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Year 3 > Physciatry > Flashcards

Physciatry Flashcards

1
Q

3Depression

SSRIs (Selective Serotonin Reuptake Inhibitors)

3 drugs

A

Citalopram (1st Line)

Sertraline

Fluoxetine (kids)

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2
Q

MOA of SSRIs

A

Selectivly inhibits serotonin reuptake from synaptic cleft.

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3
Q

Side effects of SSRIs (3)

A

Nausea
sexual dysfunction

serotonin syndrome.

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4
Q

Contraindications of SSRIs

(3)

A

MAOIs (risk of serotonin syndrome)

caution with QT prolongation (especially Citalopram).

triptans

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5
Q

Depression

(2nd Line kind of, generally SSRI>SSRI>SNRI)

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

2 drugs

A

Venlafaxine

Duloxetine

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6
Q

MOA of SNRIs

A

MOA: Inhibits reuptake of serotonin and noradrenaline.

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7
Q

Side affects SNRIs

(3)

A

Hypertension (Venlafaxine)
nausea
Insomnia

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8
Q

Contraindications SNRIs (2)

A

Uncontrolled hypertension

renal impairment

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9
Q

TCAs (Tricyclic Antidepressants) (low yield)

2 drugs

A

Amitriptyline

Imipramine

Clomipramine

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10
Q

MOA TCAs (Tricyclic Antidepressants)

A

Inhibits reuptake of norepinephrine and serotonin

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11
Q

Side effects TCAs (4)

A

Sedation
anticholinergic effects
cardiotoxicity
weight gain.

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12
Q

Contraindications TCAs (2)

A

elderly (fall risk)
Cardio issues

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13
Q

2 examples MAOIs (Monoamine Oxidase Inhibitors)

treatment-resistant depression or atypical depression

A

(irreversible) Phenelzine+Tranylcypromine

(reversible) Moclobemide

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14
Q

MAOIs MOA

A

Inhibits breakdown of serotonin, norepinephrine, and dopamine

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15
Q

MAOIs Side effects (2)

A

Hypertensive crisis (with tyramine foods),

Postural hypotension

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16
Q

Contraindications MAOIs

(2)

A

SSRIs/SNRIs

pheochromocytoma

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17
Q

Bipolar, mood stabilisers (3 drugs)

A

Lithium

Sodium Valporate

Atypical Antipsychotics

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18
Q

Lithium MOA

A

Lithium is thought to work by modulating neurotransmitter release, particularly serotonin and dopamine

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19
Q

Lithium side affects (3)

A

Tremor
hypothyroidism
nephrotoxicity

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20
Q

Contraindications Lithium

(2)

A

Severe renal impairment

dehydration

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21
Q

Sodium Valproate MOA

A

Increases GABA availability

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22
Q

Sodium Valproate Side effects (2)

A

Weight gain

hepatotoxicity

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23
Q

Sodium Valproate Contraindications (2)

A

Pregnancy

liver disease

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24
Q

Atypical Antipsychotics drugs (3)

A

Olanzapine (weight gain)

Quetiapine

Aripiprazole (least AEs) for schizophrenia

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25
Q

Atypical Antipsychotics MOA

A

Dopamine (D2) receptor antagonism, serotonin antagonism

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26
Q

Side effects Atypical Antipsychotics (3)

A

Weight gain (main)

metabolic syndrome,

EPS

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27
Q

Atypical Antipsychotics Contradictions (2)

A

Diabetes

elderly with dementia

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28
Q

Schizophrenia
Typical Antipsychotics

2 drugs

A

Haloperidol

Chlorpromazine

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29
Q

Typical Antipsychotics, MOA

Eg Haloperidol

A

Blocks dopamine D2 receptors

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30
Q

Typical Antipsychotics Side effects (4)

A

Extrapyramidal symptoms (EPS High Yield)

tardive dyskinesia (Tetrabenezine)

hyperprolactinemia

Neuroleptic Malignant Syndrome

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31
Q

Typical Antipsychotics Contraindications (2)

A

Parkinson’s disease

QT prolongation

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32
Q

Schizophrenia

1st line Tx

2nd Line

3rd/4th Tx Resistance

A

1st Line Aripiprazole (less AE’s)

2nd line Risperidone

3rd/4th line= (Clozapine Tx Resistance)

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33
Q

Schizophrenia Atypical Antipsychotics drugs (2)

A

Risperidone (less side affects, but does give Hyperprolactinaemia)

