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Psych Flashcards

1
Q

Recommended weekly alcohol

A

14 units
at least 2 alcohol-free days per week
no bingeing

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2
Q

Describe the risks of alcohol

A

Alcohol affects every organ in the body.
When drunk, obviously affects…injuries, memory, social, work etc.

Long-term brain damage, depression, obesity, DM, heart disease, liver damage, infertility
Lots of cancers more common in drinkers

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3
Q

How is acute dystonia different from tardive dyskinesia?

A

dystonia: sustained muscular contractions or spasms

dyskinesia are movements, like grimacing, protruding tongue

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4
Q

Risk assessment should include which considerations

A

Self
Others
Children
Property

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5
Q

What is the common action of antidepressants?

A

elevate monoamine NT in the synaptic cleft

most block NA and serotonin reuptake

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6
Q

Example of TCA

A

amitriptyline

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7
Q

Indications for TCAs

A 
Depression
Anxiety disorders (inc OCD: clomipramine)
Chronic pain
Nocturnal eneuresis
Narcolepsy

Good sedative. Often used as adjunct to those receiving a non-sedating antidepressant, eg SSRI

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8
Q

MoA for TCAs

Side-effects

Contraindications

A

Pre-synaptic blockade of both NA and serotonin reuptake pumps (and dopamine to a lesser extent)
Blockade of muscarinic, histamminergic and alpha–adrenergic receptors

Muscarinic side-effects: dry mouth, constipation, urinary retention, blurred vision
Alpha-adrenergic s/e: postural hypotension
Histminergic: weight gain, sedation
Cardiotoxic effects: QT prolongation, ST elevation, heart block, arrhythmias

CONTRAINDICATED IN:
RECENT MI, ARRHYTHMIAS
SEVERE LIVER DISEASE
MANIA
HIGH RISK OF OVERDOSE
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9
Q

Examples SSRI

A

sertraline
citalopram
fluoxetine

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10
Q

Indications for SSRIs

A

Depression
Anxiety
OCD
Bulimia (fluoxetine)

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11
Q

MoA for SSRIs

Side-effects

Contraindications

A

Selective presynaptic blockade of serotonin reuptake pumps
(low cardiotoxicity)

Alerting (can encourage agitation after initiation)
GI upset at initiation
Loss of appetite/ weight loss
Insomnia
Sweating
Sexual dysfunction

No contraindications, really

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12
Q

Example of SNRI.

What does it stand for?

A

Venlafaxine

Serotonin-noradrenalin reuptake inhibitor

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13
Q

Examples of MAOI

A

Phenelzine

Isocarboxazid

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14
Q

Indications for MAOIs

A

Depression
Anxiety
Eating disorders
Others: chronic pain, Parkinson’s, migraine prophylaxis, TB

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15
Q

MoA for MAOIs

Side-effects

Contraindications

A

Non-selective and irreversible inhibition of monoamine oxidase A + B

Inhibition of A results in accumulation of NTs, impairing the metabolism of certain amines in drugs/ food
Amines may accumulate to dangerously high levels –> life-threatening hypertensive crisis (early warning is throbbing headache)

Contraindicated in phaechromocytoma, CVD, hepatic impairment, mania

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16
Q

What is RIMA?

A

Reversible inhibition of monoamine oxidase A

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17
Q 
When might mirtazapine be prescribed?
What class of drug is it?
A

Depression, where sedation and increased appetite are desired.

NaSSA (noradrenergic and specific serotonergic antidepressant)

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18
Q

Which foods and drugs to be avoided on MAOIs?

