PSYCH Flashcards
What class of drug is Mirtazapine
Noradrenergic and specific serotonergic antidepressant
Targets certain serotonin receptors to increase levels of noradrenaline and serotonin
3 examples of SSRIs
Fluoxetine
Sertraline
Paroxetine
3 examples of SNRIs
Serotonin-noradrenaline reputable inhibitors
Inhibit reuptake of BOTH serotonin and noradrenaline so the body makes more
Venlafaxine
Duloxetine
Desvenlafaxine
3 examples of MAOIs
Monoamine Oxidase Inhibitors
Inhibit MO enzymes which break down neurotransmitters such as norepinephrine, dopamine, serotonin -> increased levels in brain
Phenelzine
Tranylcypromine
Isocarboxazid
What is flight of ideas and what condition is it a feature of
Patient speaks very quickly
Rapidly jumps between topics but there is a link between the topics
Feature of mania
If no links think Knight’s move thinking- loosening of association linked with schizophrenia
Give 3 examples of an atypical antipsychotic
Clozapine
Olanzapine
Quetiapine
COQ
What MH drug can you not take Triptans with
SSRI’s
Triptans are migraine and cluste headache relief
Serotonergic activity in both
Presents with e.g. tachycardia, hyperthermia, restless, confused
How do you discern between paranoid personality disorder and schizotypal personality disorder
Both can have suspicious and mistrust of the world
PPD is more ‘positive’ symptoms such as perceived threats to individual
SPD is more ‘negative’ e.g. lack of social integration whilst holding odd beliefs e.g. neighbors in a cult
Which generation of antipsychotics would you experience acute dystonic reaction with
First-generation
Dystonia is involuntary muscle movements
E.g. torticollis, oculogyric crisis
How to discern between antisocial personality disorder and borderline personality disorder
Both have impulsivity as key feature
Antisocial is repeated failure to conform to social norms and disregard for safety
Borderline is unstable affect with fluctuating self image and recurrent suicidal ideation
Antisocial is far more common in men, borderline is far more common in women
4 risk factors for GAD
35-54
Divorced/ separated
Living alone
Being a lone parent
Being 16-24 is protective
What kind of therapy is effective for borderline personality disorder
Dialectical behavior therapy
Focus on controlling strong emotional reactions
Adverse effects of clozapine
Agranulocytosis and neutropenia is a life threatening side effect
Reduced seizure threshold
Constipation
Myocarditis (baseline ECG taken before tx)
Hypersalivation
What do you give in alcohol withdrawal
Decreasing doses of long-acting benzodiazepines
E.g. diazepam or chlordiazepoxide
Long-term use of alcohol leads to upregulation of excitatory glutamate receptors (inhibits the excitatory effect of glutamate) and downregulation of GABA receptors (more GABA which is depressive)
If alcohol stops, then the inhibition of the glutamate stops and so the sympathetic nervous system becomes overactive presenting with restlessness, sweaty, tremors etc
Long-acting benzodiazepines potential GABA so slow down the nervous system
What is it called when patients intentionally create symptoms e.g. causing hypoglycemia
Munchaunsen’s syndrome
Aka fictitious disorder
How do you manage acute dystonia secdonary to antipsychotics
Vs how do you manage tardive dyskinesia when you have been taking antipsychotics for several years
TArdive dyskinesia- have been TAking antipsychotics for several years -> give Tetrabenezine
Acute dySTonia common when STarting antipsychotics- give Procyclidine
When commencing lithium treatment, when should lithium levels be monitored
Weekly
And always checked 12 hours post-dose
What drug is given to deter people from drinking and how does it work
Disulfiram (Antabuse)
Inhibitor of acetaldehyde dehydrogenase- build up of acetaldehyde reacts with alcohol to vomit violently
Severe Sx so prescribe carefully
What drug do you give to stop alcohol cravings
Acamprosate (Campral)
Take 3 times a day
Mechanism unclear
Minimal side-effects and can take with alcohol
OR ALSO GIVE LOMG ACTNIG BENZO
What is an alternative opiate replacement therapy to methadone (sublingual tablet)
Buprenorphine
Less sedating than methadone
What mechanism of action is duloxetine
Serotonin and noreadrenaline reuptake inhibitor
Dulo= duel
Which antidepressants give the following side effect:
Can’t see cant pee, cant spit cant shit
Tricyclic antidepressants especially ones that antagonise muscarinic receptors
E.g. imipramine
Blurred vision
Urinary retention -> incontinence
Dry mouth
Consolation
What do you give in PTSD if CBT or EMDR therapy is ineffective
SSRI or Venlafaxine (SNRI)
What type of memory loss can come from ElectroConvulsive Therapy
Retrograde amnesia (can’t remember past)
Not anterograde (cant form new memories)
What do u give in treatment of delirium tremens/alcohol withdrawal
Chlordiazepoxide or diazepam
symptoms of SSRI discontinuation syndrome
Anxiety, restlessness
Dizziness
Electric shock sensations
Difficulty sleeping
Unsteadiness
GI symptoms
First line tx of mild ocd
exposure and response prevention (ERP) therapy.
