Psych Flashcards
4 categories of Antipsychotic SEs
Tardive dysknesia:
- choreoathetoid movements + pouting of jaw
Acute dystonia:
- torticollic
- oculogyric crisis
Extrapyramidal:
- Parkinsonism
Akathesia: restlessness
3 major clusters of symptoms for PTSD
Intrusive recollections
Hyperarousal
Avoidance
First line Rx for PTSD
If mild and <4/52: watch and wait
Otherwise, EMDR
can consider antidepressant if refractory to EMDR
What is Section 7
Application for Guardianship
ie. enables care in community where cannot be provided without the use of compulsory powers
Guardian usually a social worker, who can require a person to live in specific place, attend specific places for treatments, grant access to authorised persons
MMSE score suggestive of dementia
<24/30
Scoring system for anxiety/GAD
Hamilton Anxiety Scale
When to monitor for SEs and efficacy of drugs in GAD?
2, 4, 6, 12 weeks
Anorexia features
Distorted body image
Weight maintained below 15% of normal
(BMI <17.5)
Social phobia features
Intense, persistent fear of being negatively evaluated by others resulting in avoidance of social situations
Somatisation definition
2 year Hx multiple various physical symptoms for which no cause found. Refusal to accept reassurance
Has a family tendency
Hypochondriasis definition
Persistent belief that one has underlying illness (eg. cancer) underlying their symptoms
No familial tendency
What is echopraxia/echokinesis?
Feature of schizo
Involuntary imitation of another’s actions
What is Ambitendency?
Co-existence of mixed feelings
Lithium blood monitoring
Aim 04-1.2
Monitor level 12h post dose:
On days 4-7 after commencing
Then once weekly for 4 weeks
Then monthly
Depo antipsychotic options (atypical and typical)
Atypical: Risperidone
Typical: Haloperidol
88yo presents with daughter with forgetfulness and confusion. MMSE 24/30. Recently started on Mirtazapine for low mood.
Dx and Rx?
Depressive peudodementia
Improves with treatment of low mood
Lithium toxicity features
Tremor Dysarthria Renal impairment Nystagmus Ataxia Convulsions
Side effect of SSRI that can cause confusion/drowsiness
Hyponatraemia/SIADH
Switching from SSRI to Venlafaxine
Withdraw SSRI, commence low dose venlafaxine
EXCEPTION: Fluoxetine has long half-life
IE. leave 4-7 day gap between stopping Fluoxetine and commencing Venlafaxine
Relative and absolute contraindications to ECT
Relative: infarction stroke/MI
Absolute: Recent subdural/subarach
OCD Treatment
Exposure and Response Treatment
Avoidant personality disorder and Rx
Very shy, feel inadequate, hypersensitive to rejection. Paralysed by this into social isolation.
Rx: psychotherapy (basis of PD Rx)
Bipolar I vs Bipolar II
I: presents with mania ~severe and function impaired
II: involves hypomania ie. not involving hospital admission and can continue functioning
Indication for Venlafaxine in depression
If low risk suicide + 2 SSRIs already not worked -> SNRI eg. Venlafaxine, prior to considering ECT
Temporal lobe SOL can cause which Sx?
Personality change
Cognitive deficit
What is fugue?
Severe end of dissociate spectrum:
- forgets whole personal history and may take on a new persona
Antidepressant discontinuation syndrome:
Features?
Which antidepressants more likely?
Symptoms 2-3 days after stopping:
- GI disturbance
- vivid dreams
- nightmares
- insomnia
- headaches/sweat/lethargy
~Short acting antidepressants eg. Venlafaxine, Duloxetine
Anxiety and depression are a feature of withdrawal from many illicit drugs - but which features are more specific to cocaine withdrawal?
paranoia
fornication
Systemic therapy use
Couples therapy
Dysfunctional family therapy
Patient’s dad died. Since then, getting into trouble, rude, argumentative, moody
Rx?
Interpersonal psychotherapy ~interpersonal relationships
Ways of testing frontal lobe function
Verbal fluency (ask patient to recall as many words starting with a letter in 1min)
Estimating
Clock drawing test
Response inhibition/motor preservation (ask patient to tap twice when you tap once and vice versa)
Abstract thinking (link between pairs eg. cat and dog)
Which ages is ECT not recommended for?
Ages 5-11
Appropriate therapy for possibly autistic child?
Social skills support training
Depression is most common in which dementia
Vascular dementia > Alzheimers
Patient now abstinent from alcohol, going on a business trip, wants help to remain abstinent on trip
Disulfiram
