psych Flashcards
How long should an antidepressant be continued after remission of symptoms?
6 months
How long can someone be detained under Section 2 of the Mental Health Act?
it allows admission for ASSESSMENT for up to 28 days
How long can someone be detained under section 3 of the MHA?
Patient can be detained for admission for TREATMENT for up to 6 months
How long can you detain someone in hospital under the 5(2) Mental Health act?
Section 5(2) gives doctors the ability to detain someone with a mental health issue WHO IS ALREADY IN hospital for up to 72 hours for assessment
(i.e. a non psychiatry doctor such as med reg can use this for holding power)
Following this they may sectioned under a section 2 or 3
HOWEVER this does not allow you to give them treatment against their will
How long can a nurse detain a patient in hospital under the 5(4) of the mental health act?
Section 5(4) gives nurses the ability to detain someone with a mental health issue in hospital for up to 6 hours.
What is section 4 of the MHA?
to allow someone to be admitted to hospital as an emergency for ASESSMENT for up to 72 hours, where a section 2 would cause unnecessary delay - requires only one doctor
Typically changed to a section 2 once in hospital
What is section 135 of the MHA?
Police can enter someone’s home, even if by force, to take them to a place of safety e.g. hospital due to concern about their mental health - for assessment for up to 24 hours
What is the section 136 of the MHA?
Police can take someone found in a public place to a place of safety (e.g. Hospital) if they have immediate concerns about their mental health
What are symptoms of lithium toxicity?
- nausea, diarrhoea
- blurry vision
- ataxia
- hyper-reflexia
- confusion
What are some factors that increase the risk of lithium toxicity?
- dehydration
- hyponatraemia
What are the symptoms of neuroleptic malignant syndrome?
- fever
(hyperthermia) - lead pipe muscle rigidity
- autonomic instability (tachycardia, sweating)
- tremor
- leukocytosis
- elevated creatine phosphokinase (CPK) level.
HYPOREFLEXIA
TYPICALLY CAUSED BY ANTIPSYCHOTICS
What are the symptoms of serotonin syndrome?
if patients are taking multiple medications that increase serotonin levels - or for example an SSRI overdose
More rapid onset than NMS usually hours.
- sweating
- diarrhea
- fever
- autonomic instability
- seizures
- hypereflexia
- tremor
VERY similar to NMS except NMS has rigidity and raised CK
What are symptoms of anticholinergic syndrome?
- confusion + hyperactive delirium - agitation - picking at imaginary objections
- blurry vision
- dry mouth
- hypoactive bowel sounds
- urinary retention
What is the mechanism of action of Bupropion?
It is an antidepressant also used in the treatment of smoking cessation
It is a norepinephrine and dopamine re-uptake inhibitor AND a nicotinic antagonist (reduces cravings and smoking withdrawal)
What is an important adverse effect of Bupropion?
It lowers the seizure threshold and is therefore contraindicated in epilepsy
What are common side effects of SSRIS?
- weight gain
- gastrointestinal (GI) upset
- sexual dysfunction (reducing libido, orgasm, delayed ejaculation - thus they are sometimes used for premature ejaculation),
What are symptoms of TCA overdose?
- anticholinergic symptoms - dry mouth, urinary retention,
- dilated pupils (parasympathetic system causes pupil constriction - anticholinergics inhibit this)
- cardiac arrhythmia (can prolong QRS/QT and PR intervals)
- metabolic acidosis
What is the treatment for TCA over dose? e.g. amitriptyline
- supportive
- gastric lavage or activated charcoal
- IV sodium bicarbonate to treat the metabolic acidosis
What is fergoli syndrome?
Delusional belief that usually someone they don’t know is following them an impersonating someone close to them
E.g seeing a stranger and thinking it’s their wife but she has changed her appearance - feeling that different people are actually the same person.
What is Capgras syndrome?
Delusional disorder where they believe someone close them has been replaced by an identical imposter
What is Cotard’s syndrome?
Nihilistic delusions of their body or self having disappeared - they may believe they are dead or do not exist or have lost blood or their internal organs
“Walking corpse” syndrome
Can lead to self starvation
What is an important adverse effect of Olanzapine?
O for obesity
can cause weight gain + insulin resistance
What is an important adverse effect of Clozapine?
Agranulocytosis
What are some positive symptoms of shizophrenia?
Hallucinations (usually auditory)
Delusions
Disorganized
speech and behavior - this can include catatonia
A person with catatonic behavior is unresponsive and generally unmoving, much like a statue. However, he or she may instead have peculiar movements, such as prolonged grimacing or repeating words that others say (echolalia).
What are some negative symptoms of schizophrenia?
