Psychiatric treatments Flashcards
Management of PDs
a) Psychotherapy types
b) Drugs may required in what 3 instances?
a) Psychodynamic, CBT, DBT, group psychotherapy
b) Comorbid depression, transient psychosis (olanzapine), severe agitation (BDZs, haloperidol)
Management of PDs
a) Psychological treatments
b) Drugs may required in what 3 instances?
c) There should be a _____ management plan
a) Psychodynamic, CBT, DBT, group psychotherapy
b) Comorbid depression, transient psychosis (olanzapine), severe agitation (BDZs, haloperidol)
c) Crisis management
CBT
a) What does it involve?
b) In what conditions might cognitive (guided discovery) or behavioural (e.g. ERP) therapy predominate?
c) Type used for PTSD
d) 2 strategies to make CBT more available?
a) Identify the problem
Develop an understanding of the link between thoughts, feelings and behaviours
Set goals and strategies
Learn skills to apply in day to day life (set homework)
b) Depression - cognitive. Anxiety/OCD/stress - behavioural?
c) Trauma-focused (TF-CBT)
d) Computerised CBT (cCBT) and IAPT
Psychotherapy vs. counselling
Counselling used to help someone cope with recent events they have found difficult.
It does not aim to help you change as a person
Psychoanalytic (Freudian) therapy vs CBT
- What approach combines these two approaches?
- Psychoanalytic therapies analyses past trauma
- CBT tends to focus on the present and the future
- Cognitive analytic therapy (CAT)
Interpersonal therapy.
Aims to help the patient understand how problems may be connected to the way their relationships work
Helps identify how to strengthen relationships and find better ways of coping
Dialectical behavioural therapy (DBT)
- What condition is it useful in
‘Dialectics’ means trying to balance seemingly contradictory positions
…balancing acceptance (accepting yourself as you are) and change (making positive changes in your life)
Mostly aimed at helping problems associated with borderline personality disorder
Repeated self harming, relationship problems
Family therapy - often used in…?
CAMHS
Dopamine pathways
a) Give the 4 type and the disease state each is responsible for
b) Nicotine attaches to ACh receptors in the VTA, causing dopamine release where?
c) Schizophrenia dopamine hypothesis for positive and negative psychosis
a) Mesocortical - Negative symptoms of psychosis
Mesolimbic - Positive symptoms of psychosis, and addiction
Nigrostriatal - PD, EPSEs
Tuberoinfundibular - Hyperprolactinaemia
b) Nucleus accumbens
c) Overactivity of D2 receptors (Mesolimbic = hallucinations)
Underactivity of D1 receptors (Mesocortical = blunted and apathetic)
Serotonin
a) Where is it produced
b) Function: 4 things that serotonin regulates
c) Main receptor implicated in psychiatric conditions
d) What drug class are agonists to 5HT1 receptors?
e) What drugs are antagonists to 5HT3 receptors?
a) Raphe nucleus
b) Regulates mood, stressm, social behavior, appetite and digestion, sleep, memory, and sexual desire and function
c) 5HT2a
d) Triptans - used in migraine prevention
e) Ondansetron, metoclopramide (also a D2 antagonist)
Side effects of:
a) SSRI (SSSSSSS)
b) SNRI (SHAT)
Sexual dysfunction (but useful in premature ejaculation)
Stomach upset (diarrhoea, nausea, vomiting, ulcers - if on NSAIDs as well)
Size (weight gain)
Sleep difficulties
Suicidal thoughts
Stress (anxiety)
Serotonin syndrome
Same as SSRI, plus…
Hypertension
Agitation
Tachycardia
TCAs
a) 4 neurotransmitters they affect
b) Common SEs (mnemonic: TCA)
c) Main indication in current practice
d) Overdose: signs and complications
e) Overdose: treatment
a) Serotonin, Noradrenaline, Histamine, ACh
b) Toxic to the heart (arrhythmia, heart block),
CNS (drowsy, memory impairment, confusion)
Anticholinergic (dry mouth, blurred vision, constipation, urinary retention)
c) Neuropathic pain (often coexists with depression)
d) - Anticholinergic effects: altered mental status, dry mouth, mydriasis (pupil dilation), fever
- Cardiac effects: LONG QT, hypertension, tachycardia, arrhythmias (VT, VF)
- CNS effects: syncope, seizure, coma, myoclonus, hyperreflexia, hypoventilation
- Gastrointestinal effects: decreased bowel sounds
e) Detox:
- activated charcoal,
- gastric emptying,
- whole bowel irrigation
- If broad QRS, give IV sodium bicarbonate
Lithium
a) MoA
b) Signs of toxicity
c) Causes of toxicity
d) Treatment of toxicity
a) Inhibits cAMP which inhibits monoamines
b) Coarse tremor, hyperreflexia, coma, seizures, heart block
c) Poor renal function, overdose, infection, stressor, dehydration
d) Stop lithium, rehydrate, haemodialysis,
- whole bowel irrigation
Atypical antipsychotics
a) 4 receptors acted on
b) Greatest effect on weight gain (2)
c) Lowest side effect profile
a) 5HT2a (serotonin), D1 and D2 (dopamine) and alpha/beta adrenergic receptors (noradrenaline), muscarinic receptors
b) Olanzapine, Clozapine
c) Aripiprazole
Neuroleptic malignant syndrome (NMS)
a) Pathophysiology
b) Presentation (mnemonic: FEVER)
c) Investigation to confirm
d) Causes: offending drugs and triggers
a) Central D2 receptor blockade or dopamine depletion in the hypothalamus and nigrostriatal/spinal pathways
b) - Fever,
- Encephalopathy,
- Vital signs (tachycardic),
- Elevated creatine kinase,
- Rigidity and other PD features
c) Serum creatine kinase (CK) raised
d) Usually 1st generation APs (commonly haloperidol), often after initiating or upon increasing dose
