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General ISCE stuff > Psych > Flashcards

Psych Flashcards

1
Q

What are the defining features of Bipolar Disorder?

DIG THIS

A
  • mood disorder characterised by episodes of abnormally elevated or irritable mood (mania)
  • with disruptive symptoms of:
    • Distractibility
    • Inappropriate behaviour
    • Grandiosity
    • Talkativeness
    • Hyperactivity
    • flight of Ideas
    • decreased need for Sleep
  • over at least 1 week
  • followed or preceded by other episodes of depression / low mood
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2
Q

What are the risk factors for BPD?

A

FHx, mood disorder <20 years of age, stressful life events, PMHx of depression, hx of substance misuse

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3
Q

What are the basic investigations to exclude organic causes?

A

FBC, TFTs, serum vitamin D, toxicology screen

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4
Q

Name examples of mood stabilisers vs atypical antipsychotics used in BPD

A

Mood stabilisers - lithium, sodium valproate, carbamazepine

Atypicals - risperidone, olanzapine, quetiapine, aripiprazole

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5
Q

How would you manage an acutely agitated patient with BPD?

A

Aim to provide a tranquil environment with reduced stimuli, attempt verbal deescalation
IM neuroleptic (1: aripiprazole or olanzapine, 2: haloperidol or lorazepam)
May require urgent psychiatric hospitalisation

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6
Q

What is the ICD-10 criteria for a diagnosis of depression?

A

At least 2 typical symptoms PLUS at least 2 other core symptoms

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7
Q

What are the typical symptoms of depression

A

Depressed mood
Anhedonia
Fatigue or loss of energy

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8
Q

What are the characteristic features of ‘depressed mood’ in depression

A

most of the day, nearly every day, little variation, lacks responsiveness, may be worse in am

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9
Q

What are the ‘core’ symptoms of depression (not ‘typical’)

A 
Weight change
Disturbed sleep
Psychomotor agitation or retardation
Reduced libido
Worthlessness / guilt
Difficulty concentrating
Recurrent thoughts of death or suicide
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10
Q

What does the mnemonic ‘SAW EMAIL’ stand for?

A 
Symptoms of depression:
Sleep disturbance
Appetite reduced
Weight loss
Energy low
Mood low
Anhedonia
Irritability
Libido loss
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11
Q

How do you divide contributing factors to mental health disorders?

A

Predisposing, precipitating and perpetuating factors

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12
Q

What the main differentials for Depression?

A 
Physical illness - hypothyroidism, Cushing’s, cancer (hypercalcaemia)
Drugs
Bereavement (up to 12 months)
Prolonged grief disorder
Bipolar affective disorder
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13
Q

What investigations should be performed to exclude organic disease in Depression?

A

FBC, ESR, B12/folate, U&Es, LFTs, TFTs, glucose, calcium

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14
Q

What is the first-line class of antidepressants and give examples

A

SSRIs e.g. fluoxetine (<18s), citalopram, sertraline (IHD)

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15
Q

What 3 main investigations should be performed when monitoring patients on SSRIs and why?

A

FBC (anaemia due to bleeding)
U&E (hyponatraemia)
ECG with citalopram (prolonged QTc)

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16
Q

What are the notable side effects of SSRIs?

GASH-BS

A

GI upset - nausea and vomiting, low appetite
Agitation, anxiety, insomnia and drowsiness
Sexual dysfunction - anorgasmia, impotence, failed ejaculation, decreased libido; (May also be prescribed in premature ejaculation)
Hyponatraemia - requires regular blood monitoring, any antidepressant or antipsychotic could cause this
Rare Bleeding and Bruising - avoid Aspirin and NSAIDs
SSRI discontinuation syndrome

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17
Q

What is and are the symptoms of SSRI discontinuation syndrome?

A

Side effects of abrupt withdrawal of SSRIs - dizziness, flu-like symptoms, fatigue, gait disturbance, headache, insomnia, nausea.

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18
Q

What are the serious side effects of SSRIs?

A

Rare seizures
Rare activation of suicidal thoughts (especially adolescents/young adults)
Rare induction of mania

19
Q

What is second line for antidepressant therapy?

A

Alternate SSRI

20
Q

What two drugs are third line antidepressants and what are their classes, notable side effects and advantages?

A

Mirtazipine or Venlafaxine
Venlafaxine = SNRI - short half-life, given BD, common SEs sweating and HTN
Mirtazipine = NaSSA (noradrenaline and serotonin specific antagonist) - drowsiness (May be helpful to aid sleep when given as evening dose), can improve N&V in chemo patients, less risk of sexual side effects (good alt to SSRIs). Possible risk of BM suppression.

21
Q

What tests are required before starting lithium therapy?

A

FBC, UEs, TFTs, βhCG, ECG

22
Q

How do you monitor lithium?

What is the therapeutic range for lithium?

A

12-hours post-dose
Blood test after 5 days then every week for 4 weeks until stabilised, then every 3 months
Check TFTs, U&Es, Ca2+ every 6 months
0.4-1.0mmol/L

23
Q

What are the notable side effects of lithium?

Think Violet Beauregarde

A 
Water symptoms (polyuria, polydipsia)
GI symptoms (abdo pain, nausea)
Goitre (euthyroid or hypothyroid)
Acne, rash, alopecia
Metallic taste
Idiopathic intracranial hypertension
24
Q

What are the serious / life-threatening side effects of lithium?

