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Psychiatry > Psychiatric treatment and medication > Flashcards

Psychiatric treatment and medication Flashcards

1
Q

define the dopamine hypothesis for schizophrenia

A

suggest:
1-hyperactivity of the mesolimbic dopamine pathways
-accounts for the positive syx of schizophrenia

2-defifcinecy of dopamine in the mesocrotical dopamine pathway
-accounts for negative and cognitive syx of schizophrenia

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2
Q

examples of first generation antipsychotics 4

A

flupentixol

chlorpromazine hydrochloride

haloperidol

sulpride

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3
Q

examples of second generation antipsychoticvs 6

A

amisulrpide

aripiprazole

clozapine

olanzapine

quetiapine

rispperidone

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4
Q

indications for antipsychotic use 2

A

schizoprhrenia and related disorders

bipolar affective disorder

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5
Q

movement disorder adverse effects of antipsychotis 4

A

acute dystonia
-involuntary contractions of skeletal muscle

pseudo-parkinsonism
-tremor, rigidity and hypokinesia

akathisia
-motor restlessness
-subjective feeling of tension and inability to tilerate inactivity which gives rise to restless movement

tardive dyskinesia
-late onset hyperkinetic, involuntary movement s

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6
Q

autonimic affects of antipsychoics 4

A

anti-adrenergic
-postural hypotension
-ECG chagnes (QTc prolongation) (can cause torsades)

anti-cholinergic
-dry mouth
-blurring of vision
-constipation
-dificultuy with micurtiion and retention

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7
Q

other adverse effects of antipsychotics

A

neuroleptic malgingant syndrome
-potentially fatal
-causes muslce rigidit, extreme EPS, severely elevate body temp and hyperteions and tachycardia

convulsant activity
-antispychotics (esp chlorpromazine) can lower seizure threshold

pigmentation of the skin

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8
Q

metabolic effects of antipsychotics 2

A

weight gain
-occurs with clozapine and olanzapine
-linked to DM

Endocrine
-hyperprolactinaemia
-can cause reduced labido and sexual dysfunction men
-menstrual irregularities and lactation in nonpregnnat females

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9
Q

hypersensitivity reactions to antipsychotics 2

A

cholestatic jaundice
-phenothiazine class (chlorpromazine)

skin reactions
photo seneisivty rahses

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10
Q

what is clozapine licsended for

A

treatment ressitant schizophrenia

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11
Q

why are second generation APs favourable to first generation

A

have fewer extrapyradimal side effects
-dont cause tradive dyskinesia
-not elevate prolactin

have more metabolic effects tho (weight gain)

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12
Q

most important side effect to consider for clozapine
-how is this managed

A

potenially fatal agranulocytosis

occurs in 0.5-2% of ptx

-managed by WBC monitoring initially as inpatient then community
-weekly for 18wks
-then fortnightly for up to one year
-then monthly

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13
Q

describe the link of clozapine and smoking and the risk associated

A

tobacco induces hepatic enzymes
-patients on clozapine will have reduced plasma levels

reduction or cessation in smoking will result in increased clozapine plasma levels
-this can cause dose related adverse effects

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14
Q

define hypomania vs mania

A

Mania and hypomania differ with respect to duration, intensity, and functional impairment:

Duration: In mania, an elevated or irritable mood lasts at least one week. In hypomania, symptoms last for at least 4 days.
Intensity: In mania, symptoms are severe, and in hypomania, they are mild to moderate.
Functional Impairment: In mania, critical life activities such as work and social relationships are impaired. In hypomania, there is no functional impairment.

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15
Q

definition of bipolar disorder

A

repeated (at least two) episodes were patients mood andactivityu levels are significantly disturbed
-on some occasion an elevation of modd and increased energy and acitivyt (hypo(mania))
-on some occasions lowering of moood and decreased energy and activity (depression)

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16
Q

describe the young mania rating scale

A

This is an 11-item instrument used to assess the severity of mania (Young et al 1978). (2)

Elevated Mood
Increased Motor Activity Energy
Sexual Interest
Sleep
Irritability
Speech (rate and Amount)
Language-Thought Disorder
Content
Disruptive-Aggressive Behaviour
Appearance
Insight

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17
Q

state the three main mood stabilisers used in the UK 3

A

lithium

carbamazepine

valporate

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18
Q

describe the uses of lithium in psychiatry 5

A

acute treatment of hypo(mania)

prophylaxis of bipolar or schizo

prophylaxis of recurrent depressive illness

augmentaiton of antidepressants in acute depressive illness

treatment of depresison in bipolar disorder

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19
Q

goals of acute treatment of mania 3

A

reducing mental and physical overactivity

improving features of psychosis

prevent deterioration in health due to exhaustion, sleep deprivation and poor fluid intake

