Psych Brief Flashcards
Describe the first-line investigation for a young female with a BMI of 16 presenting with primary amenorrhea.
Ultrasound
Female BMI 16 with bony pain first inv……
DEXA scan ..osteoporosis
What is the priority in managing a patient with anorexia nervosa?
Monitoring electrolyte levels, especially potassium (hypo K)
Define the main difference between bulimia and anorexia nervosa.
Bulimia patients typically maintain a normal weight.
How does anorexia nervosa affect pregnancy outcomes?
It often leads to low birth weight infants.
Do individuals with body dysmorphic disorder always have a high BMI?
No, even with a normal BMI, they may perceive themselves as overweight.
Effect of anorexia nervosa on pregnancy……
Effect of malaria on pregnancy…….
Effect of cocaine on pregnancy……
Effect of smoking on pregnancy……..
Effect of anorexia nervosa on pregnancy……Low birth weight
Effect of malaria on pregnancy…….low birth weight
Effect of cocaine on pregnancy……low birth weight
Effect of smoking on pregnancy……..low birth weight
Inv NOT routine in anorexia nervosa……
gonadotropins
Long term prognosis of bulimia nervosa……
Long term prognosis of OCD….
Long term prognosis of borderline personaity disorder…
Long term prognosis of generalized anxiety…..
Long term prognosis of panic attack……
Long term prognosis of bulimia nervosa……depression
Long term prognosis of OCD…..PSYCHOSIS
Long term prognosis of borderline personaity disorder….psychosis
Long term prognosis of generalized anxiety…..depression
Long term prognosis of panic attack…….depression
Female always feel that she is overweight although normal BMI…
.body dysmorphic disorder
Causes of body dysmorphic disorder?
1-bulimia nervosa
2-anorexia nervosa
3-amputated limb
4-acromegaly
5- neglect syndrome
Most common course of obsessive compulsive disorder….
wax and wane
Most common course of depression…….
.regressive
Distrustiful suspicious person……Female with history of crimes, drug abuse, sexual troubles, left her family and lives alone……
Male with history of crimes, drug abuse, sexual troubles, left his family and lives alone more than 18 ys……
Most risk with borderline……suicide
Psychotherapy for borderline……
Psychotherapy for trichillomania…..
Male lives alone doesnot care about people……
Male lives alone feels being rejected……..
Male lives alone with with ideas of reference……
Male with high self esteem doesnot show empathy….
.paranoid
Female with history of crimes, drug abuse, sexual troubles, left her family and lives alone……borderline
Male with history of crimes, drug abuse, sexual troubles, left his family and lives alone more than 18 ys……antisocial
Most risk with borderline……suicide
Psychotherapy for borderline……dialectal
Psychotherapy for trichillomania…..aversion
Male lives alone doesnot care about people……schizoid
Male lives alone feels being rejected……..avoidant
Male lives alone with with ideas of reference……schizotypal
Male with high self esteem doesnot show empathy….narcissitic
Female being abused by her boy friend but still feels as if she can never live without him……
Female gives great care to the order of furniture in her home and has a strict schedule of her life routine…
Female during interview wears sexy clothes and tries to seduce the employer to get the job……
Child 5 ys his mother complains of his overactivity and that he doesnot listen to what she says…..
First step to confirm ADHD……
Drug of choice for ADHD…….
Most imp test for ADHD………..
Female being abused by her boy friend but still feels as if she can never live without him…… dependent
Female gives great care to the order of furniture in her home and has a strict schedule of her life routine… Obsessive compulsive
Female during interview wears sexy clothes and tries to seduce the employer to get the job……historionic
Child 5 ys his mother complains of his overactivity and that he doesnot listen to what she says…..ADHD
First step to confirm ADHD……call the teacher and ask for his grades
Drug of choice for ADHD…….methyphenidate
Most imp test for ADHD………..hearing test
Boy 4 ys old with low IQ limited social activity, limited language development , fascinating with certaing toys…..
Boy 4 ys old with normal IQ , limited social activity, normal language development , fascinating with certaing toys…..
Kid diagnosed as asperger syndrome on SSRI now agitated:
Most common cause……….SSRI ( side effect)
2nd most common cause…….part of the disease
Boy 4 ys old with low IQ limited social activity, limited language development , fascinating with certaing toys…..AUTISM
Boy 4 ys old with normal IQ , limited social activity, normal language development , fascinating with certaing toys…..asperger
Kid diagnosed as asperger syndrome on SSRI now agitated:
Most common cause……….SSRI ( side effect)
2nd most common cause…….part of the disease
Describe the long-term prognosis of bulimia nervosa.
It is often associated with depression.
What is the most common psychiatric disorder causing the highest rate of death?
