Psych quickfire Flashcards
Narcolepsy
a) Diagnostic test and findings
b) Tetrad of symptoms
c) Management
a) Multiple sleep latency test (MSLT) - earlier onset of sleep, early onset REM sleep (REM present on napping)
b) Type 1 narcolepsy:
- Hypersomnia, cataplexy, sleep paralysis, hypnagogic/pompic jerks
- Caused by deficiency of hypocretin
Type 2 narcolepsy
- narcolepsy without cataplexy
- normal levels of hypocretin
c) Conservative:
- Avoid alcohol and smoking, especially before bed
- Good sleep hygiene
- Scheduled napping
- Exercise 20 mins daily
Medication:
- Modafinil
- Ritalin
Fragile X syndrome
a) What is it?
b) Presentation
c) Diagnostic test
a) The most common inherited cause of learning disability, affects males 2x more than females
- Inherited in an X-linked DOMINANT fashion from the FMR1 (fragile X mental retardation 1) gene
b) - Learning disability, autism, ADHD
- Thin face with large ears
- Large testes in boys post-puberty (macro-orchidism)
- Congenital heart disease - MVP
- Joint laxity
c) FMR1 gene testing
Lithium toxicity
a) Risk factors
b) Normal range and toxic range
c) LITHI-Mum (side effects)
d) Toxic effects
e) Best antihypertensives to use in someone on lithium
a) - AKI, renal impairment
- Diuretics, ACE, NSAIDs
- Hyponatraemia
- Dose changes
b) 0.6 - 1.2 normal
>1.4 can cause toxicity
>2 can cause seizures, coma, death
>4 necessitates dialysis
c) Leukocytosis
Insipidus
Tremor (fine)
Hypothyroid (risk increased if thyroid antibodies present)
Increased appetite
Mum - teratogenic (Ebstein’s anomaly)
d) - Coarse tremor, ataxia, confusion, nystagmus, seizures, coma
- Nausea, vomiting, diarrhoea
e) CCBs
- avoid ACE, ARB and diuretics
BPD
a) Splitting
a) Creating representations of people as all good or all bad (extremes)
Anorexia nervosa vs. atypical anorexia nervosa
Anorexia nervosa (binge-eating/purging-type)* vs. bulimia nervosa
*Compared to restricting-type (dieting, fasting, exercise)
Anorexia - low BMI
Atypical anorexia - weight loss but normal BMI
Anorexia nervosa (binge-eating/purging-type) - low BMI
Bulimia nervosa - normal BMI
Alcohol dependence
a) Medications used and MoA
b) Contraindications
After assisted withdrawal, offer acamprosate or naltrexone (or if not tolerated, disulfiram)
If high risk drinking/dependency, but withdrawal not undertaken, offer nalmefene
Acamprosate: acts on NMDA and GABA to reduce cravings, and also reduces withdrawal symptoms
- Avoid in severe hepatic impairment
Naltrexone: opioid antagonist (like naloxone), reduces cravings
- caution in mild-moderate hepatic impairment, avoid in severe
Disulfiram: acetaldehyde dehydrogenase inhibitor (prevents metabolism of ethan-al to ethan-oic acid)
Nalmefene: opioid inverse agonist (causes opposite effects of opioids)
Smoking cessation
a) 2 non-NRT drugs and their MoA
Varenicline (Champix)
- Partial agonist to nicotine receptor
- Reduces ability of nicotine to bind, therefore reduces pleasure of smoking
- Caution if history of seizures (lowers seizure threshold)
Bupropion
- Dopamine-noradrenaline reuptake inhibitor
- Reduces pleasure from smoking
- Contraindicated in history of seizures (lowers seizure threshold)
Benzo vs opiate withdrawal
Both cause agitation, anxiety, sweaty, insomnia
Benzos more likely to cause seizures
Opiates also cause diarrhoea, vomiting, abdo cramps, goosebumps
PTSD
a) Triad
b) Treatments
a) Flashbacks, avoidance/anxiety/emotional numbing, hyper-vigilance
b) - Trauma focused CBT
- Eye movement desensitisation and reprocessing (EMDR)
NMS
a) Treatment
a) - Supportive - IV fluids, paracetamol
- Stop causative drug
- Dantrolene - Acts on skeletal muscle cells by interfering with calcium efflux, thereby stopping the contractile process.
