Psych Flashcards
How long after their last drink may someone develop seizures
36 hours
How long after their last drink may someone develop delirium tremens
72 hours
How does SSRI discontinuation syndrome present?
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
GI symptoms- pain, cramping, diarrhoea, vomiting
paraesthesia
How should SSRIs be stopped and why?
gradually reduced over 4 weeks (not necessary with fluoxetine)- can cause SSRI discontinuation syndrome
What SSRI is most likely to cause long QT syndrome
citalopram
RF for bipolar disorder
adverse childhood experiences
exposure to viruses in utero
cannabis and cocaine use
recent childbirth
family history (first degree relatives have a 5x greater risk than the general population)
what is bipolar
A disorder characterised by recurrent episodes of depression and mania/hypomania
What is a manic episode?
excessively elevated mood and energy which significantly impacts normal functions.
Lasts at least one week and causes marked impairment in social or occupational functioning, or includes psychotic features such as delusions or hallucinations
what features may be preset in a manic episode?
abnormally elevated mood
increased energy
decreased sleep
grandiosity
disinhibition and sexually inappropriate behaviour
flight of ideas
pressure speech
increased libido
psychosis
irritability
what is a hypomanic episode
an episode characterised by milder symptoms of mania without a significant impact on function
Only needs to last 4 days and does not include psychotic features
based on DSM-5 what is bipolar type 1
depression and at least one episode of mania
based on DSM 5 what is bipolar type II
at least one episode of major depression and one of hypomania
what is cyclothymia
mild symptoms of hypomania and low mood- not enough to cause significant disruption to functioning
1st line treatment of an acute manic episode
antipsychotic medications - onlanzapine, quetiapine, risperidone
second line management of a manic episode
lithium or sodium valporate
management of a depressive episode in bipolar
olanzapine plus fluoxetine
Long term management of bipolar
lithium - mood stabilised
alternate- sodium valporate
what is a potential complication of lithium therapy in bipolar
lithium toxicity
what is the therapeutic range of lithium
0.4 to 1 mmol/l
at what concentration of lithium can toxicity occur
1.5
How does lithium toxicity present?
coarse tremor
hyperreflexia
acute confusion
polyuria
seizure coma
what may precipitate lithium toxicity
dehydration
drugs- diuretics, NSAIDs, ACEi
renal failure
how does tardive dyskinesia present?
chewing, blinking, jaw pouting, lip smacking
how does schizotypal personality disorder present?
‘magical thinking’ and odd beliefs
ideas of reference
unusual perceptual disturbances
odd eccentric behaviour
lack of close friends
odd speech but not incoherent
what are clang associations
ideas related only by rhyme or being similar sounding
what is tangentiality
wandering from one topic to the next without returning
what is circumstantiality
the inability to answer a question without giving an excessive, unnecessary detail
They will eventually circle back to the point which differs from tangentiality
what are neologisms
new word formations that might be formed by combing two words
what is word salad
completely incoherent speech where real words are strung together in a nonsense sentence
what is knights move thinking
a severe type of loosening of associations where there are unexpected and illogical leaps from one idea to the next
what is flight of ideas
a feature of mania where there are leaps from one topic to another but with discernible links between them
what is echolalia
repetition of someone elses speech
what differs between hypochondria and somatisation disorder
somatisation is where a person is concerned by persistent unexplained symptoms whereas hypochondrial disorder the patient is concerned with a specific diagnosis such as cancer
what are long term complications of lithium use
hyperparathroidism and hypercalcaemia - bones stones groans and psychic moans
what physiological abnormalities can occur in anorexia
hypokalaemia
low FSH, LH, oestrogen and testosterone
raised cortisol
raised testosterone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3
what medication is preferred to chlordiazepoxide in alcoholics with severe liver cirrhosis
lorazepam
why can chlordiazepoxide cause problems in liver cirrhosis
chlordiazepoxide undergoes hepatic oxidation by the cytochrome P450 system which is impaired with cirrhosis
what is the strongest risk factor for suicide
a previous suicide attempt
what type of antipsychotics can lead to glucose dysregulation and diabetes