Anorexia nervosa
What is the primary psychotherapy approach used for borderline personality disorder?
Dialectical behavior therapy
Define the behavior of a person with schizoid personality disorder.
They prefer to live alone and are indifferent to social relationships.
How does cocaine use during pregnancy affect the baby?
It can lead to low birth weight in newborns.
What is the drug of choice for treating ADHD?
Methylphenidate
Describe the characteristics of a child with autism.
They may have limited social activity, language development, and show fascination with specific objects or toys.
8 ys child doing recurrent grimacing and recurrent strange sounds….
Most common association with Tourret’s……
Drug of choice for tourret’s……antipsychotic
Child 14 ys with history of drinking alcohol and recurrent fighting with his peers in school…….
6 ys old kid doesno have many friends accused before of making making fights……….
8 ys child doing recurrent grimacing and recurrent strange sounds….Tourret’s
Most common association with Tourret’s……OCD
Drug of choice for tourret’s……antipsychotic
Child 14 ys with history of drinking alcohol and recurrent fighting with his peers in school…….conduct
6 ys old kid doesno have many friends accused before of making making fights……….oppositionsl deficient disorder
What is the most common association with Tourette’s syndrome?
Obsessive-compulsive disorder (OCD)
Is masturbation considered a normal act?
Yes
Is being gay or lesbian considered a normal act?
Yes
TTT of choice for :
Anorgasm………..
Premature ejaculation……….
Vaginismus…………
TTT of choice for :
Anorgasm………..self stimulation
Premature ejaculation……….squeeze technique
Vaginismus…………vaginal dilators
Male feels orgasm by rubbing his body against clothed females in crowded places……
Male feels orgasm by having sex with kids….
Male feels that he is a woman in male’s body and asking for plastic surgeries to change his sex…..
Male feels orgasm by rubbing his body against clothed females in crowded places……frotteruism
Male feels orgasm by having sex with kids….pedophilia
Male feels that he is a woman in male’s body and asking for plastic surgeries to change his sex…..transsexualism
Young females with recurrent attacks of hyperventilation, palpitationg and feeling as if she will die….
panic
What is the squeeze technique used for?
Premature ejaculation
Describe the treatment for an acute attack of panic.
Benzodiazepine
Lab of panic…..
alkalosis, hypocapnea and increased O2
Woman with marked fear each time she has to give public speaking…..
Best ttt for specific phobia…..
Imp test for dementia……..
There is no definitive investigation for Alzheimer
Alzheimer is not preventable nor curable
First to be affected in Alzheimer……
Least likely to be affected with Alzheimer is
Psychiatric illness increases in incidence………..
2nd most common cause of death in australia….
Woman with marked fear each time she has to give public speaking…..social phobia
Best ttt for specific phobia…..gradual exposure
Imp test for dementia……..MMSE test|( less than 24)
There is no definitive investigation for Alzheimer
Alzheimer is not preventable nor curable
First to be affected in Alzheimer…….memory
Least likely to be affected with Alzheimer is face recognition
Psychiatric illness increases in incidence………..dementia
2nd most common cause of death in australia….dementia
Memory affection with normal aging sometimes very similar to Alzheimer except that there is no impairment of normal function……..
Drug of choice for alzeheimer….
Best drug for alzeheimer with heart disease……..
Dementia + visual hallucinations + parkinsonism…
Dementia+personality changes+abnormal movements…
Dementia + marked personality and attitude changes…..
Dementia+urine incontinence+abnormal gait…..
Dementia+young aged male with uncontrolled HTN….
Short history of dementia+sleeping troubles….
Old age in the hospital sleeping during the day, agitated…
Most imp inv for delirium…….
Most imp drug to control agitation in delerium…..
Agitation in admitted person…..
TTT of alcohol withdrawal…..
Female being raped now complains
of flashbacks and troubles in sleeping……
Memory affection with normal aging sometimes very similar to Alzheimer except that there is no impairment of normal function…….. he lives independently
Drug of choice for alzeheimer….donepezil, tacrine
Best drug for alzeheimer with heart disease……..memantine
Dementia + visual hallucinations + parkinsonism….lewy body
Dementia+personality changes+abnormal movements…Huntington
Dementia + marked personality and attitude changes…..frontal lobe dementia
Dementia+urine incontinence+abnormal gait…..normal pressure hydrocephalus
Dementia+young aged male with uncontrolled HTN….vascular
Short history of dementia+sleeping troubles….depression
Old age in the hospital sleeping during the day, agitated…delerium
Most imp inv for delirium…….urine analysis
Most imp drug to control agitation in delerium…..antipsychotic
Agitation in admitted person…..think of alcohol withdrawal
TTT of alcohol withdrawal…..diazepam
Female being raped now complains of flashbacks and troubles in sleeping……PTSD
Most effective ttt in PTSD…..