A

Tyramine-rich foods (cheese, pickled/ smoked fish, liver, beer)

Drugs (adrenaline, NA, amphetamines, cocaine, ephedrine/ pseudoephedrine (decongestants), L-dopa, dopamine)
Even LA containing adrenaline

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19
Q

Symptoms of serotonin syndrome

A

neuromuscular abnormalities, altered consciousness, autonomic instability

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20
Q

How to avoid serotonin syndrome

A

At least 2 weeks between MAOI and starting other antidepressant

Opiates when on MAOI

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21
Q

Symptoms of discontinuation syndrome

A

GI upset, agitation/ insomnia, dizziness, headache, tremor

SSRIs worse culprits
should be tapered down

fluoxetine OK

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22
Q

Examples of mood stabilisers

Which are acute mania?

A

lithium, valproate, carbamazepine, lamotrigine

acute: lith, v
prophylaxis: all

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23
Q

How might clearance of lithium be decreased?

A

almost entirely excreted by kidneys
so renal failure, dehydration, older adults
avoid diuretics (esp thiazides), NSAIDs, ACEi

v narrow therapeutic window

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24
Q

Signs of lithium toxicity

A 
diarrhea
vomiting
stomach pains
fatigue
tremors
uncontrollable movements
muscle weakness
drowsiness
weakness
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25
Q

What must be tested prior to initiating lithium therapy?

A

FBC
U&Es
thyroid function (can cause hypothyroidism)
pregnancy test
ECG if cardiac risk factors (can cause T wave inversion/ flattening)

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26
Q

What is the general difference between first and second generation antipsychotics?

A 
fewer EPSE
(although clozapine only true atypical with diff receptor profile - all will produce EPSE at certain doses)
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27
Q

Examples of first gen and second gen antipsychotics

A

1st: chlorpromazine, haloperidol
2nd: clozapine, olanzapine, quetiapine, risperidone (can be given as depot)

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28
Q

Indications for anti-psychotics

A

Schiz, schizoaffective, delusional disorders
Depression or mania with psychotic symptoms
Psychoactive episodes secondary to medical conditions/ drugs
Delirium
Behavioural disturbance in dementia
Severe agitation, anxiety, violent/ impulsive disorders

Non-psych: motor tics, N&V (prochlorperazine)

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29
Q

Why should caution be used in prescribing antipsychotics in alcohol withdrawal?

A

Lowers seizure threshold

30
Q

MoA anti-psychotics

A

Blockade of dopamine receptors
Most second-gen also block serotonin receptors
Block other receptors too

31
Q

Side-effects of anti-psychotics

A

EPSE: Parkinsonian symptoms, dyskinesias, neuroleptic malignant syndrome
Hyperprolactinaemmia: galactorrhoea, amenorrhoea & infertility, sexual dysfunction

Muscarinic blockade
Alpha-adrenergic blockade
Cardiac effects: prolongation of QT, arrhythmias
Metabolic effects: risk of metabolic syndrome (esp second gen)
Dermatological effects: photosensitivity, skin rashes (esp clozapine and blue/grey discolouration in sun)

Lowering of seizure threshold, hepatotoxicity, cholestatic jaundice, pancytopenia, agranulocytosis

32
Q

Examples of autonomic dysfunction

A

hyperthermia, sweating, tachycardia, unstable BP

33
Q

Differences in causes of neuroleptic malignant syndrome and serotonin syndrome

A

SS: after 1-2 doses of serotonin meds (often SSRIs + MAOIs)
NMS: within 4-11 days of initiating dopamine antagonist (antipsychotics, metaclopramide)

34
Q

Differences in onset of NMS and serotonin syndrome.

Mortality

A

NMS more insiduous, SS acute

SS has low mortality, NMS 20% die if untreated

35
Q

Treatment for neuroleptic malignant syndrome

A

Bromocriptine
Dantrolene (for muscle spasmm)
ECT

36
Q

Treatment for serotonin syndrome

A

Cyproheptadine (serotonin antagonist)

37
Q

Differences in neuromuscular abnormalities in NMS and SS

A

Reduced activity in NMS: severe leadpipe rigidity, bradyreflexia, stiff muscles may lead to dysphagia and dyspnoea