Clozapine (gives Seizures)

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34
Q

Schizophrenia Atypical Antipsychotics drugs MOA

A

Blocks D2 and serotonin receptors

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35
Q

Schizophrenia Atypical Antipsychotics side effects (3)

A

Weight gain

Sedation

Agranulocytosis (Clozapine)

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36
Q

Schizophrenia Atypical Antipsychotics Contraindications (2)

A

Bone marrow suppression

Metabolic disorders

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37
Q

Anxiety Disorders drugs (2)

A

Benzodiazepines: Diazepam, Lorazepam (SHORT TERM)

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38
Q

Anxiety Disorders drugs MOA

A

Enhances GABA activity

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39
Q

Anxiety Disorders drugs side effects (3)

A

Sedation, dependence, respiratory depression.

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40
Q

Anxiety Disorders drugs Contraindications (2)

A

Respiratory failure
Chronic alcohol use.

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41
Q

short term Anxiety management (not Benzos) drug

A

Buspirone

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42
Q

short term Anxiety management drug Buspirone MOA

A

Partial agonist of serotonin receptors

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43
Q

short term Anxiety management drug Buspirone side effects (3)

A

Dizziness

Headache

Nausea

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44
Q

short term Anxiety management drug Buspirone contradictions

A

Severe hepatic impairment

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45
Q

Obsessive-Compulsive Disorder (OCD)

SSRIs 1st line Tx OCD

(3)

A

Fluoxetine (Cardio risks)

Sertraline

Escitalopram

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46
Q

SSRIs MOA

A

Increases serotonin by inhibiting reuptake.

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47
Q

SSRIs Side effects (2)

A

Nausea

Sexual Disfunction

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48
Q

SSRIs contradictions (1)

A

MAOIs (due to risk of serotonin syndrome).

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49
Q

Attention Deficit Hyperactivity Disorder (ADHD)
Stimulants drug

A

Methylphenidate (Ritalin)

Long acting: Concerta

Dexamphetamine

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50
Q

Attention Deficit Hyperactivity Disorder (ADHD)
MOA

A

Increases dopamine and norepinephrine levels.

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51
Q

Attention Deficit Hyperactivity Disorder (ADHD)
Side effects (3)

A

Insomnia

appetite suppression

increased heart rate

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52
Q

Attention Deficit Hyperactivity Disorder (ADHD)
Contraindications (2)

A

Cardiovascular disease

anxiety

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53
Q

Attention Deficit Hyperactivity Disorder (ADHD)
Non-stimulants drug

A

Atomoxetine (2 months to work)

Guanfacine ( 2 weeks to work)

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54
Q

Attention Deficit Hyperactivity Disorder (ADHD)
Non-stimulants MOA

A

Selective norepinephrine reuptake inhibitor

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55
Q

Attention Deficit Hyperactivity Disorder (ADHD)
Non-stimulants Contradictions (2)

A

Severe hepatic impairment

cardiovascular disease

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56
Q

3 weeks 6 days - which disease?
4 weeks 0 days - which disease?

A

3 weeks 6 days - Acute stress disorder

4 weeks 0 days - PTSD

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57
Q

Unexplained symptoms
Somatisation = XXX
hypoChondria = YYY

A

Unexplained symptoms

Somatisation = Symptoms
hypoChondria = Cancer

58
Q

Less than 1 mth = brief psychotic disorder
> 1 mth < 6 mth = schizophreniform
> 6 mth = schizophrenia

A

Less than 1 mth = brief psychotic disorder
> 1 mth < 6 mth = schizophreniform
> 6 mth = schizophrenia

59
Q

Antidepressant+ smoking cessation drug

A

Bupropion

60
Q

MOA Bupropion

A

inhibiting the reuptake of dopamine and norepinephrine, increasing their levels in the brain to improve mood and reduce cravings

61
Q

Side effects of Bupropion (4)

A

Insomnia
dry mouth
Seizure Risk
weight loss

62
Q

Contradictions Bupropion (4)

A

Seizure Disorder: Bupropion lowers the seizure threshold, so it’s contraindicated in individuals with a history of seizures.

Eating Disorders: Conditions like anorexia nervosa and bulimia increase the risk of seizures with bupropion.

Alcohol or Benzodiazepine Withdrawal: Both increase seizure risk, making bupropion unsafe in these situations.

MAOI Use: Concurrent use with monoamine oxidase inhibitors (MAOIs) can lead to severe interactions; a two-week washout period is required.