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20
Q

options for acute treatment of mania 5

A

mood stabilisers
-lithium first line

antipsyhotic drugs

other mood stabilites
-lamotrigine and gabapentin

benzos- lorazepman and clonazepam

ECT

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21
Q

predictors of poor responses to lithium

A

rapid cycling disorders or chornic depresion

mixed affective states

alcohol and drug misuse

mood-incongruent psychotic features

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22
Q

define mixed affective staet

A

simultaneous presenc of features of mania and depression

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23
Q

define rapid cycling disorders

A

4 distinct periods of abnormal mood within the year

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24
Q

lithium use in pregnancy

A

lithium is teratogenic
-causes tricuspid valve deformity and thyroid function of the new born infants

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25
Q

what is checked before commencement of lithium 3

A

need TFTs, ECG and kideny function tests before commenced

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26
Q

main drug interactions with lithium 2

A

NSAIDs

Thiazide diuretics

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27
Q

what physcial state in lithium a danger in

A

dehydration (diarrhoea or excess sweating)
as toxicity can occur

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28
Q

common side effects of lithium 7

A

N+V

diarrhoea

metalic taste in mouth

cognitive dulling

tremor

muscle weakness

weigh gain

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29
Q

serious side effects of ltihium 4

A

hypothyroidism -MAIN

hyperparathyroidism

renal tubular necorsis- renal failure

nephrogenic diabetes inspidius

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30
Q

presentation of lithium induced hypothyroidism and managemnt

A

can occur with a frank goitre

(lithium interfere with thyroid function by competing with iodine for absorption into thyroid gland)

corrected by giving thyroxine

-reversible on stopping lithium

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31
Q

renal tubular necrosis in lithium use overview

A

rare

-unlear origin

develop renal failure with progressive reduction in renal clearance

management:
-therapueitc bloods monitoring checked 3/12 allows early detection ie eGFR

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32
Q

importantt roles of multidisaplinary memebrs for psychaitric patients 5

A
  1. Community Psychiatric Nurse allocated and their role would be to monitor mental state and adherence with medication.
    1. Housing Officer present to monitor and report on state of housing and related issues.
    2. Occupational Therapy assessment to assess Activities of Daily Living (ADL) (3 marks)
      4. General Practitioner for physical health review.
    3. Social Work to perform a Needs Assessment focusing on social functioning.
33
Q

management of lithium overdose 3

A

prinicple - reduction of ansopriong and increased clearance of lithium

-diuresisi via IV fluids
-Gastirc lavage
-Whole bowel irrigation

34
Q

basic prinicples of prescribing antidepressants

A

discuss w ptx- choice of drug and utility/vaiblilt

discuss w patient likely outcomes-
-gradual relief from depressive syx over several weeks

pprescibre dose of antidepressants -
that is likely to be effective

withdraw antidepressants gradually
-always inform patients of risk and nature of discontinuation syx

for a single episode
-contine treatment for 4066months after resolution of syx

35
Q

what is the prinicple theory that underpins use of antidepressants and describe ti

A

monoamine theory of depression

depressive syndrome is due to an absolute or relative decrease in monoamines, or of receptor sensitivity at certain receptor sites in the brain

36
Q

state the monoamine neurotransmitters in the brain 3

A

noradrenaline (NA)

dopamine (D)

serotonin (5HT)

37
Q

state the different types of antidepressants and some examples 4

A

tricyclics
-amitryptylin

SSRI
-sertraline, fluoextine, citalopram

SNRI
-venlafaxine

Monoamine oxidate inhibiotrs (MAOIs)
-phenalzine

38
Q

MOA of antidepressants

A

enhance functional activity of NA and/or 5HT

-*wait 6 weeks to evaluate effects of antidepressants on an individual basis

39
Q

first choice antidepressants

A

SSRIs

-safe in overdose and heart disease
-good adverse effect profile

40
Q

SSRI side effects 7

A

GI
-Nausea
-appeitie loss
-dry mouth
-diarhoea

CNS
-insomia
-dizziness
-anxietry
-fatigue

other
-sweating
-delyaed orgasm and anorgasmia

41
Q

worry with St john worts use

A

if coprescribed with SSRI or other 5-HT potentiating drugs can cause serotonergic syndrome

42
Q

neurological features of serotonin syndrome 6

A

Neurological
-myoclonus
-nystagmus
-headache
-tremor
-rigidity
-seizures

43
Q

mental state features of serotonin syndroem 4

A

mental state
-irritability
-confusion
-agitation
-hypomania

44
Q

other features of serotonin syndrome

A

hyperpyrexia

sweating

diarrhoea

cardiac arrhymias

death

45
Q

CBT concepts

A

thoughts feelings physcial sensations and behvaiours interconnected

negative thoughts and feelings can trap you in a vicious cycle

46
Q

what is the focus of CBT

A

dealing with automacitv negative thoughts

47
Q

automatic negative thoughts are a nromal everyday occurrence but why are they worse in anxiety and Depression 3

