Psych Flashcards
What type of incontience do TCAs cause? Why?
Tricyclic antidepressants can cause overflow incontinence (anticholinergic effect)
How to remember anorexia features?
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
How long after admission to hosp does delirium tremens usually present?
48-72 hours
List some metabolic side effects of antipsychotics
dysglycaemia, dyslipidaemia, and diabetes mellitus
A 45-year-old female complains of lower back pain, constipation, headaches, low mood, and difficulty concentrating. What medication?
Long-term lithium use can result in hyperparathyroidism and resultant hypercalcaemia
A young man is seen with his mother. She is concerned that he is socially withdrawn. He is bright and is doing well in his job as a engineer. During the consultation he seems emotionally cold and has little interest in either praise or criticism
Schizoid personality disorder
Timing of symptoms following alcohol withdrawal
Alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
Oculogryic crises are caused by? Give an example
chlorpromazine. This patient is describing an oculogyric crisis, a type of acute dystonic reaction. These reactions are associated with first-generation antipsychotics, as they most commonly cause extrapyramidal side effects.
citalopram drug class
SSRI
Benzo MOA
enhance the effect of GABA, the main inhibitory neurotransmitter
AD of choice for children and adolescents
fluox
SSRI post choice following MI
Sertraline
1st line medication for PTSD following trauma foccused CBT or EMDR therapy
Venlafaxine or SSRI
What might be enlarged on examination of someone with anorexia?
Parotidomegaly
What medication causes reduced seizure threshold?
Clozapine reduces seizure threshold, making seizures more likel
Management of mania/hypomania in patients taking antidepressant
consider stopping the antidepressant and start antipsychotic therapy
For more severe OCD, or if unresponsive to CBT/exposure and response prevention
add an SSRI
When treating OCD, compared to depression, the SSRI usually requires what?
higher dose and a longer duration of treatment (at least 12 weeks) for an initial response
Antidepressants should be continued for how many months to reduce the risk of relapse?
at least 6 months after remission of symptoms to decrease risk of relapse
What is used in the treatment of delirium tremens/alcohol withdrawal?
Chlordiazepoxide or diazepam, also give thiamine
Stopping of voluntary movement or staying still in an unusual position
Catatonia
patients who are overly sensitive and can be unforgiving if insulted, question loyalty of those around them and are reluctant to confide in others
Paranoid personality disorder
Difference between obsession and compulsion
An obsession is an intrusive, unpleasant and unwanted thought. A compulsion is a senseless action taken to reduce the anxiety caused by the obsession.
Hypochondriasis AKA
illness anxiety disorder
Drug class to be avoided with SSRI
Triptans
When stopping an SSRI, how long should dose be reduced over?
When stopping a SSRI the dose should be gradually reduced over a 4 week period
What blood test result are SSRIs associated with?
Hyponatraemia
What is strongest RF for psychotic disroders?
Family Hx
A female librarian comes for advice. Her colleagues find her inflexible in her approach to her work. She easily becomes annoyed if her ‘systems’ are interfered with and generally likes to work by herself, using lists and rules to structure her day
obsessive-compulsive personality disorder
Belief of having the removal of a thought by an external force
thought withdrawal
Most common side effect of clozapine
constipation/intestinal obstruction
Most common endocrine disorder with lithium toxicity
Hypothyroidism is the most common endocrine disorder developing as a result of chronic lithium toxicity
Two drug classes that SSRIs should not be given with
Triptans and MAOIs (e.g. rasgiline)
Drug that can cause a benign leucocytosis
Lithium
Common complciation of SNRI
Hypertension, check BP before initation
What drug may be trialled as an alternative to a SSRI in moderate/severe OCD?
Clomipramine may be used as an alternative first-line drug treatment to an SSRI if the person prefers clomipramine or has had a previous good response to it, or if an SSRI is contraindicated
What Sx point to a diagnosis of depression rather than dementia?
Rapid onset, biological symptoms and global memory loss
Drug class of mirtazapine
noradrenergic and specific serotonergic antidepressant (NaSSA) which increases release of neurotramsitters by blocking alpha2 adrenoreceptors
What to atypical antipsychotics cause an increased risk of in the elderly?
Stroke and VTE
What may TCAs cause?
Urinary retention
What is a big SE of benzos?
Anterograde amnesia
risk of SSRI during third trimester of prenganyc
isk of persistent pulmonary hypertension of the newborn
Acute dystonia secondary to antipsychotics is usually managed with
procyclidine
What to do if clozapine doses are missed for more than 48 hours?
the dose will need to be restarted again slowly
What is disulfiram? What does it do> How does it work?
