Psychiatric Flashcards
1
Q
what is the common pharmacological action of antidepressants?
A
elevate levels of one or more monoamine neurotransmitters n the synaptic cleft
2
Q
How do tricyclic antidepressants work?
E.g Amitriptyline
A
blockage of both noradrenaline and serotonin re-uptake pumps presynaptically
3
Q
How do SSRI work?
E.g citalopram, Fluoxetine, Sertaline
A
selective presynaptic blockage of serotonin re-uptake pumps
4
Q
How do SNRI work?
e.g Venlafaxine
A
presynaptic blockage of both serotonin and noradrenaline re-uptake pumps (with no affect on muscarinic, histaminergic or alpha-adrenergic receptors)
5
Q
How do Monoamine oxidase inhibitors (MAOI) work?
E.g Phenelzine, Tranylcypromine, Isocarboxazid
A
non-selective and irreversible inhibits of monoamine oxidase A and B
6
Q
How to Reversible inhibitor of Monoamine oxidase A work?
e.g moclobeminde
A
selective and reversible inhibition of monoamine oxidase A
7
Q
Indications for SSRI’s?
A
Depression
Anxiety disorders
OCD
Bulimia Nervosa
8
Q
What SSRI is used in Bulimia nervosa?
A
Fluoexetine
9
Q
indications for TCA?
A
Depression Anxiety disordrs OCD Chronic pain nocturnal enuresis
10
Q
indications for MAOI?
A
Depression
anxiety
Eating disorders
Parkinsons
11
Q
S.E and contraindications of SSRI?
A
- Fewer anticholinergic affects than TCA and are not sedating
- Are alerting, so prescribe in morning
- Common SE= N&V, diarrhoea, pain, anxiety, agitation, weight loss and loss of appetite, insomnia, sweating sexual dysfunction
- CI= Mania
12
Q
Tricyclic Antidepressants- SE and CI?
A
- SE- dry mouth, constipation, urinary retention and dizziness (anticholinergic effects)
- Postural hypotension (due to alpha-adrenergic)
- Weight gain and sedation (histaminergic)
- Cardiotoxic–> Prolonged QT, ST elevation, heart block, arrythmias
- CI= recent MI, arrhythmia, severe liver disease, mania
13
Q
MAOI- SE and CI?
A
- Now is 2nd line due to many interactions with certain foods
High risk of Serotonin syndrome
S.E- Anticholinergic effects and postural hypertension
CI- Phaeochromoctyoma, CVD, hepatic impairment , Mania
14
Q
What is serotonin syndrome?
A
neuromuscular abnormalities, altered conscious level, autonomic instability
Is fatal
15
Q
Name the 2 types of Mood stabilisers?
A
1) Lithium
2) Anti-convulsants= sodium valproate, carbamazepine and lamotrigine
16
Q
Indications for lithium?
A
- Acute mania
- Prophylaxis of bipolar affective disorder
- Treatment for resistant depression
17
Q
Indications for sodium valporate?
A
- Epilepsy
- Acute mania
- Prophylaxis of Bipolar
18
Q
indications for carbamazepine?
A
- epilepsy
- Prophylaxis of Bipolar
- Trigeminal neuralgia
19
Q
Lithium range ?
A
- 0.5-1
Over 1.5 is toxic, and over 2 is dangerous
20
Q
What drugs can increase lithium levels?
A
- Diuretics, NSAIDs and ACE-i (stopping renal clearance)
21
Q
S.E of lithium?
A
- Thirst, polydipsia polyuria, weight gain, oedema
- Fine tremor
- Precipitation of skin problems
- Concentration/memory problems
- ECG changes= T wave flattening or inversion
- Hypothyroidism
- Leucocytosis
22
Q
Signs of lithium toxicity?
A
- N&V, apathy, coarse tenor, ataxia, muscle weakness
- Dangerous levels= nystagmus, dysarthria, impaired consciousness, hyperactive tension reflexes, renal function and electrolyte imbalances
23
Q
Things to do before prescribing lithium? (testing for CI)
A
- FBC
- Renal function and electrolytes
- Thyroid function
- Pregnancy test
- ECG
24
Q
S.E of sodium valproate?
A
- Increased appetite and weight gain
- Sedation and dizziness
- Ankle swelling
- N&V
- Tremor
- Can cause haematological abnormalities and raised liver enzymes
25
S.E of carbamazepine?