Common side effect of long-term lithium
hyperparathyroidism and resultant hypercalcaemia
stones, bones, abdominal moans, and psychic groans’.
How could myocarditis secondary to clozapine use present
general malaise over the last few days with accompanying chest pain. He looks uncomfortable and sweaty on the bed.
What side effects can mirtazipine cause that may be helpful
Sedation and increased appetite
So often used in insomniacs who have bad appetite
What do you give in moderate/ severe ocd when SSRIs don’t work
clomipramine
A tricyclic antidepressant- the only one liscenced
What class is mirtazapine
Alpha-2 receptor antagonist
How long do Sx need to be to diagnose chronic insomnia
3 months
Which syndrome do patients think they’re dead
Cotard
Wht is PTSD when its less than 4 weeks after the event an how do you treat
Acute stress disorder
Trauma-focused CBT first line
Sometimes benzos used first line in sleep disturbance etc
Which personality disorder only displays the negative symptoms of schizophrenia
Schizoid
What is the difference between Wernicke’s encephalopathy an Korsakoff’s syndrome and how do they each present
Korsakoff’s is a complication of Wernicke’s encephalopathy
Both effects of alcohol
Wernicke’s=
- Opthalmoplegia (weakened eye muscles)
- Confusion
- Ataxia
Korsakoff’s=
- anterograde amnesia (forgets previous interactions)
- confabulation (making up 2 different stories about day)
Timing of alcohol withdrawal:
- symptoms
- seizures
- delirium tremens
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours (hallcinations, tachycardia, hypertension, hypertermia, agitation, diaphoresis)
Symptoms of delirium tremens (72 hours after alcohol withdrawal- 3 days)
hallcinations, tachycardia, hypertension, hypertermia, agitation, diaphoresis
How do you manage acute dystonia secondary to antipsychotics
Procyclidine
Which SSRI in kids
fluoxetine
How does serotonin syndrome present
Autonomic hyperactivity (hyperthermia, sweating)
Neuromuscular abnormalities (hyperreflexia and rigidity)
Often due to SSRI and MAOI combination (e.g. Sertraline and Selegiline)
Which SSIR is the most likely to cause ECG abnormalities such as QT prolongation and Torsades de pointes
Citalopram
Which blood test is raised in alcohol
Gamma GT (Gamma glutamyl transferase)
What class is escitalopram
SSRI
Second line after sertraline
What is Hoovers sign
It is performed by having the patient lie supine and then asking them to flex the hip of the affected leg against resistance. If the patient has an organic weakness, the examiner will feel pressure on the heel of the unaffected leg as the patient involuntarily extends the hip to compensate for the weakness. If the patient has a non-organic weakness, the examiner will not feel any pressure on the heel of the affected leg.
