Psych additional Flashcards
alcohol withdrawal sx and times
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
sx- tremor, tachycardia, sweating, anxiety
Factors associated with poor prognosis of schizophrenia
- strong family history
- gradual onset
- low IQ
- prodromal phase of social withdrawal
- lack of obvious precipitant
Schneider’s first rank sx for schizophrenia
- Delusions
- Auditory hallucinations
- Thought disorder: insertion, withdrawal, broadcasting
- Passivity phenomena
what is schizoid personality disorder
tendency towards solitariness, lack of interest in social relationships, and emotional detachment
what is schizotypal PD
- Ideas of reference (differ from delusions in that some insight is retained)
- Odd beliefs and magical thinking
- Unusual perceptual disturbances
- Paranoid ideation and suspiciousness
- Odd, eccentric behaviour
- Lack of close friends other than family members
- Inappropriate affect
- Odd speech without being incoherent
difference between schizoid and schizotypal
Schizoid = AVOID
Schizotypal = type of schizophrenia (has weird thoughts)
personality disorder clusters
- Cluster A (MAD): - ‘odd or eccentric’ - paranoid, schizoid, schizotypal
- Cluster B (BAD): ‘dramatic, erratic or emotional’ - histrionic, emotionally unstable(/borderline), dissocial, narcissistic
- CLuster C (SAD): ‘anxious and fearful’: anankastic, anxious (avoidant) and dependent.
What is Russell’s sign?
calluses on the knuckles or back of the hand due to repeated self-induced vomiting
bulimia
purging behaviours
vomiting
laxative
exercise
diuretics
schizoaffective disorder
combination of psychotic symptoms and prominent mood symptoms (e.g., mania or depression).
What are the main approaches to managing OCD?
- CBT (exposure and response prevention)
- SSRIs (most commonly fluoxetine)
- 3rd line: clomipramine (TCA)
discontinuitation sx of SSRIs
- increased mood change
- restlessness
- difficulty sleeping
- unsteadiness
- sweating
- GI sxs: pain: cramps, diarrhoea, vomiting, paraesthesia
Duloxetine mechanism of action
serotonin and noradrenaline reuptake inhibitor
What is the most appropriate action to take with regards to SSRIs prior to ECT treatment for this patient?
Antidepressant medication should be reduced but not stopped when a patient is about to commence ECT treatment
What is Charles Bonnet syndrome?
A phenomenon in which patients with severe visual impairment report vivid hallucinations
What is Othello syndrome?
Also known as delusional jealousy, is a delusional disorder with male preponderance in which patients hold a firmly held belief that their partner is unfaithful, in the absence of proof.
what is acute dystonia?
sudden involuntary muscle contractions and spasms, often affecting the neck (torticollis), jaw, and tongue.
what is tardive dyskinesia?
rhythmic involuntary movements e.g. grimace, chewing, sucking movements (mainly facial)
what is parkinsonism?
tremor,rigidity,bradykinesia
mx of parkinsonism
change the drug/dose,
sometimes anticholinergics like procyclidine can help
what is akathisia
unpleasant feeling of restlessness
mx of akathisia
change drug/dose, or give
propranolol, benzos
examples of typical antipsychotics
haloperidol
Chlorpromazine
examples of atypical antipsychotics
aripiprazole
Clozapine
Risperidone
Olanzapine
examples of EPSEs
- acute dystonia
- akathisia
- parkinsonism
- tardive dyskinesia
What is the most appropriate medication choice to prevent further seizures in alcohol withdrawal?
chlordiazepoxide
side effects of mirtazapine
- increased appetite
- increased sleep
first line medication for GAD
sertraline
difference between knight’s move and flight of ideas
- Knight’s move= thinking there are illogical leaps from one idea to another
- Flight of ideas there are discernible links between ideas
what food to avoid on SSRI
Grapefruit juice is a CYP inhibitor and can increase serum levels of SSRIs
what is conversion disorder
loss of motor and sensory function, which typically arises during periods of stress
drug itneraction that can cause serotonin syndrome
SSRIs and MAOIs so never co-prescribe
what are side effects of clomipramine (TCAs)
Dry mouth (anticholinergic) and weight gain (antihistaminic)
what medication can precipitate a benign leucocytosis
lithium
Most appropriate antidepressant to start post MI
sertraline
features of anorexia
- most things low
- G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
unexplained sx
Somatisation = Symptoms
hypoChondria = Cancer
delusional parasitosis
Patient with a fixed, false belief (delusion) that they are infested by ‘bugs’
side effect of steroid use
steroid-induced psychosis
Metabolic side effects of antipsychotics
- dysglycaemia
- dyslipidaemia
- diabetes mellitus
What pattern of memory loss is characteristic for severe depression
global memory loss, can mimic dementia but is pseudodementia
most effective antipsychotic for dealing with negative symptoms
clozapine
short term side effects of ECT
- headache
- nausea
- short term memory impairment (retrograde amnesia more common than anterograde amnesia)
- memory loss of events prior to ECT
- cardiac arrhythmia
RF for GAD
- Aged 35- 54
- Being divorced or separated
- Living alone
- Being a lone parent
what happens when a pt takes disulfiram
Within twenty to thirty minutes of alcohol consumption results in unpleasant symptoms, including facial flushing and nausea and vomiting
what is korsakoff syndrome
- complication of wernicke’s encephalopathy
- It’s features include: anterograde amnesia, retrograde amnesia, and confabulation
triad for wernicke’s encephalopathy
- ophthalmoplegia (often a lateral rectus palsy and/or horizontal nystagmus)
- confusion
- ataxia (though any cerebellar signs can be present)
what is Erotomania (De Clerambault’s syndrome)
The presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms
differing demographic in antisocial PD and borderline PD
Antisocial personality disorder more often affects men than it does women,
Borderline personality disorder affects more women than men.