63
Q

2nd line antidepressant?

A

Mirtazapine (atypical antidepressant) NaSSAs

64
Q

Mirtazapine MOA

A

↑ serotonin and norepinephrine release by blocking presynaptic alpha-2 receptors,

and also blocks specific serotonin receptors, leading to an antidepressant effect.

65
Q

Mirtazapine side effects (3)

A

Drowsiness

Increased Appetite/ Weight Gain

Dizziness and Orthostatic Hypotension(Elderly)

66
Q

Mirtazapine Contraindications (3)

A

MAOI Use (2 week washout period)

Severe Hepatic Impairment

Known Hypersensitivity

67
Q

1 ° alcholol drug treamtent (2)

A

Acamprosate/ Naltrexone

68
Q

Acamprosate MOA

A

Restores the balance of GABA and glutamate neurotransmitter systems disrupted by chronic alcohol use, reducing cravings

69
Q

Naltrexone MOA

A

Blocks opioid receptors, reducing the pleasurable effects of alcohol.

70
Q

Naltrexone side effects (2)

A

Sleep issues

Liver issues

71
Q

Naltrexone contradictions (3)

A

Liver issues

Opioids

Pregnancy

72
Q

Acamprosate side effects (3)

A

Diarrhea

Nausea

Headache

73
Q

Acamprosate contradictions (2)

A

Pregnancy

Severe Renal issues

74
Q

PHQ-9 Questionnaire, what for?

A

Depression scale (2 weeks)

5-9 indicates mild depression

20-27 indicates severe depression

75
Q

Serotonin Syndrome (3)

A
  1. Triad of Symptoms: Key features include neuromuscular excitation (e.g., clonus, hyperreflexia, tremor), autonomic dysregulation (e.g., hyperthermia, tachycardia), and altered mental status (e.g., agitation, confusion).
  2. Caused by Excess Serotonin: Often triggered by combining serotonergic drugs (e.g., SSRIs, MAOIs, TCAs, or certain analgesics like tramadol).
  3. Rapid Onset and Treatment: Symptoms usually appear within hours of exposure to the offending agent(s) and can be managed by discontinuing serotonergic drugs, supportive care, and sometimes medications like benzodiazepines or cyproheptadine (a serotonin antagonist).
76
Q

OD Paracetamol

Tx

A

Acetylcysteine

77
Q

OD Opioids

Tx

A

Naloxone

78
Q

OD Benzodiazepines

Tx

A

Flumazenil

79
Q

OD Beta blockers

Tx

A

Glucagon for heart failure or cardiogenic shock

Atropine for symptomatic bradycardia

80
Q

OD Coke

Tx

A

Diazepam

81
Q

What is worse Bipolar I or II?

Give context

A

Bipolar I is worse

Bipolar I Disorder: full mania (often + depression)

Bipolar II Disorder: hypomania + severe depressive episode (functioning)

82
Q

Generalised Anxiety Disorder (GAD) (5)

A

Excessive Worry – at least 6 months.

Restlessness

Muscle Tension

Sleep Disturbance

Impairment in Functioning

83
Q

Cluster A – Suspicious

Paranoid Personality Disorder: what is it?

A

distrust and suspicion, which can significantly impact relationships and interactions in clinical settings.

84
Q

Cluster B – Emotional or Impulsive

What are the 3 below disorders about?

Antisocial Personality Disorder

Borderline Personality Disorder

Narcissistic Personality Disorder

A

Cluster B – Emotional or Impulsive

Antisocial Personality Disorder: criminal behaviour, lack of empathy, and social harm.

Borderline Personality Disorder: emotional instability, impulsivity, fear of abandonment, and relationship difficulties.

Narcissistic Personality Disorder: Known for grandiosity, need for admiration, and sensitivity to criticism.

85
Q

Cluster C – Anxious

Obsessive-Compulsive Personality Disorder (OCPD):

Avoidant Personality Disorder

A

Obsessive-Compulsive Personality Disorder (OCPD):

perfectionism, control, and rigidity

Avoidant Personality Disorder: pervasive fear of rejection and avoidance of social situations, which can resemble social anxiety disorder but with different underlying motivations.

86
Q

Dissociative Disorders (3 high yield), explain

Depersonalisation-Derealisation Disorder

Dissociative Amnesia

Dissociative Identity Disorder

A

Depersonalisation-Derealisation Disorder: Important for recognising dissociative symptoms like feeling detached from oneself (depersonalisation) or the world (derealisation).

