Psych Flashcards
what is Russels sign
calluses on the knuckles or back of the hand due to repeated self-induced vomiting - due to bulimia
what is the name of the fine hairs associated with an6aemia
lanugo hair
what form of memory loss is found in depression
global (short, long-term, working memory loss)
Factors suggesting diagnosis of depression over dementia
short history, rapid onset
biological sx e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests/disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
what is the DSM diagnostic criteria for depression
5/9 sx, nearly every day for at least 2 weeks:
- Depressed mood/ irritability (feels/appears sad or empty or teary)
- Anhedonia:
- Significant weight or appetite change.
4.Sleep alterations: Insomnia or hypersomnia. - Activity changes: Psychomotor agitation or retardation.
- Fatigue
- Guilt /worthlessness:
- Cognitive issues: think/ concentrate/ make decisions,
- Suicidality:
depression stepwise Mx
Mild:
* low-intensity therapy e.g. (CBT).
mod-sev
* higher-intensity CBT/interpersonal therapy
- and meds 1st line: (SSRI) sertraline.
- Immediate referral: in active suicidality,
- Refractory (tx resistant) depression - lithium/ Electroconvulsive Therapy (ECT).
SSRIs should be used with caution in young people, which SSRI is suitable for children/ adolescents
fluoxetine
A pt with ``Hx depression6 is on6 sertralin6e, H`e recen6tly b5egan6 takin6g ib5uprofen6 due to a sports in6jury. what further medication n6eeds to b5e prescrib5ed?6
PPI
SSRIs commonly cause GI Sx as S/E, so PPI is needed when pt on SSRI & NSAID
(NICE: don’t prescribe SSRI &NSAID but if it has to be done, give PPI)
Give 4 drugs/drug groups which should cause in6teraction6s with `SSRIs
NSAIDS-inc aspirin (GI bleed risk)
warfarin/heparin (bleeding risk)
triptans (serotonin syndrome)
MOAIS (e.g. resegiline =- serotonin syndrome)
which SSRI should be avoided in pregnancy
Paroxetine
to avoid serotonin syndrome, how long should a pt waiting between stopping & starting MAOIs and SSRIs.
To avoid this, patients should be given a 14-day washout period between MAOIs and SSRIs.
what are the metabolic S/E of atypical antipsychotics
hyperlipidemia, hypercholesterolemia, hyperglycemia,hyperprolactinemia and weight gain.
typical- mainly EPSE & hyperprolactinaemia
atypical- less EPSE/hyperprolactinaemia, more of the other metabolic effects
give x2 examples of typical & atypical antipsychotics
typical: haloperidol, chlorpromazine
atypical: clozapine, risperidone, olanzapine
what 4 features make up EPSE for antipsychotics
- Parkinsonism
- acute dystonia - sustained muscle contraction (e.g. torticollis)
- akathisia (severe restlessness)
- tardive dyskinesia ( abnormal, involuntary, motions - most common is chewing and pouting of jaw)
what are the non- metabolic S/E of antipsychotics (excluding EPSE)
- antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
- sedation, weight gain
- neuroleptic malignant syndrome: pyrexia, muscle stiffness
- reduced seizure threshold (greater with atypicals)
- prolonged QT interval (particularly haloperidol)
lithium
- therapeutic range
- excreted primarily by…..
0.4-1.0 mmol/L
primarily by the kidneys. - has a long plasma half-life being excreted
lithium monitoring: how long after the last dose should the sample be taken?
12 hrs
following a change in dose how frequently should lithium levels be checked until the levels are stable
weekly
once stable, lithium levels should be checked every…. months
3
how often should thyroid and renal function be checked in a pt on lithium
6monthly
give x2 long-acting benzos
give x1short acting benzo
long acting - diazepam, chlordiazepoxide
short acting - lorazepam
Give the Sx of alcohol withdrawal in
6-12 hrs
36 hrs
48-72hrs
6-12hrs Sx start: tremor, sweating, tachycardia, anxiety
36hrs: seizures
48-72 hrs: delirium tremens (delrius & trembling : coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia)
Mx in alcohol withdrwal
1st line
who to Adx
long-acting benzo (diazepam/chlordiazepoxide)
Adx
Hx wthdrawal seizures/ delirium tremens
deficinency of what vitamin couses Wernickes encephalopathy
Thamine - B1
give pabrinex (paBr1nex)
what triad suggests wernickes encephalopathy
confusion, ataxia, ophthalmoplegia/nystagmus
what type of amnesia is associated with korsakoffs syndrome
anterograde amnesia ( limited retrograde amnesia & confabulation)
give risk factors for schizophrenia
FHx - strongest (e.g. 10% if parent/sibling affected)
childhood trauma
heavy cannabis use in childhood
Black Caribbean ethnicity
migration
living in an urban environment
give 5 types of Negative sx
Remember by 5A’s:
– Affect blunted = restricted emotion with poor emotional display
– Alogia = paucity of speech
– Asociality = social isolation
– Anhedonia = Lack of pleasure
– Avolition = Lack of motivation
Schizophrenia Management - what are the 1st, 2nd and 3rd line treatments
mx in acute episodes of dangerous behaviour
Antipsychotics
1st line: atypical anti-psychotics (quetiapine, olanzapine, risperidone)
2nd: typical anti-psychotics (haloperidol, chlorpromazine etc.)
3rd line is clozapine only for refractory psychosis
acute episodes, sedatives: lorazepam, promethazine, or haloperidol
which thought disorder presents as the formation of new words, which might include the combining of two words.
Neologisms
which thought disorder is a feature of schizophrenia
Knight’s move thinking
what 5 factors indicate an increased risk of future suicide attempts
- efforts to avoid discovery
- planning
- leaving a written note
- final acts such as sorting out finances
- violent method
what psych conditions are the following therapies used to manage?
Exposure and response prevention (ERP)
Dialectical Behaviour Therapy (DBT)
Prolonged Exposure Therapy (PE)
Exposure and response prevention (ERP) - OCD
Dialectical Behaviour Therapy (DBT) - EUPD (personality disorders in general)
Prolonged Exposure Therapy (PE) - PTSD
What scale is used to rate the severity of OCD
Y-BOCS scale
severe - >3hrs/da on obsession/compulsion
what are the management options in
mild, mod, severe OCD?
mild
- low intensity ERP
- if needed, add more intense ERP/ SSRI
mod
- SSRI ( NOT fluoxetine) / intense ERP
- 1st line alternative to SSRI - clomipramine
sev
- secondary care referral
- with SSRI & ERP
what are the type A personality disorders
paranoid
schizoid
schizotypal
what are the type B personality disorders
antisocial
borderline (EUPD)
histrionic
narcissistic
what are the type c personality disorders
obsessive-compulsive
avoidant
dependent
whats the difference between schizoid and schizotypal personality disorders>
both type A
schizoid 0 indifference, lack of interest
schizotypal - lack of close friends, onlyu family, eccentric behaviour, ideas of reference
Mx of GAD ( 1st, 2nd, 3rd line)
1st - SSRI ( e.g. sertraline)
2nd - SSRI ( e.g. citalopram)
3rd - switch to SNRI (e.g. duloxetine)
