psych Flashcards by Doha SM Basiouni Ibraheem

aside from lithium,

what is first line treatment of bipolar depressive episode

lamotrigine

antidepressants

How well did you know this?

Not at all

Perfectly

aside from lithium,

what is first line treatment of bipolar manic episode

antipsychotic - risperidone or olanzipine

How well did you know this?

Not at all

Perfectly

what are some second line treatments of bipolar?

valproate
carbemazipine
oxcarbmazepine
topiramite
gabapentin
phenytoin

How well did you know this?

Not at all

Perfectly

if bipolar resistant to depression

ECT

How well did you know this?

Not at all

Perfectly

what is lithium mechanism of action

inhibits dopamine neurotransmission

promotes GABAergic (inhibitory transmission)

downregulates NMDA (excitatory)

How well did you know this?

Not at all

Perfectly

what monitoring required in lithium?

serum lithium 
U&amp;Es 
eGFR
BMI
thyroid
CALCIUM

How well did you know this?

Not at all

Perfectly

what are the side effects of lithium?

LITHIUM CON

Leukocytosis
Increased weight
Tremor
Hypothyroid
Insipidus (diabetes)
Urine output
Mums beware (teratogenic)

Cardiac - Long QT
Oedema
Nephro/neurotoxicity

How well did you know this?

Not at all

Perfectly

what are the first rank symptoms of schizo?

delusional perception
auditory hallucinations (3rd person!)
thought alienation
passivity phenomena

How well did you know this?

Not at all

Perfectly

what are the second rank symptoms of schizo?

delusions (grandiose)
2nd person auditory
thought disorder
catatonia
negative symptoms
- blunted affect
- apathy
- alogia

How well did you know this?

Not at all

Perfectly

what dopaminergic pathways involved in schizo and

nigrostriatal - normal
tuberoinfundibilar - normal
mesocortical - low
mesolimbic - hyperactive

How well did you know this?

Not at all

Perfectly

which pathways do typical antipsychotics affect?

mesolimbic
tuberoinfundibular
nigrostriatal
CHOLINERGIC

How well did you know this?

Not at all

Perfectly

what class is haloperidol
risperidone
promazine
flupentixol
chlorpromezine

typical

How well did you know this?

Not at all

Perfectly

where do atypical antipsychotics work?

mesolimbic

serotonin

How well did you know this?

Not at all

Perfectly

where does aripiprizole work?

mesolimibic - agonist and antagonist

serotonin

How well did you know this?

Not at all

Perfectly

where does clozapine work?

mesolimbic

serotonin

How well did you know this?

Not at all

Perfectly

EPSEs

tardive dyskinesia
parkinsonism
akathisia
acute dystonia

How well did you know this?

Not at all

Perfectly

what are the serotonergic side effects that you get from

diabetes
hyperlipidaemia
weight gain

How well did you know this?

Not at all

Perfectly

What are the effects of tuberinfindibular?

galactorrhoea
gynaecomastia
infertility

How well did you know this?

Not at all

Perfectly

what are the side effects of aripiprizile?

as it is a dopamine agonist, can cause compulsive behaviours

gambling
risky behaviour
withdrawal if aripiprizole stopped

How well did you know this?

Not at all

Perfectly

clozapine side effects?

agranulocysosis and constipation

used to treat negative symptoms

How well did you know this?

Not at all

Perfectly

what are anticholinergic side effects

dry mouth
constipation
urine retention
hypotension
long QT

How well did you know this?

Not at all

Perfectly

how is neuroleptic malignant syndrome managed?

abcde
stop causative drug
iv benzos for agitation
cooling, antipyretics
treat rhabdomhyolysis
bromocriptine and amantadine used as muscle relaxants

How well did you know this?

Not at all

Perfectly

what are the signs of bulimia?

dental erosion
parotid hypertrophy
russels sign
arrhythmia

How well did you know this?

Not at all

Perfectly

what are the signs of anorexia?

lanugo hair
telogen effluvion
carotenderma
dry skin cracked nails
proximal muscle weakness

How well did you know this?