- N&V
- skin rashes
- Blurred or double vision
- Ataxia, drowsiness and fatigue
- Hyponatraemia, haem abnormalities and raised liver enzymes
26
Name x2 1st generation antipsychotics?
- Chloropromazine
| - Haloperidol
27
Name x4 2nd generation (atypical) antipsychotics?
- Clozapine
- Olanzapine
- Quetiapine
- Risperidone
28
Mode of action of anti-psychotics?
- Antagonism of dopamine D2 receptors in the mesolimbic dopamine pathway--> area associated with delusions, hallucinations, thought disorders etc. Also area where most illicit drugs work, thus euphoria etc...
29
What is different about Clozapines mode of action?
its a weak D2 antagonist, but a strong affinity for serotonin type 2 and D4
30
S.E of Clozapine?
- Rare serious side effects such as agranulocytosis, myocarditis and cardiomyopathy
- thus reserved for treatment resistant cases
(needs weekly FBC's then montly)
31
what are the extrapyramidal S.E of anti-psychotics?
- parkinsonism motorsyptoms
- acute dystonia
- Akathisia
- Tardive dyskinesia
32
indications for antipsychotics?
- Schizophrenia, schizoaffective disorder, delusional disorder
- depression or mania with psychosis
- psychosis due to substance abuse
- delirium
33
Triad in Neuroepileptic malignant syndrome and Serotonin syndrome?
- neuromuscular abnormalities
- altered consciousness
- autonomic dysfunction
34
NMS vs Serotonin syndrome?
- NMS= caused by too much dopamine antagonist. Get reduced activity (rigidity, dysphagia etc)
- SS= too much serotonin (increased activity)
35
Blood results of NMS and SS?
elevated CK, WCC and hepatic transaminases
| Also see a metabolic acidosis
36
Drugs used for Anxiety and lack of sleep?
- Benzodiazepines
37
Mode of action of benzo's?
potentiate the action go GABA
38
indications for benzo's?
- insomnia
- Anxiety disorders
- alcohol withdrawl
- akathisia
- acute mania or psychosis (sedation)
39
indication for Electroconvulsive therapy?
- severe depression (when life is threatened, poor fluids and feeding, suicidal intent etc)
40
S.E of ECT?
| CI of ECT?
```
S.e= loss of memory. confusion, Nausea, headache and muscle pain
CI= Heart disease, Raised ICP, risk of cerebral bleeding etc
```
41
What is a mental disorder?
any disorder or disability of the mind
42
What is the mental health act?
provides a legal framework for the care and treatment of individuals with mental disorders
43
What is a section 2?
Admission for assessment.
compulsory detention for assessment. used for when diagnosis and response to treatment are unknown. lasts for 28 days and requires 2 doctors (one doctor must be section 12 approved)
44
What is a section 3?
Admission for treatment.
Compulsory admission fo treatment. used when diagnosis and treatment is established. Can last up to 6 months and needs 2 doctors to approve (one doctor must be section 12 approved)
45
What is a section 4?
Emergency admission for assessment.
done when there is no time to wait for section 2 procedures in the community. lasts 72 hours (1 doctor above F2 can do it)
46
What is a section 5 (2)?
doctors holding power.
detention of a hospital inpatient receiving any form of treatment in order to give time for section 2 or 3 (doesn't have to be psych)
Any doctor can do
47
What is a section 5(4)?
Nurses holding power of up to 6 hours. must be registered mental health nurse
48
What is a section 135?
Police to enter a private premises to remove someone with a suspected mental health disorder to a place of safety . can last up to 72 hours
49
What is a section 136?
Police to remove someone suspected with mental health disorder from public place to a place of safety for up to 72 hours
50
3 core symptoms of Depression?
- low mood
- adhedonia
- anergia
51
The other symptoms of depression can be divided in to?
- Biological
| - Cognitive
52
Biological symptoms of depression?
- Early morning wakening
- Depression is worst in morning
- marked loss of appetite with weight loss
- psychomotor retardation or agitation
- loss of libido
53
Cognitive symptoms of depression?
- reduced concentration or memory
- poor self esteem
- guilt
- hopelessness
- suicide or self harm
54
In severe depression with psychosis, what hallucinations are often experienced?