Normal people exert opposite pressure when extending one leg, psychogenic people don’t
Conversion vs somatisation
Conversion disorder, also known as Functional Neurological Symptom Disorder (FNSD), is characterised by neurological symptoms such as weakness, paralysis, sensory loss or seizures. These symptoms are often inconsistent with known neurological or medical conditions. The key feature of conversion disorder is the presence of a ‘conversion’ mechanism, where psychological distress is believed to be converted into physical symptoms.
On the other hand, Somatisation disorder (now more commonly referred to as Somatic Symptom Disorder under DSM-5) involves multiple unexplained physical complaints across different organ systems including pain, gastrointestinal symptoms like nausea, sexual symptoms and pseudoneurological complaints that persist for years. This condition usually begins before age 30 and occurs more frequently in women. It’s thought to represent a maladaptive way of expressing emotional distress through physical symptoms.
Knights move vs flight of ideas
Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
What is the main risk factor associated with SSRI use in the first trimester
Small increased risk of congenital heart defects
Weigh up risks and benefits
What is the main risk factor associated with SSRI use in the third trimester
Persistent pulmonary hypertension of the newborn
What is the risk of using paroxetine in the first trimester
Congenital malformations
What class is Rasagiline
Monoamine oxidase inhibitor (MAOI)
Only really used if other meds aren’t working/ are contraindicated
Should never be combined with SSRIs
Meds hierarchy for GAD
SSRI 1 e.g. sertraline
SSRI 2 e.g. citalopram
SNRI 3 e.g. duloxetine
How does medical management differ for GAD and panic disorder
Both start with SSRIs
If they dont work then
In PD you give imipramine or clomipramine (tricyclic antidepressants)
In GAD you give duloxetine (SNRI)
What is more suggestive of schizophrenia: low appetite or insomnia
Insomnia
Circadian rhythm disturbance
In which atypical antipsychotic would you want to arrange a full blood count if they had an infection
Clozapine
Agranulocytosis/ neutropenia is a life-threatening side effect of clozapine
3 core Sx of depression
Low mood
Low motivation (anhedonia)
Low energy (anergia)
What is the most common endocrine side effect of chronic lithium toxicity
Hypothyroidism
Can lead to feeling more tired, reduced appetite and constipation
Do you give lithium or antipsychotics in (hypo)manic episodes
antipsychotics
Give lithium to prevent their reoccurrence
In which antipsychotic should you take care when quitting smoking
Clozapine
Smoking cessation can cause a rise in clozapine blood levels
Which finding is positive in Hoover’s sign
No contralateral movement is a positive finding
This suggest functional cause vs organic
What is the mainstay in managing personality disorders
Dialectical behavior therapy
Side effects of clomipramine (4)
Dry mouth
Blurred vision
Urinary retention
Weight gain
It is a tricyclic antidepressant
Can’t see cant pee can’t shit can’t spit
NSAID and SSRI what is the risk
GI bleeding
Give a PPI
It is though that SSRI may deplete platelet serotonin leading to a reduction in clot formation so increased risk of bleed
FIRM STOP acronym for SSRI discontinuation syndrome
Discontinuation Syndrome (FIRM STOP)
Flu like Sx
Insomnia
Restlessness
Mood swings
Sweating
Tummy problems (pain, cramps, D+V)
Off balance
Parasthaesia
Which antipsychotic decreases seizure threshold
Clozapine
What class of drug is Venlafaxine
SNRI
What is the timeframe for lithium level checking after a change in dose
After a change in dose, lithium levels should be taken a week later and weekly until the levels are stable
Once levels are stable they can be checked every three months.
