Psych Flashcards
1st and 2nd line Mx in OCD
1) SSRI - fluoxetine 2) if 12 months of SSRI does not work, try alternative SSRI or clomipramine (TCA)
NMS Vs serotonin syndrome
NMS - lead pipe rigidity
Serotonin syndrome - hyperreflexia, myoclonus
questionnaire for GAD
GAD-7
core symptoms of ptsd
flashbacks
nightmares
hyperarousal / startle response
avoidance
1st rank sx of schizophrenia
auditory hallucinations
delusional perceptions
thought disorder - broadcasting, withdrawal, insertion
passivity
when is interpersonal therapy used
depression
baseline Ix for lithium
measure BMI, FBC, U&Es, TFTs, ECG before starting
ix when starting antipsychotics
FBC, U&Es, LFTs, prolactin, fasting blood glucose,
BP, lipids, weight
+ ECG !
monitoring when on antipsychotics
FBC, U&Es, LFTs, prolactin, fasting blood glucose,
BP, lipids, weight
+ cardiovascular risk assessment !
special tests for IVDUsers
physical exam for track marks
screen for hep B/hep C/HIV
blood cultures
section 17
allows leave for a specified amount of time from a current section
post partum psychosis mx
admission to mother and baby unit (allows breastfeeding, healthy development of attachment between mother + baby, maintains mother’s confidence in being a mother)
MDT approach - perinatal psychologist, psychiatrist, GP, nurses, health visitor, social services
antipsychotics - olanzapine/risperidone/quetiapine
talking therapies
education
long term complications of turner’s
htn
dm
infertility
mx of turner’s
further ix - echo for cardiac abnormalities, renal USS + DMSA for renal abnormalities, opthamology for visual disturbances, annual checks for BP, HbA1c, etc
MDT !!!!!! = paeds endocrinologist, psychologist, gynae, nephro, cardio, specialist nurses
can consider GH therapy for growth + oestrogen for induction of puberty
psychological support
support groups
piloerection
opiate withdrawal
derealisation
episodes when you feel that you are not real, seen in acute stress reaction
temporal lobe
memory
ECT C/I
no absolute C/I
relative C/I include: recent MI/stroke, increased ICP, severe HTN
OCD criteria
> 2 weeks of recurring unpleasant/intrusive thoughts or mental images or repetitive acts/mental operations
lewy body dementia onset
insidious
frontotemporal dementia onset
insidious, rapid progression
tardive dyskinesia tx
tetrabenazine
akasthesia tx
propanolol / lorazepam
dystonia tx
procyclidine
parkinsonism tx
procyclidine
when would you give NaSSA over SSRI
when there are particular issues with sleep / appetite, eg mirtazapine
benzodiazpeine wtihdrawal sx + mx
sx - insomnia, tremor, anxiety, sweating, tinnitus, nausea, vomiting, perceptual disturbances
mx - switch from short acting benzos to long acting (diazepam), then dose gradually reduced
extracampine hallucinations
things outside normal sensory field eg hearing alien voices
paraideolic illusion
seeing meaningful images in vague stimulus (eg seeing face in a fire)
OCD tx
exposure response prevention therapy
SSRIs (fluoxetine preferred, paroxetine, sertraline) for 12 months, if no improvement can switch to alternative SSRI / clomipramine (TCA)
learning difficulties by IQ
mild 50-70
moderate 35-49
severe 20-34
profound <20
insomnia mx
short term <4week mx:
sleep hygiene advice
if there is significant daytime impairment, prescribe short-acting benzos or Z drugs
review in 2 weeks
long term >4week mx:
sleep hygiene advice
prescribe short-acting benzos or Z drugs to take for up to 4 weeks
refer to CBT
questionnaire for social phobia
SPIN
questionnaire for depression
PHQ9
safest SSRI in people with hx of ischemic heart disease
sertraline
types of schizoaffective disorder
manic
depressive
knight’s move thinking is assoc. w/ …
schizophrenia
psychosis
ICD10 anorexia criteria
restrictive/purging behaviour designed to reduce calorie intake
body dysmoprhia/fear of gaining weight/being fat
BMI < 18.5
risk factors of eating disorder
being previously overweight
family hx
occupation (model, dancer)
T2DM
anorexia complications
electrolyte abnormalities --> arrhythmias dehydration hypoglycaemia multi organ failure death risk of self harm + suicide
when is inpatient tx necessary in eating disorder
BMI < 13
rapid weight loss
high suicide risk
serious physical complications
what MMSE score indicates cognitive impairment
< 25 / 30
what MMSE score indicated normal cognition
