Psych Flashcards
Stages of change
Preparation Action Relapse (Precontemplation) Contemplation
Transitional model of stress
STRESSORS (life events, daily hassles, chronic stressors) interact with RESOURCES (personality, social support, coping skills) resulting in APPRAISAL which may or may not produce a STRESS RESPONSE
Motivational interviewing stages
- Expressing empathy
- Avoiding argument
- Supporting self-efficacy
- Rolling with resistance
- Developing discrepancy
Antipsychotic extrapyramidal side effects (4)
- Parkinsonism -intention tremor
- Acute dystopia - totricollis, oculogyric crisis
- Akathisia - severe restlessness
- Tardive dyskinesia -chewing, pouting
Side effects of antipsychotics not including extrapyramidal effects (6)
- Increased VTE and strike risk in the elderly
- Antimuscarinic effects e.g. dry mouth, urinary retention, blurred vision, constipation
- Sedation
- Weight gain
- Raised prolactin - galactorrhea
- Neuroleptic malignant syndrome
Side effects of typical vs. atypical antipsychotics
Typical - more extrapyramidal side effects
Atypical- more metabolic side effects
SSRI Interactions (3)
- NSAIDs and Asprin - increased GI bleeding, avoid or co-prescribe PPI
- Warfarin/Heprin - avoid SSRI, use mirtazapine instead
- Triptans- use a different class
Prognostic indicators of schizophrenia (5)
- Strong family Hx
- Gradual onset
- Low IQ
- Premorbid Hx of social withdrawal
- Lack of obvious precipitant
Side effects of ECT
Short term x5
Long term x1
Short term- headache, nausea, short-term memory impairment, memory loss of events prior to ECT, cardiac arrhythmia
Long term - memory impairment
Benzodiazepine withdrawal symptoms
Neuro x3
Psychological x5
Other x1
Neuro: tinnitus, tremor, seizures
Psychological: insomnia, irritability, anxiety, perceptual disturbance, decreases appetite
Other: perspiration
3x features of somatisation
Multiple physical symptoms, more than two years, patient won’t accept reassurance or negative test results
2x Key features of hypochondriac disorder
Persistent belief in underlying disease, won’t accept negative test results
3x key features of conversion disorder
Loss of motor/sensory skill
Not feigned
Not seeking material gain
3x key features of dissociative disorder
Separating memories from normal consciousness
Psychiatric symptoms such as amnesia, fugue, stupor
Worst form is dissociative identity disorder
What is munchausen’s disorder
AKA factious disorder, intentional production of symptoms. May be by proxy e.g. when a parent reports or produces symptoms in their child
What is malingering?
Fraudulent stimulation or exaggeration of symptoms for material gain
Physiological abnormalities in anorexia nervous (6 low and 5 high)
Low: potassium, reproductive hormones, T3, hypotension, bradycardia, BMI
High: cortisol, growth hormone, glucose, cholesterol, carotin
How long should you reduce dose of SSRI before discontinuing
4 weeks
Which SSRI doesn’t require dose reduction on discontinuation
Fluoxetine
Which SSRI has a higher rate of discontinuation symptoms?
Paroxetine
What are SSRI discontinuation symptoms?
Increased mood change, restlessness, difficulty sleeping, unsteadiness, sweating, GI disturbance, parasthesia
When should you consider reducing SSRI dose or stopping therapy?
6 months after remission if symptoms
Neurotransmitter mechanism in alcohol withdrawal
Chronic alcoholism causes increase in GABA and decrease in NMDA type glutamate receptors.
Withdrawal causes decrease in GABA and an increase in NMDA glutamate receptors
Features of alcohol withdrawal with associated time scale
6-12 hours: sweating, tachycardia, tremor, anxiety
36 hours: seizures
72 hours (delirium tremens): coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
Management of alcohol withdrawal
Chlordiazepoxide with a gradually reducing dose, carbamezamine if seizures
Management of depression by classification
Suspected: Assessment, support, active monitoring, psychoeducation
Mild-moderate: psychosocial intervention, medication, referral
Moderate-severe: medication, high intensity psychosocial intervention, collaborative care and referral
Severe and complex: ECT, crisis support, inpatient management
Management of anxiety
Psychological: self help, CBT, psychological therapy
Medication: SSRIs, short term benzodiazepines or propranolol for palpitations
Gate control theory of pain
Neural relays, ‘gates’ are located in the dorsal horn of the spinal cord and the degree to which they’re open controls how many pain signals are sent to the brain
What class is Mirtazipine?
Noradrenergic and specific serotonergic antidepressant
what to do with antidepressant when starting patient on ECT?
reduce to minimum dose gradually
What is dysthymia?
mild depressive symptoms over more than 2 years
Main risk of antipsychotic use in the elderly
Stroke and VTE
management of extra-pyramidal side effects
procyclidine
side effects of clozapine (5)
agranulocytosis (1%), neutropaenia (3%) reduced seizure threshold constipation myocarditis: a baseline ECG hypersalivation
What is catatonia?
Stopping of voluntary movement or staying still in an unusual position
physiological features of anorexia nervosa
hypokalaemia low FSH, LH, oestrogens and testosterone raised cortisol and growth hormone impaired glucose tolerance hypercholesterolaemia hypercarotinaemia low T3
venlafaxine MOA
serotonin and noradrenaline reuptake inhibitor
lithium side effects (10)
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
hyperparathyroidism and resultant hypercalcaemia
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
what is tardive dyskinesia?
chewing, jaw pouting or excessive blinking
features of sleep paralysis
paralysis - this occurs after waking up or shortly before falling asleep
hallucinations - images or speaking that appear during the paralysis
How long must symptoms be present for a diagnosis of PTSD?
1 month
