Psych

Question 1

What type of drug is mirtazapine? When should it be given? What other effects does it have?

Answer 1

Atypical antipsychotic

Evening as makes drowsy
Can increase appitite

Question 2

Cyclisine is what type of antiemetics, can we give it IV

Answer 2

Acts on H1 and M1

Don’t give it IV - gives a high and can get stuck on it

Question 3

Hand foot and mouth disease causative agent

Answer 3

coxsackie A virus

Question 4

What do we mean by extrapyradmilal side effects?

Answer 4

Parkinsonism

Question 5

Neurolwpyic malignant syndrome w is related to what?

Answer 5

Dopamine associated drugs

Question 6

Typical vs atypical generation

Answer 6

All block dopamine receptors

First generation have highaffinity to dopamine so typically generate extra pyramidal side effects

Second not as strong so atypically generate symptoms so atypically generate extra pyramidal side effects

Question 7

Do clozapine get extra pyramidal side effects?

Answer 7

No

Question 9

Main extrapyradimal side effects

Answer 9

Akathesia - inner restlessness
Parkinsonism (shuffling gait, expressionless face)
Dystonia - muscle spasm head and neck, can be due to metoclopeomide of domperodome (dopamine blocking antiemetics)
Tardive dyskinesia - lip smacking, puckering

Question 11

Clozapine main side effect

Answer 11

Agranulocytosis and weight gain (increases hunger)
Myocarditis, long qt
Lower seizure threshold
CONSTIPATION** - reduction in bowel movement, so give laxido !! - can lead to atonic bowel

Question 13

Seizure like activity on clozapine, why

Answer 13

Because it reduces the threshold

Question 14

How is clozapine metabolised

Answer 14

In liver cytochrome p450

Nb smoking induces liver enzymes, so if you stop smoking will have more clozapine in body

Question 15

How can we break secure attatchments for kids?

Nb secure attachment ->

Answer 15

Depressed/withdrawn parent ->
Angry parent ->
Unpredicatable parent (fruit machine) eg drugs/alcohol ->
Bereavement/loss ->

Question 16

Adopted vs Foster

Answer 16

Adopted = every right as a parent
Foster = Glorified baby sitter - still need parents consent for ops etc

Question 17

Anxious vs avoidant

Answer 17

Anxious - parents not there/let down/bullied/friendships left them/people not sticking around for them -> project that into current relationships, so they’ll assume that people will leave them

Flattery/if you leave this room I’ll kill myself -> trying to keep people around unhealthily

Avoidant , have been hurt in the past -> expect people will hurt them -> keep them at arms length, have prickly armour on.You have to earn your way into their trust.

Anxious x Avoidant -> depending on the situation will demonstrate both anxious and avoidant. Can turn into Borderline personality disorder

Question 18

What is akathasia?

Answer 18

Neuropsychiatric symptom of restlessness and an urge to move . Can mean that the patient is in distress or side effect of antipsychotics

Question 19

Emergency detention certificate vs Short term detention certificate vs cto (compulsory treatment order)

Answer 19

EDC 72 hours - think has mental disorder, fy2 and above should try to get mho but may not be possible. Can’t treat against wish.

Short term 28 days needs psychiatric (section 22 doctor). Needs MHO. Continuously monitored. Can treat against wish. Can appeal against.

CTO = up to 6 months - goes to tribunal to help decide.

Question 20

Levomyptomazine uses

Answer 20

Nausea - calming effect as it’s slightly an antipsychotic

Question 22

Memantime uses

Answer 22

Moderate to severe dementia

Question 23

Detained for more than 2 months, what do you need to give psych meds?

Answer 23

T3 form if unable to consent

T2 if able to consent

Question 24

Giving meds covertly means what?

Answer 24

Giving patients meds without their knowledge for when we know they’re needing it. Needs reviewing, may be able to then take overtly if improves psych symptoms. Covert medication plan.