Increased activity in SS: myoclonus, tremor, hyperreflexia, less severe rigidity

38
Q

MoA of hypnotics and anxiolytics

A

GABA receptors

benzos + Z drugs

39
Q

Meds used in alcohol dependence

A

acamprosate, disulfiram

40
Q

When is ECT considered

A

Most effective treatment for severe depression
poor fluid intake
puerperal
strong suicidal intent
psychotic features/ stupor
antidepressants ineffective/ not tolerated

effective for establish mania (but may precipitate mania in pts with bipolar)
certain schiz

41
Q

how often is ECT needed

A

usually 2-3 times/week

4-12 treatments

42
Q

Depression lite

A

Dysthymia

43
Q

How long should antidepressant be tried before deciding it doesn’t work?

A

6-8 weeks

44
Q

Bipolar lite

A

Cyclothymia

45
Q

Two mine types of non-situational anxiety

A

GAD

Paroxysmal anxiety

46
Q

Difference between schizoid and schizotypal personality disorders

A

Schizoid: cold, indifferent to people/ praise/ criticism

Schizotypal: eccentric behaviour

47
Q

Histrionic personality disorder

A

Dramatic, exaggerated expressions of emotion, attention-seeking, seductive etc.

48
Q

Avoidant PD

A

hypersensitive to critical remarks/ rejection, fears of inadequacy

49
Q

What is an adjustment disorder?

A

When symptoms are considered out of proportion to original stressor
resolves ~6 months (otherwise consider other diagnosis)

50
Q

What is an acute stress reaction?

A

Symptoms last up to 3 days - externally shut-down, if severe like a stupor

51
Q

Anorexia definition

A

self-imposed weight 15% below expected (ie BMI 17.5 in adult)

52
Q

PSYCHOSIS

A

mental state in which reality is grossly distorted

53
Q

HALLUCINATION

A

perceptions in absence of external stimuli - little insight

54
Q

Extracampine hallucinations

A

false perceptions outside limits of person’s sensory field

55
Q

Functional hallucination vs reflex hallucination

A

F: normal sensory stimulus needed to precipitate hallucination in same modality

R: normal sensory simulus in one modality precipitates hallucinations in another

56
Q

PSEUDOHALLUCINATION

A

hallucinations with insight
arises from subjective inner space, not under conscious control
eg PTSD flashbacks

57
Q

DELUSION

A

Unshakable false belief not accepted by other members of pt’s culture

58
Q

Types of schizophrenia

A

Paranoid: dominated by presence of delusions and hallucinations (positive symptoms) - onset of illness later/ better prognosis

Hebephrenic: delusions/ hallucinations are fleeting or not prominent - thought disorganisation, disturbed behaviour, flat affect - younger, worse prognosis

Catatonic: rare

Residual: 1 year predominantly chronic negative symptoms with at least 1 clear-cut psychotic episode

59
Q

Age of onset schiz

incidence vs prevalence

A

M: 18-25
F: 25-35

men have higher incidence but prevalance about same (high male mortality)

60
Q

high expressed emotion

A

family/ carers too involved affects schizophrenics - 35hrs +

61
Q

How much pabrinex in DT

A

2 ampoules, BD

for 5 days

62
Q

Difference in fatality: heroin withdrawal vs benzo withdrawal

A

heroin withdrawal not fatal

benzo is

63
Q

Section 2
What is it?
Duration?

A 
Admission for assessment
28 days (can be transformed to s3)
64
Q

Section 3
What is it?
Duration?

A 
admission for treatment
6 months (can be extended)
65
Q

Section 4
What is it?
Duration?

A

Emergency admission for assessment (Dr)

72h (to allow s2/3)

66
Q

Section 5(2)

A

Dr’s holding power
Detention of hosp in-patient
72h

67
Q

Section 5(4)

A

Nurse’s holding power

6h

68
Q

Section 17

A

Community treatment order

69
Q

Section 135

A

Police can enter private premmises to remmove someone with suspected MH problem

70
Q

Section 136

A

Police can remove someone from public space

Medicine (30 decks)

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