Drug of choice for PTSD…..
Drug of choice for OCD……
Drug of choice for depression…..
Drung of choice for GAD……
Long term ttt for panic….
Most effective ttt in PTSD…..group councelling
Drug of choice for PTSD…..SSRI
Drug of choice for OCD……SSRI
Drug of choice for depression…..SSRI
Drung of choice for GAD……SSRI
Long term ttt for panic….SSRI
Define transvestism.
Male feeling orgasm by wearing his girlfriend’s underwear
What is the most common association with panic disorder?
Agoraphobia
How is vaginismus treated?
Vaginal dilators are used
Do individuals with transsexualism seek plastic surgeries to change their sex?
Yes
What is the main cause of Wernicke’s encephalopathy?
Thiamine deficiency
Describe the main symptom of a patient with frontal lobe dementia.
Marked personality and attitude changes
What is the drug of choice for Alzheimer’s disease?
Donepezil or tacrine
Female patients with long history of hospital admissions with many procedures and surgeries done…..
Kid admitted hospital becomes sick only when his mom visits him…..
Male patient presents with symptoms of insomnia and dereased appetite but has problems with immigration……
Male patient comes to the clinic with severe renal colic asking for strong analgesics, his investigations normal…..
First step in this patient…urine sampling in front of you
Male patient alcoholic now complains of nystagmus, gait instability and drowsy….
Main cause of wernike’s encephalopathy….
TTT of wernike’s encephalopathy….
18 ys female patient failed an exam 6 months age, since that time she doesnot feel she is the same person before the exam…..
Female patients with long history of hospital admissions with many procedures and surgeries done…..factitious
Kid admitted hospital becomes sick only when his mom visits him….. mauchusen syndrome by proxy
Male patient presents with symptoms of insomnia and dereased appetite but has problems with immigration……think of malingering
Male patient comes to the clinic with severe renal colic asking for strong analgesics, his investigations normal…..malingering
First step in this patient…urine sampling in front of you
Male patient alcoholic now complains of nystagmus, gait instability and drowsy….wernike’s encephalopathy
Main cause of wernike’s encephalopathy….thiamine deficiency
TTT of wernike’s encephalopathy….THIAMINE then GLUCOSE
18 ys female patient failed an exam 6 months age, since that time she doesnot feel she is the same person before the exam…..adjustment disorder
How is PTSD commonly treated?
Group counseling is the most effective treatment
Police brings to you male confused doesn’t know his name, addressor any thing about his work….
Causes of IMPULSE CONTROL DISORDER:
1-KLEPTOMANIA
2-PYROMANIA
3-TRICHILLOMANIA
4-PATHOLOGICAL GAMBLING
Female patient with recurrent acts of stealing of stuff she doesnot really needs….
Main ttt of kleptomania…..
Male patient with recurrent episodes of doing firing in home and school……
Why pyromanics do firing……
Female patient with no hair on half of her scalp…
Most common cause of fires in australia……….
Police brings to you male confused doesn’t know his name, addressor any thing about his work…. dissociative fugue
Causes of IMPULSE CONTROL DISORDER:
1-KLEPTOMANIA
2-PYROMANIA
3-TRICHILLOMANIA
4-PATHOLOGICAL GAMBLING
Female patient with recurrent acts of stealing of stuff she doesnot really needs…. KLEPTOMANIA
Main ttt of kleptomania…..aversion
Male patient with recurrent episodes of doing firing in home and school……pyromania
Why pyromanics do firing……satisfaction
Female patient with no hair on half of her scalp… TRICHILLOMANIA
Most common cause of fires in australia……….pyromania
Define frotteurism.
Male feeling orgasm by rubbing his body against clothed females in crowded places
What is the best treatment for specific phobia?
Gradual exposure therapy
How is delirium managed in hospitalized patients?
Antipsychotic drugs are used to control agitation
Describe the presentation of a patient with Lewy body dementia.
Dementia with visual hallucinations and parkinsonism
What is the long-term treatment for panic disorder?
- CBT
- Behavioural therapy (Graded exposure)
- SSRI for 6-12m (Fluoxetine)¥
NOTE: if there is no trigger, exposure therapy is not indicated
Do individuals with pedophilia feel orgasm by having sex with kids?
Yes
Define malingering.
Feigning illness for secondary gain, such as obtaining strong analgesics
How is vascular dementia characterized?
Young aged male with uncontrolled hypertension
Describe the main symptom of a patient with normal pressure hydrocephalus.
Dementia with urine incontinence and abnormal gait
What is the most important investigation for delirium?