- Dopamine agonists - bromocriptine
Ganser syndrome
Idiopathic disorder (may be in conjunction with stress or psychosis), causing:
- Nonsensical answers to questions (e.g. 2 + 2 = 5)
- Pseudohallucinations
- Impaired consciousness
- Conversion disorder
Buspirone
a) MoA
b) Use
a) Partial serotonin receptor agonist
b) Anxiety, short-term use
Which SSRI is expressed the least in breastmilk?
Sertraline
Schizoid vs schizotypal
Schizoid are typically withdrawn loners, emotionally cold
Schizotypal are also loners, but are more eccentric, paranoid, often with delusions of reference
ECT
a) indications
b) types and course
c) side effects
d) efficacy
- Depressive stupor/catatonia
- Psychotic depression
- Refusal of food and drink
- Dangerously suicidal
- Situations where delay in antidepressant treatment* may cause risk to life
*Antidepressants can take around 2 weeks to have an effect, whereas ECT is much more immediate
b) Unilateral or bilateral
Twice a week for 3-8 weeks
c) - Initial: headache, jaw ache, confusion, small risk of seizure
- Long term: retrograde amnesia, no increased risk of stroke/epilepsy
d) - 68% effective in severe depression
- 50% well at 1 year (vs 5% on trial of 3rd antidepressant)
Panic disorder vs phobia
Panic disorder occurs across a range of situations, whereas phobias are specific (e.g. agoraphobia, social phobia)
OCD
a) Treatment
a) - CBT and exposure response prevention (ERP)
- SSRIs if needed
Postnatal depression
a) Features
b) Onset (vs. baby blues)
a) Guilty feelings, lack of enjoyment from baby, poor sleep even when baby is asleep, worthlessness, inability to cope, suicidality
b) After 2 weeks from delivery
- vs. baby blues (in first week)
Clozapine
a) Indication
b) Side effects
c) Monitoring
a) 2 different classes of antipsychotics at therapeutic dose for 6 weeks
b) - Hypersalivation, weight gain, diabetes, seizure risk
- Agranulocytosis, pancytopenia
c) - Weekly FBC for 18 weeks, then every 2 weeks
- Weight and lipids at baseline, then 3 monthly for a year, then yearly
- Fasting glucose at baseline, then 4-monthly for a year, then yearly
- Prolactin levels at baseline, then 6-monthly, then yearly
Somatisation vs hypochondriasis
Somatisation
- symptoms
- Multiple and varied over 2 years or more despite negative results and doctor assurances constitutes somatisation disorder
Hypochondriasis - anxiety
Valproate overdose
a) when levels are what factor above normal
b) features
c) treatment
a) 10-20x
b) Hypotonia, hyporeflexia, miosis, weakness, respiratory depression, coma
(Opposite to serotonin syndrome)
c) Activated charcoal
Gastric lavage
Haemodialysis
Body dysmorphic disorder
Management
Exposure response prevention
Clomipramine
Serotonin syndrome vs NMS
a) Clinical features
b) Causes
a) Clinical features:
Oh MAN, I’ve got serotonin syndrome:
- Mental state (anxiety, agitation, confusion, coma)
- Autonomic (fever, sweating, HTN, tachy, mydriasis*)
- Neuromuscular (tremor, clonus, hypertonic, brisk reflexes
*Mydriasis not present in NMS
NMS - FEVER:
- Fever
- Encephalopathy
- Vital signs (tachycardic)
- Elevated creatine kinase (more common than in serotonin syndrome)
- Rigidity and other PD features
b) Causes of serotonin syndrome - SSRIs and other serotonergic medications
Causes of NMS - dopamine antagonists
