Psych Flashcards
What are the common and less common side effects of dexamphetamines?
Common side effects
- decreased appetite (esp lunch)
- Weight loss (Deceleration of linear growth but does not affect adult height or peak growth velocity)
- sleep onset delay
- Psych: psychosis, mania, hallucinations
- Tics 15-30% develop motor tics most of which are transient
DSM 5 criteria for OCD
1) presence of obsessions or compulsions or both
2) the obsessions or compulsions or time consuming (>1hr/day) or cause clinically significant distress or impairment in social, occupational or other important areas of function
3) the obsessive compulsive symptoms are not attributable to the physiological effects of a substance or other medical condition
4) the disturbance is not better explained by the symptoms of another mental disorders
Treatment for OCD
CBT along or CBT in combination with SSRI (higher dose) more moderate to severe cases
In OCD with comorbid tics CBT+SSRI > CBT > placebo = SSRI
Clomipramine (TCA) for treatment resistant illness
Most common reason for deliberate self harm
1) Get relief from a terrible state of mind
2) cutters = punish myself
2) poisoners = I wanted to die
Hereditability of schizophrenia
Monozygotic twins 33%
Dizygotic twins 7%
Parents 5-10% (college answer 5%)
Heretability of Anorexia Nervosa
MZ twin 65%
DZ twin 30%
First degree relative 6-10 times more likely
Clinical features of refeeding syndrome
Hypophosphatemia
- hallmark of the syndrome and predominant cause of the refeeding syndrome (14%)
- stores of phosphate are depleted during episodes of anorexia nervosa and starvation. When nutritional replenishment starts and patients are fed carbohydrates, glucose causes release of insulin, which triggers cellular uptake of phosphate (and potassium and magnesium) and a decrease in serum phosphorous levels.
- Insulin also causes cells to produce a variety of depleted molecules that require phosphate (eg, adenosine triphosphate and 2,3-diphosphoglycerate), which further depletes the body’s stores of phosphate
- The subsequent lack of phosphorylated intermediates causes tissue hypoxia, myocardial dysfunction, respiratory failure due to an inability of the diaphragm to contract, hemolysis, rhabdomyolysis, and seizures.
●Hypokalemia
●Congestive heart failure
●Peripheral edema
●Rhabdomyolysis
●Seizures
●Hemolysis
The risk of developing the refeeding syndrome is directly related to the amount of weight loss during the current episode and the rapidity of the weight restoration process
Patients are at the highest risk for the refeeding syndrome in the first one to two weeks of nutritional replenishment and weight gain
Sides effects of haloperidol/Risperidone
Extrapyramidal side effects
- dystonic reactions -> IV benztropine
- constipation
- anorexia
- increased/decreased BSL
Neuroleptic malignant syndrome
Clinical manifestations
Ix
Mx
The tetrad of NMS symptoms typically evolves over one to three days. Each feature is present in 97 to 100 percent of patients:
1) Mental status change is the initial symptom in 82 percent of patients
This often takes the form of an agitated delirium with confusion rather than psychosis. Catatonic signs and mutism can be prominent. Evolution to profound encephalopathy with stupor and eventual coma is typical
2) “lead-pipe rigidity”
Superimposed tremor may lead to a ratcheting quality or a cogwheel phenomenon. Other motor abnormalities include tremor (seen in 45 to 92 percent), and less commonly, dystonia, opisthotonus, trismus, chorea, and other dyskinesias
3) Hyperthermia is a defining symptom according to many diagnostic criteria. Temperatures of more than 38°C are typical (87 percent), but even higher temperatures, greater than 40°C, are common (40 percent)
- > less consistent sx in second gen antipsychotics
4) Autonomic instability typically takes the form of tachycardia (in 88 percent), labile or high blood pressure (in 61 to 77 percent), and tachypnea (in 73 percent)
Ix:
Elevated CK
Non specific
- raised WCC, hypocalcemia, hypomagnesemia, hypo- and hypernatremia, hyperkalemia, and metabolic acidosis are frequently observed,
Mx:
Stop causitive agent
Supportive care
Benzodiazelines for behavioural disturbance
Patients with significant hyperthermia and rigidity should be admitted to an intensive care unit
Complications of neuroleptic malignant syndrome
Dehydration
●Electrolyte imbalance
●Acute renal failure associated with rhabdomyolysis
●Cardiac arrhythmias, including torsades de pointes and cardiac arrest
●Myocardial infarction
●Cardiomyopathy
●Respiratory failure from chest wall rigidity, aspiration pneumonia, pulmonary embolism
●Deep venous thrombophlebitis
●Thrombocytopenia
●Disseminated intravascular coagulation
●Deep venous thrombosis
●Seizures from hyperthermia and metabolic derangements
●Hepatic failure
●Sepsis
DSM 5 criteria for ASD
1) persistent deficits in social communication and interaction
- deficits in socio-emotional reciprocity
- deficits in non verbal communicative behaviours used for social interaction (e.g eye contact, understanding gestures, lack of facial expressions, non verbal)
- deficits in developing, maintaining, understanding relationships (e.g. imaginative play, adjusting behaviour to suit social contexts, absence of interest in peers)
2) restricted, repetitive patterns of behaviour, interests or activities (At least 2 of the following)
- stereotyped/repetitive movements, use of objects or speech (e.g. lining up toys, idiosyncratic phrases)
- insistence of sameness, inflexible adherance to routines, ritualised patterns of verbal/non verbal behaviour (e.g. extreme distress to small changes, rigid thinking patterns, greeting rituals, need to eat same food)
- highly restricted or fixated interests that are abnormal in intensity or focus
- hyper/hypo activity to sensory input or unusual interest in sensory aspect of the environment (e.g. apparent indifference to pain/temp, adverse response to specific sound/texture, excessive smelling/touching object, visual fascination with lights)
HEADDSS
Home Health Education Employment Activities Drugs Depression Safety Sexuality
Serotonin syndrome clinical features
1) cognitive - agitation, delerium, hallucinations, coma
2) autonomic - tachycardia, nausea, diarrhoea, sweating, shivering, hyperthermia
3) somatic - tremor, myoclonus, hyperreflexia (most specific signs)
Rapid onset (hours)
Primary side effects of Risperidone
Mild sedation
Hypotension
Akathisia (subjective feeling of restlessness)
Prolactin elevation (menstrual irregularity)
Weight gain
Others:
Moderate risk of extrapyramidal SEs
Increased dream activity
Clinical presentation of refeeding syndrome
Patients with severe anorexia nervosa (i.e. less than 75% of ideal body weight) and those who have lost a large amount of weight rapidly are at risk for the refeeding syndrome during the first two to three weeks of refeeding.
Patients with severe weight loss who are rapidly refed are at greatest risk
While refeeding syndrome has been defined primarily by manifestations of severe hypophosphatemia (including cardiovascular collapse, rhabdomyolysis, seizures, and delirium) a number of abnormalities that occur with refeeding can produce suchsymptoms.Hypokalemia and hypomagnesemia can lead to cardiac arrhythmias. Hypokalemia results from insulin secretion in response to a caloric load, which shifts potassium into cells. The etiology of hypomagnesemia in this setting is not known.
Wernicke’s encephalopathy can occur with refeeding in a thiaminedeficient patient and manifest as delirium.Thus, in addition to medical monitoring of vital signs, carefully monitoring electrolytes (including potassium and phosphate daily) and looking for signs ofo edema, congestive heart failure, and mental status changes are important during refeeding.