A

experieced more frequently

harder to challenge

helpful/balancing thoughts are crowed out

48
Q

CBT approach 5

A

here and now

problem focused

specific strategies

homework

more directive than other therapies

49
Q

5 areas model of CBT

A

a life situation, relationship or practical problem
-then with the CBT approach you do:
-altered thinking
-altered physical sensations/syx
-altered emotions
-altered behaviours

50
Q

what is CBT good for 6

A

depression

anxiety

OCD

eating disorders

phobias

panic

51
Q

describe psychodynamic psychotehrapy

A

past relationships recreated in current relationship:
-transference
-counter transfernce

aims
-improve insight (identify unhelpful unconicous processes and defense mechanisms
-improve management of distress

52
Q

define defence mechanisms

A

protect us from emotioal distres by preventing experience of unacceptable feelings/impulses/conflicts

can be on spectrum from conscious to unconscious

everyone uses them not necessarily pathological

53
Q

regarding defence mechanisms:
-define projection

A

attributing unacceptable feelings/thougths to someone else

54
Q

regarding defence mechanisms:
-define splitting

A

all good/ all bad

55
Q

regarding defence mechanisms:
-define displacement

A

an individual transferring negative feelings from one person or thing to another.

56
Q

regarding defence mechanisms:
-define
repression and suppression

A

repression- unconscious

suppression- concious

both- ‘forgetting’

57
Q

regarding defence mechanisms:
-define intellectualisation

A

focusing on facts, ignoring emotional content

58
Q

regarding defence mechanisms:
-define rationalisation

A

rational justifications/ excuses for behaviour

59
Q

regarding defence mechanisms:
-define sublimation

A

unacceptable feelings/thoughts into acceptable channel

60
Q

what is the main principle of family (systemic) therapy

A

mainly in CAMHS
-family seen together

based on:
-syx is not a problem of the child but a problem of the family system
-no one person to blame

family is seen as a system of relationships
-all contribute to maintaining the system and hence the symptoms

61
Q

method of family therapy

A

promote effective communication patterns within the family

-therapist and team take a ‘one-down’ position

postmodern approach
-family are experts and have the answers

62
Q

overview of counselling

A

most common psychotherapy
-mainly promary care and usually short term

aim to help person become celare about problems and then come up with own answers
-therapist tend to avoid giving answers

not aim to bring fundamental change but instead bolster existing coping strategies

63
Q

what is the danger with tricyclic antidepresants

A

dangerous in overdose
-seizures
-comas
-arrythmias

64
Q

an example of a noradrenaline and specific serotonin antidepressant (NaSSAs)

A

mirtazapine

65
Q

important info on antidepressants for exams 3

A

selec drug based on side effect profile
-ie poor appetite and poor sleep- mirtazpaine

wathc for discontinuation symptoms vs addiction

sexual side effects could be hidden agenda

66
Q

info on antipsychotics for exams 3

A

differences betweeen first generation and second generation

monitoring
-weight
-BP
-ECG
-glucose/HbA1c
-lipids

remind patient to wear sunscreen

67
Q

what is the teratongenic effect of valporate

A

neural tube defects

68
Q

what is the teratogenic effect of lithium

A

ebsteins anomaly -a rare heart defect that’s present at birth (congenital). In this condition, your tricuspid valve is in the wrong position and the valve’s flaps (leaflets) are malformed

69
Q

why is ECT one of teh safest psych treatments 2

A

least side effects

fastest acting- life saving

70
Q

what happens in ECT

A

controlled siezure
-improves mood and psychotic syx

71
Q

indications for ECT 3

A

severe depression- sucidal ideation, psychomotor retardation

catatonia

treatment resistant psychosis

72
Q

contraindications for ECT

A

no absolute contraindications

73
Q

how often is ECT usually performed

A

twice/week

up to 12 sessions

74
Q

consent for ECT?

A

patinet needs to give consent or 2nd opinion from mental welfare commission

75
Q

what is given for ECT 2

A

general anaesthetic

muscle relaxant

76
Q

risks of ECT 4

A

mainly from anaesthetic

dentition

headache and muslce pains, vomiting

long term: memory can be affected

77
Q

mainstay of psychosurgery

A

anterior cingulotomy
-targets anterior cingulate cortex (part of. limbic system)

78
Q

what is anterior cingulotomy psychosurgery used for 2

A

treatment resistant mood disorder

treatment resistant OCD

79
Q

other psychosurgery exmaples 2

A

transcranial magentic stimualtion

vagal nerve stimulation

Psychiatry (21 decks)

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