Not at all

Perfectly

what is refeeding syndrome characterised by?

``` hypophosphataemia hypomagnesemia hypokalaemia thiamine deficiency salt + water retention ```

how does refeeding present?

``` arrhythmias gi disturbance weakness sob delirium seizures nystagmus ```

how is refeeding prevented?

monitor electrolytes thiamine supplementation slow refeeding

what investigation for personality disorder?

mmpi minnesota eysenck personality questionnaire

how are alcohol units calculated?

percentage * vol in L

can you prescribe SSRIs with MAOIs?

no, serotonin syndrome phenelzine

what is the effect of SSRIs on natraemia?

hyponatraemia?

what are the core features of depression?

1. low mood 2. anhedonia 3. anergia

how is bipolar diagnosed?

at least 2 disturbances in mood | at least 1 manic/hypomanic

how would alzheimer's look postmortem?

widespread cerebral atrophy

what does refeeding syndrome affect?

potassium magnesium phosphate

how to calm a patient with PD or LBD>

im lorazepam | avoid haloperidol/olanzipine

what are the features of aspirin overdose?

respiratory alkalosis due to hyperventilation then progresses to metabolic acidosis patients have tinnitus vomiting dehydration

how is aspirin od managed?

iv rehydration activated charcoal urinary alkalisation!!! dialysis if severe poisoning

how would opiate od present?

pinpoint pupils hypoventilation - resp acidosis reduced gcs pupils dilate in withdrawal

which ecg abnormality in anorexia?

qt prolongation (electrolyte disturbance/weight loss)

which type of amnesia more common following ect?

retrograde amnesia (remembering events prior to insult

what is anterograde amnesia?

can't form new memories

what are the side effects of donepezil?

``` diarrhoea n,v bradycardia hypersalivation urinary incontinence ```

what is the effect of anorexia on wbc count?

low

patient with palpitations and feeling on edge all the time sometimes exercise induced. what investigation?

48 hour holter monitor ecg

what is transient global amnesia

temporary but total disruption of amnesia perseveration preserved functioning?

what are the symptoms of heroin withdrawal?

``` sweating watering eyes rhinorrhea yawning GI upset anxiety and irritability ```

which ssri in breastfeeding?

sertraline and paroxetine

first line managament of schizophrenia?

risperidone

beta amyloid plaques and neurofibrillary tangles with hyperphosphorylated tau proteins. what?

alzheimers

how to distinguish bulimia from anorexia?

bulimia has normal bmi binge eating and purging is also in anorexia

how do antipsychotics work?

dopamine receptor antagonism

if patient is intolerant of methylphenidate, what to do?

switch to atomoxetine facial tics are a side effect of methylphenidate

how is severe alzheimer's treated?

memantine

what is a side effect of memantine?

``` constipation impaired balance dizziness drowsiness dyspnoea hallucination vomiting ```

which type of diuretic associated with lithium toxicity?

thiazide | bendroflumethiazide

what is a mild depressive episode ?

two core + 2 additional features

how to differentiate borderline and impulse eupd?

borderline = uncertainty with self-image, intense relationships, try to avoid abandonment impulsive = outbursts, unstable mood

which medications avoided in depression?

tca = overdose is bad

what is hypnogogic?

as you fall asleep

what is hypnopompic?

as you wake up | pompous, high head, wake up

give examples of dopamine agonists?

ropinirole

what causes serotonin syndrome

``` tramadol phenelzine st johns wort ecstasy amphetamines ```

how is serotonin syndrome treated?

``` iv fluids benzodiazepines serotonin antagonists: - cyproheptidine - ```

how is neuroleptic malignant syndrome treated?

iv fluids dantrolene bromocriptine (dopamine agonist)

how are epses treated?

procyclidine

how is tardive dyskinesia treated?

tetrabenazine

which antipsychotic LEAST associated with prolactinaemia

aripiprizole

pt on lithium has constipation. what

hypercalcaemia due to hyperparathyroidism | Bisphosphonates for hypercalcaemia?