Psych Flashcards
what does emergency detention cover
- up to 72 hours
- for assessment only, NOT treatment
- must be done by a fully registered doctor,
- preferably also a mental health officer also present
what does short term detention cover
- for assessment and treatment
- 28 days
- need a psychiatrist and MHO to approve it
what does a Compulsory treatment order cover
- lasts for 6 months, can be extended by 6 months again if required
- must be approved by a tribunal
- application = two medical professionals
what are most common side effects of SSRIs
insomnia
nausea
reduced libido
headache
GI sx
“emotional numbness”
agitation
what SSRI is safest in epilepsy
citalopram
what SSRI is safest in cardiac problems
sertraline
what SSRI is associated with long QT syndrome
ciralopram
what is an example of a NaSSA and when is it useful
mirtazepine
patients with insomnia and reduced appetite
what are side effects of mirtazepine
weight gain [due to increased appetite]
sedation
constipation
dizziness
GI upset with alcohol
common side effects of TCA
Sedation, cardiotoxicity, tremor
what are the anti-muscarinic effects of TCAs
dry mouth, constipation, urinary retention, impotence, visual disturbance
most lethal anti-depressant in overdose
TCAs
safest SSRI in MI Hx
sertraline
due to GI upset, what classes of drugs should SSRI be avoided co-prescribed with
NSAIDs, Warfarin, Aspirin, Triptans
how do SSRI work
selective pre-synaptic blockade of serotonin re-uptake pumps
how do TCAs work
pre-synaptic blockage of both noradrenaline and serotonin reuptake pumps
Side effects of TCA
sedation
weight gain
dry mouth, nose, urinary retention
postural hypotension
tachycardia
arrhythmia
heart block
what changes on an ECG can be seen with TCAs
prolonged QT interval
ST segment elevation
contraindications to TCAs
recent MI arrhythmia severe liver disease mania high risk of over dose
what is phenelzine an example of and what is it MOI
MOAI
inhibition of monoamine oxidase A and B
when is a MOAI used
atypical depression, anxiety disorders
SE of MOAI
can cause hypertensive crisis if mixed with foods containing tyramine
Sx = flushing, headache, increased BP, CVA
Tx = alpha blocker
If used with another anti-depressant can cause = serotonin syndrome
contraindications of MOAI use
phaechromocytoma
cerebrovascular disease
hepatic impairment
mania
what are examples of SNRI
venaflaxine, duloxetine
what are examples of NaSSA and MOI
mirtazapine
presynapatic alpha 2 receptor blockade
[get extra pyramidal SE]
what should not be prescribed in patients on lithium
NSAIDs
ACEi
Diuretics
lithium - contraindications
pregnancy breastfeeding impaired renal function thyroid disease cardiac conditions neurological conditions
lithium - side effects general
confusion, headache, concentration problems constipation dry mouth, thirst fine tremor hypothyroid weight gain
lithium - side effects toxicity
diarrhoea, N+v decreased potassium ataxia, myoclonus coarse tremor convulsions, coma
lamotrigine - side effects
N/V, diarrhoea
skin rash - steven johnson syndrome
carbamazepine - side effects
agranulocytosis
aplastic anaemia
hyponatramia , fluid retention
what are the two categories of anti psychotics
1st gen = typical [haloperidol, chlorpromazine]
2nd gen = atypical [clozapine, olanzapine, quitiapine, risperidone]
general side effects of anti psychotic
dry mouth, constipation, urinary retention
postural hypotension
sedation, weight gain
prolonged QT interval
arrhythmia
galactorrhea gynaecomastia amenorrhoea infertility sexual dysfunction
how should extra-pyramidal side effects and acute dystonia cause by anti-psychotics be treated
anticholinergics e.g. procyclidine
what time frame does acute dystonia appear after starting anti-psychotic and what is it
72 hours
involuntary sustained muscular contractions
what is akathisia, when does it appear and how can it be treated
restless legs, feel need to move around
6-10 days
propanolol or short term BZDs
what is tardive dyskinesia
rhythmic involuntary movements of head, limbs, trunk
what disease is clozapine reserved for due to its side effects
treatment resistant schizophrenia
inheritance of huntingtons
autosomal dominant
types of dementia
vascular alzheimers dementia with lewy bodies fronto-temporal dementia alcohol related parkinsons related
1st line Tx of alzheimers
