psych Flashcards
mx of hypomania in primary care
routine referral to community mental health team
length of symptoms to be classed as depressive episode
2 weeks
moa of benzodiazepines
enhance the effect of GABA
conversion disorder
loss of motor or sensory function
may be caused by stress
which medications can cause psychosis
corticosteroids
mx of OCD with mild, moderate and severe functional impairment
mild - CBT including ERP (exposure and response prevention)
moderate/severe - add an SSRI to CBT + ERP
ix to be considered in elderly patients with new onset psychosis
CT head to rule out organic cause
what should be co-prescribed if a person is on an SSRI and an NSAID
PPI due to GI bleeding risk
drug mx of generalised anxiety disorder
- Sertraline (SSRI)
- alternative SSRI (e.g. Citalopram) or SNRI (e.g. Duloxetine)
- Pregabalin
circumstantiality
inability to answer a questions without excessive, unnecessary detail, but the question is eventually answered
flight of ideas
leaps from one topic to another with discernible links but if asked a question they do not answer
seen in mania and bipolar
adverse effects of tricyclic antidepressants
urinary retention leading to overflow incontinence dry mouth blurred vision constipation drowsiness weight gain
paranoid personality disorder
patients are overly sensitive and can be unforgiving if insulted
they question the loyalty of those around them
reluctant to confide in others
how long should SSRIs be withdrawn over
gradually reduce the dose over 4 weeks
examples of tricyclic antidepressants
Amitriptyline
Clomipramine
Imipramine
moa of Venlafaxine
serotonin and noradrenaline reuptake inhibitor (SNRI)
adverse effects of mirtazapine
appetite increase (and subsequent weight gain) drowsiness
Knight’s move vs flight of ideas
Knight’s move - no links between ideas
flight of ideas - links between ideas
what metabolic disorders can long-term lithium use cause
hyperparathyroidism and resultant hypercalcaemia
‘stones, bones, groans, moans’
Munchausen’s syndrome
purposefully causing symptoms
adverse effects of ECT
headache and nausea
short-term memory impairment + retrograde amnesia of events prior to ECT
cardiac arrhythmias
main 3 features of PTSD
re-experiencing, e.g. flashbacks
avoidance
hyperarousal
how long should patients remain on SSRIs even if their symptoms get better
at least 6 months following remission
core symptoms of depression
low mood
anhedonia
substance disorder mx: which medication is a ‘deterrent’ that cannot be taken with alcohol (causes violent vomiting)
Disulfiram
substance disorder mx: which medication is an ‘anti-craving’ medication that is safe in combination with alcohol
Acamprosate
bilateral resting tremor on antipsychotics
Parkinsonism
SSRI for children and adolescents
Fluoxetine
mx of tardive dyskinesia from antipsychotics
Tetrabenazine
both begin w T
mx of acute dystonia from antipsychotics
procyclidine and benztropine
adverse effects of SSRIs
SSSS: stomach upset sexual dysfunction sodium low serotonin syndrome
mx of acute stress disorder
CBT
benzodiazepines can be used for acute symptoms
what should be monitored when prescribing SNRIs?
BP
what should be monitored when prescribing citalopram
ECG
what should be monitored when prescribing SSRI
U&Es
SSRI risks during pregnancy
first trimester - small increased risk of congenital heart defects
third trimester - persistent pulmonary hypertension of newborn
mx of anorexia nervosa in young people
- anorexia focused family therapy
2. CBT
what do antipsychotics in the elderly increase risk of
stroke and VTE
when do acute dystonia and tardive dyskinesia present
acute dystonia - in first few days/weeks of taking antipsychotics
tardive dyskinesia - after many years
mx of neuroleptic malignant syndrome
stop antipsychotic
IV fluids
Dantrolene and Bromocriptine can be used
which antidepressants can lead to ‘tyramine cheese reaction’
MAOI , e.g. Phenelzine
features of anorexia
most things low
G’s and C’s high - growth hormone, glucose, glands (salivary), cortisol, cholesterol
adverse effects of atypical antipsychotics
weight gain
hyperprolactinaemia
clozapine - agranulocytosis and reduced seizure threshold
mx of schizophrenia
atypical antipsychotics
CBT
mx of delirium tremens
long-acting benzodiazepines, e.g. chlordiazepoxide or diazepam
