Psych Flashcards
What is transient global amnesia?
A neurological condition characterised by a temporary but total disruption of both short and long term memory. Other cognitive functions are preserved
Give 3 questionnaires used for depression severity
PHQ-9
HADS
BDI-II
What is 1st line in moderate-severe depression?
CBT and SSRI/SNRI
How should an antidepressant be stopped?
Reduce the dose/frequency gradually over a 4 week period (not necessary for fluoxetine)
How long does it take for the effects of antidepressants to be seen
2 weeks
How long should you give somebody on an antidepressant with inadequate response?
6-8 weeks then consider switching
Give some features of serotonin syndrome
Confusion Delirium Shivering Sweating Changes in blood pressure Myoclonus
What drug class is citalopram?
SSRI
If somebody presents with new onset palpitations and feeling on edge, what is the 1st line next step management?
48hr holter ECG
What is 1st line drug management of Alzheimers?
Acetylcholinesterase inhibitors e.g. donepezil, galantamine, rivastigmine
When are drugs like donepezil and rivastigmine contraindicated in Alzheimers?
Long QT syndrome, sinus bradycardia (less than 50), 2nd/3rd degree heart block
What is 1st line in treating MND?
Riluzole (anti-glutamate) - potentiates movement
How does autoimmune encephalitis present?
VIRAL ILLNESS prior to symptom onset (demyelination)
Confusion Seizures Movement disorders Behavioural changes Emotional lability Cognitive impairment Reduced Conscious level
How do you treat autoimmune encephalitis?
Steroids and IV IgG/Plasma exchange
What is cotard delusion
Belief that the patient is dead, non-existant or rotting
What pathological findings are seen in the brain in Alzheimers?
Beta-amyloid plaques
Neurofibrillary tangles
Hyperphosphorylated TAU proteins
What symptoms does Lewy Body dementia classically present with?
Triad of:
- REM sleep disorder
- History of falls
- Lilliputian hallucinations
What antipsychotic should be switched to if patients experience prolactinaemia from other antispsychotics
Aripiprazole
Why do patients commonly experience prolactinaemia from antipsychotics e.g. rispiridone/haliperodol
They are dopamine receptor antagonists
Which SSRIs are most appropriate in breastfeeding?
Sertraline and paroxetine
What are 1st line in ACUTE mania mangement?
Antipsychotics e.g. haloperidol, risperidone, quetiapine
What is 1st line in long term management of bipolar?
Lithium
How long must symptoms of anxiety be present to diagnose GAD?
6 months
How long must depression symptoms be there to diagnose depression
2 weeks
What are the criteria for mild depression
2 core symptoms and 1 biological symptom
What is 1st line for mild depression?
Low intensity psychological intervention - guided self help or group CBT
What features are associated with better prognosis in schizophrenia?
High IQ Sudden onset Obvious precipitating factor Strong support network Positive symptoms predominant
What is 1st line in schizophrenia?
Atypical antipsychotics e.g. risperidone
When should clozapine (atypical antipsychotic) be started in schizophrenia
When schizophrenia has not responded to 6-8 week courses of 2 different antipsychotics
How do you treat Delirium tremens?
Chlordiazeproxide
Fluids
Pabrinex
Anti-emetics
What can be used to treat the somatic symptoms of anxiety? e.g. tremor in hands
Beta blockers
What is fronto-temporal dementia also known as?
Pick’s disease
What are the pathology findings in FT dementia?
Intracellular TAU protiens
Atrophy of frontal and temporal lobes
What class of drug is venlafaxine?
SNRI
What does SNRI stand for?
Serotonin and noradrenaline reuptake inhibitor
Give some short term side effects of ECT
Headache Nausea Short term memory impairment Memory loss of events prior to ECT Cardiac arrhythmia
What is Munchausen’s syndrome?
Purposefully causing symptoms e.g. taking too much insulin to cause hypos
What is an oculogyric crisis?
Involuntary upward deviation of the eyes with restlessness and agitation. It is a dystonic reaction to certain drugs e.g. antipsychotics
How do you treat an oculogyric crisis?
IV antimuscarinic e.g. benztropine/procyclidine
If a patient responds well to SSRI treatment, how long should they stay on them to prevent relapse?
6 months
What class of drug is amitryptyline?
Tricyclic antidepressants
What is the general threshold age for personality disorder diagnosis?
18 years old
If CBT or EMDR are ineffective in PTSD, what drug treatments are first line?
Venlafaxine or an SNRI
What drug classes increase the risk of serotonin syndrome when taking an SSRI
MAOIs
Triptans
What is tardive kinesia?
How does it present?
A late onset extrapyramidal side effect of long term antipsychotic use.
Presents with chewing, jaw pouting, excessive blinking
What do you need to check before starting someone on venlafaxine?
Blood pressure, SNRIs are associated with development of hypertension
What should be monitored before starting citalopram?
ECG due to an increased risk of QT prolongation / ventricular arrhythmias
What is an electrolyte abnormality seen in SSRI usage
Hyponatraemia
What is the risk of SSRIs in the 1st trimester?
Congenital heart defects
What is the risk of SSRIs in the 3rd trimester?
Persistent pulmonary hypertension of the newborn
What is the peak incidence of seizures after alcohol withdrawal?
36 hours
What is the peak incidence of DT after alcohol withdrawal
72 hrs
What is the 1st line treatment for delirium?
Haloperidol 0.5mg (or olanzepine)
Except for in Parkinson’s
What is the 1st line treatment for delirium in Parkinson’s?
Low dose lorazepam
Haloperidol can worsen parkinson symptoms
What drug can be used to treat tardive dyskinesia?
Tetrabenazine
What class of drug can cause urinary retention?
Tricyclic antidepressants e.g. amitryptyline
What is the hallmark sign of refeeding syndrome?
Hypophosphataemia
What is section 135 of the MHA?
Section 135 is an order allowing the police to forcefully enter a property of a person believed to be mentally ill, in order to allow a mental health assessment.
What is section 136 of the MHA?
allowing the police to remove a person from a public place who is believed to be mentally ill, to take them to a “place of safety” for a mental health assessment.
What is 1st line in those seeking to maintain abstinence from alcohol?
Acamprosate
What happens to cortisol and GH in anorexia nervosa?
They are raised
What is cholesterol like in anorexia nervosa
Raised
What are the 1st rank symptoms of schizophrenia?
Delusional perceptions
Auditory hallucinations
Delusions of thought
Passivity phenomenon