cholinesterase inhibitor i.e. donepezil, rivastigmine
what cannot be given in dementia with lewy body
haloperidol = can cause parkinsons
what are the parkinsonisms Sx
muscular rigidity
bradykinesia
resting tremor
how else can thiamine be written
B1
what is the effect of anorexia on blood results
G’s and C’s raised
= GH, Glucose, Cortisol, Cholesterol
Low FSH
1st line treatment for anorexia in kids
‘anorexia focused family therapy’
treatment of GAD
1st line = SSRI
2nd line = SNRI
18 month treatment
[panic disorder/phobias only 6 months]
how is GAD often described
free floating
time frame for acute stress response, acute stress disorder, acute PTSD, chronic PTSD
acute stress response = 48 hours
acute stress disorder = 4 weeks
acute PTSD = 4 weeks - 3 months
chronic PTSD = more than 3 months
Tx of PTSD
Psychological
- EMDR [eye movement desensitisation and reprocessing]
Medication
1st line = SSRI
2nd line = SNRI or BZDs
3rd line = anticonvulsants
duration of treatment = 12 months
Tx of OCD
Psychological
- ERP > 20 hours [exposure and response prevention]
Medication
1st line = SSRI
2nd line = SNRI or BZDs
positive sx of schizophrenia
delusions = bizarre, paranoid, grandiose, nihilistic
persecutory ideas
hallucinations = auditory; 3rd person, running commentary, discussing patient
passivity phenomena
though broadcasting, withdrawal, insertion, interference
negative sx of schizophrenia
apathy
lack of motivation
social withdrawal
cognitive impairment
blunting of affect [limited range of emotion]
incongruent affect [laughing at sad story]
catatonia
tx for schizophrenia
1st line = risperidone
2nd line = Aripiprazole
treatment resistant = clozapine
hallmarks of delirium
acute and fluctuating
inattention
altered level of consciousness
disorganized thinking
tx for delirium
haloperidol 1-10mg [0.5mg in elderly]
if alcohol failure = BZDs i.e. Lorazapem [also use in patients with parkinsons]
what is conversion disorder
loss of sensory or motor function
what is somatoform disorder
physical symptoms suggestion a physical disorder with no evidence of organic disease
what are the cluster A PD and what harry potter character are they
Cluster A = weird
Paranoid = mad-eye moody
- distrust and suspicious
Schizoid = snape
- detachment from social relationships, restricted emotions
Schizotypical
what are the cluster B PD and what harry potter character are they
Cluster B = wild
Antisocial = bellatrix
- disregard for others, occuring since age 15
Borderline/Emotionally Unstable = lavender brown
- unstable inter-personal relationships, self-image, marked impulse, associated with ADHD, learning difficulties
Histrionic = draco
- excessive emotion, attention seeking, inappropriately sexual behavior
what are the cluster C PD and what harry potter character are they
Cluster C = worried
Avoidant = neville longbottom
- feeling adequate, hypersensitive to negative feedback
Dependant = ron weasley
- need to be taken care of, clingy, submissive
Obsessive-Compulsive = Umbridge
- inflexible to change, preoccupied with perfection
learning disability cutoffs IQs
Mild = 50-69
Moderate = 35-49
Severe = 20-34
Profound < 20
triad of Sx in autism
abnormal social interaction
communication impairment
rigid/restrictive or repetitive behavior
ICD-10 criteria for dependence
- strong desire to take
- difficulty in controlling
- physiological withdrawal state
- increasing tolerance [need a higher dose]
- neglect of alternative pleasures
- persistence despite evidence of harm
pyscotherapy developed by frued and jung
psychoanalysis
what can CBT be used for
personality disorders - psychopathy generalised anxiety disorder panic disorder phobias acute stress disorder
neurotransmitter affected in schizo, depression and anxiety
depression = serotonin schizo = dopamine anxiety = GABA
list the panic disorders
panic disorder panic attack agoraphobia [fear of leaving house] specific phobia social phobia
what are the components of capacity
1) Understand and retain relevant information
2) Use and weigh that information to make a decision
3) Communicate that decision
what section of the adults w/ incapacity act can authorise treatment of a physical disorder in someone without capacity to consent to that treatment
section 47
what are the different sub headings of AWI act
Power of Attorney - grant when you have capacity
Guardianship
Section 47 certificate of incapacity
