psych Flashcards
physical symptoms no explanation 2 years, patient refuses to accept reassurance or negative test results
somatisation disorder
overdose on paracetamol treat with
N-Acetylcysteine
overdose of amitriptyline
IV bicarbonate
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
Malingering
autism 3 necessary features
global impairment of language and communication
impairment of social relationships
ritualistic and compulsive phenomena
how do you stop SSRIs?
which SSRI is worst and best for stopping
When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.
SADPERSON score useful for?
suicide risk
PHQ-9 score is
a 9 question tool for depression
what percentage of Alzheimers is genetic?
what are the genes involved?
5-10%
basic pathophysiology of Alzheimers
amyloid precursor protein is a intramembrane protein in cells in the brain. it is usally cleaved by gamma secretase and alpha secretase. if another enzyme beta secretase cleaves instead then you create an insoluble protein which builds up outside of cells forming plaques and causing tau phosphorylation (we think)
tau proteins inside neurons which normally support it are phosphorylated. they change shape and form clumps called neurofibrillary tangles
what seperates mania from hypomania?
the presence of psychotic symptoms = mania
which tool for post natal depression?
edinburough scale
What is the most appropriate time to take blood samples for therapeutic monitoring of lithium levels?
12 hours after last dose
do Phenytoin levels need to be monitored?
Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:
- adjustment of phenytoin dose
- suspected toxicity
- detection of non-adherence to the prescribed medication.0
clozapine, what must you check?!
FBC for agranulocytosis
true risk factors for suicide
The following is a list of suicide risk factors taken from the Preventing suicide in
England paper from the Government:
Gender - males are three times as likely to take their own life as females
Age - people aged 35-49 years now have the highest suicide rate
Mental illness
The treatment and care they receive after making a suicide attempt
Physically disabling or painful illnesses including chronic pain
Alcohol and drug misuse
The loss of a job
Debt
Living alone - becoming socially excluded or isolated;
Bereavement
Family breakdown and conflict including divorce and family mental health problems
Imprisonment
which antidepressant should be used post-MI?
Sertaline has the most evidence
Causes of visual hallucinations
Lewy body dementia Alcohol induced Frightening ones - - > delirium. Drug induced Charles bonnet syndrome I those who are visually impaired Sleep disturbance Cjd
Diagnosis if dementia requirements?
Objective evidence of decline in two cognitive domains
Functional decline
Other pathology excluded
Routine assessment for dementia
Screening cognitive test like 6CIT FBC RENAL LIVER FUNCTION THYROID FUNCTION RANDOM GLUCOSE B12 AND FOLATE CALCIUM ONLY SYPHILIS FROM HIGH RISK GROUP
Memory clinic assessment for dementia
History and mental state
Standardised cognitive assessment like MMSE, ACE-R, MOCCA
Drugs that increase QT interval. It is essential to do an ecg as a preasssesment
Antipsychotics
Factors associated with worse prognosis in schizophrenia
strong family history gradual onset low IQ premorbid history of social withdrawal lack of obvious precipitant
balanoprosthitis, what is it and what to rule out and how to treat?
male candida, rule out glycosuria and treat with antifungals
treatment for scabies?
Permethrin 5% cream
pep drugs
Truvada 245, ftc and raltegravir 400Bd
how long after UPSI can you use progesterone only emergency contraception?
3 days licensed, useful up to 5
after 5 days upsi what emergency contraception would you be able to still use?
IUCD (copper coil)
3 emergency contraceptives
uripristal acetate, IUD (copper coil)(most effective), progesterone pill
when cant you have uripristal acetate as emergency because wont work
when taking inducers like carbemazipine or high stomach ph like ppi or after 120 hours