- 2nd person auditory
| - olfactory (smell of rotting flesh)
55
To diagnose depression, mild, moderate or severe, what must the patient have?
- A 2 week history of 2/3 core symptoms plus...
- Mild= 2 other symptoms
- moderate= 3 other
- severe= 4 other but all core symptoms!
56
What is Dysthymia?
- A chronically depressed mood that usually has its onset in early adulthood and may remain throughout the patients life, with variable periods of wellness in between.
57
What is cyclothymia?
- A milder version of bipolar affective disorder resulting in instability of mood involving mild elation and mild depression. It has no interference with every day life.
58
What is Schizoaffective disorder?
Diagnosis made when patients presents with both mood symptoms (depression or mania) and schizophrenic symptoms within the same episode of illness
59
What is Bipolar affective disorder?
- Mood is considered to deviate from normal to either a depressed or elated (manic) pole
60
What is mixed affective disorder?
- when manic and depressive symptoms rapidly alternate (in same day)
61
What are the Biological symptoms of Mania?
- Decreased need for sleep
| - Increased energy
62
What are the cognitive symptoms of Mania?
- Elevated sense of esteem or grandiosity
- poor concentration
- accelerated thinking (pressure of speech) (flight of ideas)
- impaired judgement and insight
63
What is hypomania?
- mood elevation with periods of depression. not as bad as bipolar affective disorder. considerable interference with life.
64
What is Psychosis?
- a mental state in which reality is grossly distorted, resulting in symptoms such as delusions, hallucinations and though disorder
65
What is a hallucination?
- perception scouring in the absence of an external physical stimulus, which have the following important characteristics...
- to the patient, the hallucination is as real as a normal sensory experience
- they are experienced via 1 of the 5 sensory modalities
- they occur without an external stimulus
66
What are the 4 types of Auditory hallucinations?
1) Elementary
2) first person (own thoughts spoken out loud)
3) Second person (patients hears a voice talking directly to them)
4) third person (patient hears multiple voices talking to them, e.g. devil and angel)
67
What is an illusion?
misperception of a real external stimuli
68
What is a pseudohallucination?
a hallucination experienced by the patient but they regard it not true but continue to experience the hallucination.
69
What is a delusion?
- unshakable false belief that is not accepted by others
- no difference between delusion and true belief to patient
- delusion is false due to faulty reasoning
- out of keeping with patients social and cultural beliefs
70
What is a primary delusion?
do not occur in response to any previous psychopathological state
71
What is a secondary delusion?
- the consequence of pre-existing psychopathological state
72
What are mood congruent delusions?
- content of delusions are appropriate to patients mood (seen in depression or mania etc.)
73
What is Capras syndrome?
- belief that a familiar person has been replaced with an exact double/imposter= delusion of misidentification
74
What is Fregoli syndrome?
- belief that a complete stranger is actually a familiar stranger already known to one
75
What are somatic delusions?
- false belief concerning ones body- e.g. bowels are rotting, skin is dirty with bacteria
76
What is circumstantial thinking?
-Speech is delayed in reaching its final goal as of the over inclusion of detail, however the speaker will then get to the point
77
What is tangential thinking?
- Speaker derives from the original train of thought but never returns to the original point
78
What is flight of ideas?
- thinking is markedly accelerated, resulting in a stream of connected concepts
79
What is loosening of association?
- patients train of thought shifts suddenly from one very loosely or unrelated idea to the next
80
What is thought blocking?
- patients experience a sudden cessation to their flow of thought, often mid-sentence
81
What is preservation?
- an initial correct response inappropriately repeated (often organic brain disease)
82
What are negative symptoms?
- Negative symptoms are thoughts, feelings, or behaviors normally present that are absent or diminished in a person with a mental disorder.
83
6 clinical deficits that come under negative symptoms?
1) Marked apathy
2) poverty of thought and speech
3) blunting of affect
4) social isoloation
5) poor self care
6) cognitive deficits
84
diagnostic guidlines for Schizophrenia?
One or more of the following: (for a month)
a) thought echo, insertion, withdrawn or broadcast
b) Delusions of control or passivity delusional perception
c) Hallucinatory voices giving a running commentary
d) bizarre delusions
OR 2 or more of the following:
i) hallucinations that occur every day for weeks that are associated with fleeting delusions or sustained over valued ideas
ii) thought disorganisation
iii) catatonic symptoms
iv) negative symptoms
v) change in personal behaviour
85
What are schneiders first rank symptoms of schizophrenia?
