Psych Flashcards
What are the features of schizoid personality disorder
Solitary, lack of interest detached
Symptoms start in adolescence
Odd/eccentric
No desire to interact with others
What are the features of schizotypical personality disorder
Odd speech and beliefs, magical thinking, eccentric behaviour
What are the features of antisocial personality disorder
Don’t conform to social norms lie, aggressive and irresponsible
What are the features of histrionic personality disorder
Sexual seductive, dramatic, need to be centre of attention
What are the main poor prognostic indicators in Schizophrenia
Fam history
Gradual onset
Low IQ
Prodromal social withdrawal
No precipitant
What are some side effects of Clozapine
Treats schizophrenia
If you stop smoking this will increase levels of clozapine in the blood- notify Dr if you stop smoking
Risk of agranulocytosis so need FBP monitoring
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation
Atypical antipsychotics like clozapine can cause weight gain and hyperprolactinaemia
What is the timeline for alcohol withdrawal
Seizures 36 hrs after
Delirium Tremes 72 hrs after
Management
Long acting benzos- diazepam or chlordiazepoxide
What are the two different types of bipolar disorder and how are they managed
Type 1 - mania and depression
Type 2- hypomania and depression
Mania- Psychotic symptoms for 7 days or more - hallucinations/ delusions
Hypomania-Decreased or increased functioning for 4 days or more
Management of mania/ hypomania- stop antidepressant and give antipsychotic eg. Olanzapine or haloperidol
Don’t give an antidepressant without a mood stabaliser- antidepressant alone can worsen mania
Manage depression- fluoxetine
What are some increased risks for people with bipolar disorder
Increased risk diabetes, CVD and COPD
What is a brief psychotic disorder
Psychotic symptoms last less than a month
What is schizoaffective disorder
Psychotic and mood disorders present together in an episode or within 2 weeks of each other
What is tangentiality
Answers diverge from a topic - psychotic feature
Why are triptans and SSRI’s contraindicated
Risk of Serotonin syndrome
What are the side effects of tricyclic antidepressants
Drowsy, dry mouth, blurred vision, constipation, urinary retention causing frequent leaking
-Overflow incontinence due to anticholinergic effect
Amitryptylline is a TCA
What is illness anxiety disorder
Persistent belief in an underlying disease and doesn’t accept reassurance
What is conversion disorder
Loss of motor or sensory function not faking them
What is dissociative disorder
Disassociating memories - psych symptoms- amnesia
Multiple personality disorder
What is factitious disorder
Mucnhausans - physical and psychological symptoms produced
What is malingering
Exaggerating symptoms for financial gain
What are somatic symptoms in depression
More biological depressive episode
More severe than an episode with no somatic symptoms
Loss of emotional reactivity
Diurinal mood variation
Anhedonia
Early morning waking
Psychomotor agitation/ retardation
Loss of appetite/ weight
Loss of libido
What are the features of avoidant personality disorder
Fearful/ anxious
View themselves as inferior and reluctant to engage
Still a strong desire to have interaction with others
What is the most common treatment for panic disorder
SSRI (sertraline) and CBT
If SSRI’s no response/ contra use Imipramine or clomipramine
Symptoms need to be present for at least 1 month
What are some side effects of antipsychotics
Parkinsonism
Acute dystonia (sustained muscle contraction)
Akathisia- restlessness
Tardive dyskinesia - abnormal involuntary movements eg. pouting or chewing
Increased risk of stroke and VTE
Anti-muscarinic effects- dry mouth, urinary retention, constipation
Sedation, weight gain
Raised prolactin
Neuroleptic malignant syndrome- pyrexia and muscle stiffness
Prolonged QT
Reduced seizure threshold
Apiprazole- has the best side effect profile- if patients are suffering from side effects on the other medications
When are personality disorders diagnosed
At 18
BPD is the only one that can be diagnosed before if sufficient evidence
What is the treatment for OCD
Use Ybocs scale- severe if they spend more than 3 hrs per day on obsession and compulsion
1. CBT
2. SSRI and CBT
