psych Flashcards
1
Q
PHQ-9 score - what are NICE cut-offs for
(a) less severe depression
(b) more severe depression
and first-line Rx
A
(a) <16 - refer to CBT
(b) > or = 16 - SSRI and refer to CBT
2
Q
what needs to be checked before starting venlafaxine
A
blood pressure
3
Q
A patient taking chlorpromazine develops a bilateral resting tremor. What side-effect of antipsychotic medication is this an example of?
A
Parkinsonism
4
Q
sustained muscle contraction (e.g. torticollis, oculogyric crisis) is what side effect
A
acute dystonia
5
Q
what is the treatment of acute dystonia (sustained muscle contraction - torticollis, oculogyric crisis)
A
procyclidine
6
Q
severe restlessness caused by anti-psychotics is called what?
A
akathisia
7
Q
Abnormal, involuntary choreoathetoid movements e.g. chewing and pouting of jaw
A
tardive dyskinesia
8
Q
2 adverse effects/warnings of increased risk of when antipsychotics are used in elderly patients
A
Increased risk of stroke and VTE
9
Q
acute stress disorders has a timeframe of what period after the traumatic event
A
acute stress reaction in first 4 weeks
PTSD is after 4 weeks
10
Q
acute stress disorder management
A
trauma-focused CBT first line
benzodiazepines for acute symptoms
11
Q
SSRIs are associated with what electrolyte abnormality
A
hyponatraemia
12
Q
what is the most common side effect of SSRIs
A
GI symptoms
13
Q
What should be prescribed if a patient is taking SSRIs and NSAID
A
PPIs
14
Q
Which two SSRIs have a higher propensity for drug interactions
A
Fluoxetine
Paroxetine
15
Q
Citalopram main adverse effect
A
Prolongs QT interval
16
Q
Interaction between warfarin/heparin and SSRIs
What other medication can be considered instead
A
NICE advises avoiding SSRIs
Consider mirtazapine
17
Q
What 4 medications should you be cautious of with SSRIs
A
- NSAIDs - give PPI
- Triptans - avoid SSRIs
- Aspirin
- Warfarin/heparin - give mirtazapine instead
18
Q
After starting antidepressant therapy, patients should be reviewed after…
A
2 weeks
For patients under age of 30 or increased risk of suicide after 1 week
19
Q
If a patient makes a good response to antidepressant therapy they should continue on treatment for at least how long
A
6 months to reduce risk of relapse
20
Q
When stopping SSRI, dose should be gradually reduced over how long?
A
4 week period
21
Q
What SSRI has the highest incidence of discontinuation symptoms
A
Paroxetine
22
Q
Somatisation definition
A
Multiple physical SYMPTOMS
At least for 2 years
Patient refuses to accept reassurance or negative test results
23
Q
Conversion disorder definition
A
Loss of motor or sensory function
Patients may be indifferent - la belle indifference
24
Q
Muchausen’s syndrome is also known as
A
Factitious disorder
25
ICD-10 criteria requires depressive symptoms to be present for at least..
2 weeks
26
HAD scale - what are the score thresholds
0-7 normal
8-10 borderline
11+ anxiety/depression
27
PHQ-9 scoring thresholds
<16 less severe depression
>16 severe depression
28
Cluster A personality disorder
Odd or eccentric
Paranoid
Schizoid
Schizotypal
29
Cluster B personality disorder
Dramatic, emotional, erratic
Antisocial
Borderline
Narcissistic
30
Cluster C personality disorder
Anxious and fearful
Obsessive-compulsive
Avoidant
Dependent
31
Management of personality disorders
Dialectal behaviour therapy
32
jealousy where a person is convinced their partner is cheating on them
what condition
Othello syndrome
33
3 adverse effects of atypical antipsychotics
1. weight gain
2. clozapine - agranulocytosis
3. hyperprolactinaemia
34
what is the first line SSRI for generalised anxiety disorder
sertraline
35
Generalised anxiety disorder, first line treatment is sertraline. If this is ineffective, what can be offered?
1. offer alternative SSRI or SNRI (duloxetine, venlafaxine)
2. if cannot tolerate SSRIs or SNRIs, offer pregabalin
3. weekly follow up is recommended for under 30s for the first month
36
management of panic disorder
1. CBT or drug treatment
2. SSRIs are first line.
3. If contraindicated or no response after 12 weeks then imipramine or cloipramine should be offered
37
5 factors associated with poor schizophrenia prognosis
1. Strong family history
2. Gradual onset
3. Low IQ
4. Prodromal phase of social withdrawal
5. Lack of obvious precipitant
38
first-line treatment for children and young people with anorexia nervosa
family based therapy
39
diagnosis of anorexia is now based on the DSM5 criteria and BMI and amenorrhoea are no longer specifically mentioned.
what are the 3 criteria?
