psych Flashcards
what is the most common endocrine disorder developing as a result of chronic lithium toxicity?
hypothyroidism
when does lithium toxicity leading to hypothyroidism usually manifest in the treatment course?
between 6 to 18 months after initiation of treatment
what is a possible effect of carbemazapine?
steven johnson syndrome
what is akathisia?
movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still.-possible side effect of antipsychotics
what is bigorexia?
muscle dysphoria-you are super muscular and think you’re not. often associated with steroid misuse
what is drunkorexia?
restricting intake to drink without consuming extra calories
what is orthorexia?
obsession with ‘healthy’/’clean’ diets
what is type 1 diabetes eating disorder?
omiting insulin, also known as diabulimia.
what is the most important thing to do if you suspect TCA overdose?
perform ECG -widens QRS and prolongs QT
what is the safest TCA?
lofepramine
what is the most toxic TCA in overdose?
dosulepin
which drugs can cause neuroleptic malignant syndrome?
most common=1st generation antipsychotics
also 2nd gen antipsychotics, antidepressants, lithium.
what are the classic anticholinergic side effects?
dry mouth blurry vision constipation drowsiness sedation
if CBT or EMDR are ineffective in PTSD, what are the first line drug treatments?
venlafaxine or an SSRI
what is a common risk of SSRIs?
bleeding, can increase risk of GI bleeding if they have any other risk factors and should be prescribed PPI
because they can deplete platelet serotonin , reducing clot formation and increasing risk of bleeding.
what is the first line therapy for children and young people with anorexia nervosa?
family based therapy
which antipsychotic should you try if they’re having really bad side effects to do with their prolactin elevation?
aripiprazole-has the most tolerable side effect profile of the antipsychotics, esp for prolactin elevation.
for a diagnosis of PTSD, how long should symptoms be present for?
4 weeks
what is the most likely SSRI to cause QT prolongation and tdP?
citalopram
what is dystonia?
uncontrolled and sometimes painful muscle spasms
what are some examples of acute dystonic reactions?
torticollis-in neck muscles
opistotonus-back becomes extremely arched due to spasms
dysarthria-difficulty speaking
oculogyric crisis-prolonged upward deviation of eyes
what endocrine abnormalities can lithium cause?
hypothyroidism
hyperparathyroidism and resultant high calcium
how do you stop an SSRI?
withdraw gradually over a 4 week period
what factors make a paracetomol overdose higher risk to be more damaging?
chronic alcohol intake
malnourishment, inc anorexia nervosa
taking P450 inducing drugs like rifampicin, phenytoin, carbamazepine.
what is the indications for memantine use?
patients who are intolerant of or have a contraindication to AChE inhibitors or those with severe alzheimer’s.
why can parkinson’s disease lead to postural hypotension?
causes autonomic failure
what is the definition of postural hypotension?
fall in BP of at least 20 systolic and 10 diastolic within 3 minutes of the upright position
what are the symptoms of sudden SSRI discontinuation?
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
alcohol withdrawal timescale of symptoms?
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
how frequently should lithium levels monitoring take place till concentrations are stable?
weekly after initiation and at every dose change till concentrations are stable
how often should you check lithium levels before concentrations are stable?
weekly after initiation and after each dose change until dose is stable.
which drug manages acute dystonia secondary to antipsychotics?
procyclidine -an anticholinergic.
which SSRIs are associated with increased QT interval?
citalopram and escitalopram
if a patient has a good response to antidepressants how long should they stay on it to reduce the risk of relapse?
at least 6 months
what is cotard syndrome?
rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent
associated with severe depression and psychosis
what are the short term side effects of ECT?
headache
nausea
short term memory impairment
memory loss of events before ECT
cardiac arrythmias
what is circumstantiality?
inability to answer a question without giving excessive, unnecessary detail, however, the patient eventually returns to the original point and it is addressed.
what is conversion disorder?
psychiatric condition where psychological stress is unconsciously manifested as physical neurological symptoms-typically involves loss of motor or sensory function.
what is charles bonnet syndrome?
seeing things that are not real ( hallucinations) after losing a lot of your sight -eg associated with ARMD, cataracts. patient usually understands the symptoms aren’t real.
what are the symptoms of TCA overdose?
anticholinergic poisoning -dry mouth, dilated pupils, urinary retention
cardiac conduction defects, arrhytmias
hypothermia, hypotension, convulsions, respiratory failure
hyperreflexia and extensor plantar response
what are the symptoms of lithium OD?
delayed onset -12h or more
intially: apathy, restlessness
then: D+V, ataxia, tremor, weakness, dysarthria, muscle twitching
severe: electrolyte imbalance, dehydration, convulsions, renal failure, hypotension, coma
what are the symptoms of benzo OD?
drowsiness, dysarthria, ataxia, nystagmus, resp depression
what are the symptoms of amphetamine OD?
initially: excessive activity, wakefulness, hallucinations, paranoia, hypertension
later: convulsions, hyperthermia, exhaustion, coma
what are the symptoms of cocaine OD?
agitation, hypertension, tachycardia, dilated pupils, hyperthermia, hyperreflexia, hypertonia, hallucinations
cardiac effects-chest pain, arrhythmias, MI
what are the symptoms of opioid OD?
drowsiness, coma, resp depression, pinpoint pupils
what is the management of social anxiety disorder?
individual CBT
self help
SSRI-sertraline or escitalopram
what is avolition?
decrease in the ability to initiate and persist in self-directed purposeful activities
what is schizoaffective disorder?
schizophrenia symptoms +manic, depressed, or mixed episode symptoms happening together in the same episode (either together or within a few days of eachother) for at least 1 month.
what is schizotypal disorder?
at least several years and affecting functioning of:
eccentricities in behaviour, appearance and speech
+
cognitive and perceptual distortions, unusual beliefs, and discomfort with— and often reduced capacity for— interpersonal relationships
what is acute and transient psychotic disorder?
acute onset of psychotic symptoms.
reach max severity within 2 weeks, lasts anywhere from a few days to max 3 months.
how long does agoraphabia need to be present to be diagnosed?
several months
what is the management for specific/isolated phobias?
computerised CBT
self help
SSRI/beta blockers if severe
what mental disorders are in the category of disorders specifically associated with stress?
