Psychiatry Flashcards
Quetiapine (atypical antipsychotic) effect on weight
Promotes weight gain
First line treatment for obesity
Lifestyle intervention (CBT, diet, physical activity)
Unipolar mood disorders
Only low moods (depression)
The most strongly heritable mental illness is
Bipolar disease, 10x increase in 1st degree relatives
Mania in Bipolar I
Often extreme, increased mood and activity for more than 7 days
Mania in bipolar II
Hypomania, more than 4 days to count
Mania is defined as 3 or more of
Grandiosity, sleep decrease, speech change, racing thoughts, distractibility, agitation, impulsivity
Flight of ideas
Jumping from one idea to the next
DDX suspected mania
Hypomania, psychosis, substance use, delirium, catatonia, anxiety, endocrine, neurological, cerebrovascular
Chance of recurrence after first manic episode
90%
Treating mania
Requires medication and almost always hospitalization
Gold standard treatment for bipolar 1
Lithium
Lithium treats
BPD1, and can be helpful in BPD2
Can a breastfeeding woman take lithium?
No, lithium is contraindicated during breastfeeding
Which organ function can be reduced by lithium
Both thyroid and renal function (if used long term)
Divalproex sodium is also known as
Valproic acid
Med class Valproic acid
Anti-epileptic, can also be helpful in BPD
Can a pregnant woman take Valproic acid?
No, it is contraindicated
Main indication for Lamotrigine is
bipolar depression
Lamotrigine has a risk of which side effect
SJS - drug emergent rash
4 commonly used atypical antipsychotics include
Quetiapine, olanzapine, risperidone, aripiprazole
First line treatment for acute mania
Lithium, divalproex
First line treatment for bipolar depression
Lithium, Lamotrigine, Quetiapine
Overdose of TCAs can cause death by
Cardiac arrhythmia
How long til some benefit of antidepressants are seen?
2-3 weeks
How long until maximal benefit of antidepressants?
6-8 weeks
SADPERSONS for
Suicide and self harm behaviour
SADPERSONS stands for
Sex (male) Age (<19, >45) Depression Previous attempt Ethanol Rational thinking loss Social Organized plan No spouse Sickness
SIGECAPS screens for
Depression
SIGECAPS stands for
Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicidal ideation
How does ECT work for depression?
ECT induces generalized seizures
Most common side effect of ECT
Anterograde memory loss
Risperidone is commonly used to treat
Schizophrenia, bipolar disorder, irratability associated with autistic disorder
Risperidone class
Second generation atypical antipsychotic
Trying to conceive on risperidone
May cause hyperprolactinemia, which may cause a reversible decrease in reproductive function
Mechanism of action Risperidone
High 5HT2 and D2 receptor antagonists
Serotonin and dopamine receptor antagonist
Form 1 basic definition
Application for psych assessment
Form 1 is completed by
An MD
Form 1 is valid up to
72 hours
Form 42 basic definition
Notice to patient that theyre on a form 1 and why
Form 42 is completed by
MD, given to patient
Form 2 basic definition
Order for examination
Form 2 filled out by
Justice of the peace, based on information from public, family, friend, loved ones
Form 2 is valid for
7 days
When a patient arrives due to form 2
They must be assessed then placed on form 1, admitted voluntarily, or allowed to leave
Form 3 basic definition
Certificate of involuntary admission
Form 3 can last
Up to 14 days
Form 3 must be signed by
A different doctor than the form 1, a psych consult
Form 30 basic definition
Notifies the patient theyre on a form 3, and why, and what their rights are
PTSD first line treatments
Trauma focused CBT and antidepressants (SSRI/SNRI)
PTSD related nightmares can be treated with
Prazosin - alpha blocker
In what case of cognitive impairment would you choose to order CSF in investigations?
If it is early onset
Routine imaging for cognitive impairment
Brain CT or MRI
Routine lab testing with cognitive impairment
CBC, B12, TSH, CMP
Initial workup for suspected dementia should include
Neuropsychological testing, lab work, and imaging
Adjustment disorder is
Mood and behaviour symptom onset within 3m of an identifiable stressor
Management for adjustment disorder is
Psychotherapy with adjunctive pharmacotherapy (short term sleep aids, or anxiolytics)
Personalization
Seeing yourself as the cause of some negative external event for which you were not primarily responsible
What % of personality traits are inherited?
40-60%
Cluster A personality disorders “odd and eccentric” (3)
Paranoid, schizoid, schizotypal
Cluster B personality disorders “dramatic, emotional, erratic” (4)
Histrionic, narcissistic, antisocial, borderline
Cluster C personality disorders “anxious, fearful” (3)
Avoidant, dependent, obsessive compulsive
Most common personality disorder is
Obsessive compulsive personality disorder
Define obsessive compulsive personality disorder
Pervasive pattern of perfectionism, inflexibility, and need for control, stable course over time
Major depressive disorder Sx must be present for
2+ weeks
How many Sx does a person need for diagnosing MDD?
