Psych Flashcards
SE of Clozapine for Tx-resistant schizophrenia? (after trying >/=2 anti-psychotics for at least 6wks each)
Agranulocytosis/Neutropenia (**Monitor WCC often!)
weight gain, excessive salivation, neutropenia, myocarditis, arrhythmias
NB: if clozapine doses are missed for >48hrs - must restart dose by titrating it in again carefully (OTHERWISE WORSE SE WHEN RESTARTING)
General SE of atypical anti-psychotics?
METABOLIC SEs:
Weight gain (esp Olanzapine, Quetiapine)
Hyperprolactinaemia (Risperidone; D2 inhibits prolactin release)
Dyslipiadaemia (Risperidone)
+ sedation, reduced seizure thresholds
Risk of stroke and VTE in elderly
What can cause clozapine levels in blood to rise/fall?
Rises if: Smoking cessation, alcohol binges
Falls if: Start smoking/smoking more, alcohol cessation, omitting doses
SE of ECT?
Memory impairment (retrograde memory loss - event PRIOR to ECT) Drowsiness Confusion Headache Nausea Aching muscles Cardiac arrhythmia Appetite loss
Long term: apathy, anhedonia, diff concentrating, loss of emotional responses, difficulty learning new info
Difference between mania and hypomania?
The presence of psychotic symptoms (grandiose/auditory illusions etc) + mania lasts at least 7 days (hypomania 3-4days)
Hypomania indicates ROUTINE referral to CMHT
vs. URGENT referral in mania/severe depression
What differentiates between psychosis and OCD?
Higher level of insight present in OCD but not in psychosis (delusional)
OCD associated with depression (30%), also schizo, Sydenham’s chorea, Tourette’s, anorexia
Difference between flight of ideas and Knight’s move?
Discernible links between ideas in flight of ideas. However, Knight’s move has illogical leaps
Define the following thought disorders: Circumstantiality Tangentiality Neoligisms Clang associations Word salad Knight's move Flight of ideas Preservation Echolalia
Circumstantiality = excessive unnecessary detail when answering a q
Tangentiality = wandering from a topic and doesnt return to it
Neoligisms = new word formations (combining, etc)
Clang associations = relates ideas together because they sound similar/rhyme
Word salad = incoherent sentences (real words but nonsense sentences)
Knight’s move = unexpected illogical leaps from one idea to the next
Flight of ideas = leaps from topic to topic but logical (some link between them)
MANIA (Bipolar)
Preservation = repeats ideas/words despite trying to change topic
Echolalia = repeats someone’s words, including the q asked
What food should patients taking MAOIs (Monoamine oxidase inhibitors) avoid and why?
Cheese, bovril, Oxo, marmite, broad beans (contains tyramine)
Causes a hypertensive crisis
Factors associated with increased risk of suicide?
Male Hx of self harm Alcohol/drug misuse Hx of mental illness (depression, schizo - 10% commit suicide) MHx chronic disease Advancing age Unemployment/social isolation/living alone Unmarried/divorced/widowed
+ if previous attempt, then the following confer increased risk of another (completed) attempt:
efforts to avoid discovery, planning, written note, final acts (writing a will), violent method
Protective factors against suicide risk?
Family support, children at home, employment, religious belief
What are Schneider’s first rank symptoms?
Auditory hallucinations (>/= 2 voices, third person, thought echo, running commentary)
Thought disorder (insertion, withdrawal, broadcasting)
Passivity phenomena (controlled by external influence, actions/impulses/feelings imposed on them or influenced by others)
Delusional perceptions (2 stage - first perception of normal object then sudden intense delusional insight)
+ impaired eyesight, incongruity/blunting of affect, decreased speech, neologisms, catatonia, negative symptoms (blunting, anhedonia, alogia, avolition)
Features of PTSD?
Re-experiencing (flashbacks, nightmares), avoidance, hyperarousal (hypervigilance, sleep problems, exaggerated startling, irritability, diff concentrating), emotional numbing
To diagnose: PERSIST FOR OVER 1 MONTH (DSM IV criteria)
What is Othello syndrome?
Pathological jealousy (convinced partner has been unfaithful without proof)
Isolated event or secondary to schizo, personality disorder
Poor prognostic factor of schizophrenia?
Strong FHx, GRADUAL onset, low IQ, pre-morbid Hx of social withdrawal, lack of obvious precipitant
Examples of SNRIs and what are they used to treat?
Venlafaxine, Duloxetine
Treats: Major depressive episodes, GAD, social anxiety disorder, panic disorder, menopausal symptoms
If patient is on aspirin and you are prescribing SSRI, what precautions do you need to take?
Co-prescribe a PPI to prevent GI bleeding (e.g. Lansoprazole)
First choice SSRI in a pt with Hx of cardiovasc disease?
Sertraline (esp post-MI)
Whereas Citalopram and escitalopram are associated with dose-dependent QT interval prolongation (So DONT use in congenital long QT syn or pre-existing QR prolongation)
When do you prescribe Mirtazapine instead of a SSRI?
when the pt is on warfarin/heparin
When do you prescribe Mirtazapine (NaSSA) instead of a SSRI?
When the pt is on warfarin/heparin
Usually given to older people as it stimulates appetite and is sedative (taken in evenings)