1. restriction of energy intake relative to requirements leading to low body weight
2. intense fear of gaining weight or becoming fat even though underweight
3. disturbance in way weight or shape is experienced or denial of seriousness of current low body weight
40
NICE recommend adults with anorexia should have one of which three treatments
1. individual eating disorder focused CBT (CBT-ED)
2. Maudsley anorexia treatment for adults (MANTRA)
3. specialist supportive clinical management (SSCM)
41
To screen for depression, which two questions are most useful to ask?
'During the past month, have you been bothered by ....'
feeling down, depressed, or hopeless
and
having little interest or pleasure doing things
42
when checking lithium levels, the sample should be taken how many hours post-dose
12 hours
43
how often should lithium levels be monitored?
weekly, after starting lithium or after each dose change, until concentrations are stable
44
In patients who take lithium, what other things need to be checked (other than lithium levels) and how often?
BMI, serum electrolytes, eGFR, (renal function) and thyroid function every 6 months
45
Venlafaxine and other SNRIs are associated with the development of what condition
Hypertension
46
what needs to be monitored at initiation and dose titration of venlafaxine and other SNRIs ?
Blood pressure
associated with hypertension!
47
For people presenting with mild to moderate symptoms of PTSD of less than 4 weeks duration, what management may be appropriate
Period of watchful waiting
48
What are the 4 features of PTSD
1. Flashbacks
2. Avoidance
3. Hyperarousal
4. Emotional numbing
49
Management of PTSD
1. Debriefing is NOT recommended
2. Watchful waiting if <4 weeks symptoms
3. Military personnel have access to treatment by armed forces
4. Trauma focused CBT or EMDR
5. Venlafaxine or SSRI or risperidone
50
NICE recommend classifying OCD impairment with what scale and into what categories
Y-BOCS scale
Mild, moderate or severe
51
Management of OCD - mild, moderate, severe
- Mild - first-line = CBT, exposure and response prevention (ERP). After that, SSRI or more intensive CBT can be offered.
- Moderate = SSRI (fluxoetine for body dysmorphia) or intensive CBT. Consider clomipramine if cannot have SSRI
- Severe = refer to mental health team. While awaiting assessment, offer combined SSRI (or clomipramine) + CBT
52
If treatment with SSRI for OCD is effective, then how long should it be continued for at least to prevent relapse and allow time for improvement
AT LEAST 12 months
53
Compared to depression, the regime for SSRI for OCD differs how?
Requires a higher dose
Longer duration of treatment (at least 12 weeks) for initial response
Patient must continue it for at least 12 months to prevent relapse + allow time for improvement
54
Benzodiazepines mechanism of action
Enhance effect of GABA by increasing frequency of chloride channels
55
Committee on Safety of Medicines advises that benzodiazepines are only prescribed for what period of time
2-4 weeks
56
How should you withdraw a benzodiazepine
- Withdraw in steps of about 1/8 range of daily dose every 2 weeks
- Switch patients to equivalent dose of diazepam
- Reduce dose of diazepam every 2-3 weeks in steps of 2 or 2.5mg
- Time needed for withdrawal can vary from 4 weeks to a year or more
57
Patients who withdraw too quickly from benzodiazepines can experience withdrawal - similar to alcohol withdrawal. This may occur up to how long after stopping?
Up to 3 weeks after stopping
58
side effects of tricyclic anti-depressants
Dry mouth
Blurred vision
Urinary retention
Constipation
Postural hypotension
Prolonged QT interval
59
Low dose amitriptyline is commonly used in the management of what 2 things
Neuropathic pain
Prophylaxis of headache (migraine + tension)
60
Clozapine monitoring requires what and when
FBC every week for 18 weeks
Then every 2 weeks after
Until 1 year of treatment
61
What is required before starting haloperidol
ECG
62
Which syndrome is characterised by a person believing they are dead or non-existent?