Urine analysis
Do individuals with factitious disorder have a long history of hospital admissions with many procedures done?
Yes
Define PTSD.
Post-Traumatic Stress Disorder
How is PTSD commonly treated pharmacologically?
SSRI medication is the drug of choice
What is the drug of choice for OCD?
SSRI medication
Describe the presentation of a patient with Huntington’s disease.
Dementia with personality changes and abnormal movements
What is the first step in managing a patient with suspected malingering?
Urine sampling in front of the healthcare provider
How is adjustment disorder characterized?
Feeling like a different person after a specific stressful event
Describe the presentation of a patient with Mauchausen syndrome by proxy.
Child becomes sick only when the caregiver is present
What is the drug of choice for depression?
SSRI medication
Describe dissociative fugue
A dissociative disorder characterized by sudden, unexpected travel away from home or customary place, often memory loss of one’s past.
Define impulse control disorder
A psychiatric condition where individuals struggle to resist impulses or urges that may harm themselves or others.
How is kleptomania treated?
Main treatment is aversion therapy.
Do pyromaniacs set fires for satisfaction?
Yes, pyromaniacs set fires for satisfaction.
Describe trichotillomania
A disorder where individuals have an irresistible urge to pull out their hair, leading to noticeable hair loss.
What is the main treatment for grief?
Support is the main treatment for grief.
Main ttt of grief……
TTT of grief and depression……
TTT of marked insomnia with grief…..
Most imp to depression with grief………
Grief + visual hallucination…..
Main ttt of grief……support
TTT of grief and depression……SSRI
TTT of marked insomnia with grief…..benzodiazepines
Most imp to depression with grief………suicidal ideation
Grief + visual hallucination…..normal grief
Imp question to patient with postpartum ……
Main risk factor for postpartum psychosis……….
Most imp to check in mom after labor…..
Main ttt of mild post partum depression……
Important steps for mild postpartum blue……
Treatment of cases of postpartum psychosis…
Imp question to patient with postpartum …… if she have any feeling of hurting herself or her baby
Main risk factor for postpartum psychosis……….primipara
Most imp to check in mom after labor…..mood
Main ttt of mild post partum depression……family support
Important steps for mild postpartum blue……family involvement and continue breast feeding
Treatment of cases of postpartum psychosis…involuntary admission and .ECT
Define circumstantiality
Inability to answer a question without giving excessive, unnecessary detail, but eventually answering the question.
Inability to answer a question without giving excessive, unnecessary detail.. but eventually will answer the question…….
if doesnot answer the question…..
feeling that you saw this situation before….
Female patient told you that a very famous celebrity loves her…
Male patient came to told shouting that he is the God and should be followed…..
Old age patient anxious telling you his neighbors trying to kill him by putting poisons in his food ….
Patient feels that the people are talking about him….
Main ttt of delusions………
Inability to answer a question without giving excessive, unnecessary detail.. but eventually will answer the question…….Circumstantiality
if doesnot answer the question…..tangentiality
feeling that you saw this situation before….deja vu
Female patient told you that a very famous celebrity loves her…delusion of erotomania
Male patient came to told shouting that he is the God and should be followed…..delusion of grandiosity
Old age patient anxious telling you his neighbors trying to kill him by putting poisons in his food ….delusion of persecution
Patient feels that the people are talking about him….delusions of reference
Main ttt of delusions………antipsychotics
How is delusion of grandiosity characterized?
Belief that one has exceptional abilities, wealth, or fame, often leading to a sense of superiority.
2 sisters sharing the same psychotic’s symptoms…
Female patient with recurrent thoughts of cleaning her hands..
When you commit the recurrent tought ………
Long term prognosis of OCD……
Most common course of OCD………
TTT of choice of OCD…….
TTT of choice of OCD in kids………
BEST PSYCHOTHERAPY……
2 sisters sharing the same psychotic’s symptoms…folie a deux
Female patient with recurrent thoughts of cleaning her hands..OCD
When you commit the recurrent tought ………compulsions
Long term prognosis of OCD……psychosis
Most common course of OCD………wax and wane
TTT of choice of OCD…….SSRI
TTT of choice of OCD in kids……….fluvoxamine
BEST PSYCHOTHERAPY……exposure and prevention
Do individuals with OCD experience compulsions?
Yes, individuals with OCD experience compulsions in response to recurrent thoughts.
Female patient worries about her financial condition and also about her husband’s work ……
Main ttt of GAD…..
