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Passmedicine MRCP Part 1 > Psych Gap > Flashcards

Psych Gap Flashcards

1
Q

Atypical Antipsychotics

A

clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole: generally good side-effect profile, particularly for prolactin elevation

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2
Q

Adverse effects of atypical antipsychotics

A

weight gain
clozapine is associated with agranulocytosis (see below)
hyperprolactinaemia

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3
Q

Risk of developing schizophrenia

A

Risk of developing schizophrenia
monozygotic twin has schizophrenia = 50%
parent has schizophrenia = 10-15%
sibling has schizophrenia = 10%
no relatives with schizophrenia = 1%

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4
Q

Acute Stress Disorder vs PTSD

A

Acute Stress Disorder: within 4 weeks
PTSD: after 4 weeks

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5
Q

Alcohol Withdrawl

A
  1. Long Acting Benzo: Chlordiazepoxide or Diazepam
  2. Lorazepam if hepatic failure
  3. Carbamazepine
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6
Q

Anorexia biochemical features

A

Anorexia features
- most things low
- G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

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7
Q

Panic Disorder Management

A
  1. CBT or Drugs
  2. Drugs: SSRI
  3. Emipramine or Clomipramine
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8
Q

Side Effects of Tricyclic Antidepressants

A

As well as 5-HT and NA, tricyclics interact with number of other receptors that contribute to their side-effect profile:
antagonism of histamine receptors
- drowsiness

antagonism of muscarinic receptors:
- dry mouth
- blurred vision
- constipation
- urinary retention

antagonism of adrenergic receptors
- postural hypotension

lengthening of QT interval

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9
Q

Name the Tricycli Antidepressants

A

More sedative
(ADCT)
Amitriptyline (Worst in overdose)
Dosulepin (Worst in Overdose)
Clomipramine
Trazodone

Less Sedative:
(Nil)
Imipramine
Lofepramine (Safest in overdose)
Nortriptyline

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10
Q

Name the Benzos

A

1. Short-Acting Benzodiazepines:
- Midazolam
- Oxazepam

2. Intermediate-Acting Benzodiazepines
- Alprazolam
- Lorazepam
- Temazepam
- Clonazepam

3. Long-Acting Benzodiazepines
- Diazepam
- Chlordiazepoxide

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11
Q

Name Typical and Atypical Antipsychotics

A

Typical First-Generation Antipsychotics
- Haloperidol
- Fluphenazine
- Chlorpromazine

Atypical (Second-Generation) Antipsychotics
- Clozapine
- Olanzapine
- Quetiapine
- Aripiprazole
- Risperidone
- Amisulpride

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12
Q

Name the SSRIs

A

Fluoxetine
Citalopram
Escitalopram
Paroxetine
Sertraline

  • Fluoxetine and paroxetine have a higher propensity for drug interactions
  • Paroxetine has a higher incidence of discontinuation symptoms.
  • citalopram (although see below re: QT interval) and fluoxetine are currently the preferred SSRIs
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13
Q

PTSD Rx

A
  • Trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases
  • drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then** venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline** should be tried.
  • In severe cases, NICE recommends that risperidone may be used
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14
Q

Acute Stress Disorder
vs
PTSD
vs
Post Concussion Syndrome

A

Post concussion: symptoms start soon (within a few day) Plus a obvious h/o Concussion!

Acute stress disorder : symptoms onset < 1 month after traumatic event

PTSD: symptoms onset > 1 month after onset, last few months

Post concussion: symptoms start soon (within a few day) Plus a obvious h/o Concussion!

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15
Q

Interactions of SSRIs

A
  • NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
  • warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine

- triptans - increased risk of serotonin syndrome
- monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

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16
Q

Side Effects of Lithium

A

L- leucocytosis
I- intracranial hypertension
T- tremor, Toxic to nephrons
H- hypothyroidism
I U- increased urine( nephrogenic DI )
M- mothers (expectant mothers can cause Ebstein`s anomaly)

17
Q

Rx for Bulimia

A
  • eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  • children should be offered bulimia-nervosa-focused family therapy (FT-BN)
  • pharmacological treatments have a limited role - a trial of high-dose** fluoxetine is currently licensed for bulimia but long-term data is lacking**
18
Q

Bulimia Presentation

A
  • binge eating
  • followed by recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
    - recurrent vomiting may lead to erosion of teeth and Russell’s sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting
19
Q

Benzo’s M/A

A

Benzodiazepines enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels

20
Q

Name the MAOIs

A

works by inhibiting the activity of monoamine oxidase, an enzyme that breaks down neurotransmitters like serotonin, norepinephrine, and dopamine. This increases the availability of these neurotransmitters in the brain.

  • Phenelzine
  • Tranylcypromine
21
Q

MAO cannot be given to people taking which food?

A

Tyramine containing food eg: cheese, pickled herring, Bovril, Oxo, Marmite, broad beans
because of hypertensive reactions

22
Q

Things to avoid seasonal affective disorder

A

sleeping tablets as this can make the symptoms worse

23
Q

Factors associated with poor prognosis

A

Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

24
Q

Strongest Risk factor for Schizophrenia

A

Family History

25
Q

Side Effects of Antipsychotics

A
  • 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)
26
Q

Which atypical antipsychotic has higher risk of obesity and dyslipidemia

A

Olanzapine

27
Q

Which atypical antipsychotic is associated with Agranulocytosis

A

clozapine

28
Q

M/A of Barbiturates and Benzodiazepines

A

They enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels.

Barbiturates increase the duration of chloride channel opening

Both works on chloride channel-
Barbi wants increase duration and Ben wants increase frequency

29
Q

What is CBS/ Charles Bonnet Syndrome
It is associated what?

A
  • ## persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousnessThe most common ophthalmological conditions associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract.
30
Q

Difference between Wernickes Encephalopathy vs Korsakoff Syndrome

A

Korsakof = Anterograde and Retrograde amnesia

Korsakoff kant remember

Wernickes = wobbly

31
Q

Duloxetine M/A

A

Serotonin and noradrenaline reuptake inhibitor

32
Q

How to differentiate between Factitious disorder/ Munchausen’s syndrome

A

Malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Passmedicine MRCP Part 1 (12 decks)

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