> 27 / 30
ECT indications
catatonia
neuroleptic malignant syndrome
mania
Section 4
allows emergency admission to hospital when there is not enough to arrange section 2
its duration is 72h
TCA overdose
dilated pupils urinary retention dry mouth tachycardia agitation blurred vision constipation prolonged QT
lithium overdose
coarse tremor hyperreflexia confusion polyuria seizure coma
vascular dementia medical mx
aspirin + manage CVS risk factors
formication
feeling of insects crawling over/under skin due to stimulant intoxication/withdrawal (MDMA, cocaine, amphetamines) or alcohol withdrawal
SSRI side effects
increased agitation/suicidal thoughts at the start GI upset increased risk of GI bleeding loss of libido / erectile dysfunction hyponatremia
SSRI discontinuation sx
FIRM STOP
Flu like sx
Insomnia
Restlessness
Mood swings
Sweating
Tummy problems
Off balance (ataxia)
Paresthesia
Time needed for GAD dx
6 months
at least 3 of the following sx are needed for GAD dx
SPINE FM
Sleep disturbance Poor sleep Irritability Nervousness/restlessness Easily Fatigued Muscle tension
GAD tx
SSRI –> alternative SSRI –> SNRI –> pregabalin
Lithium toxicity
Coarse tremor Hyperreflexia Nystagmus Seizures Ataxia
when is community based alcohol detox offered
if drinking >15 units / day
or AUDIT score > 15
when is inpatient alcohol detox offered
if drinking > 30 units/day
or SADQ score of 30+
or hx of epilepsy, delirium tremens, seizures following withdrawal
or significant psychiatric comorbidity / learning disability
or vulnerable social background (eg child, homeless)
A 46 year old male inpatient has recently been initiated on clozapine following relapse
of paranoid schizophrenia. He reports chest pain and tachycardia. ECG demonstrates
ST elevation. Which is the most likely diagnosis?
myocarditis
- one of the adverse effects of clozapine is myocarditis so a baseline ECG should be done before prescribing. Sx include chest pain, SOB, arrhythmias
drug classes where you may get prolonged QT
TCAs
antipsychotics
citalopram
what to check before starting atypical antipsychotics
check BMI, pulse, BP, fasting blood glucose or HbA1c,
lipid profile
atypical grief reaction
delayed grief reaction = when > 2 weeks passes before grieving begins
prolonged grief reaction = difficult to define
opioid detox
tx = liquid methadone or sublingual buprenorphine (decision up to personal preference), clonidine + lofexidine can help sx
given inpatient for up to 4 weeks
given in community for up to 12 weeks
Wernicke’s encephalopathy triad
confusion
ataxia
nystagmus
Korsakoff’s triad
anterograde amnesia
retrograde amnesia
confabulation
serotonin syndrome in a patient who is taking an SSRI and a concurrent medication?
concurrent medication likely to be MAOi or triptan
what drugs should not be taken at the same time as taking an SSRI
heparin/warfarin NSAIDs aspirin triptans MAOi
patient has a good response to SSRI and now wants to discontinue it. What advice should be given?
if the patient has had a good response, they should take the SSRI for 6 months before discontinuation as there is a higher risk of relapse if discontinued early.
most likely SSRI to cause torsades de pointes
citalopram
chronic insomnia definition
struggling to sleep more than 3 nights a week for more than 3 months
Dizziness, electric shock sensations, GI upset, restlessness, sweating, difficulty sleeping after discontinuing medication?
SSRI discontinuation syndrome
What should be monitored at initiation and dose titration of venlafaxine?
BP
venlafaxine and other SNRIs can lead to development of hypertension. if the patient is found to be hypertensive before starting venlafaxine, then a reduced dose should be considered.
formication vs delusional parasitosis
Delusions of parasitosis are distinct from formication.
Formication involves the cutaneous sensation of crawling, biting, and stinging.
Formication does not involve the fixed conception that skin sensations are induced by parasites. Patients with this condition can accept proof that they do not have an infestation.
in which type of antipsychotic is hyperprolactinaemia more common
typical antipsychotics
murmur in Ebstein’s anomaly
pansystolic murmur
depression tx
1) SSRI
2) if fails, alternative SSRI
3) if fails, SNRI
4) others
mx for benzo overdose
flumezanil