Long term prognosis of GAD……
Female patient with recurrent thoughts of washing her hands…
Young boy taking more than 10 showers per day…
Drug of choice for OCD in kids……
Young male with recurrent attacks of sleeping per day that are accompanied with hallucinations……
Main ttt of narcolepsy……
Female patient worries about her financial condition and also about her husband’s work ……GAD
Main ttt of GAD…..SSRI
Long term prognosis of GAD……depression
Female patient with recurrent thoughts of washing her hands…OCD
Young boy taking more than 10 showers per day…OCD
Drug of choice for OCD in kids……fluvoxamine
Young male with recurrent attacks of sleeping per day that are accompanied with hallucinations……narcolepsy
Main ttt of narcolepsy……psychostimulant
Describe narcolepsy
A neurological disorder characterized by excessive daytime sleepiness, sudden attacks of sleep, and sometimes hallucinations.
What are the types of hallucinations associated with narcolepsy?
Hypnagogic hallucinations occur before sleep, while hypnopompic hallucinations occur upon waking up.
Define obstructive sleep apnea
A sleep disorder where breathing is briefly and repeatedly interrupted during sleep, often due to obstruction of the airway.
Hypnogogic ………..
Hypnopompic ……
Middle age male obese with recurrent attacks of sleeping and his wife complains of his snoring……
Inv of choice…….
First advice for this patient…..
TTT of choice……
What does insomnia means……
Main ttt of insomnia……
Drug of choice for insomnia….
Hypnogogic ………..before sleep
Hypnopompic ……after walking up
Middle age male obese with recurrent attacks of sleeping and his wife complains of his snoring……Obstructive sleep apnea
Inv of choice…….polysomonography
First advice for this patient…..loss weight
TTT of choice……CPAP
What does insomnia means……bad quality of sleep
Main ttt of insomnia……non pharmacological
Drug of choice for insomnia….short acting benzodiazepine
First advice for this patient…..loss weight
Obstructive sleep apnea
First advice for this patient…..loss weight
TTT of choice……CPAP
What does insomnia means……
Main ttt of insomnia……
Drug of choice for insomnia….
What does insomnia means……bad quality of sleep
Main ttt of insomnia……non pharmacological
Drug of choice for insomnia….short acting benzodiazepine
How is generalized anxiety disorder (GAD) treated?
Main treatment is with selective serotonin reuptake inhibitors (SSRIs).
Describe the duration required to diagnose depression
Diagnosis of depression typically requires symptoms to persist for at least 2 weeks.
What is the duration needed to diagnose schizophrenia?
Schizophrenia diagnosis requires symptoms to persist for at least 6 months.
Define schizophreniform disorder
A mental disorder with symptoms similar to schizophrenia but lasting between 1 to 6 months.
How is brief psychotic disorder diagnosed in terms of duration?
Diagnosis of brief psychotic disorder requires symptoms to last for a brief period of time.
When does the effect of SSRI typically appear?
2-6 weeks
No effect after usage of SSRI for 1 week….
just continue
When should you shift to another drug if there is no effect after 2 months of SSRI usage?
Shift to another SSRI
1. Ineffectiveness:
- Criteria: If there is no significant improvement in depressive symptoms after an adequate trial period (usually 6-8 weeks) at an appropriate dose.
- Action: Consider switching to another SSRI, an SNRI, or a different class of antidepressants.
2. Side Effects:
- Criteria: If the patient experiences intolerable side effects that interfere with daily functioning and do not diminish over time.
- Action: Switch to another antidepressant with a different side effect profile.
3. Partial Response:
- Criteria: If there is a partial response but not full remission of symptoms.
- Action: Consider switching to another antidepressant or augmenting with another medication.
4. Patient Preference:
- Criteria: If the patient prefers a different treatment approach due to personal reasons or side effects.
- Action: Discuss alternative medications or therapeutic options.
5. Drug Interactions:
- Criteria: If there are problematic drug interactions with other medications the patient is taking.
- Action: Switch to an antidepressant with a lower risk of interactions.
1. Direct Switch:
- Suitable when switching between SSRIs or from an SSRI to an SNRI.
2. Cross-Tapering:
- Gradually reduce the dose of the current antidepressant while simultaneously starting the new one, often used when switching between different classes of antidepressants.
3. Washout Period:
- Necessary when switching from or to MAOIs to prevent serotonin syndrome; usually involves a 2-week washout period.
- Continuous Evaluation: Monitor the patient closely for withdrawal symptoms, side effects, and overall response to the new medication.
- Support: Provide psychological support and regular follow-up appointments to address any concerns during the transition.
For more detailed guidelines, refer to the RACGP guidelines on antidepressant prescribing.
How long should SSRI be used for at least in general cases?