- Flat affect
- apathy
- Neglect of hygiene
- Social withdrawal
- Lack of motivation
- Lack of speech
What type of hallucinations are most common in schizophrenia?
auditory
What are Schneider’s first rank symptoms of schizophrenia?
they are POSITIVE symptoms
- Auditory hallucinations
- Thought withdrawal, insertion and interruption
- Thought broadcasting
- Somatic hallucinations
- Delusional perception
- Feeling or action experienced as or influenced by external agents
What are baby blues?
- Occurs postpartum typically mild symptoms that resolve within about 10 days after birth
- anxious
- tearful
- difficulty concentrating
- difficulty sleeping
- mood swings
What is agoraphobia?
Agoraphobia is a fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong.
When exposed to their phobia they may experience a panic attack.
What is bulimia?
binge eating + loss of control + guit
Purging behaviours - starvation, vomiting, exercise, laxatives etc
Is not associated with severe weight loss
What are important adverse effects of lithium?
hypothyroidism
hyperparathyroidism and hypercalcaemia
Nephrogenic diabetes insipidus
How to tell apart NMS and serotonin syndrome?
Both give pyrexia, hypertonia, tachycardia and changes in mental state
But NMS gives you LEAD PIPE RIGIDITY and high CK
What is the first line treatment for children and adolescents with anorexia (who are not acutely unwell)
family therapy
Other types of therapy, such as cognitive-behaviour therapy or psychodynamic psychotherapy, may be used in conjunction with family therapy to address specific symptoms or issues.
What is mania and hypomania?
Hypomania and mania are periods of over-active and high energy behaviour that have a significant impact on day-to-day life.
Hypomania is a milder version of mania that typically lasts for a shorter period. This is usually a few days
Mania is a more severe form. It typically lasts for a week or longer, unless it is cut short by treatment.
What is the treatment for acute mania or hypomania?
Antipsychotic drugs (such as haloperidol, olanzapine, quetiapine, and risperidone) are used in the treatment of acute episodes of mania or hypomania;
(lithium is a prophylaxis in bipolar - takes a few days to work)
In patients already taking prophylactic treatment with lithium or valproate, optimise the dose of the lithum/valproate. if there is no improvement an antipsychotic drug can be added
What is schizoid personality disorder?
Schizoid: Despite the name, patients with schizoid personality disorder do not share many characteristics with schizophrenics.
These people are cold, withdrawn, and have little interest in friends, romance, or sex.
They have no friends or close contacts, and they prefer it this way. Mnemonic: “Schizoid” rhymes with “android”).
They do not have any delusions or hallucinations
Schizotypal personality disorder
- odd preoccupations and beliefs
- eccentric
- socially isolated & uncomfortable with others
Again, these patients do not meet criteria for schizophrenia, but their personality is characterized by odd magical beliefs (e.g., a belief in telepathy or aliens), ideas of reference, or eccentric clothing
What is the mechanism behind extra pyramidal side effects caused by antipsychotics?
Due to D2 receptor antagonism
Older generation antipsychotics have higher affinity for the D2 receptor so are more likely to cause EPS
What is the treatment for antipsychotic induced extra pyramidal symptoms?
Acute dystonia and Parkinsonism caused by an antipsychotic can be managed with an anticholinergic medication
- procyclidine
- benztropine
Name one of the older generation antipsychotics that have an increased risk of EPS
Haloperidol
What is Akathisia and what is the treatment
Restlessness, urge to move
Can reduce the antipsychotic or switch to a different one
Propranolol may help
What is the management of tardive dyskinesia?
50% of cases are reversible
Stop anticholinergic if prescribed
Reduce dose of antipsychotic or switch to a different one eg Clozapine
Tetrabenazine
What is antipsychotic induced Parkinsonism
Can cause tremor and cog wheel rigidity
What is tardive dyskinesia
Typically occurs after long term use
Anticholinergics don’t help and can make it worse
What is the difference between avoidant personality disorder and social phobia?
avoidant personality disorder
- fear of rejection
- SOCIAL ISOLATION
- feelings of inadequacy & hypersensitivity to criticism
- Shy away from work or social relationships because of fears of rejection
Social phobia
- fearful of social situations
- similar but they have FEAR OF EMBARRASSMENT
- including public speaking/performing situations
What are the symptoms of an acute dystonic reaction?
- onset minutes to hours after taking the medication
- involuntary contraction usually of face and neck
- torticollis
- eyes [oculogyric crisis]
What are symptoms of CHOLINERGIC syndromes eg caused by acetylcholinesterase inhibitors
SLUDE
SALIVATION
LACRATIPM
URINATION
DEFECTATION
GI UPSET
EMESIS