Side effects of zopiclone
Increased fall risk
- agitation
- constipation
- decreased muscle tone
- dry mouth
- bitter taste in mouth
Similar to benzos
Zopiclone mechanism of action
Binds to GABAa-containing receptors (the α2-subunit of the GABA receptor)——- this appears to be the same as benzos but they are structurally different
Causes enhancement of the actions of GABA
So makes u sleepy
Given in insomnia
Increased fall risk
What to do RE antidepressant meds when youre about to haveECT
Reduce the dose but dont stop completely
Which MH drug can cause hyponatraemia
SSRIs
Especially in the elderly
4 general side effects of SSRIs
General side effects
GI symptoms most common
GI bleed risk
Hyponatraemia especially in the elderly
Increased anxiety and agitation straight away after starting
Which 2 SSRIs have a higher propensity for drug interactions
Fluoxetine and paroxetine
Name 3 drugs that SSRIs interact with
NSAIDs- can give with a PPI (risk of GI bleed)
Triptans- avoid
Warfarin/ heparin- NICE recommends avoiding and giving mirtazipine
When should patients be reviewed after stating an SSRI
If under 25 after 1 week
If over 25 after 2 weeks
Name 5 atypical antipsychotics
CORQA
Clozapine
Olanzapine
Risperidone
Quetiapine
Aripiprazole
What type of drug is chlorpromazine
Typical antipsychotic
High risk of extra-pyramidal symptoms
What is the psychotherapy given in PTSD
Eye movement desensitization and reprocessing (EMDR)
Which MH drug class can cause hypertension
SNRI
E.g. Venlafaxine
What blood test should you run when you change sertraline dose
Urea and electrolytes
To check for hyponatraemia
Should check before and after dose change
Describe the symptoms of tardive dyskinesia in long-term antipsychotic use
Irregular jerky movements e.g. lip smacking, jaw/ mouth movements, tapping hands or feet, excessive blinking,
Slow movements e.g. writhing/ squirming, wiggling
Muscle spasms e.g. difficulty swallowing, making grunting noises, postural changes
What is the type of CBT used in OCD
Exposure and response prevention
What is the type of CBT used in OCD
Exposure and response prevention
What is the first line treatment for children and young people with anorexia nervosa
Anorexia focused family therapy
6 stages of the change cycle
Precontemplation- not ready to change
Contemplation- aware that the problem exists but no commitment to action
Preparation-
Action-
Maintenance- sustained change, new behaviour replaces old
Relapse
Cannabis MOA
THC (psychoactive component )binds to CB1 receptors (inhibitory action so is a depressant)
Indirectly increases dopamine release
MDMA/ ecstasy MOA
Blocks serotonin reuptake increasing amounts of free serotonin at the synapse
Also increases dopamine and noradrenaline
Amphetamines/ speed MOA
Causes neurotransmitter transporters to run in reverse
Disrupts storage of neurotransmitters in synapses leading to increased amounts of neurotransmitters
LSD MOA
Binds to 5-HT (serotonin) receptors causing serotonin release
Most of any drug
Also indirectly increases dopamine and glutamate levels
Heroin (diamorphine) MOA
Binds to mu-opioid receptors leading to feelings of euphoria and analgesia
Inhibits GABA- leads to increase in dopamine release
Cocaine/ crack MOA
Blocks monoamine reuptake transporters
Leads to increased levels of dopamine, noradrenaline and serotonin
Can lead to serotonin syndrome if taken with SRIs
.which drug reduces gambling cravings
Naltrexone
Which med is an antidote to benzos
Fulmazenil
Differences between methadone and buprenorphine in opioid replacement therapy
Buorenorphine is lower starting dose
Methadone is an agonist is has similar effects as heroine- no withdrawal, no high
Bupremorphine is partially agonist and partially antagonist so prevents the heroin binding if u use it alongside- even heroine wouldn’t produce the high
How does opiate overdose present
Resp depression
Bradycardia
Reduced GCS
Pinpoint pupils
MEDICAL EMERGENCY
How does opiate withdrawal present in the first day vs later
First day:
Lacrimation
Achy/ tired
Agitation and can’t sleep
Sweating and tachycardia and hypertension
Later:
N and v and d
Goosebumps
V v v v strong drug craving
Massive Dysphoria
Apparently feeels awful but not dangerous
.
What is naltrexone
Naltrexone is an opioid receptor antagonist that can be used to aid with relapse prevention in previously opioid-dependent patients.
