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Anxiety - Depression - Bipolar X Antipsychotics ✔ Psychosis X ED - Lithium ✔

1
Q

What does an MSE consist of?

A

Mental state exam: (ASEPTIC Risk)
Appearance and behaviour
Speech
Emotion- mood
Perception- hallucinations
Thought - form and content
Insight
Cognition - orientation
Risk - to self, to others, from others

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1
Q

What type of drug is Clozapine and what is the MoA?

A

Atypical antipsychotic
D2 and 5HT2 antagonist

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2
Q

What are the three main side effects of clozapine?

A

Agranulocytosis
Constipation - severe leading to BO
Hypersalivation

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3
Q

What is the most important parameter to monitor in a pt on clozapine, and how often?

A

WCC
FBC done every week, for 18 weeks
(then fortnightly for a year, and monthly for maintenance)

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4
Q

What are the ICD 10 criteria for PTSD?

A

Exposure to stressful event
Symptoms w/in 6/12 of event
Persistent remembering/reliving
Avoidance of similar situations
Increased psychological sensitivity/hypervigilance

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5
Q

What is the management of PTSD w/in 3 months of the event, and after?

A

W/in 3 months- watchful waiting and trauma focused CBT
After- Trauma focused CBT or EMDR. Medications- paroxetine, mirtazapine, amitriptylline

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6
Q

What are the indications to start medication in PTSD?

A

Little benefit from psychological therapy
Patient preference
Co morbid depression or severe hyperarousal

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7
Q

What are the ICD 10 main criteria for GAD?

A

Symptoms for 6/12
There for majority of the time e.g. 4 days in a week
At least 4 symptoms, and 1 autonomic arousal

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8
Q

What are some of the possible symptoms of GAD?

A

Worry, tension, apprehension, poor concentration.
Palpitations, sweating, tremor, dry mouth.
Tight chest/pain, SOB, abdo pain

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9
Q

What are some organic differentials for GAD?

A

Excessive caffeine or alcohol
Drug or alcohol withdrawal
Anaemia
Hyperthyroid
Hypoglycaemia

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10
Q

What questionnaire is used to screen for GAD?

A

GAD 7

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11
Q

What are th management options for GAD?

A

BIOPSYCHOSOCIAL model
Bio- SSRI 1st line
Psycho- psychoeducation groups, CBT, applied relaxation
Social- support groups, self help methods, exercise

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12
Q

What are the possible symptoms of paranoid schizophrenia, and how are they classified?

A

Positive symptoms:
Hallucinations
Delusions- perceptions or thought insertion/wthdrawal/broadcast
Negative symptoms:
Amotivation
Autism- self absorption
Affect flattened
Alogia
Ambivalence

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13
Q

What are some organic differentials for schizophrenia?

A

Drug/alcohol induced psychosis
Temporal lobe epilepsy
Encephalitis
Early dementia
Delirium
Thyroids dysfunction
Metabolic syndrome- from antiP

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14
Q

How is paranoid schizophrenia managed?

A

Bio- atypical antiP. Adjuvants e.g. benzos. ECT.
Psych- CBT, psychoeduction and family intervention, art therapy
Social- support groups (Rethink, SANE), supported employment programmes

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15
Q

What is the ICD 10 criteria for anorexia nervosa?

A

FEED for 3 months:
Fear of weight gain
Endocrine- amenorrhoea or sexual dysfunction
Emancipation- BMI <17.5 or >15% below expected BW
Distorted body image

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16
Q

How does the presentation of AN differ from BN?

A

AN:
Underweight
Do not get cravings for food
Do not binge eat
More likely to have endocrine dysfunction

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17
Q

What are some differentials for anorexia?

A

Organic- malignancy, hyper T, DM, substance misuse.
Non organic- bulimia, OSFED, OCD, depression, shizophrenia

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18
Q

What is the ICD 10 criteria for bulimia nervosa?

A

‘Bulimia Pts Fear Obesity’
Behaviours to prevent weight gain/compensatory
Preoccupation w/ eating
Fear of weight gain
Overeating-2 or more times per week, for at least 3 months

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19
Q

In what way may a bulimia pt purge?

A

Vomiting
Laxatives
Diuretics
Enemas

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20
Q

What are the complications of repeated vomiting?

A

Dental erosion, mallory weiss tears, enlarged parotids, aspiration pneumonia, dehydration, hypokalaemia, renal stones/failure, oligomenorrhoea, osteopenia, seizures, cog impairment
Russell’s sign- callus on back of hand

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21
Q

What are the factors predicting a better prognosis with an ED?

A

Young onset
For a shorter time
Desire to get better

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22
Q

Briefly describe schizoid vs schizotypal disorder

A

Schizoid- prefer solitude and may display indifference to praise or criticism
Schizotypal- prefer solitude and may have odd eccentric behaviour/speech/beliefs and may display magical thinking, ideas of reference etc.

23
Q

What is the MoA of benzodiazepines?

