psych from psmd Flashcards
which class of drugs can cause vte in elderly?
atypical antipsychotics
what is a side effect of metoclopramide?
it is an anti-emetic and may cause extrapyramidal side effects such as tardive dyskinesia
which antidepressant post MI?
sertraline
how is tardive dyskinesia treated?
tetrabenazine (Tardive, Tetrabenazine)
how long should medication with SSRI be continued?
at least 6 months, dose reduced over 4 months
how does conversion disorder manifest?
typically involves loss of motor or sensory function
may be caused by stress
how does somatisation disorder present?
multiple symptoms present for 2 years
despite negative scans/test results, patients don’t accept reassurance
how does hypochondriasis present?
patient believes they have a specific illness
not reassured
what is the biggest risk factor for schizophrenia?
family history of schizophrenia
when do the symptoms of alcohol withdrawal start?
6-12 hours
when do seizures occur in alcohol withdrawal?
36 hours
when does delirium tremens occur?
72 hours after withdrawal
what are the symptoms of alcohol withdrawal?
tremor
sweating
tachycardia
anxiety
what are the symptoms of delirium tremens?
course tremor confusion delusion auditory/visual hallucinations fever tachycardia
what is the first line treatment of delirium tremens?
benzodiazepines such as chlordiazepoxide
in patients with hepatic failure, lorazepam
what is the treatment of delirium tremens in pts with hepatic failure?
lorazepam
should you use phenytoin for alcohol withdrawal seizures?
not as effective
when should serum lithium be checked
12 hours post dose!
which SSRI is first line in adolescents and children?
fluoxetine
what do you always need to rule out for patients presenting with symptoms of anxiety?
hyperthyroidism
what is the first line treatment of GAD?
SSRI
What is the second line treatment of GAD?
SNRI eg venlafaxine
what type of drug is zuclopenthixol?
typical antipsychotic
what is a common side effect of typical antipsychotics such as zuclopenthixol?
parkinsonism
what are the EPSEs?
- Parkinsonism
- Akathisia
- Tardive dyskinesia
- Acute dystonia
what is tardive dyskinesia?
late onset, sometimes irreversible side effect of typical antipsychotics
abnormal, involuntary movements such as:
- chewing, pouting jaw, blinking,
DIFFICULTY SWALLOWING
what is acute dystonia?
sustained muscle contractions such as torticollis/oculogyric crisis
how is acute dystonia managed?
procyclidine
how is tardive dyskinesia managed?
tetrabenazine
what is anankastic personality disorder also known as?
obsessive compulsive personality disorder
what is the only absolute contraindication of ECT?
raised ICP
what are the short term side effects of ECT?
- headache
- nausea
- short term memory impairment
- memory loss of events prior to ECT
- CARDIAC ARRHYTHMIA
what are some long term side effects of ECT?
memory impairment
does ECT increase risk of epilepsy?
no
what investigation should be carried out in older patients who present with new onset psychosis?
CT head to rule out organic cause for psychosis
which psychiatry drugs can cause urinary retention and so overflow incontinence?
tricyclic antidepressants
amitriptylline
why do TCAs cause urinary retention?
they have anticholinergic effects
what are the side effects of TCAs
tachycardia
dry mouth
mydriasis
urinary retention
why must patients on MAOIs avoid tyramine?
tyramine + MAOIs = hypertensive crisis
what are the features of post-concussion syndrome?
headaches
fatigue
anxiety
dizzness
how to distinguish between post-concussion and PTSD?
PTSD - onset of symptoms delayed and last longer
what are clang associations?
alliterative/rhyming words
what scoring system is used for the management of alcohol withdrawal in hospital?
CIWA-Ar scale
score>8 needs medication
what type of drug is clozapine?
atypical antipsychotic
5HT2a
binds to serotonin and dopamine receptors
treats negative symptoms of schizophrenia too
what type of drug is olanzipine?
atypical antipsychotic
5HT2a
binds to serotonin and dopamine receptors (more to serotonin)
what is the most common side effect of olanzipine?
weight gain
hyperprolactinaemia
what are the side effects of clozapine?
agranulocytosis reduced seizure threshold constipation myocarditis hypersalivation
when is clozapine used?
if 2 or more antipsychotics have been tried (including 1 atypical) for 6-8 weeks
which antipsychotic is associated with agranulocytosis?
clozapine
what antipsychotic can cause drooling?
clozapine
what baseline tests must you do before starting clozapine?
ECG - clozapine can cause myocarditis
FBC for agranulocytosis
what is the risk of antipsychotics in the elderly?
increased risk of VTE/stroke
what is the criteria for OCD diagnosis?
lasting for more than 2 weeks obsessions/compulsions
what is a side effect of long term atypical antipsychotic use?
glucose dysregulation, diabetes
what is flight of ideas a feature of?
mania
what does SSRI use during the first trimester increase the risk of in fetus?
heart defects
how do SSRIs affect fetus if used in third term?
persistent pulmonary hypertension
which SSRI has an increased risk of congenital malformations?
paroxetine
what drug can precipitate a leucocytosis?
lithium (also corticosteroids/betablockers)
- benign
how often should lithium blood level be checked once the dose has been established?
every 3 months
when should lithium levels be checked after dose change?
after a week and weekly until the levels have stabilised
how would you treat mania in a patient with known BD
refer urgently to CMHT
how would you treat hypomania in a patient with BD?
refer routinely to CMHT
how would you differentiate between mania and hypomania
mania has psychosis/delusions
what can cause a rise in clozapine levels without dose increase?
smoking cessation
what electrolyte abnormality is associated with long term lithium use?
hypercalcaemia due to hyperparathyroidism
what are the symptoms of hypercalcaemia?
stones bones moans and groans
kidney stones
bone/back pain
constipation
depression
usually caused by lithium long time use
are antidepressants addictive?
no
patients should remain on them for at least 6 months
what does zopiclone do in the elderly?
increase the risk of falls
how does zopiclone work?
similar to benzodiazepines
enhances GABA by binding to GABA-a receptors
how is akathisia treated?
propranolol
what class of drug is mirtazipine?
noradrenergic and specific serotonergic antidepressants
Blocks alpha2 adrenoceptors
not the same as SNRI
Which class of drugs can cause anterograde amnesia?
benzos
lorazepam etc
anterograde - memory recall and creation impaired
what can steroids cause in psychiatry?
psychosis