atypical antipsychotics (clozapine, olanzapine, risperidoe)
How long do symptoms of PTSD need to be present for diagnosis
4 weeks
first line antidepressant in children
fluoxetine
describe a schizoid personality disorder
- few activities if any provide pleasure
- emotional coldness, flattened affect
- apparent indifference to praise or criticism
- little interest in sexual experiences
- lack of close friends or desire for relationships
first line treatment of PTSD
trauma focused CBT or eye movement desensitisation and reprocessing therapy (EMDR)
what is conversion disorder
functional neurological disorder- the patient presents with neurological symptoms such as paralysis, blindness or seizures without an explained cause
which antipsychotic has the most tolerable side effect prophile
aripiprazole
describe paranoid personality disorder
hypersensitivity and an unforgiving attitude when insulted
unwarranted tendency to question the loyalty of close friends
reluctance to confide
preoccupation with conspirational beliefs and hidden meaning
first line drug treatment for PTSD
venlafaxine
what medication for alcohol dependence acts as a deterrent by causing patients to vomit on ingestion of alcohol
disulfiram
what medication for alcohol dependence acts as an anti-craving medication
acamprosate
which medication for opioid dependence can be used instead of methadone as a tablet under the tongue
buprenorphine
a PHQ score above what suggests severe depression
greater than or equal to 16
what may be shown on the ABG of someone with bulimia nervosa
metabolic alkalosis
what may be shown of the ECG of someone with bulimia
first degree heart block
tall P waves
flattened T waves
occurs due to hypokalaemia
what medication can be used to treat acute dystonia secondary to antipsychotic use
procyclidine
are pseudohallicinations part of the normal grieving process
yes
how does serotonin discontinuation syndrome present?
diarrhoea
vomiting
abdominal pain
sweating
restlessness
inability to sleep
what are the key features of PTSD
re-experiencing = flashbacks, nightmares, repetitive and distressing intrusive imagaes
avoidance= avoiding people and situation resembling the associated event
hyperarousal = hypervigiliance for threat, exaggerated startled response, sleep problems, irritability, difficulty concentrating
emotional numbing= lack of ability to experience feelings
what prescribed medication can cause a sudden onset of psychosis
steroids
what lifestyle change could cause clozapine blood levels to rise
smoking cessation
what antipsychotic can cause seizures
clozpien
what is thought withdrawal
a belief that someone is removing thoughts
how long does a period of depression need to occur for for it to be classified as a depressive episode
2 weeks
how does catatonia present?
stopping of voluntary movement or staying still in an unusual position
second line options for anxiety
different SSRIs- paroxetine, escitalopram
SNRIs- venlafaxine, duloxetine
how does tardive dyskinesia present
lip smacking, difficulty swallowing, excessive blinkingh
how can you differentiate between knights move and flight of ideas
there is discernible links between ideas in flight of ideas- there are not in knights move
what is the mechanism of duloxetine
serotonin and noradrenaline reuptake inhibitor
over how long should an SSRI be stopped?
over 4 weeks
when should lithium levels be checked
7 days after a dose change- 12 hours after last dose
what antidepressant might be prescribe to have the additional effect of increasing appetite
mitrazapine
how does the dose of SSRIs differ in treating OCD and in treating depression
usually a higher dose is needed in OCD
how long do SSRIs need to be taken to see a benefit in OCD
12 weeks
what is the risk of taking SSRIs in the third trimester
persistent pulmonary hypertension of the newborn
in patients under 25 how long after starting SSRIs should they be reviewed
1 week
which type of antipsychotics can cause acute dystonia
typical antipsyhotics
what is the first line treatment of borderline personality disorder
dialectical behavioural therapy
differentials for generalised anxiety disorder
aged 35-54
being divorced or separated
living alone
being a lone parent
can sumatriptans be taken with SSRIs
no - risk of serotonin syndrome
first line drug treatment of panic disorder?
SSRI
if clozapine is stopped for more than 48 hours how does it need to be restarted
it needs to restarted slowly and retitrated up to the correct dose
SE of zopiclone in elderly
increased risk of falls
first line management of OCD if functional impairment is mild
CBT including exposure and response therapy
