PSYCH Flashcards
When does delirium tremens present?
2-3 days post alcohol consumption
What symptoms do you get with delirium tremens? (5)
- delirium -> fluctuating consciousness/aggression
- hallucinations
- coarse tremor
- fever
- tachycardia
How do you treat delirium tremens?
Chlordiazepoxide
+ thiamine
When is the peak incidence of seizures post alcohol withdrawal?
36 hour
When would symptoms of alcohol withdrawal first start?
6-12 hours after last drink
What are the symptoms of Wernicke’s encephalopathy?
confusion
ophthalmoplegia
ataxia
What are the symptoms of Korsakoff’s psychosis?
Retrograde amnesia
Anterograde amnesia
Confabulation
How would you screen for alcohol misuse?
CAGE
C - have you felt that you should cut down?
A - do you get annoyed when people tell you to stop?
G - do you ever feel guilty
E - do you ever need an eyeopener in the morning?
What are 3 pharmacological drugs that help to maintain alcohol abstinence?
- Disulfiram →
unpleasant reaction if drink, doesn’t stop craving
– Acamprosate → reduces cravings
– Naltrexone → decreases
pleasurable effects of drinking alcohol
What is the ICD-10 criteria for diagnosing mild/moderate/severe depression?
mild = 4 symptoms
moderate = 5-6 symptoms
severe= 7+ symptoms
What are the 3 main features of depression?
low mood
anhedonia
anergia
Give 4 common side effects of SSRIs?
- nausea/vomiting
- loss of appetite
- agitation
- loss of libido
Give 4 common side effects of TCA
- dry mouth
- constipation
- drowsiness
- weight gain
Give 4 withdrawal symptoms of antidepressants
- restlessness/agitation
- altered feeling ( irritable/anxious/panic)
- altered sensation (electric shock)
- dizzy
What is generalised anxiety disorder?
Excessive anxiety and worry, more days than not, for at least 6 months about multiple different aspects
Give 4 symptoms of GAD?
- restlessness
- easily fatigued
- sleep disturbance
- difficulty concentrating
What is panic disorder?
Sudden onset anxiety + at least 4 symptoms of:
- SOB
- palpitations
- shakiness
- nausea
- fear of dying
How is panic disorder treated?
Propranolol 40mg OD
What scoring system is used to assess for depression/anxiety?
Depression - PHQ-9
Anxiety - GAD-7
What is the difference between mania and hypomania?
Mania = symptoms <7days, elevated mood, irritability + PSYCHOSIS
Hypomania = symptoms ,4 days, no marked impairment in social functioning, no psychosis
How would you manage an acute episode of mania?
- therapeutic trial of oral antipsychotic
- if ineffective trial different antipsychotic
- lithium
What are the side effects of lithium?
LITHIUM
Lethargy
Insipidus (diabetes)
Tremor
Hypothyroidism
Insides (GI)
Urine (decreased)
Metallic taste
Give 4 drugs that should not be prescribed alongside lithium
ACE-i/ARB
diuretics
NSAIDs
Which factors might precipitate lithium toxicity?
dehydration
renal failure
diuretics/ACEi/ARB/NSAIDs/metronidazole
Give 5 symptoms of lithium toxicity
- coarse tremor
- hyperreflexia
- acute confusion
- seizure
- polyuria
How do you treat lithium toxicity?
mild-moderate = volume resuscitation with normal saline
severe = haemodialysis
Give 3 psychotic symptoms?
hallucinations
delusions
thought disorder
Give 4 examples of psychosis with negative symptoms
emotional blunting
reduced speech
loss of motivation
self-neglect
what is knights move thinking?
no links between sentences
Which antipsychotic drugs can you NOT prescribe in pregnancy?
carbamazepine
clozapine
lithium
What is the criteria for a diagnosis of schizophrenia?
1 month history of
<1 :
- 3rd person auditory hallucinations
- thought disorder
- passivity
- delusional perceptions
<2 :
- persistent hallucinations
- catatonic behaviours
- negative psychosis
- social withdrawal
What is schizoaffective disorder?
bipolar + schizophrenia
Give 2 examples of typical antipsychotics
haloperidol
chlorpromazine
Give 4 examples of atypical antipsychotics
risperidone
aripiprazole
clozapine
olanzapine
Give 4 examples of extrapyramidal side-effects
- Parkinsonism
- Acute dystonia
- Akathisia
- Tardive dyskinesia
What is the mechanism of action of typical antipsychotics?
dopamine receptor antagonist (D2)
Which psych drugs can you not take whilst breast feeding?
- carbamazepine
- clozapine
- lithium
Which side effect causes involuntarily repetitive movements?
Tardive dyskinesia
How is tardive dyskinesia treated?
tetrabenazine
What is acute dystonia and how is it treated?
Sustained, painful, involuntary muscle contraction
treated - procyclidine
What is the treatment for OCD?
- low intensity CBT including ERP
- SSRI
- clomipramine
What are the triad of symptoms for PTSD?
- hyperarousal
- avoidance
- re-experiencing
How is PTSD treated?
- trauma focused CBT +/- EMDR
- venlafaxine/SSRI
what clinical signs might you see in someone with anorexia?
- bradycardia
- enlarged salivary glands
- hypotension
- proximal myopathy (squat test)
What blood results would you see in someone with anorexia nervosa?
- hypOkalaemia
- raised cortisol, growth hormone, cholesterol
- impaired glucose tolerance
What are the complications of anorexia nervosa?
- pancreatitis
- constipation
- refeeding syndrome
What is the management for someone with anorexia nervosa ?
- CBT (with family)
- monitor U&Es and ECG
- oral supplements to correct electrolyte imbalance
- dentist + DEXA scan
What is section 2 of MHA?
- used for assessment
- 28 days (can’t be renewed)
- need 2 drs and AMHP
What is section 3 of MHA?
- 6 months
- used for treatment (CAN be renewed)
- need 2 drs and AMHP
What is section 4 of MHA?
- 72 hours
- Used in emergency
- not enough time for 2nd dr
- 1 dr and 1 AMHP
What is section 5 (4) of MHA?
Detains pt for 6 hours
- used by nurses to stop pt leaving
What is section 5 (2) of MHA?
72 hours holding power for Dr
What is section 135 of MHA?
police - used to take to or keep you at place of
safety (need a warrant to enter your home)
What is section 136 of MHA?
police - used to enter your house without warrant