Dissociative Amnesia: Focus on memory loss for personal information following trauma.

Dissociative Identity Disorder: Known as multiple personality disorder; associated with trauma and distinct alternate identities.

87
Q

Catatonia (3 buzzwords)

A

Immobility or Stupor

Mutism

Posturing (holding unusual positions)

88
Q

Factitious Disorder (Munchausen Syndrome)
(3 buzzwords)

A

Self-induced symptoms

Attention-seeking

Frequent hospital visits

89
Q

Reactive Attachment Disorder

(3 buzzwords)

A

Emotional withdrawal

Early neglect

Difficulty forming attachments

90
Q

Functional Neurological Disorder (Conversion Disorder)

(3 buzzwords)

A

Non-organic symptoms

Psychological stressor

Motor/sensory dysfunction (e.g., weakness, non-epileptic seizures)

91
Q

Cotard Delusion (3 buzzwords)

A

Dead or dying belief

Nihilistic delusion

Severe depression

92
Q

Capgras Syndrome (3 buzzwords)

A

Imposter delusion

Misidentification

Psychotic conditions (e.g., schizophrenia)

93
Q

Depersonalisation-Derealisation Disorder (3)

A

Detached from body

Unreal surroundings

Triggered by stress

94
Q

Dissociative Amnesia (3)

A

Memory gaps

Trauma-related

Autobiographical info lost

95
Q

Dissociative Identity Disorder (3)

A

Multiple identities

Distinct personalities

Childhood trauma

96
Q

Alien hand syndrome (3)

A

Involuntary hand movements

“Mind of its own”

Brain lesion

97
Q

De Clérambault’s Syndrome (Erotomania) (3)

A

Belief of being loved by celebrity

Stalking/harassment

Often young, single women

98
Q

Alice in Wonderland Syndrome (3)

A

Distorted body perception

Time distortion

Linked to migraines

99
Q

Koro Syndrome (3)

A

Genital retraction delusion

Anxiety/panic

Cultural links (Asia)

100
Q

Body Integrity Dysphoria (3)

A

Desire to remove body part

Feels part doesn’t belong

Distress with healthy limb

101
Q

Alcohol withdrawal
symptoms: x hours
seizures: y hours
delirium tremens: z hours

A

Alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

102
Q

Manic Episode

(3)

A

Euphoric or irritable mood - Extremely elevated or irritable mood lasting at least a week.

Functional impairment - Severe disruption in daily life, possibly requiring hospitalization.

Psychotic features - Possible delusions or hallucinations in severe cases.

103
Q

Hypomanic Episode

(3)

A

Elevated mood - Noticeable increase in energy and mood, lasting at least four days.

No major functional impairment - Changes in mood/behavior do not severely disrupt daily functioning.

No psychotic features - Psychosis is absent, distinguishing it from full mania.

104
Q

PTSD Tx

1st

2nd

Line

A

1st CBT+EMDR

2nd SSRI (Venlafaxine)

105
Q

Section 2 –

A

Allows compulsory admission for assessment for up to 28 days; cannot be renewed but can lead to Section 3 if treatment is required.

106
Q

Section 3 –

A

Permits compulsory admission for treatment for up to six months, renewable if ongoing treatment is needed.

107
Q

Section 4 –

A

Emergency 72-hour detention in urgent cases needing one doctor and an AMHP; leads to a full assessment.

108
Q

Section 5(2) –

A

Allows a doctor to detain a voluntary inpatient for up to 72 hours in an emergency.

109
Q

Section 5(4) –

A

Allows a nurse to detain a voluntary inpatient for up to 6 hours in an emergency.

110
Q

Section 136 –

A

Section 136 – Enables police to detain someone from a public place and bring them to a safe location for assessment, lasting up to 24 hours.

111
Q

Section 12 Doctor –

A

Qualified, often a psychiatrist, who participates in Mental Health Act assessments alongside another doctor.

112
Q

Major Depressive Disorder (3)

A

Rapid onset

cognitive symptoms

reversible

113
Q

Alzheimer’s Disease (3)

A

Gradual progression

memory loss

irreversible

114
Q

Frontotemporal Dementia (3)

A

Personality change

behavioral issues

language deficits

115
Q

Lewy Body Dementia (3)

A

Fluctuating cognition

visual hallucinations

Parkinsonism

116
Q

Schizotypal Personality Disorder (3)

A

Eccentric Behavior –

Magical Thinking –

Social Anxiety –

117
Q

Schizoid (3)

A

Detached – Indicates emotional detachment and lack of desire for close relationships.

