Psych (things I forget) Flashcards
What is the difference between tardive dyskinesia, acute dystonia and akathisia?
Tardive dyskinesia = prolonged use - choreoathetoid movements
Acute dystonia = acute reaction - sustained muscle contraction e.g. torticollis/oculogyric crisis
Akathisia = acute reaction - motor restlessness
What are 4 main side effects of typical antipsychotic use?
- Acute dystonia
- Akathisia
- Parkinsonism
- Tardive dyskinesia
What is used to manage tardive dyskinesia, acute dystonia and akathisia?
Tardive dyskinesia = tetrabenazine
Acute dystonia = procyclidine (2nd line = benzotropine)
Akathisia = propranolol
When should patients new on SSRIs be reviewed?
<25 = 1 week
>25 = 2 weeks
What are the clinical features of SSRI discontinuation syndrome?
- Dizziness
- Electric shock sensations
- Anxiety
- Sweating
- GI symptoms
- Restlessness
What should be done in patients on antidepressants displaying symptoms of mania/hypomania?
Stop antidepressant and start antipsychotic
What are risk factors for schizophrenia?
- Male
- Black
- Family history
- Cannabis use
- Childhood abuse
What are prognostic indicators in schizophrenia?
Good = female/predominance of positive sx
Bad = gradual onset of sx/onset in adolescence
What are the NICS/CKS aspects of management for schizophrenia?
- Assess risk of harm to self and others
- Referral to psychiatric team
- Antipsychotic under specialist supervision
- Signpost to support for self/family
- Offer CBT
- Treat co-existing psychiatric/substance disorders
Which antidepressant commonly causes increased appetite and subsequent weight gain?
Mirtazapine (NaSSAs)
What is clang association?
Ideas related only by rhyme or being similar sounding
What should be done to patients with depression who are about to commence ECT?
Reduce antidepressant medication
What is catatonia?
State in which someone is awake but does not seem to respond to other people and their environment/state of near unconsciousness or insensibility
What is the diagnostic criteria for chronic insomnia?
Trouble falling/staying asleep at least 3 nights per week for >3 months in patients of any age
Describe the PHQ-9 score for depression
- <=4 = minimal
- 5-9 = mild
- 10-14 = moderate (talking therapy)
- 15-19 = moderately severe (pharmacotherapy)
- > =20 = severe (pharmacotherapy + referral)
Describe alcohol withdrawal timeframes
6-12 hours = symptoms
36 hours = seizures
72 hours = delirium tremens
What does acamprosate do?
NMDA receptor antagonist - reduces alcohol cravings
What does disulfiram do?
Acetaldehyde dehydrogenase inhibitor - causes unpleasant symptoms when someone has alcohol
What does naltrexone do?
Reduces the pleasurable effects of alcohol
What medications are used in drug overdoses?
Naloxone
Paracetamol - acetylcysteine
What are investigative features of anorexia?
- Most things low
- Gs and Cs raised = Growth hormone, Glucose, salivary Glands, Cortisol, Cholesterol, Carotinaemia
What is neuroleptic malignant syndrome and what are the causes?
Life-threatening disorder characterised by confusion, rigidity and fever
- Adverse reaction to antipsychotics (dopamine receptor agonists)
- Abrupt withdrawal of dopaminergic medication
What are the investigations for neuroleptic malignant syndrome?
- Raised CK
- Raised WCC
- Deranged LFTs
- Abnormal U&Es
- Metabolic acidosis
What is the difference between conversion disorder and somatisation disorder?
Conversion disorder = loss of motor/sensory function
Somatisation disorder = multiple unexplained symptoms >2 years
What electrolyte imbalance are SSRIs associated with?
Hyponatraemia
What are the risks of SSRIs in pregnancy?
1st trimester = increased risk of congenital heart defects
2nd trimester = increased risk of persistent pulmonary HTN
What is De Clerambault’s syndrome?
A delusion in which someone believes that a famous person is in love with them
What is Capgras syndrome?
A delusion in which someone believes that a person closely related to them has been replaced by an imposter
What is Cotard syndrome?
A delusion in which someone believes that they are dead or non-existent
What should be monitored at initiation and dose titration of SNRIs?
Blood pressure
What should be monitored at initiation and dose titration of SSRIs?
U&Es
What should be monitored at initiation and dose titration of TCAs?
ECG
What are the clinical features of lithium toxicity?
- Coarse tremor
- Ataxia
- Hyperreflexia
- GI upset
- Polyuria
What are the investigations for generalised anxiety disorder?
- 24 hour urine metanephrines
- ECG
- FBC
- Iron studies
- TFTs
What score is used to investigation alcohol abuse?
AUDIT
Give 2 examples of typical antipsychotics and their common side effect
- Haloperidol
- Chlorpromazine
- Parkinsonism’s
What is the difference between hypoactive sexual desire disorder, female sexual arousal disorder and sexual aversion disorder?
- Hypoactive sexual desire disorder = lack of interest in sex but not physiological response to arousal (lack of interest but may still enjoy)
- Female sexual arousal disorder = lack of desire to have sex and experience vaginal dryness
- Sexual aversion disorder = disgust at thought of sex
What is the management for mood stabilisation in bipolar affective disorder?
- Lithium
- Sodium valproate may be used second line
Give 2 examples of monoamine oxidase inhibitors and the main complication
- Phenelzine
- Isocarboxazid
- Tyramine cheese reaction
How often does clozapine need to be monitored?
- 1 blood test (FBC) per week for the first 18 weeks
- Fortnightly until 1 year
- Monthly
What are the side effects of clozapine and when may the dose need to be adjusted?
- AGRANULOCYTOSIS
- Reduced seizure threshold
- Constipation
- Myocarditis
- Hypersalivation
- Dose adjustment needed if patient stops/starts smoking
What test can be done to test cognition?
6CIT - six item cognitive impairment test
What do egosyntonic and egodystonic mean?
Egosyntonic - in keeping with ones’ beliefs and values
Egodystonic - very different to ones’ normal beliefs and values
What is the difference between flight of ideas and knight’s move thinking and what are they commonly seen in?
Knight’s move = thoughts move from one topic to another without any logical connections between them (schizophrenia)
Flight of ideas = increased rate of thought and some logical links between frequent changes of topics (mania/hypomania)
What is the management for OCD?
- CBT/exposure and response prevention
- SSRI (not fluoxetine)
- Clomipramine
What is the management for PTSD?
- Trauma-focused CBT/eye movement desensitisation and reprocessing therapy
- Venlafaxine
- SSRI
What are the first rank symptoms of schizophrenia?
- Third person auditory hallucinations
- Thought disorders
- Delusional perceptions
- Passivity phenomenon
What are positive symptoms of schizophrenia?
- Hallucinations
- Thought disorders
- Delusional perception
- Passivity phenomenon
- Persecutory delusions
What are negative symptoms of schizophrenia?
- Affective blunting
- Poverty of speech (alogia)
- Anhedonia