A

Enhancing the effect of GABA

24
What are the core symptoms of depression?
Anergia Anhedonia Low mood
25
What medications can cause neuroleptic malignant syndrome?
Antipsychotic medications. Sudden cessation or reduction in dose of dopaminergic meds e.g. levodopa.
26
How is neuroleptic malignant syndrome managed?
Stop antipsychotic Monitor vitals and supportive management- fluids to prevent renal failure, cooling Bromocriptine may be used. Benzodiazepines may be used.
27
What are the complications of neuroleptic malignant syndrome?
PE Renal failure Shock
28
7-10 days after initiating a medication: Patient presents with pyrexia, muscle rigidity, confusion, fluctuating consciousness and autonomic instability. What is the most likely diagnosis? What is the causative medication?
Neuroleptic malignant syndrome Antipsychotic
29
7-10 days after initiating a medication: Patient presents with acute painful contractions of the neck(oculogyric crisis), coarse tremor and restlessness. What is the most likely diagnosis? What is the causative medication?
Extrapyramidal side effects (dystonia presents within days, akathisia presents in the first months, parkinsonism takes weeks to months to occur) Typical antipsychotic.
30
2 months after initiating a medication: Patient presents with bradykinesia, coarse tremor and restlessness. What is the most likely diagnosis? What is the causative medication?
Extrapyramidal side effects (dystonia presents within days, akathisia presents in the first months, parkinsonism takes weeks to months to occur) Typical antipsychotic.
31
What are the extra pyramidal side effects and when do they occur?
Dystonia - days Parkinsonism - weeks to months Akathisia - months Tardive dyskinesia - years
32
What investigations are done if neuroleptic malignant syndrome is suspected?
CK (raised) FBC (leucocytosis) LFTs (deranged)
33
What extra monitoring is done for clozapine in particular?
FBC (WCC) weekly for 18 weeks. Fortnightly for 1 year. Monthly for maintenance
34
What extra monitoring is done for clozapine and olanzapine in particular?
Fasting glucose is done after one month's treatment, then every 4-6 months in addition to standard glucose testing for antipsychotic (At baseline and then 4-6 months, then yearly)
35
What parameters are monitored for all patients taking antipsychotics?
FBC, UE, LFT- baseline, annually Fasting glucose- baseline, 6 months, annually Lipids- Baseline, 3 months, annually ECG- Baseline BP- Baseline Prolactin- Baseline, 6 months, annually BMI/weight/waist size- Baseline, 3 months, annually CK- baseline
36
What atypical antipsychotics can be given IM?
Depot: Olanzapine Risperidone Aripriprazole
37
7-10 days after initiating a medication: Patient presents with polydipsia, fine tremor, hair loss and polyuria. What is the most likely diagnosis? What is the causative medication?
Lithium ADRS.
38
7-10 days after initiating a medication: Patient presents with oliguria, coarse tremor and ataxia. What is the most likely diagnosis? What is the causative medication?
Lithium toxicity
39
What monitoring is required during use of lithium?
Baseline: UE, eGFR, TFT, pregnancy test. ECG. UE every 6 months. TFT annually. Lithium levels 12 hours after first dose. Weekly until therapeutic level is stable for 4 weeks. Maintenance monitoring is 3 monthly.
40
How long should lithium be taken before there is clear benefit?
Up to 18 months
41
When is clozapine prescribed?
If psychotic symptoms are resistant to two other antipsychotics
42
What is the mechanism of action of antipsychotics? Difference between typical and atypical?
Mainly antagonist of D2 receptors. Also have affinity for muscarinic, serotonin, histaminergic and adrenergic receptors (explaining their side effect profile) Typical have greater affinity for dopaminergic receptors. Atypical have greater affinity for serotonergic receptors.
43
What pathways do antipsychotics work on, and how does this treat schizophrenia?
Mesolimbic to inhibit positive symptoms. Mesocortical dopamine pathways to inhibit negative pathways. (Also nigrostriatal and tuberoinfundibular)
44
What pathways do antipsychotics work on, and how does this cause side effects?
Nigrostriatal causes EPSE. Tuberoinfundibular causes endocrine side effects. (also mesolimbic and mesocortical)
45
What is the MoA of lithium?
Decreases intracellular sodium and calcium. Modulates dopamine and serotonin neurotransmitter pathways.
46
When is lithium absolutely C/I?
Untreated hypoT Addison's disease Brugada syndrome
47
What are the indications for ECT?
Prolonged or severe mania Catatonia Severe depression- life threatening or treatment resistant
48
What are the side effects of ECT?
Peripheral nerve palsies Cardiac arrhythmias Confusion Dental trauma Anaesthetic risks Muscular aches Short term memory impairment Status epilepticus
49
What are the C/I for ECT?
MI Cerebral aneurysm Raised ICP Stroke <1 month ago Status epilepticus Pregnancy
50
What are poor prognostic indicators in schizophrenia?
Strong FH Gradual onset Low IQ Prodromal phase of social withdrawal Lack of obvious precipitant
51
Which SSRI is commonly used for its side effects of sedation and appetite increase?
Mirtazapine
52
What medication can be given in a pt with GAD, who cannot tolerate SSRI or SNRI?
Pregabalin
53
What medications can be given for ADHD?
First line- methylphenidate 2nd- atomoxetine 3rd- dexamphetamine
54
Define mild, moderate, severe and profound LD in terms of intellectual performance
Mild 50-70 Moderate 35-49 Severe 20-34 Profound <20

Finals (8 decks)

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