A

Lithium toxicity
Renal impairment (interstitial nephritis)
Nephrogenic diabetes insipidus
Arrhythmia, cardiovascular changes, sick sinus syndrome, bradycardia, hypotension

25
Q

What are the symptoms of lithium toxicity?

A

GI (diarrhoea, anorexia, vomiting)
Ataxia, dysarthria, delirium, tremor, memory problems
Drowsiness, restlessness, apathy

26
Q

What class of anti-depressants does amitriptyline belong to? How would you explain the MOA?

A

Tricyclic antidepressants - thought to work by increasing levels of a chemical called serotonin in your brain, can help improve your mood.

27
Q

What are the main CIs for amitriptyline?

A

Arrhythmias, recent MI, glaucoma, manic phase of BPAD.

28
Q

How do you take amitriptyline?

A

One tablet a day, usually before bed as can make you feel sleepy. May start on lower split doses so smaller tablets 2-3 times a day to reduce the chance of side effects.

29
Q

How long does amitriptyline take to have an effect? How long do you take it for?

A

4-6 weeks

Recommend 6 months - 1 year after you’ve stopped feeling depressed, and then reduce your dose slowly.

30
Q

What are the common side effects of amitriptyline?

A

Weight gain, sedation; urinary retention, dry mouth, constipation, and blurred vision; hypotension & dizziness; hyponatraemia.

31
Q

What are the notable side effects of amitriptyline?

A

Dangerous in overdose (anticholinergic delirium)
Long QT - arrhythmias and sudden cardiac death
Lowers seizure threshold
Hyperthermia
Hepatic failure, paralytic ileus
Rare activation of suicidal thoughts
Rare induction of mania.

32
Q

What are the features of anticholinergic delirium (TCA overdose)? How would you treat it?

A

Mad as a hatter - confusion and visual hallucinations
Hot as a hare - hyperthermia
Blind as a bat - loss of accommodation reflex
Red as a beet - peripheral vasodilation
Dry as a bone - dried mucous membranes
- Physostigmine (anti-cholinesterase inhibitor)

33
Q

What are the features of Serotonin Syndrome?

A

Common: Diarrhoea, sweating, ataxia, tremor, disorientation, hypomania

Distinguishing: Myoclonus & hyperreflexia

SHIVERS
Shivering
Hyperreflexia
Increased temperature
Vital signs instability
Encephalopathy
Restlessness
Sweating
34
Q

What are the two main classes of antipsychotics? Give examples of each

A 
First-generation / typical antipsychotics e.g. haloperidol
Second-generation / atypical antipsychotics e.g. clozapine, olanzapine, risperidone
Also aripiprazole (partial agonist)
35
Q

What are extrapyramidal side effects?

How would you manage?

A 
Caused by striatal dopamine antagonism
Acute dystonia - e.g. oculogyric crisis
Akathisia - restlessness
Parkinsonism
Treat with antimuscarinic drug such as procyclidine.

Tardive dyskinesia - oro-bucco-facial dyskinesia (can be irreversible) - reduce and withdraw agent, switch to clozapine or another atypical, add clonazepam.

36
Q

Describe neuroleptic malignant syndrome

A

Can occur at any time with neuroleptics (antipsychotics).
Onset days to weeks.

Presents with:
Extreme pyrexia
Stiffness, rigidity
Confusion
Autonomic instability
Raised WBC
Raised creatinine phosphokinase (differentiates from serotonin syndrome)

FEVER: Fever, Encephalopathy, Vital sign instability, Extreme pyrexia, Rigidity.

37
Q

What are extrapyramidal side effects?

How do you treat these?

A

Akathisia (restlessness)
Acute dystonia (oculogyric crisis)
Parkinsonism
Anti-muscarinic (procyclidine)

38
Q

What are the notable side effects of antipsychotics? (Every Sexy Guy Does Weights Here)

A

EPSEs (inc. akathisia + TD)
Sexual dysfunction
Galactorrhea + amenorrhea (hyperprolactinaemia)
Dry (constipation, urinary retention, blurred vision)
Weight gain
Hypotension (dizziness) + tachycardia.

39
Q

What are the serious side effects associated with antipsychotics?

A

NMS; seizures; jaundice; agranulocytosis; sudden cardiac death; CVA.

40
Q

What are the specific side effects of olanzapine?

A

Diabetes mellitus, dyslipidaemia.

41
Q

What are the specific side effects of risperidone?

A

Hyperprolactinaemia, weight gain, sedation.

42
Q

What are the specific notable side effects of clozapine?

A

Hypersalivation, sweating; nausea, constipation; hypotension; weight gain, diabetes mellitus, dyslipidaemia; sedation, dizziness, headache.

43
Q

What are the serious side effects of clozapine?

A

Agranulocytosis, PE, myocarditis, seizures, paralytic ileus, NMS, cardiac death and CVA.

44
Q

What monitoring does clozapine require? What is an important question to ask about during review?

A

Weekly FBCs for 18 weeks, then fortnightly up to 1 year, then monthly after 1 year; Traffic light system.
Also lipid profile / LFTs, glucose, BMI etc.
Changes in coffee and smoking habit.

General ISCE stuff (3 decks)

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