5/9 with 1 being mood/adhedonia
Escitalopram, citalopram, sertraline, fluoxetine, paroxetine, fluvoxamine are from the class
SSRI antidepressants
Venlafaxine, desvenlafaxine, duloxetine are from the class
SNRI antidepressants
Bupropion drug class
NDRI
Mirtazapine drug class
NaSSA
Trazodone drug class
SARI
Amitriptyline, nortryptiline, desipramine, imipramine, clomipramine drug class
Tricyclics antidepressants
Phenelzine drug class
MAOI
What is behavioural inhibition
Distress and withdrawal from unfamiliar situations which can develop into anxiety
Primary coping strategy in anxiety is
Avoidance
Main cause of disability in anxiety is
Avoidance
Panic disorder is
Recurrent unexpected panic attacks in the absence of triggers
Agoraphobia is
Marked unreasonable fear about a situation with active avoidance of that situation
Generalized anxiety disorder is
Excessive anxiety about multiple events or activities accompanied by somatic symptoms, symptoms tend to overlap with depression
Positive psychiatric symptoms are
Excess or distortion of normal function or experience
Examples of positive psych symptoms
Delusions, hallucinations, disorganized thinking, abnormal motor behaviour
Negative psych symptoms
Diminished or absent normal function
Negative psych symptom examples
Affect diminished, avolition (loss of initiative), alogia (reduced speech), anhedonia (loss of enjoyment)
Define delusions
Fixed false beliefs that arent changeable despite evidence
Bizzare delusions differ from non bizzare because
They are clearly implausible
How long must schizophrenia sx last to be diagnosed?
6m+
MRI findings in schizophrenia
Frontal lobe smaller, bigger lateral and third ventricles than average
1st generation antipsychotics work as
Potent DA D2 blockers
2nd gen antipsychotics work by
Combination of D2 and 5HT blocking
Side effects common to type 1 antipsychotics
Extra pyramidal/motor side effects like dystonia, Parkinsonism, tardive dyskinesia
Side effects of second gen antipsychotics
Increased BMI, lipid abnormalities, diabetes
Clozapine has a higher risk of which side effect amongst antipsychotics
Agranulocytosis
Schizoeffective disorder is like schizophrenia but
The delusions and hallucinations last 2+ weeks, there must be a mood issue, and psychosis
Delusional disorder definition
One or more delusions persistent for more than a month, not markedly impaired
Schizophreniform disorder is just like schizophrenia but
Between 1 month and 6 months duration
Brief psychotic disorder duration is
At least a day, less than a month
Drugs that can cause psychosis
Cannabis, stimulants, hallucinogens
Medical issues that can cause psychosis
Delirium, structural (tumour/stroke), degeneration (huntingtons/parkinsons), epilepsy, endocrine, infections
DBT for BPD focuses on
Decreasing self harm and impulsivity, increasing ability to cope
Acute stress disorder is like PTSD but…
Less than 6m (more than 1m)
Adjustment disorder
Maladaptive reaction to a stressor, condition remits within 6m of the stressor resolving
Alcohol or benzo withdrawal is treated commonly with
Diazepam
Which benzos bypass liver metabolism?
Lorazepam, oxazepam, temazepam
Medications used to reduce alcoholism (3)
Naltrexone, acamprosate, disulfiram
Three treatment options for tobacco use disorder
Nicotine replacement therapy, bupropion, varenicline
After a suicide attempt, someone who wishes they died is
3x more likely to attempt suicide in a short time interval
Fitness to stand trial has 3 components
Understanding the nature and object of the hearing, possible consequences of the hearing, and can communicate with counsel
Duty to warn and protect (3 factors)
Identifiable target, seriousness, imminence
What are two main types of ADHD
Inattention and hyperactivity, Sx for 6m
Labeling
An extreme form of over generalization “I’m a total idiot”
Over generalization
Seeing one negative event as proof of a never ending pattern
Fortune telling
Anticipating that things will turn out badly, and this is a fact
Catastrophizing
Exaggerating the importance of negative things and the likelihood of a disastrous outcome
Which antidepressant is associated with dose dependent hypertension
Venlafaxine
MAOI hypertensive crisis refers to
Severe hypertension after patients on MAOIs ingest foods containing tyramine (sympathomimetic)
Patients treated with lithium need to be monitored for
Hypothyroidism
Treating lithium induced hypothyroidism
T4 supplementation
Circadian rhythm sleep wake disorder characterized by sleep onset insomnia and excessive morning sleepiness
Delayed sleep wake phase disorder
Circadian rhythm disorder characterized by inability to stay awake in the evening and early morning insomnia
Advanced sleep wake phase disorder