Disulfiram (also known as Antabuse) is an irreversible inhibitor of acetaldehyde dehydrogenase. This inhibition causes the buildup of acetaldehyde. The build-up of acetaldehyde within twenty to thirty minutes of alcohol consumption results in unpleasant symptoms, including facial flushing and nausea and vomiting.
What is acamprosate? How does it work? Benefits?
Acamprosate (or Campral) is taken three times a day and has shown to be effective in preventing alcohol relapse in combination with psychological support following detoxification in alcohol dependence syndrome. It is typically described as an ‘anti-craving’ medication and the underlying mechanism of action remains unclear. Acamprosate has a minimal side-effect and risk profile and is safe in combination with alcohol.
What is bupreonorphine? How is it given? Benefits?
Buprenorphine is a mixed opioid agonist/antagonist. It is typically given as a sublingual tablet and provides an alternative opiate replacement therapy to methadone. Patient’s often describe buprenorphine as less sedating, which can be a benefit or drawback depending on the context and patient.
Symptoms of hypomania in primary care
routine referral to CMHT
Scoring system for OCD
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
Scoring system for BPAD
Young mania rating scale
1st rank Sx of schizo
Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour
Thought disorders
thought insertion
thought withdrawal
thought broadcasting
Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.
Is clozapine available as a depot?
No, so give olanzapine
What endocrine disorder to rule out before diagnosing GAD?
Hyperthyroidism - do TFTs
What can smoking cessation cause in clozapine use?
A rise in clozapine blood levels
What to avoid when taking a MAOI?
tyramine containing foods (e.g. cheese) are taken alongside monoamine oxidase inhibitors a hypertensive crisis can occur
Dizziness, electric shock sensations and anxiety are symptoms of
SSRI discontinuation syndrome
How long after sample should Lithium levels be tested?
12 hours
Risk of SSRI use in first trimester
small increased chance of congeital heart defects
Should paroxetine be used in pregnancy?
NO
Risk of zopiclone in elderly
Increased risk of falls
How can acute dystonia present?
sustained muscle contraction (e.g. torticollis, oculogyric crisis)
NOTE: Torticollis or ‘wry’ neck can be diagnosed where there is unilateral pain and deviation of the neck with pain on palpation and restricted range of motion. Oculogyric crisis is a further example of an acute dystonia. Patients experience sustained upward deviation of the eyes, clenched jaw and hyperextension of the back/neck with torticollis. Given that this patient has no facial signs or symptoms, torticollis alone is a more appropriate answer.
What drug class can trigger sudden onset psychosis?
Sudden onset psychosis following course of corticosteroids - consider steroid-induced psychosis
What should be done to antidepressant dose before ECT?
Antidepressant medication should be reduced but not stopped when a patient is about to commence ECT treatment
Repetition of someone else’s speech including the questions being asked
Echolalia
Following the 2011 NICE guidelines on the management of panic disorder, what is the most appropriate first-line drug treatment?
SSRI
What can purging behaviours include?
not only vomiting, can be use of laxatives or diuretics or exercising
Short term SE of ECT
cardiac arrhythmias
What type of amnesia in ECT?
Retrograde
Cotard syndrome
characterised by a person believing they are dead or non-existent
What rating system can be used to assess alcohol withdrawal severity?
Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale
presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms
Erotomania (De Clerambault’s syndrome)
What medication may be used to treat moderate/severe tardive dyskinesia?
Tetrabenazine
delusional jealously, usually believing their partner is unfaithful
Othello syndrome
Most common SE of atypical antipsychotics
Weight gain
What medication has the most tolerable side effect profile of atypical antipsychotics?
Aripiprazole has the most tolerable side effect profile of the atypical antispsychotics, particularly for prolactin elevation
Functional neurological disorder (conversion disorder)
typically involves loss of motor or sensory function
Way to remember difference between somatisation and hypochondriasis
Unexplained symptoms
Somatisation = Symptoms
hypoChondria = Cancer
What is Hoover’s sign? What is used for?
Hoover’s sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
How long duration is needed for a diagnosis of chronic insomnia?
Chronic insomnia may be diagnosed after three months, if a person has trouble falling asleep or staying asleep at least three nights per week
What is malingering
Lying or exaggerating for financial gain is malingering, for example someone who fakes whiplash after a road traffic accident for an insurance payment
What is munchausen’s syndrome?
Purposefully causing symptoms, for example a diabetic taking too much insulin to cause hypos, is an example of Munchausen’s syndrome
What would be the most appropriate medication to help poor sleep, given the history of learning difficulty?
Melatonin