6 months
Selective Serotonin Reuptake Inhibitors (SSRIs) are generally recommended for use over a period of 6 to 12 months, according to RACGP guidelines. This duration allows sufficient time to treat the acute phase of depression and helps prevent relapse. After this period, it is crucial to evaluate the patient’s condition and consider the need for continued therapy. In some cases, especially where there is a high risk of relapse or in chronic depression, longer-term use may be appropriate, but this should be regularly reviewed and monitored by a healthcare provider.
The RACGP emphasizes the importance of safe deprescribing practices, advocating for a gradual tapering process to minimize withdrawal symptoms and potential relapse. This approach is detailed in the Maudsley Deprescribing Guidelines, which the RACGP has endorsed. These guidelines recommend individualized tapering schedules, reducing the dose by 25-50% every 2-4 weeks, and making adjustments based on the patient’s response and any withdrawal symptoms experienced oai_citation:1,RACGP - Antidepressant prescribing in general practice oai_citation:2,RACGP - RACGP endorses ‘landmark’ safe deprescribing guide.
For more detailed information, you can refer to the RACGP guidelines on antidepressant use and deprescribing.
How long should SSRI be used in a suicidal patient?
2 years
Withdraw over at least…………….. 2 weeks
Old age + severe depression………….
.ECT
What is the treatment for depression and insomnia?
Depression + decreased appetite
Mirtazapine
Depression+insomnia……..mirtazapine
Depression + decreased appetite……….mirtazapine
What is the most common season for depression?
Winter
What is the most common season for suicide?
Spring
What is the most common season for SIDS?
Winter
What is the treatment for depression with memory impairment?
Pseudodementia
What is the highest risk period for suicide after leaving the hospital?
First two weeks
What is the most important question to ask a depressed patient?
Suicidal thoughts?
What is the highest probability factor for suicide?
History of previous suicidal attempt
Farmer patient went to the downtown made sex with many prostitutes and spent all his money…..
If Acute and marked psychosis……
1st line for acute mania………
First line drug for bipolar…….lithium
Second line drug…..
Others…………….
If pregnant or lactating………..
Resistant and severe cases…….
If marked psychotic symptoms……
Farmer patient went to the downtown made sex with many prostitutes and spent all his money…..acute mania
If Acute and marked psychosis……involuntary admission
1st line for acute mania………antipsychotics
First line drug for bipolar…….lithium
Second line drug…..valproic acid
Others…………….carbamazepine
If pregnant or lactating………..carbamazepine
Resistant and severe cases…….ECT
If marked psychotic symptoms……antipsychotic drugs
Epidemiology of schizophrenia:
General population………
First degree relative……
Second degree relative……
Single parent……………..
Two parents………………
Monozygotic twins………
dizygotic twins…………..
grand father…………..…
Epidemiology of schizophrenia:
General population………1%
First degree relative………12%
Second degree relative……6%
Single parent……………..12%
Two parents………………40%
Monozygotic twins………47%
dizygotic twins…………..12%
grand father…………..…6%
What should be done once suicidal thoughts are discovered?
Involuntary admission
What is the first-line treatment for acute mania?
Antipsychotics
What is the first-line drug for bipolar disorder?
Lithium
What is the second-line drug for bipolar disorder?
Valproic acid
What should be used in resistant and severe cases of bipolar disorder?
ECT
What is the prodrome of schizophrenia in a young male showing marked drop in school grades and hallucinations?
Prodrome of schizophrenia
Male patient stands at the train stations for many hours on one leg……..
What is the drug of choice for catatonic schizophrenia?
catatonic
Benzodiazepines
What is the most common cause of death in schizophrenia?
Cardiovascular issues
Causes of death with schizophrenia: IMP
1- CVS………most common cause
2- SUICIDE………2nd most common
schizophrenia
TREATMENT
TREATMENT
Acute and marked psychosis……involuntary admission
Antipsychotics drugs
Severe and resistant cases…….ECT
What are good prognostic indicators in schizophrenia?
Family history (-), Female sex, Acute onset, Precipitating factors present, Catatonic symptoms present, Positive symptoms present, Negative symptoms absent
Most important sign in schizophrenia…….
impaired insight
What is mannerism in schizophrenia?
Abnormal repetitive behavior
What is the first step in treating weight gain secondary to antipsychotic drugs?
Orlistat
What is the first step in treating any psychiatric patient?
Establish a good relationship with the patient
What is derailment in psychiatric terms?
Incoherent speech or thoughts
Patient tells you , he woke up in the morning, war is very close to happen, Barcelona is the best foot ball team in the world, he loves his parents……….derailement
What is the most common side effect of SSRI?
Abdominal pain and agitation
What is the effective dose range for sertraline?
50-100 mg
What should be done if a patient on a low dose of SSRI shows no effect initially?
Increase the dose
What is the interaction between SSRI and ecstasy called?
Serotonin syndrome
What is the first step in managing serotonin syndrome?