Cotard syndrome
63
Difference between mania vs hypomania
Mania - lasts for 7 days. Has psychotic symptoms
Hypomania - less than 7 days. No psychotic symptoms
64
What is the commonest eye condition associated with Charles-Bonnet syndrome
Age-related macular degeneration
65
circumstantiality
what is this
long-winded answer
seen in hypomania or anxiety
66
Risk of developing schizophrenia when the following has schizophrenia:
(a) monozygotic twin
(b) parent
(c) sibling
(d) no relatives
(a) monozygotic twin = 50%
(b) parent = 10-15%
(c) sibling = 10%
(d) no relatives = 1%
67
Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI
Withdraw first SSRI before the alternative is started
68
Switching from fluoxetine to another SSRI
withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI
69
Switching from a SSRI to a tricyclic antidepressant (TCA)
cross-tapering is recommend (the current drug dose is reduced slowly, whilst the dose of the new drug is increased slowly)
EXCEPT fluoxetine - withdraw prior to starting TCA
70
Switching from fluoxetine to TCA
Withdraw fluxetine first
Then start TCA
71
Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine
cross-taper cautiously. Start venlafaxine 37.5 mg daily and increase very slowly
72
Switching from fluoxetine to venlafaxine
withdraw and then start venlafaxine at 37.5 mg each day and increase very slowly
73
Adverse effects of clozapine
Agranulocytosis
Neutropenia
Reduces seizure threshold
Constipation
Myocarditis
Hypersalivation
74
Section 2
Up to 28 days
AMHP + 2 doctors
75
Section 3
6 months
AMHP + 2 doctors
76
Section 4
72 hours
GP + AMHP + NR
77
Section 5(2)
72 hours on inpatient
Doctor
78
Section 5(4)
6 hours
Nurse
79
Section 17a
Community treatment order
Supervised community treatment
80
Section 135
Police take patient from home to place of safety
81
Section 136
Police take patient from public place to place of safety
24 hours
82
Schneider's first rank symptoms may be divided into what 4 components
1. auditory hallucinations
2. thought disorders
3. passivity phenomena
4. delusional perceptions
83
Anorexia features
including Gs and Cs
Most things are low - hypokalaemia, LH, FSH, testosterone, BP, HR
Gs and Cs are raised: growth hormone, glucose, salivary Glands, cortisol, cholesterol, carotinaemia
84
delusion that a famous is in love with them, with the absence of other psychotic symptoms
Erotomania a.k.a De Clerambault's syndrome
85
alogia is included in thought disorganisation - what is this?
little information conveyed by speech, speaking less
86
factors that increase risk of suicide
1. male sex (HR 2.0)
2. history of self-harm (1.7)
3. alcohol or drug misuse (1.6)
4. age
5. history of mental illness
6. chronic disease
7. unemployment or social isolation
8. unmarried or widowed or divorced
87
3 factors which reduce the risk of a patient committing suicide
1. family support
2. children at home
3. religion
88
management of sleep paralysis if troublesome
clonazepam
89
Mirtazapine may be prescribed due to useful side effects which include what?
Sedation - good for patients with insomnia
Increased appetite
n.b. also reduces alcohol intake
90
What is the SSRI of choice post myocardial infarction
Sertraline
91
What is the SSRI of choice in children and adolescents
fluoxetine
92
Management of schizophrenia
Oral atypical antipsychotics
CBT!
93
Once a stable dose of lithium has been achieved after weekly monitoring, how often should levels be checked?
Every 3 months
94
Depression in older people are less likely to attend with depressed mood. They tend to present with physical complaints e.g. hypochondriasis, agitation and insomnia. What is first-line treatment?
SSRIs
95
If a patient makes a good response to antidepressant therapy they should continue on treatment for at least how long after remission?
6 months to reduce the risk of relapse.
96
Schizophrenia: management
1. Oral atypical antipsychotics
2. CBT
3. Review cardiovascular risk factors
96
Depression (variable appetite, poor sleep) with excess alcohol use may benefit from which antidepressant
Mirtazapine
97
Differencer between type 1 and type 2 bipolar disorder
Type 1 - mania (>7 days) and depression
Type 2 - hypomania (4-7 days) and depression
98
patients with bipolar disease - DVLA rules
bipolar disease patients must inform DVLA of their diagnosis. manic episodes - must stop driving for at least 6 months.
99
What things other than blood tests are monitored for anti-psychotics and how often?
1. Weight - start of therapy, 3 months, annually
2. Fasting blood glucose - at the start of therapy, 6 months, annually
3. Blood pressure - baseline, frequently during dose titration
4. ECG - baseline
5. CVS risk - annually
100
What blood tests are monitored with antipsychotics?
FBC
U+Es
LFTs
These three are at the start, then annually. Clozapine is more frequent (weekly for first 18 weeks)
Prolactin - at the start, at 6 months, annually
101
How often is ECG done with antipsychotics
At baseline
102
When is cardiovascular risk assessment done with antipsychotics
Annually
103
When is BP monitored in antipsychotics
At baseline
Frequently during dose titration
104
When is fasting blood glucose and prolactin monitored with antipsychotics?
At the start of therapy
6 months
Annually
105
When are lipids and weight monitored in antipsychotics?
Start of therapy
3 months
Annually
106
When are FBC, U+Es. LFTs monitored in antipsychotics?
Start of therapy
Annually
Clozapine needs weekly FBCs for first 18 weeks
107
What tricyclic antidepressant is most dangerous in overdose
dosulepin
108
seasonal affective disorder treatment is the same as what other disorder
depression
- psych therapy and SSRI if needed
109
alcohol withdrawal timeframe for:
- symptoms
- seizures
- delirium tremens
- symptoms: 6-12 hours
- seizures: 36 hours
- delirium tremens: 72 hours
110
management of alcohol withdrawal
1. long-acting benzodiazepines e.g. chlordiazepoxide or diazepam
2. carbamazepine