Aloof – Describes the individual’s distant and indifferent demeanor.

Solitary – Highlights a preference for being alone and engaging in solitary activities.

118
Q

delirium tremens (3)

A

Confusion – Severe disorientation and altered mental status.

Tremors – Characteristic shaking, especially in the hands.

Hallucinations – Often vivid visual or auditory hallucinations.

119
Q

long-acting benzodiazepine that is commonly used to prevent alcohol withdrawal symptoms in patients with a history of heavy alcohol consumption?

Px has liver cirrhosis

A

Chlordiazepoxide

120
Q

malingering (3)

A

Intentional – The person is consciously faking or exaggerating symptoms.

External Gain – The motivation is to achieve some external benefit (e.g., financial compensation, avoiding work/ access to morphine).

Deceptive – The behavior involves deceit and is not due to genuine medical or psychological conditions.

121
Q

FIRM STOP for SSRI discontinuation syndrome

A

FIRM STOP for SSRI discontinuation syndrome

Flu like Sx
Insomnia
Restlessness
Mood swings
Sweating
Tummy problems (pain, cramps, D+V)
Off balance
Parasthaesia

122
Q

Acute Dystonia Tx

A

Procyclidine

123
Q

big AE with Zopiclone

A

Falls (old people)

124
Q

Akathisia meaning

A

immense inner restlessness

125
Q

Tardive Dyskinesia: Involuntary, jerky movements (not stiff).

NMS: Severe muscle rigidity (stiffness), fever, altered mental state.

Tardive Dystonia: Sustained muscle contractions that can involve stiffness but not as intense as NMS.

Tardive dysKINESia is abnormal involuntary MOVEMENT.

DysTONia is abnormal muscle TONE and POSTURE.

Catatonia: Can involve stiffness or rigidity but with additional features like mutism or stupor.

A

Tardive Dyskinesia: Involuntary, jerky movements (not stiff).
NMS: Severe muscle rigidity (stiffness), fever, altered mental state.
Tardive Dystonia: Sustained muscle contractions that can involve stiffness but not as intense as NMS.
Catatonia: Can involve stiffness or rigidity but with additional features like mutism or stupor.

126
Q

SSRI discontinuation syndrome
(3)

A

Dizziness

electric shock sensations

anxiety

127
Q

avoidant personality disorder (3)

A

fearful of:

criticism

being unliked

rejection

128
Q

Non-Epileptic Attack Disorder (NEAD) (3)

A

Psychogenic – indicating that the origin is psychological rather than neurological.

Dissociative – referring to the disconnection from reality often linked to the episodes.

Functional – describing symptoms that occur without structural neurological damage.

129
Q

Montgomery–Åsberg Rating Scale (MADRS)

A

A clinician-administered scale assessing the severity of depressive episodes.

130
Q

Hospital Anxiety and Depression Scale (HADS)

A

A self-assessment tool for detecting anxiety and depression in a hospital setting.

131
Q

Quick Inventory of Depressive Symptomatology Self Report 16 (QIDS)

A

A 16-item scale for patient-reported assessment of depressive symptom severity.

132
Q

Inventory of Depressive Symptomatology – Self Report 30 (IDS-30-SR)

A

A comprehensive 30-item self-report measure for evaluating depressive symptoms.

133
Q

Knight’s move

A

illogical leaps from one idea to another

134
Q

flight of ideas

A

visible links between ideas

135
Q

GAD Tx

A

Fluffy stuff > CBT > sertraline > SSRI/ (SNRI duloxetine and venlafaxine)

136
Q

Alzheimers TX?

A

Donepezil
Rivastigmine
Galantamine

2nd line : Memantine

137
Q

Histrionic personality disorder 3 buzzwords

A

Attention-seeking (excessive need to be the center of attention)

Dramatic (exaggerated emotional expression)

Seductive (inappropriate or provocative behavior)

138
Q

Postpartum Psychosis Tx

A

Olanzapine

139
Q

Generalised Anxiety Disorder Tx

A

Sertraline

(follow up in 1 week <30 years old)

140
Q

Korsakoff’s (3)

A

Confabulation

Thiamine deficiency (B1)

Memory impairment (anterograde and retrograde amnesia)

Year 3 (4 decks)

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