3. Clomipramine if SSRI contraindicated
What is the difference between Formication and delusional parasitosis
Formication- feeling fo paraesthesia which feels like bugs under the skin
Delusional parasitosis- fixed delusion that there are bugs under the skin
When are lithium levels checked
12 hrs after last dose taken
5 days after any dose changes made
Want levels between0.6-0.8
Once stable on dose check every 3 months
Gets toxic at around 1.2
Not recommended in pregnancy but not completely contraindicated
What is acute stress disorder and how is it managed
Stress reaction in the first 4 weeks after a traumatic event
PTSD diagnosed after 4 weeks
CBT and benzos to treat
What is the criteria for anorexia nervosa diagnosis
- Restriction of energy intake - low body weight
- intense fear of gaining weight/ becoming fat
- Disturbance in the body weight or shape is experienced- in denial of low weight
What are the symptoms of anorexia nervosa
Low BMI
Bradycardia
Hypotension
Enlarged salivary glands
Hypokalaemia
Low FSH, LH, oestrogen and testosterone
Impaired glucose tolerance
Hypercholesterolaemia
Low T3
What is Charles Bonnet syndrome
Recurrent hallucinations in clear consciousness usually with visual impairment
No other neuropsychiatric disturbance
Risk factors
Advanced age
Peripheral visual impairment
Social isolation / sensory deprivation
Early cognitive impairment
What is the criteria for bulimia diagnosis
-Binge eating episodes
-Lack of control over eating
-Innappropirate compensatory behaviour to prevent weight gain - Exercise/ vomiting
-Once a week for 3 months at least
CBT and fluoxetine
What is the diagnostic criteria for depression
Less severe- PHQ of less than 16
More severe PHQ over 16
PHQ- patient health questionnaire
What are the rules around switching from SSRIs
First SSRI withdrawal before alternative is started
What are the rules around fluoxetine switching to another SSRI
Withdraw then leave a gap 4-7 days before starting a low dose alternative SSRI
What are the rules around switching from an SSRI to a TCA
Cross taper- current drug reduce slowly whilst dose of new drug increase
What are the contraindications and side effects of ETC
Useful in severe depression refractory to medication
Absolute contraindication is raised ICP
Side effects
Headache, nausea, short term memory impairment, cardiac arrhythmia x
What is the stepwise management of generalised anxiety disorder
- Recognition and pyschological interventions- self help or CBT
- SSRI
- Another SSRI or SNRI (duloxetine or venlafaxine)
What are the side effects of lithium
Mood stabiliser in bipolar
Narrow therapeutic range
Nausea and vomiting
Fine tremor
Nephrotoxicity
Thyroid enlargement
ECG- T wave flattening/ inversion
Weight gain
Idiopathic intracranial HTN
Leucocytosis
Hyperparathyroidism and hypercalcaemia
When checking lithium levels check 12 hrs post dose
What are the features and management of PTSD
re-experiencing- flash backs, nightmares
Avoidance- situations and people
Hyperarousal- exaggerated startle, irritable
Emotional numbing
Trauma focussed CBT
Venlafaxine or SSRI like sertraline
If severe
Risperidone
What are the features of Schizophrenia
Auditory hallucinations
-2 or more voices discussing the patient in the third person
-Though echo
-Voices commenting on patients behaviour
Body sensations being controlled by external influence
Actions/impulses/feelings
Delusional perceptions- perceive a normal object then be delusional- the light is green so I am the king
Thought broadcasting/ withdrawal/insertion
Made up words
Impaired insight, negative symptoms- anhedonia, poor speech and motivation, catatonia
Management
Oral atypical antipsychotics
CBT
Check CVD risk factors
What drugs interact with SSRIs
NSAIDs - need to give a PPI if prescribing both together
Warfarin/ heparin
Aspirin
Triptans
Monoamine oxidase inhibitors
What is somatisation disorder
Multiple physical symptoms for at least 2 yrs
Won’t accept reassurance of negative tests
What is tangentiality
wandering from a topic on a tangent without returning to it
What medications need cautioned in lithium
ACE inhibis, diuretics- anything that increases risk of AKI
What are the side effects of olanzapine
A 2nd line antipsychotic
High BP
High BMI
Diabetes
Weight gain
Hyperprolactinaemia
