Does not treat or prevent manic episodes

130
Q

Mechanism of action LAMOTRIGINE

A

inhibition of sodium and calcium channels in presynaptic neurones and subsequent stabilisation of neuronal membrane

131
Q

Side effects lamotrigine

A

GI, rash, headache and tremor

131
Q

Contraindications of Lamotrigine

A

Combination of lamotrigine and carbamazapein causing neurotoxicity

131
Q

Monitoring lamotrigine

A

LFT, FB, U+E and inform pt to see doctor incase of hypersensitivity

132
Q

Anxiolytics vs hypnotics

A

Anxiolytics (minor tranquillisers) any drugs licensed for a variety of anxiety disorders. Called hypnotics if they are used to induce sleep.

133
Q

Types of hypnotic

A

benzodiazepines and low dose amitryptiline the so Z drugs - Zopliclone, Zolpidem, Zaleplon

133
Q

Types of anxiolytics

A

barbiturates, buspirone, beta-blocker and antipsychotics and BENZO (1st line in anxiety)

134
Q

Benzo long acting examples

A

Diazepam, nitrazepam and chlordiazepoxide, flurazepam

134
Q

Short acting Benzo

A

lorazepam, oxezepam, temazepam, midazolam,

135
Q

Indicaions benzo

A
  1. Insomnia
  2. anxiety
  3. delirium
  4. Alcohol detox
  5. Acute psychosis
  6. Violent behaviour
135
Q

Mechanims of action benzo

A

BZD enhance effect of inhibitory neurotransmitter GABA by inc frequency of chloride channels via benzodiazepines binding site of GABA-A receptor.

135
Q

Side effects of benzo

A

Drowsiness
Light headedness
cinfusion
ataxia
amnesia
dependence
resp depression

136
Q

Caution Benzo

A

Resp depression
hepatic impairment

137
Q

Propanolol use

A

anxiety disorder for somatic symptoms such as tachycardia, palpitations and tremor
Contraindications in asthma, COPD, bronchospasm, heart block and marked hypotension
Can lead to prolongation of QT

138
Q

Buspirone

A

non-sedating anxiolytic than can be used for GAD
5HT-1A agonist.

138
Q

Pregabalin

A

does not act directly GABA-A but inhibitor of glutamate, noradrenaline, and substance P
Anticonvulsant and can be used for GAD

139
Q

Procedure ECT

A
  • Only performed by psychiatrist
  • Electric current is applied via electrodes to a patients skull, aiming to induce a seizure for at least 30 seconds.
  • Under general anaesthetic
  • A muscle relaxant is given which limits motor effects of seizure
140
Q

Two types of ECT

A
  • Bilateral ECT has been shown to be more effective but with more cognitive side effects
  • Unilateral considered after cognitive side effects of first ECT or in elderly
140
Q

Seizure threshold

A

minimum electrical stimulus required to induce a seizure

141
Q

Drugs inc seizure threshold

A

anaesthetic drugs, anticonvulsants, benzodiazepines, barbiturates

141
Q

Drugs that dec seizure threshold

A

Antipsychotics, antidepressants, lithium

142
Q

Indications ECT

A
  1. Prolonged or severe mania - euphoric
  2. Catatonia
  3. Severe depression - Tearful
    1. Treatment resistant
    2. Suicidal ideation or serious risk to others
    3. Life threatening
143
Q

Side effects ECT

A

PC DAMS

  • Peripheral nerve palsies
  • Cardiac arrhythmias or Confusion
  • Dental and oral trauma
  • Anaesthetic risks
  • Muscular ache and headache
  • Short term memory impairment or status epilepticus

Long term -

  • Anterograde and retrograde amnesia
143
Q

Contraindications of ECT

A

MARS

  • MI < 3/12 or major unstable fracture
  • Aneurysm
  • Raised ICP
  • Stroke <1 month ago, a history of status epilepticus, severe anaesthetic risk
143
Q

SE Laxative abuse

A

Reduced potassium, and lack of hydration leading to arrythymias, headaches etc.

144
Q

Life threatening SE of Clozapine

A

Agranulocytosis

145
Q

What should phenelzine not be prescribed with

A

Phenelzine should not be prescribed with fluoxetine due to increased risk of central serotonin syndrome

146
Q

Which anti-emitic is not good for parkinsonism

A

metoclopramide is a dopamine antagonist and can worsen his symptoms.

147
Q

SSRI discontinuation syndrome

A

Discontinuation symptoms
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

148
Q

SSRI and pregnancy

A

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

149
Q

Hyperprolacinaemia occurs in what

A

Atypical antipsychotics

Dopamine has an inhibitory effect on the secretion of prolactin and the inhibition of dopamine by the antipsychotic relieves the inhibitory effect on prolactin release resulting increasing prolactin secretion and hence the galactorrhea.

150
Q

Olanzapine SE

A

dyslipidaemia, diabetes mellitus and weight gain

151
Q

Quetiapine SE

A

somnolence and rarely long QT syndrome.

152
Q

What antidepressant is contraindicated in Anorexia and Bulimia

A

Bupropion is an atypical antidepressant which is commonly used for smoking cessation. It is however contraindicated in anorexia nervosa or bulimia nervosa as it lowers the seizure threshold and predisposed these patients to seizures.

153
Q

Schizoaffective vs mood congruent delusions

A

Schizoaffective disorder may involve depressive psychotic features with non-congruent clinical features (eg. they may appear more manic despite depressive delusions) but this is an uncommon condition

Delusions are mood-congruent with depression (they are ‘depressing’ delusions). Psychotic depression commonly includes mood-congruent delusions.

154
Q

Acute dystonic reaction

A

oculogyric crisis, a form of acute dystonic reaction. Other signs can include tongue protrusion and jaw spasm.

eye pain and an abnormal posture. On examination her neck is fixed backwards and laterally, and her eyes are deviated upwards. She is unable to control her gaze.

Treatment is usually IV procyclidine and withdrawal of the causative medication.

155
Q

Patients with hepatic failure and alcohol withdrawal treatment

A

In patients with hepatic failure, lorazepam is preferred over chlordiazepoxide for alcohol withdrawal syndrome to avoid the risk of increased sedation

156
Q

Which pathway is inhibited to have antipsychotics cause hyperprolacinaemia

A

Inhibition of the tuberoinfundibular pathway by antipsychotics causes hyperprolactinaemia

Psychiatry (17 decks)

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