PTSD
C-PTSD
prolonged grief disorder
adjustment disorder
reactive attachment disorder
disinhibited reactive attachment disorder
what is the drug treatment of panic disorder?
SSRI-1st line
TCA -2nd line
beta blockers
what is trichotillomania?
when someone cannot resist the urge to pull out their hair -type of body focussed repetitive behaviour disorder.
what is dermatillomania?
disorder where you cannot stop picking at your skin -type of body focussed repetitive behaviour disorder.
what is in the group of obsessive compulsive related disorders?
obsessive compulsive disorder
body dysmorphic disorder (BDD)
olfactory reference disorder
body focussed repetitive behaviour disorders
hypochondriasis (health anxiety disorder)
hoarding disorder
what is olfactory reference disorder?
persistent false belief and preoccupation with the idea of emitting abnormal body odors which the patient thinks are foul and offensive to other individuals
how are anxiety disorders grouped in the ICD11?
primary fear disorders:
generalised anxiety disorder
panic disorder
agoraphobia
specific phobia
social anxiety disorder
separation anxiety disorder
selective mutism
what are the features of binge eating disorder?
frequent binges
distressing
accompanied by negative emotions (guilt/disgust)
not associated with compensatory behaviours
33-50% will become obese
what do you need to specifically ask in social history if they’re presenting with cognitive impairment?
high risk hobbies/jobs like boxing, rugby-stuff that could cause head trauma
what is hepatic encephelopathy?
altered level of consciousness as a result of liver failure -can be gradual or sudden. thought to be due to ammonia buildup.
what can episodes of hepatic encephalopathy be triggered by?
infections
GI bleeds
constipation
electrolyte imbalances
medications
what medication can decrease ammonia levels in the body?
lactulose
what is hypertensive encephelopathy?
type of hypertensive emergency where end organ damage happens in the brain-less common than other hypertensive emergencies (usually people who get it have BPs >220/110)
which test is the most widely used one to assess intellectual disability and capabilities?
wais test -weschler adult intelligence scale -most widely used intelligence and cognitive ability
what are the ranges of intellectual disability?
mild -2-3 SDs below mean. most are relatively independent, master self care, can communicate
moderate -3-4 SDs below mean. most require considerable +consistent support to achieve independent living
severe -4 or more SDs below mean. v limited communication, usually daily support in supervised environment.
profound: approximately less than 0.003rd percentile but tests can’t test lower. v limited skills -need a lot of support.
what do you need to do to a patient before ECT?
neuroimaging (CT/MRI)
how long does heroin stay in the urine?
up to 48h
how long does methadone stay in the urine?
7-9 days
how long does cannabis last in the urine?
1-3 weeks of occasional use, 4-6 weeks if heavy use
when do you do drug testing in someone on methadone?
do frequent testing at the start and do regular testing (4-6 times a year) once the person is stabilised to monitor use of additional drugs.
what are the indications for ECT?
short term and rapid improvements of severe sx after adequate trials of other treatments are ineffective/it is life threatening, in people with:
catatonia
severe depression
prolonged or severe manic episode
how does ECT work?
uses electric current to create a generalised cerebral seizure -causes changes in cerebral blood flow and regional metabolism, increases DA, hippocampal, frontal lobes, hippocampus, parahippocampal gyri, amygdala, and white matter activity and function
what are 2 absolute contraindications for ECT?
phaeochromocytoma
raised ICP with mass effect
what is echopraxia?
involuntary repetition or imitation of another person’s actions
what are the features of multiple system atrophy?
parkinsonism
autonomic disturbance -erectile dysfunction (often early feature), postural hypotension, atonic bladder
cerebellar signs (danish)
what are 2 examples of parkinsons plus syndromes?
multiple system atrophy
progressive supranuclear palsy
which drugs do you use for drug induced extrapyramidal symptoms?
procyclidine -acute dystonia
tardive dyskinesia -tetrabenazine or valproate
akathisia -propranolol or cyproheptadine
NMS -dantrolene
what is the difference between circumstantiality and tangientality?
circumstantiality -go off on tangents but come back to answer the question
tangentiality -go off on tangents and don’t go back to answer the question
which 2nd gen antipsychotic is the most likely to prolong the QTc?
risperidone
which blood tests for monitoring antipsychotics in wriske?
Hba1c
fasting BM
blood lipid
prolactin
what is a characteristic side effect of mirtazapine?
increase in apetite
what is a side effect of methylphenidate that you need to monitor?
decrease in appetite -can lead to stunted growth -patients <10 need to have their weight and height plotted at regular intervals
what are the big bloods changes in refeeeding syndrome and why?
glycogen/fat/protein synthesis and transport of glucose into cells requires phosphate, magnesium, potassium, and thiamine -these rapidly get depleted
tell me about tremors and lithium
fine tremor is normal when taking lithium
if tremor becomes course, suspect lithium toxicity
what are the 3 big systemic side effects of lithium to watch out for?
renal dysfunction
hypothyroidism
benign intracranial hypertension (BIH)
how does BIH present?
persistent headaches, visual disturbances