Also used in gambling to stop cravings
What is ondansetron
Ondansetron is a 5-HT3 receptor antagonist used as an anti-emetic. Ondansetron is often used to manage these symptoms during detoxification from alcohol or opiates.
What adverse effects of antipsychotics are especially to be considered in the elderly
Stroke and VTE risk
How to differentiate between OCD and OCpersonality disorder
In OCD the thoughts and compulsions are distressing to the patient
In OCPD they are part of their personality
What is the max daily dose of sertraline
200mg
Mesocortical pathways role in schizophrenia
Cognition and executive function
Low levels of dopamine here in schizophrenia cause negative symptoms
Mesolimbic pathway role in schizophrenia
Mesolimbic Pathway
Motivation, emotion, reward
High levels in schizophrenia cause positive symptoms
Intended site of antipsychotics
Nigrostriatal Pathway role in schizophrenia
Stimulation of movement
Normal levels in schizophrenia
Extrapyramidal side effects of antipsychotics (antagonistic effect)
Low levels of dopamine here causes increased cholinergic effect in antipsychotic medications which causes the side effects
Tuberoinfundibular Pathway
Dopamime functions as prolactin inhibitory hormone (PIH)
Normal levels in schizophrenia
Elevated prolactin in antipsychotic use
What do you give in -eclampsia and what 2 things do u need to monitor with it
Magnesium sulphate - monitor reflexes + respiratory rate
What should you always ask in a depression history
History of mania
Lack of sleep, restless p,
BMI CUT off for AN
18.5
What is Russel’s sign
Knuckles knocking on teeth during bulimia
What is the name of the abnormal hair growth in ED
Lanugo hair
What is it that causes the symptoms in refeeding and what is the most common hallmark indicator
When glucose is given too quickly
Phosphate is the key indicator (low)
Potassium and magnesium can also be low
2 medicines to treat refeeding syndrome
Thiamine= vit b 100mg TDS
Forceval OD = multivitamin
Also don’t stop giving them food
3 core sx of adhd
Inattentive
Hyperactive
Impulsive
How do stimulant adhd meds work
Increase dopamine and n levels in frontal cortex reducing core symptoms
Methylphenidate (ritalin) first line, Also adderral
Which psych drug is most likely to cause weight gain
Atypical antipsychotics
Which antipsychotic has the most sedative effect
Olanzipine
How long do you need to wait for antipsychotics to work
4-8 weeks
Which is the worst atypical antipsychotic for EPSE
Risperidone
What is the unique Sid effect profile of aripiprazole
Agitation and nausea
Opposite to most other AtypAnti which have weight gain and sedation
Usually well tolerated
Lithium MOA
Inhibits glutamate and increases GABA
Lithium side effects common
Fine tremor
GI upset, dry mouth also common
Polyuriaand polydipsia
Weight gain
Hypothyroid
Renal failure
Symptoms of lithium toxicity
Coarse tremor
Nystagmus
Ataxia /cerebellar syndrome (coordination, speech, balance)
Which mood stabiliser can cause steven-Johnson syndrome
Lamotrigine
Rare
But safety net for any rash
Which MH drug should not be taken in women with child bearing potential
Sodium valproate
Birth defects and developmental problems (1 in 10 and 3-4 in 10 respectively)
3 very common side effects of SSRI
N and V-wears off after a few days
Insomnia
Sexual dysfunction (no orgasm)
4 rare but serious side effects of SSRIs
Rash (allergy)
Self-harm risk
Hyponatraemia (tired, confused, headache, muscle cramp)
Serotonin syndrome
Risperidone 3 very common side effects
Postural hypotension
Akathisia (restless, cant stay still)
EPSE
Also common:
-raised prolactin
-sleepy
-weight gain
-constipation
Which 2 atypical antipsychotic is prolactin sparing
Quetiapien
Aripiprazole
Airpiprazole mechanism of action
Balance dopamine action
Partial agonist and antagonist