What is formication
a type of paraesthesia in which it feels like insects are crawling on the skin
where does heroin act in the brain
mu opiate agonist stimulates brain and spinal cord receptors which are normally acted on by
endogenous endorphins (reduce pain
presentation of heroin use
- pinpoint pupils
- Intense rush/buzz, feelings of euphoria
- anorexia
- decreased libido
antidote for opiate overdose
naloxone
sx of opiate withdrawal
- peaks 36-48hrs
- dysphoria, nausea, insomnia, agitation
- flu like sx
- ‘Everything runs’: diarrhoea, vomiting, lacrimation, rhinorrhoea
- gooseflesh ‘cold turkey’
signs of benzo withdrawal
- insomnia
- tremor
- agitation
- loss of appetite
- excessive sweating
- tinnitus
- seizures
antidote to benzo overdose
flumazenil
medication for alcohol dependence
- Disulfiram (aversive)
- Acamprosate (anti-craving)
- Naltrexone (anti-craving)
antidote to paracetamol overdose
N-acetylcysteine
activated charcoal if presenting within the first hour
where in the brain is affected by Alzheimer’s
- hippocampus affected early: new learning and visuospatial skills
- temporal and parietal lobes later
What is Alzheimer’s
increased B-amyloid
F>M
Age biggest RF
4As
Amnesia
Agnosia- recognition problems
Aphasia
Apraxia- inability to carry out skilled tasks despite normal motor function
what is vascular dementia
dementia due to infarcts causes by thromboembolism or atherosclerosis
presentation of vascular dementia
Stepwise progression - each step representing a sudden deterioration as an infarct occurs
what is lewy body dementia
Lewy bodies - eosinophilic intracytoplasmic neuronal structures composed from a-synuclein with ubiquitin
found in cingulate nucleus and neocortex
presentation of lewy body dementia
2/3 should alert possibility of DLB:
1. bradykinesia, rigidity, tremor
2. fluctuating confusion with variation in awareness
3. vivid visual hallucination- little men or animals
how to diagnose neuroleptic malignant syndrome
Serum creatine kinase (CK), which is a muscle enzyme that can be elevated in NMS.
mx of mania
antipsychotic e.g. olanzapine
mx of dystonia
anticholinergic e.g. benztropine or diphenydramine
mx of alzheimers and lewy body dementia
- 3 acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) for mild to moderate
- memantine (NMDA receptor antagonist) 2nd line
how to differentiate between delirium and dementia
- One of the main factors favouring delirium is impairment of consciousness,
- fluctuating sx and hallucinations = delirium
Section 2
- admission for assessment for up to 28 days, not renewable
- made by an Approved Mental Health Professional (AMHP) on behalf of 2 doctors
- one of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
section 3
- for up to 6 months, can be renewed
section 4
- 72 hour assessment order
used as an emergency - a GP and an AMHP or NR
often changed to a section 2 upon arrival at hospital
section 5(2)
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
F1 can do
section 5(4)
similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
section 135
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
section 136
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
Naltrexone use
similar to acamprosate
used for anti-craving in alcohol dependence
what is disulfiram
anti-eversive in alcohol dependence. makes you go red and feel hungover
mx of acute dystonia
procyclidine (anti-cholinergic)
Mx of tardive dyskinesia
tetrabenzine
signs of TCA overdose (e.g. amitriptylline)
- dry mouth
- dilated pupils
- arrhythmias
- seizures
- metabolic acidosis
- coma
ECG
- sinus tachycardia
- widening of QRS
- prolongation of QT interval
