Psych Flashcards
anorexia nervosa red flags
SUSS
bradycardia <50
(orthostatic) hypotension
tests to screen for unidentifiable causes of confusion
FBC, ESR, CRP, U&E, Ca, HbA1c, LFTs, TFTs, serum B12 and folate
tricyclic antidepressants urinary SEs
overflow incontinence
why is Ca checked in lithium use
hyperpara
anorexia nervosa ECG
prominent U waves - hypokalaemia
long term lithium use can lead to
hyperparathyroidism –> hypercalcaemia
(lower back pain, constipation, difficulty concentrating, low mood, headache)
differentiate depression from AD
depression has shorter history and rapid onset
SSRIs can be associated with which electrolyte abnormality
hyponatraemia esp fluoxetine
cardiac defect caused by lithium
ebstein’s anomaly
mania whilst on depression meds (sertraline) mx
stop sertraline & add olanzapine –> ++ lithium
mirtazapine mechanism
noradrenergic and specific serotonergic antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors
how gradually should SSRIs be withdrawn
over 4 weeks
SSRIs risk in 1st vs 3rd trimester
1st –> congenital heart defects
3rd –> pulmonary hypertension
TCAs cause ….. incontinence
overflow incontinence
normal FBC changes with lithium
benign leucocytosis
antipsychotics side effects timeline
Neuroleptic malignant syndrome and acute dystonia - days/weeks
tardive dyskinaesia - years
peak age 1st episode psychosis
15-30 years
tyramine containing foods (e.g. cheese) + monoamine oxidase inhibitors –>
hypertensive crisis
antidepressant that causes large increase in appetite
mitrazapine
chronic metabolic side effect MDMA/ecstasy
hyponatraemia 2ry to water intoxication
substance misuse that causes massive increase in serotonin
LSD
distinguish narcissistic from histrionic
Narcissistic - lack empathy & entitled
histrionic - attention seeking & inappropriate behaviour
a note on tx delusional disorders
medication + psychotherapy (highly resistant to medication alone)
class A drugs
MDMA/ecstasy
LSD
Heroin
Cocaine
injectable amphetamine
class B drugs
amphetamine
cannabis
ketamine
2 forms to assess cognition
MOCA & ACE-III
CBT for depression
behavioural activation
CBT for OCD
exposure & response prevention
art therapy is useful in
schizophrenia
motivational interviewing is useful in
addictions
75 year old woman with 18 month history ofmemory problems, gradually worsening. She has noother past medical history. She score 67 on ACE-IIIand her CT shows marked atrophy, especially in themedial temporal lobes. What medication
acetylcholine (acetylcholinesterase inhibitors)
75 year old woman with 18 month history ofmemory problems, gradually worsening. She has ahistory of bradycardia, gastric ulcer disease(including a confirmed ulcer) and several recentfalls. She score 67 on ACE-III and her CT showsmarked atrophy, especially in the medial temporallobes. what medication
memantine (NMDA receptor antagonist that blocks glutamate receptor)
A 55 year old woman presents with recurrent thoughts about crashing her car when she drives with passengers. They come into her mind and distress her so that she has stopped driving. She tries to stop the thoughts but they keep recurring
SSRI
summarise NaSSa (metrazapine) SEs
sedative // weight gain // agranulocytosis
neurotransmitter implicated in psychosis // depression
dopamine // monoamines
pre-lithium tests
Weight, U&E, TFT, Ca 2+, ECG, pregnancy test
dementia screen
B12, folate, TFTs
tests before antipsychotics
FBC, U&Es, LFTs, ECG, prolactin, lipids & cholesterol, HbA1C, weight, BP, pulse
tests before valproate
LFTs, amylase, FBC, pregnancy
drugs that can lead to lithium toxicity
NSAIDS // diuretics
A 42 year old man dependent on alcohol presents wanting to detoxify. He has been drinking three 3L bottles of cider per day for over two years. He has had no previous attempts at stopping using alcohol and does not wish to be admitted
chlordiazepoxide
A 50 year old woman presents asking to come off her medication. She has a long history of anxiety and depression. She is currently on lorazepam which was, started for panic attacks several years ago. She now takes doses above BNF recommended maximum limits.
diazepam
A man who is prescribed diazepam is found collapsed and unresponsive. He has a respiratory rate of 8 breaths per minute and a bradycardia. His pupils are slightly dilated but reactive. He has written a suicide note saying he wants to end his life
flumazenil
which section can run back to back
section 3
duration of section 2 // 3 // 5(2) // 5(4)
2: 28 days
3: 6m
5(2): 72hrs (FY2 holding powers)
5(4): 6hrs (nurse holding powers)
sections that can be appealed
section 2 & 3
difference between 135 & 136
135: power to enter property
136: remove from public area
the three players of assessing for sectioning
1 Dr section 12 approved
1 Dr prior knowledge of patient
1 AMHP (makes decision)
Elderly patient with delirium, requires IVantibiotics but is refusing to remain on the medical ward as needs to “get back to school for class”. what bit of the law to use to treat him
treat in hospital under MCA