How to discern between unstable angina from NSTEMI
Tropomim levels
Normal in UA
Which drug do you add in type two diabetes when they develop cardiovascular disease
SGLT-2 Inhibitors
E.e empagliflozin
First line management of someone with alcohol withdrawal symptoms
Long-acting Benzos e.f, chlordiazepoxide or diazepam
Can also give carbemazepine
3 risks of undescended testes
Cancer
Torsion
Infertility
What do you do in baby GORD if gaviscon doesn’t work after thickening food
trial PPI- only do this if they are e.g. refusing food, are distressed or not growing
Nb don’t use thickening agents at the same time as alginate therapy
Order of puberty events in girls
Breast development
Pubic hair
Growth spurt
Period
Boobs pubss grow flow
Order of puberty events in boys
Testicle growth
Pubic hair
Growth spurt
Ejaculation
Grapes drapes grow blow
If maternal AFP is high what might the child have
Omaphalocele or any other fetal abdominal wall defect e.g. gastroschisis
What to give for medical management of PTSD
Either
SSRI
OR
VENLAFAXINE
which SSRI do you not give in breastfeeding women
Fluoxetine
has a long plasma half-life and has been shown to accumulate in breast milk.
2 drugs for opiate replacement and how they are different
methadone and buprenorphine
they both prevent withdrawls by binding to opioid receptors but dont give the high
methadone can be given liquid (or tab/ injection), bup can be given sublingual (or tab/ depot)
buprenorphine is a partial agonist and antagonist - the antagonistic effect means that you cant use heroin and still get high wheras with methadone you can use on top of it
what do you give in opiate overdose
Naloxone
IM/nasal spray
ABCDE approach as medical emergency
which biochemical markers are raised in anorexia
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Causative organism bronchiolitis
RSV respiratory syncytial virus
4 pathological findings of Alzheimer’s
Cerebral atrophy (usually in medial temporal lobes)
Amyloid plaques
Neurofibrillary tangles
Reduced levels of Ach
How to treat Alzheimer’s
acetylcholinesterase inhibitors.g. Donepezil
NMDA receptor antagonists e.g. Memantine
Cognitive rehab/ stimulation
Treat any comorbid illness with CBT e.g. anxiety
Carers
OT
Social care
How to treat vascular dementia
Consider anticoagulants
Change modifiable risk factors
Psycho social as well
You can’t use Acherase inhibitors like donepezil or NMDA receptor antagonists e.g memantine
How to treat frontotemporal dementia
Don’t use AChEi’s e.g. domepezil or NMDA receptor antagonists e.g. mementine
Treat symptoms e.g. depression, can use SSRI’s
How to treat Lewy body dementia
Fine line between antipsychotics and anti Parkinsons drugs
Lewy bodies are deposited in the brain causing hallucinations (too much dopamine) and Parkinson’s features (not enough dopamine)
Too much antipsychotic will worsen Parkinson’s symptoms, too much rivastigmine (AChEi) can worsen psychosis
Contraindications of Donepezil (acetylcholinesterase inhibitor) to treat Alzheimer’s
QT prolongation
Always check ECG before starting on AChEi
Also CI in second or third degree heart block and sinus Brady <50bpm
Which MH drug can cause hyperparathyroidism and resultant hypercalcaemia
Long term lithium use
Polymorphic waves on ECG fast rate which MH drug
Citalopram is the most likely SSRI to lead to QT prolongation and Torsades de pointes
Best antidepressant for bulimia
Fluoxetine
Woman says her husband has been replaced
Capgras
Tricyclic antidepressant overdose presentation
Dilated pupils
Hypotension
Tachycardia
Dry mouth
Blurred vision
Gram negative STI which ABX
Ceftriaxone
It’s gonorrhoea
Antidote for TCA overdose
Sodium bicarbonate
Same for aspirin
Which SSRI do you have to be careful when switching out
Fluoxetine
Stop, wait 4-7 days, then start new drug
Long Half-life
