Psych COPY Flashcards by Daniel Taylor

Negative symptoms of psychosis

Anhedonia
alogia
asocial
avolition

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+ symptoms of psychosis

Hallucinations
delusions
thought disorder

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Alcohol Withdrawal a management

Benzodiazepine (chlordiazepoxide)
Psychosis -> Haloperidol
Thiamine deficiency -> Pabinex

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Alcohol withdrawal symptoms

Delerium 
dehydration 
cognitive impairment 
Paranoid delusions 
Tremor 
Autonomic arousal

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Mx of substance misuse

Hep B vaccine
CBT + Movitational interviewing
Social support

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Management of PTSD presenting <3 months from event

Watchful waiting
Trauma focussed CBT
Sleep disturbance managed with zopiclone

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4 clinical features of PTSD

reliving
Avoidance
Hyperarousal
Emotional Numbing

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Management of anxiety

SSRI -sertraline

SNRI - venlafaxine

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ICD-10 diagnosis of anxiety

4 symptoms

at least one is of autonomic arousal eg palpitations, dry mouth, sweating, tremor

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Bloods done for alcohol dependancy

FBC - anaemia (microcytic)
U/E - Dehydration, renal failure 
LFT
B12/folate 
Amylase

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Organic causes of schizophrenia

Drugs (alcohol, cannabis, MDMA, levodopa)
Huntingtons disease
dementia
syphilis

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Alcohol depednance long term medical treatment

Disulfam - increase acetaldehyde when you drink
Acomprosate - increase GABA, decreasing craving
Naltrexame - Blocks opioid receptors, prevents reward

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Kosakoffs psychosis?

Irreversable memory loss + confabulation and disorientation

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Two theories for the development of alcohol dependancy

Social learning theory - copy friends and parents

Operant conditioning - positive negative reinforcement.

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Antidepressant for children and adults first line

Child = fluoxetine 
Adult = sertraline then venlafaxine or mirtazipine (if insomnia)

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Inx for dementia

MMSE
AMT
Addenbrookes cognitive exam
Montreal cognitive assessment

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Alzheimers management

AchE inhibitors (rivastigmine)

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2 typical and 2 atypical antipsychotics

Atypical - Rispiridone Clozapine olanzepine

Typical - Halloperidol Fluphenazine

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Extrapyramidal Side effects of antipsychotics

Parkinsonism
Akathisia (feeling restless)
Dystonia
Tardive dyskinesia (abnormal involuntary movements)

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Side effects of antidepressants

Antimuscarinic (functional incontinence)
Antihistaminic - sedation and weight gain
Increased weight
prolonged QT

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Indications for ECT

severe depression
Catatonia
Fucking off the walls with mania

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Issues with smoking in patients with schizophrenia

If the patient is on clozapine

Smoking cessation can increase blood levels of clozapine

4 Problems with SSRIs

GI upset (also common in SSRI discontinuation syndrome) 
Sexual dysfunction 
Tremor 
Avoid in epileptics and mania

Extra-pyramidal side effects of Anti-psychotics

Parkinsonism - bradykinesia, tremor, Rigidity
Akethesia - restlessness
Dystonia
Tardative dyskinesia

3 Side effects of TCAs

Anti-cholenergic Increased appetite and weight gain Arrhythmias postural hypotension

Risk for elderly patients on antipsychotics

Section 5(4) and 5(2) of MHA?

4 = Nurse holding power. Lasts 6 hours. Medications can not be given

Section 2 of MHA

28 days for assessment and treatment 2 doctors, + AMHP On s12 doctor

Section 3

6 months for treatment 2 doctors + AMHP One s12 doctor

Section 4

Emergency order 72 hrs 1 doctor + 1 AMHP

1dt and 2nd Mx for insomnia

1 - CBT | 2 - Benzodiazepine

Causes of neuroleptic malignant syndrome

Anti-psychotics | Dopaminergic drugs

How to stop and SSRI

over a 4 week period reduce the dosage

What is serotonin syndrome

``` comes on shortly after starting and SSRI Increased serotonin Headache, agitation, hypothermia Autonomic defects - shivering, sweating Myoclonus and increased reflexes ```

Suicide RF

``` Male Hx of self harm alcohol and drug misuse Mental illness Old age chronic disease ```

Risk of successful suicide

``` Planning Effort to avoid discovery Leaving a note final acts (finances) Violent method ```

Anti-psychotic that reduces seizure threshold the most

Clozapine

5 drugs in mx of alcoholism (short term and long)

``` Chlordiazeperoxide (treats/prevent DTs) Thiamine (wernickes encephalopathy) IV pabrinex (as above) Disulfiran - makes hangovers worse Acomprosate (decrease GABA so decrease cravings) Naltrexene - blocks opioid receptors ```

Lithium side effects

``` Leukocytosis Increased reflexes Tremor Hypothyoidism Impaired renal function Urine (polyuria) Metallic taste ```

1) What is the safest SSRI to prescribe post MI 2) You start a 22yo man on Citalopram - what should you a) Screen for b) counsel the patient about c) follow up 3) SSRi to use in children an young people

1) Sertraline 2) Suicide risk. Agitation and anxiety when starting. Follow up appt in 2 weeks 3) Fluoxetine

Safest antidepressants to use in pregnancy and breast feeding

Sertraline and fluoxetine in pregnancy, as well as amitriptyline (TCA) Paroxetine and sertraline in breast feeding

A patient has difficulty sleeping and is tired all the time and depressed. They are often off their food and as a result have lost 8 kilos. What is the best antidepressant to start them on and why?

Mirtazipine Improves insomnia - increases appetite and weight gain.

Pt presents to A&E with a headache, confusions, hallucinations, sweating and high BP. On the SCS you see yesterday they saw their GP regarding depression 1) What is the likely cause of their symptoms, what management may they have been started on to cause these symptoms 2) Likely other symptoms/signs 3) Management

1) Serotonin syndrome. Caused withering minutes of first taking SSRI 2) Tachycardia. Myoclonus. Increased reflexes. Tremor. 3) Stop SSRI and supportive measures

Names 2 first and 2 second gen antipsychotics

1st Haloperidol and Chlorpromazine 2nd Olanzepine and Clozapine

2 side effects of clozapine

Agranulocytosis | Hyper-salivation

Other side effects of antipsychotics

Anti-histaminic - weight gain, sedation Anti-muscarinic - can't wee, can't see, can't spit can't shit Increased prolactin - titties. Anti-adrenergic - Postural hypotension, Tachycardia, Ejaculatory failure

First line mx for bipolar disorder | Second line

Lithium | Valproate

How would you follow up a patient started on lithium

1) Bloods 12hr after lithium dose at least every 3m - FBC (leukocytosis) and lithium level. 2) U/Es - renal output 3) TFTs

1) Cause of lithium toxicity | 2) Symptoms of Lithium Toxicity

1) 4 Ds (Dehydration, Drugs (NSAIDs and ACEI), Diuretics, Depletion of Sodium) 2) TOXIC T - tremor O - oliguria/renal failure X - AtaXia I - Increased reflexes C - Convulsions, confusion and coma

Contraindication of valproate

Pregnant - neural tube defects = spina bifida

Indication of poorer prognosis in schizophrenia

Low IQ

When should a patient be reviewed following a dose change of their lithium

1 week

3 drugs to be cautious prescribing alongside SSRI

NSAIDS - GI bleed give PPI Heparin Warfarin