Hospitalization
First step in serotonin syndrome….
.stop both drugs
If you have to select one of them……..stop offending drug 1st
What should be avoided in patients taking MAOI?
cheese and wine
What should be screened in a patient taking MAOI?
Blood pressure
What to do if a patient on SSRI complains of no improvement?
Just continue the medications
What should never be done with SSRI suddenly?
Tapering should be done for 2 to 4 weeks
What is the effect of an overdose of TCA?
Arrhythmia
What is the most important investigation for TCA overdose?
ECG
How to assess the severity of TCA overdose?
Duration of QRS complex
What is the antidote for TCA overdose?
NaHCO3
What tests should be done in a patient on lithium?
TSH and RFTs
What is the main side effect of lithium toxicity?
Ataxia, dysarthria, delirium
What is the treatment for lithium toxicity?
Dialysis
What is the main side effect of carbamazepine?
Leucopenia
What is the main side effect of lamotrigine?
Rash
What is dystonia?
Neck contracted to one side
How to treat acute dystonia?
Diphenhydramine and benztropine
What are the main two categories of drugs causing extrapyramidal symptoms?
Antipsychotic and antiemetic drugs (metoclopramide)
What is akathisia?
Continuous urge to move around the room
What is tardive dyskinesia?
Twitching of face, tongue, and hand
What is neuroleptic malignant syndrome?
High fever, high blood pressure, rigidity
What are the risks associated with neuroleptic malignant syndrome?
Rhabdomyolysis, acute renal failure
What is the treatment of choice for neuroleptic malignant syndrome?
Dantrolene or bromocriptine
What should be monitored in a patient on clozapine?
CBC (agranulocytosis)
What is the most common antipsychotic to cause palpitations?
Clozapine
What should be monitored in a patient on olanzapine?
FBS and lipid profile
What is the first-line therapy for schizophrenia?
Olanzapine
What is the drug with the least side effects?
Olanzapine
What is the treatment for delusions in pregnancy?
Olanzapine
schizophrenia+ oversleeping…..
respiridone
drug for delusions in pregnancy………
olanzapine
What is the most important step in psychotherapy?
Establishing a good relationship with the patient
What is the least effective antipsychotic drug?
Quetiapine
What is the treatment of choice for an old male severely depressed patient refusing to eat?
ECT
What is the main side effect of ECT?
Transient memory disturbance
From whom do you need consent before ECT?
Health tribunal authority
What is the main benefit of ECT?
Immediate effect
What is the first step for a schizophrenic patient taking marijuana?
Stop marijuana
How long should SSRI be used in suicidal patients?
2 years
What type of SSRI is used in kids?
Fluvoxamine
What is most important to monitor in venlafaxine?
Blood pressure
What is the treatment for morphine toxicity?
Naloxone
What is the drug for morphine withdrawal?
Methadone
What is the drug for drug rehabilitation?
Methadone
What are the symptoms of morphine withdrawal?
Piloerection, yawning, rhinorrhea, myalgia
What is the main side effect of benzodiazepine withdrawal?
Agitation
What is the treatment for benzodiazepine overdose?
Flumazenil
What is the effect of cocaine on the brain?
Stroke
What is the effect of cocaine on the nose?
Septal perforation
What is the effect of cocaine on the heart?
MI
What is the effect of cocaine on the skin?
Bugs under the skin
What is the effect of cocaine on the placenta?
Abruptio placenta
What is the effect of cocaine on the fetus?
Low birth weight, teratogenic
What is the most common teratogenic substance?
Alcohol followed by smoking
What is the main side effect of cocaine withdrawal?
Skin bugs
What is the main side effect of PCP toxicity?
Vertical/horizontal nystagmus
What is the main side effect of LSD toxicity?
Hallucination
What is the main side effect of cannabis toxicity?
Increased appetite, dry mouth, conjunctival injection
What is the active form of cannabis?
tetra hydro cannabinoid
What is the main treatment to help a patient stop smoking?
Nicotine replacement therapy
Describe the purpose of a nicotine patch.
A nicotine patch is used to help individuals quit smoking by providing a controlled release of nicotine through the skin.
Do you know the key questions in an alcohol questionnaire?
- Have you ever felt the need to Cut down on your drinking? 2. Have you ever felt Annoyed by criticism of your drinking? 3. Have you ever felt Guilty about drinking? 4. Have you ever had to take a morning Eye opener?
Define the significance of a morning eye opener in alcohol addiction detection.
The presence of a morning eye opener (needing a drink in the morning to function) is a crucial sign indicating severe alcohol addiction.
How can family history impact the risk factors for Anorexia nervosa, Bulimia nervosa, and Binge eating?
