Psych Flashcards
How long do depressive symptoms have to persist to make a diagnosis of depression?
2 weeks
What are the 3 key symptoms of depression?
- Low mood
- Anhedonia
- Energy loss
How do you define mild depression?
5 symptoms of depression AND mild functional impairment
How do you define severe depression?
Most symptoms, marked functional impairment with or without psychotic symptoms
Give two ways of assessing depressive symptoms
- Patient Health Questionnaire 9 (PHQ-9)
2. Hospital Anxiety snd Depression Scale (HAD score)
What might happen if you mix SSRI with MAO inhibitor?
Serotonin Syndrome
What key condition should tricyclics be avoided in?
Heart failure
Give and example of a MAO inhibitor
Phenelzine
What is the risk of using MAO inhibitors?
Hypertensive crisis
What might trigger bad side effects in patients on MAOis?
Tyrosine (avoid cheese, red wine, broad beans)
What drug class is Mirtazipine?
Noradrengergic and specific seretonergic antidepressant
What 4 drugs might cause serotonin syndrome?
SSRIs
MAO inhibitors
Amphetamines
Ecstasy
Give some autonomic symptoms of serotonin syndrome
Tachycardia Sweating Fever Tachypnoea Fever Arrhythmia
Give some cognitive symptoms of serotonin syndrome
Agitation
Confusion
Hallucination
Give some neuromuscular symptoms of serotonin syndrome
Tremor
Ataxia
Seizures
How long does hypomania need to last diagnostically?
<4 days
How to long does mania need to last diagnostically?
> 7 days
What is the DSM-IV-TR definition of ‘Bipolar’?
Manic episode +/- depressive
What must you be careful about when initiating treatment for someone with a long Hx of psych problems, but only just being diagnosed with bipolar?
Make sure you stop any SSRI treatment!!!!
What type of medication is given for people with bipolar?
Mood stabilisers
Give 3 different examples of mood stabilisers
- Lithium
- Antiepileptics (valproate, carbamazepine)
- Antipsychotics (used in acute mania)
Why is lithium the favoured medication for bipolar?
It treats both mania and depression
Why do patients on lithium need to be closely monitored?
Lithium has a very narrow therapeutic range
What do you need to monitor if a patient is on lithium?
- Renal function (creatinine, U+E)
2. TFT’s (hypothyroidism)
What are the side effects of lithium?
L - Leukocytosis I - Insipidus T - Tremor H - Hypothyroid I - Increased U - Urine M - Mums - teratogenic
What are some signs of lithium toxicity?
Blurred vision, weakness, coarse tremor, ataxia, nausea, vomiting, oliguria, coma
According to WHO, what 4 domains are affected in schizophrenia?
- Thinking
- Language
- Perception
- Sense of self
How long do symptoms need to last in order to get diagnosed with schizophrenia?
1 month
What are some 1st rank symptoms in schizophrenia?
Delusional perception Auditory hallucinations - 3rd person Thought insertion Thought removal Thought broadcasting Somatic passivity
What are some negative symptoms in schizophrenia?
Flat affect
Lack of motivation
Anhedonia
Poverty of speech
Side effects of of atypical antipsychotics
Metabolic syndrome T2DM Stroke Weight gain Sedative
What are the conditions for trying clozapine?
Must have tried 2 drugs for 6 weeks each
What do you need to look out for when a patient is on clozapine?
Agranulocytosis
What happens in acute dystonia?
- Facial grimacing
- Involuntary upward eye movement
- Muscle spasms of the tongue, face, neck and back
- > back muscle spasms cause the trunk to arch forward)
- Laryngeal spasms
What syndrome might occur when starting or increasing dose of antipsychotics?
Neuroleptic Malignant Syndrome
What are the symptoms of Neuroleptic Malignant Syndrome?
Autonomic instability Fever Stiffness (lead pipe) Seizures Coma
What would you expect from an ABG of someone with neuroleptic malignant syndrome?
Metabolic Alkalosis
What blood marker might be raised in neuroleptic malignant syndrome?
Creatinine kinase
How would you treat neuroleptic malignant syndrome?
IV fluids - prevent AKI
Benzodiazepines
Bromocriptine
Muscle relaxants
Name 5 anxiety disorders
- Generalised anxiety disorder
- Panic
- Post-traumatic stress
- Phobias
- Obsessive compulsive
How do you define the obsessions of OCD?
Uncontrollable, intrusive, recurrent thoughts of distressing nature
What is a phobia?
A strong, irrational fear or something that poses little or no real danger
Symptoms of PTSD (6)
Intrusive thoughts of traumatic event Nightmares Flashbacks Isolation Angry outbursts Hypersensitivity
What is a personality disorder?
Rigid, maladaptive traits that cause great distress or an inability to get along with others
What type of behaviours do cluster A PD have?
Odd or eccentric
What are 3 examples of cluster A PD?
Paranoid
Schizoid
Schizotypical
What type of behaviours do cluster B PD have?
Emotional, dramatic or erratic
What are 4 examples of cluster B PD?
Borderline
Antisocial
Histrionic
Narcissistic
What type of behaviours do cluster C PD have?
Anxious or fearful
What are 3 examples of cluster C PD?
Obsessive compulsive
Dependent
Avoidant
Features of schizoid PD?
Detached and cold
Doesn’t interact with others
Rich fantasy world
No eye contact
Features of schizotypical PD?
Odd ideas and behaviour
Lack or inappropriate emotion
May have hallucinations/delusions but not significant to diagnose schizophrenia
Features of antisocial PD?
Incapable of empathy
Manipulative behaviour
Impulsive
Aggressive (quick temper)
Features of BPD?
Low self esteem, intense feeling of rejection
Develops very intense feelings for people very quickly
Find it hard to control emotions they feel very intensely -> emotional rollercoaster
Often self-harm, engage in risky behaviour
Associated with depression, alcohol abuse
Finds it difficult to cope with life stresses
Name risks for suicide
Sex - male Age under 19, or over 45 Depression Previous suicide attempt Ethanol abuse / drug abuse Rational thinking loss - psychosis etc. Separated from partner Organised, well thought out attempt No social support Sickness e.g. chronic illness
What are the elements of capacity?
- Can understand information
- Can retain information
- Can weigh up pros and cons
- Can formulate and communicate a decision
How long does a section 2 last?
28 days
What is a section 2 used for?
Assessment - under section
What is required during a section 2?
The opinion of 2 doctors. One psychiatrist and one other doctor who has prior knowledge of the patient
Can a section 2 be renewed?
No