1) delusional perception
2) delusions of thought control (insertion, withdraws broadcast)
3) delusions of control
4) hallucinations (audible)
86
What is paranoid schizophrenia?
Dominated by presence of hallucinations and delusions (positive symptoms) negative symptoms and catatonic symptoms are not prominent.
87
What is Hebephrenic/disorganised schizophrenia?
characterised by thought disorganisation, disturbed behaviour and inappropriate or flat affect
88
What is catatonic schizophrenia?
rare form characterised by one or more catatonic symptoms
89
What is residual schizophrenia?
1 year of predominantly negative symptoms which must have been preceded by at least one clear cut psychotic episode in the past
90
What is delusional disorder?
the development of a single or set of delusions for a period of at least 3 months is the most or only prominent symptom. comes on in middle age and can persist throughout life.
91
What are the 2 components of Anxiety?
- Thoughts of being apprehensive, nervous or frightened
| - Awareness of physical reaction to anxiety= autonomic or peripheral
92
What is generalised (free floating) Anxiety?
- does not occur in discrete episodes and tends to lasts hours, days etc. associated with excessive worrying, or apprehension of normal events
93
What is paroxysmal anxiety?
- abrupt onset, discrete episodes and short and severe. ETC panic attacks
- Can be divided into Episodes without an external threat or those with
94
What is Generalised anxiety disorder? what are the 3 key elements?
patients describe excessive worry about minor matters and are apprehensive on most days
1. apprehension
2. motor tension (inability to relax)
3. autonomic overactivity (sweating and shit)
95
What is panic disorder?
Characterised by presence of panic attacks that occur unpredictability and not restricted to any particular situation.
96
What are obsessions?
involuntary thoughts, images or impulses which have these following characteristics..
- recurrent and intrusive (unpleasant or distressing)
- enter the mind against conscious resistance
- patients recognise them as product of their own mind
97
What are compulsions?
repetitive mental operations or physical acts with the following characteristics
- patients fell compelled to perform them in response to their own obsessions or irrational rules
- they are performed to reduce anxiety through thoughts that they will prevent a dreaded event
98
What is the diagnosis criteria of OCD?
purely obsessions and compulsions without any other psychiatric illness.
- present for at least 2 weeks
- distressing patients life
- acknowledge from patients own mind
- obsessions are unpleasantly repetitive
- one thought or act is restricted unsuccessfully
- a compulsive act isn't pleasurable
99
4 conditions that patients can develop after a traumatic stressor?
1) an acute adjustment disorder
2) acute stress reaction or PTSD
3) Dissociative disorder
4) another psychiatric condition- depression, anxiety etc
100
What is adjustment disorder?
- emotional or behavioural symptoms within 3 months of the first stressor but resolves in 6 months
- characterised by mood or anxiety symptoms
- many experience suicidal ideation
101
What is acute stress reaction?
- happens few minutes after initial stressor and results n patients becoming dazed and disorientated. can last up to 48 hours
102
What is PTSD?
-develop between 1-6 months of initial traumatic stressor
repetitive re-expereince of traumatic event in form of flashback, internal or external cues resembling stressor and hallucinations or illusion.
-will try to avoid the stressor
- increased arousal (insomnia, angry outbursts etc)
- Can have amnesia during re-experience
103
What is delirium?
- acute or fluctuating cognitive impairment and consciousness, drowsy or agitated, psychosis may be present, and will all continuously fluctuate
104
Name some causes of delirium? (illness)
- infection/sepsis
- hypoglycaemia
- electrolyte disturbances
- thyroid
105
Name some drugs that can cause delirium?
- Anticholinergics
- Benzo's
- Opiates
- CO
- Cannabis
106
What is Dementia?
- A syndrome of acquired progressive generalised cognitive impairment associated with functional decline. Conscious level is normal. Symptoms should be present for 6 months before diagnosis.
107
Alzheimers disease progression?
- Gradual onset with progressive cognitive decline- early memory loss
108
Vascular dementia progression?
- Stepwise deterioration in cognition
- Evidence of cerebrovascular disease or stroke
- Focal neurological signs and symptoms
109
What is mixed dementia?
- Alzheimers and vascular