Anorexia nervosa: family history of atheletism, Bulimia nervosa: history of child abuse, Binge eating: family history of obesity.
Weight loss in young female without others symptoms except psychic problems……
drug or alcohol abuse
Describe the drug of choice for catatonic schizophrenia.
The drug of choice for catatonic schizophrenia is benzodiazepine.
What is the most common drug used in parties according to the content?
Ecstasy (MDMA) is the most common drug used in parties.
Explain the main sign of amphetamine withdrawal according to the content.
The most important sign of amphetamine withdrawal is paranoia.
Most important sign of amphetamine toxicity……
psychosis followed by hallucinations
Drug of choice for agitation of drugs……….
antipsychotic
How should a patient on SSRI who complains of no improvement be managed?
If a patient on SSRI complains of no improvement, the recommendation is to just continue the medications.* SSRI takes at least 2-6 weeks to be effective
Describe the first step if a patient on SSRI still has symptoms.
The first step if a patient on SSRI still has symptoms is to increase the dose.
What is the most common side effect of SSRI according to the content?
The most common side effect of SSRI is abdominal pain and agitation.
Explain the first step if a patient on SSRI develops side effects.
If a patient on SSRI develops side effects, the first step is to shift to another SSRI.
Do you know the first step if a patient on SSRI develops serotonin syndrome after taking tramadol?
The first step if a patient on SSRI develops serotonin syndrome after taking tramadol is to stop both medications.
Define the synergistic effect between Donepezil and SSRIs.
The synergistic effect between Donepezil and SSRIs refers to an increased risk of side effects when these medications are used together.First step……..stop both of them
How should a homeless psychotic patient brought in by the police be initially managed?
The first step for a homeless psychotic patient brought in by the police is to gather collateral history from the police.
Police brings to you homeless psychotic patient :
First step………….collateral history from the police
If agitated………antipsychotic then admission
If not agitated………….admission
Where to admit……….psychiatric unit
DD of sudden withdrawal manifestation in teenagers??
1-drug abuse……..need to be excluded first
2-depression…..associated with decreased appetite, enegery, sleep and suicisal thoughts
3-prodrome of schizophrenia……associated with delusions and hallucinations
Delusion with pregnancy…………
Drug causing teratogenicity in first trimester…..
Drug causing teratogenicity in last trimester…..
First step if mom complains of behaviouir of her son …..
Child refuses to take his medications first step…..
Delusion with pregnancy…………olanzapine
Drug causing teratogenicity in first trimester…..anticonvulsant
Drug causing teratogenicity in last trimester…..antipsychotic
First step if mom complains of behaviouir of her son …..interview with the son
Child refuses to take his medications first step…..talk to the boy
Currently ttt of choice in agitated person if:
Psychotic patient………..
Delirious patient………..
Postoperative……………..
Amphetamine toxicity…………………
Alcoholic………
Alcoholic and liver impairment……..
Mentally retarded kid……….
Currently ttt of choice in agitated person if:
Psychotic patient………..antipsychotic medications
Delirious patient………..antipsychotic medications
Postoperative……………..antipsychotic medications
Amphetamine toxicity…………………antipsychotics
Alcoholic………diazepam
Alcoholic and liver impairment……..lorazepam
Mentally retarded kid……….respiridone
Describe the initial management approach for a child who refuses to take their medications.
The initial step for a child who refuses to take their medications is to talk to the child and address their concerns.
What is the treatment of choice for lithium toxicity according to the content?
The treatment of choice for lithium toxicity is dialysis.
Explain the action to take if a patient with dementia needs urgent surgery.
If a patient with dementia needs urgent surgery, the first step is to ask for their advanced directive.
How should a patient with Selective Mutism be described according to the content?
A patient with Selective Mutism will speak freely in some settings (usually at home) but not in others.
Selective Mutism………….
Patient with dementia needs urgent surgery first step….
Main Psychiatric disease that increases rapidly in Australia……
Most imp to check in a female after labor……..
Treatment of choice of lithium toxicity ……
Most common drug used in parties…..
patient doesnot speak English………
Least effective antipsychotic drug……..
Selective Mutism…………. where children will speak freely in somesettings (usually at home) but not in others
Patient with dementia needs urgent surgery first step….ask for advanced directive
Main Psychiatric disease that increases rapidly in Australia……dementia
Most imp to check in a female after labor……..mood
Treatment of choice of lithium toxicity …… dialysis.
Most common drug used in parties…..Ectasy( MDMA)
patient doesnot speak English……….get interpretor on telephone
Least effective antipsychotic drug……..quetiapine
Describe the least effective antipsychotic drug mentioned in the content.
The least effective antipsychotic drug mentioned is quetiapine.
