psych day before cards Flashcards
Avoidance of tyramine-rich foods is necessary when taking which class of medication?
MAOI’s
Consumption of tyramine-rich foods (eg. red wine, cheese, beef/chicken liver, pickled herring) when taking monoamine oxidase inhibitors (MAOIs) can precipitate a hypertensive crisis,
Chairman Mao was responsible for a famine so you couldnt have anything nice like cheese or red wine
How do typical antipsychotics work?
Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways
More likely to cause EPSE + hyperprolactinaemia
Haloperidol. chlopromazine
Atypical?
Act on a variety of receptors (D2, D3, D4, 5-HT)
More metabolic side effects
Clozapine, risperidone, olanzapine
What are some other side effects of antipsychotics?
antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
raised prolactin
may result in galactorrhoea
due to inhibition of the dopaminergic tuberoinfundibular pathway
impaired glucose tolerance
neuroleptic malignant syndrome: pyrexia, muscle stiffness
reduced seizure threshold (greater with atypicals)
prolonged QT interval (particularly haloperidol)
Adverse effects of clozapine?
Adverse effects of clozapine
agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation
Dose adjustment of clozapine might be necessary if smoking is started or stopped during treatment.
What do benzos do?
Benzodiazepines enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels.
What are the weird syndromes you need to remember?
De Clerambault’s = erotomania (excessive horniness); makes sense, it’s French
Cotard syndrome = believing you’re dead
Othello syndrome = delusional jealousy (usually of a partner) #Shakespeare
Capgras delusion = believing a (close) acquaintance has been replaced by an imposter
Charles Bonnet syndrome (not DE Bonnet) = Recurring hallucinations in those with impaired vision
Depression vs dementia?
Factors suggesting diagnosis of depression over dementia
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
I dont know answers for example
What is a CI for ECT?
ONLY high ICP
How long can a grief disorder last
up to 12 months
Can start 2 weeks after event
Hoe do MAOis work?
serotonin and noradrenaline are metabolised by monoamine oxidase in the presynaptic cell
Non-selective monoamine oxidase inhibitors
e.g. tranylcypromine, phenelzine
used in the treatment of atypical depression (e.g. hyperphagia) and other psychiatric disorder
not used frequently due to side-effects
Difference between a a section 4 and 5(2)
Section 4
72 hour assessment order
used as an emergency, when a section 2 would involve an unacceptable delay
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
What is circum stantiality?
Circumstantiality is the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.
What is tangentiality?
Tangentiality refers to wandering from a topic without returning to it.
What is a neologism
Neologisms are new word formations, which might include the combining of two words.
What is a clang association?
Clang associations are when ideas are related to each other only by the fact they sound similar or rhyme.
What is knights move?
Knight’s move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.
What is flight of ideas?
Flight of ideas, a feature of mania, is a thought disorder where there are leaps from one topic to another but with discernible links between them.
What are the side effects of using TCA’s?
Side effects of TCAs = ‘TCAs’ - block alpha receptors
Thrombocytopaenia
Cardiac (arrhythmias, MI, stroke, postural hypotension)
Anticholinergic (tachycardia, urinary retention, dry mouth, blurry vision, constipation) - Cant see, cant pee cant spit, cant sh*t
Seizures
dythymic disorder vs cyclothymia?
Dysthymic is just depressive sx that are not bad enough to be classed as depression > 2 yrs
cyclothymia is depression + hypomania for 2 years with rapid changes and episodes only lasting a few days at a time
Treating acute mania?
ANTIPSYCHOTICS:
Haloperidol
Olanzipine
Quetiapine
Risperidone
Lithium can be used for acute treatment as well as long-term
BENZOS can also be used for short term acute behavioural disturbance
Lithium things to be aware:
L – leukocytosis
I – Insipidus diabetes (nephrogenic)
T – Tremors (if coarse, think toxicty)
H – Hydration (easily dehydrates, need to drink a lot as renally cleared)
I – increased GI motility
U – Underactive thyroid
M – Metallic tastse (warning of toxicity), mums beware – teratogenic
Lithium + diuretics = beware dehydration
Lithium + NSAIDS = beware kidney damage
1st rank sx of schizo
Delusional perceptions
3rd person auditory hallucinations (running commentary, hears people talking ABOUT them, not to them)
Thought disorder/ alienation (broadcast, withdrawal, insertion, deletion)
Passivity phenomena (made to do or feel things against their will – as if someone is controlling their thoughts, feelings and actions)
I am pretty sure this will be in the exam !! LEARN
4 EPSE’s and descriptions of them:
Acute dystonic reaction (hours)
Muscle spasm, acute torticolis, eyes rolling back
Parkinsonism (days)
Tremor, bradykinesia
Akathisia (days to weeks)
“inner restlessness, pacing and agitated, often intolerable. They literally can’t stop moving e.g. shaking legs, touching table
Massive RF for suicide in young males with schizophrenia
Tardive dyskinesia (months to years)
Grimacing, tounge protrusion, lipsmacking
Very difficult/impossible to treat as you’ve upregulated all the D2 receptors
These side effects are worse and more common in the older antipsychotics
Medical tx’s for alcohol abuse?
Disulfram – blocks alcohol metabolism resulting in flushing, headaches, anxiety and nausea
Acamprosate - acts on GABA to reduce cravings and risk of relapse
Naltrexone – opioid receptor antagonist
Wernickes triad?
TRIAD OF:
Confusion/intellectual impairment
Ataxia
Ophthlamoplegia (eye muscle paralysis) and nystagmus
Due to thiamine deficiency – most commonly seen in those who abuse alcohol
Pathological changes in Alzhiemers disease?
Neuronal loss
Neurofibrillary tangles
Amyloid plaques
LEARN THIS WELL – apparently a favourite in exams
What is the pathophysiology of huntingtons?
Reduced GABA (reduced inhibition)
Causing dopamine hypersensitivity and increase in dopamine transmission
Increased stimulation at thalamus and cortex leading to involuntary movements
Heroin use signs
Euphoria
Pinpoint pupils (ALWAYS - check for this, can mean overdose)
Drowsiness
Constipation
Respiratory depression (especially in OD)
Withdrawal sx for heroin?
“Goose flesh” (piloerection)
Pupil dilatation
Yawning
Sweating
Abdominal cramps
Insomnia
features of NMS?
Can come on over hours to days
Hyper pyrexia
Hyporeflexia
Sweating
Normal pupils
Tachycardia
Rigidity
Raised CK
SS features?
Can come on over minutes/hours
Hyperthermia/ hyperpyrexia
Sweating
Hyperreflexia
Clonus
Rigidity
Altered mental state
Dilated pupils
