Psych Flashcards
What are the defining features of Bipolar Disorder?
DIG THIS
- 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
What are the risk factors for BPD?
FHx, mood disorder <20 years of age, stressful life events, PMHx of depression, hx of substance misuse
What are the basic investigations to exclude organic causes?
FBC, TFTs, serum vitamin D, toxicology screen
Name examples of mood stabilisers vs atypical antipsychotics used in BPD
Mood stabilisers - lithium, sodium valproate, carbamazepine
Atypicals - risperidone, olanzapine, quetiapine, aripiprazole
How would you manage an acutely agitated patient with BPD?
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
What is the ICD-10 criteria for a diagnosis of depression?
At least 2 typical symptoms PLUS at least 2 other core symptoms
What are the typical symptoms of depression
Depressed mood
Anhedonia
Fatigue or loss of energy
What are the characteristic features of ‘depressed mood’ in depression
most of the day, nearly every day, little variation, lacks responsiveness, may be worse in am
What are the ‘core’ symptoms of depression (not ‘typical’)
Weight change Disturbed sleep Psychomotor agitation or retardation Reduced libido Worthlessness / guilt Difficulty concentrating Recurrent thoughts of death or suicide
What does the mnemonic ‘SAW EMAIL’ stand for?
Symptoms of depression: Sleep disturbance Appetite reduced Weight loss Energy low Mood low Anhedonia Irritability Libido loss
How do you divide contributing factors to mental health disorders?
Predisposing, precipitating and perpetuating factors
What the main differentials for Depression?
Physical illness - hypothyroidism, Cushing’s, cancer (hypercalcaemia) Drugs Bereavement (up to 12 months) Prolonged grief disorder Bipolar affective disorder
What investigations should be performed to exclude organic disease in Depression?
FBC, ESR, B12/folate, U&Es, LFTs, TFTs, glucose, calcium
What is the first-line class of antidepressants and give examples
SSRIs e.g. fluoxetine (<18s), citalopram, sertraline (IHD)
What 3 main investigations should be performed when monitoring patients on SSRIs and why?
FBC (anaemia due to bleeding)
U&E (hyponatraemia)
ECG with citalopram (prolonged QTc)
What are the notable side effects of SSRIs?
GASH-BS
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
What is and are the symptoms of SSRI discontinuation syndrome?
Side effects of abrupt withdrawal of SSRIs - dizziness, flu-like symptoms, fatigue, gait disturbance, headache, insomnia, nausea.
What are the serious side effects of SSRIs?
Rare seizures
Rare activation of suicidal thoughts (especially adolescents/young adults)
Rare induction of mania
What is second line for antidepressant therapy?
Alternate SSRI
What two drugs are third line antidepressants and what are their classes, notable side effects and advantages?
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.
What tests are required before starting lithium therapy?
FBC, UEs, TFTs, βhCG, ECG
How do you monitor lithium?
What is the therapeutic range for lithium?
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
What are the notable side effects of lithium?
Think Violet Beauregarde
Water symptoms (polyuria, polydipsia) GI symptoms (abdo pain, nausea) Goitre (euthyroid or hypothyroid) Acne, rash, alopecia Metallic taste Idiopathic intracranial hypertension
What are the serious / life-threatening side effects of lithium?
Lithium toxicity
Renal impairment (interstitial nephritis)
Nephrogenic diabetes insipidus
Arrhythmia, cardiovascular changes, sick sinus syndrome, bradycardia, hypotension
