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Psychiatry Flashcards

1
Q

Core symptoms of depression

A

Depressed mood for most of day, everyday for 2 weeks of more
Diurnal mood variation (worse in morning)
Anhedonia - don’t enjoy things they normally do
Fatigue

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2
Q

Typical symptoms of depression

A 
Poor appetite, affecting weight 
Disrupted sleep 
Decreaesed libido 
Reduced concentration 
Feelings of worthlessness 
Recurrent thoughts of death, ideation or suicide attempts
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3
Q

Classification of depression

A

Subthreshold - <5 symptoms
Mild depression - few symptoms and minor functional impairment
Moderate - functional impairment between mild and severe
Severe - most symptoms, marked impairment of function. With or without psychotic symptoms

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4
Q

Management of mild to moderate depression

A

Antidepressants- SSRI

High intensity psychological intervention - CBT

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5
Q

Screening tools for depression

A

Patient health questionnaire 9 (PHQ-9)
— 9 iterm, self-administered scale

Hospital anxiety and depression scale (HADS)
— 14 questions, self-administered

Black depression inventory II (BD-II)
— 21 item

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6
Q

Key differences between mani and hypomania

A

Mania = psychotic symptoms (delusions of granduer or auditory hallucinations)

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7
Q

Management of bipolar

A

Psychological interventions specifically for bipolar
Anti-psychotic (acute)
Lithium- mood stabiliser of choice. Alternative is sodium vaporate semisodium
Can also add an anti-depressant

Hypomania - routine referral to community mental health team
Mania - urgent referral to CMHT

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8
Q

SSRI examples, side effects, monitoring

A

Flouxetine - children
Citalopram - adult
Sertraline

SE:

  • GI low appetite, N+V (most common)
  • increased risk of GI bleeding
  • sexual dysfunction (5HT2a receptors)
  • hyponatraemia
  • serotonin syndrome (withdrawal?)
  • weight gain (5HT3 receptors)
  • increased suicide risk acutely
  • citalopram - increased QT interval - Do ECG before starting

All:
Monitor FBC (anaemia GI bleeding)
U&E (hyponatraemia)

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9
Q

TCA examples, MoA, Side effects and monitoring

A

Used less commonly now due to SEs

Amitryptyline
Imipramine
Inhibit serotonin and NE reuptake
Non-selextive monoamine transporters inhibitors

FATAL IN OD (block sodium channels = arrhythmia) 
Drowsiness
Dry mouth
Blurred vision 
Constipation
Urinary retention 
QT prolongation
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10
Q

Mirtazapine mechanism of action

A

Noradrenergic and selective serotonin blocker

Causes sedation and increases appetite

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11
Q

SNRI examples and SEs

A

Venaflaxine
Duloxetine

Tremors
Increased BP and HR
Anti-cholinergic effects

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12
Q

When is sertraline best used?

A

In ischaemic heart disease

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13
Q

Monoamine oxidase inhibitors examples, SEs

A

Serotonin and NE is metabolised by monoamine oxidase in presynaptic cell = increase these

Tranylcypromine
Phenelezine

Hypertensive reactions with tyrosine containing foods - cheese broad beans
Anticholinergic effects

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14
Q

Features of schizophrenia

A

First rank symptoms:
Auditory hallucinations, thought disorders, passivity phenomena, delusional perceptions

Auditory hallucinations- third person. Two or more voices discussion patient in third person. Thought echo,

Thought disorders - thought insertion, withdrawal, broadcasting

Passivity phenomena - bodily senses being controlled. Actions/feelings being imposed by others

Others - impaired insight, blunting of affect, decreased speech, neologism, catatonia

Negative symptoms - anhedonia, decreased speech, blunted emotional responses, apathy

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15
Q

Management of schizophrenia

A

Oral anti-psychotics first line
CBT should be offered
Modification of cardiovascular risk factors
Social support- social skills training, housing and benefits
Lifestyle- cardio, activity, diet, exercise
Tackle alcohol and drug addiction

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16
Q

Side effects of anti-psychotics

A

Common - anti-cholinergic. - blurry vision, dry mouth, urinary retentions, constipation
Weight gain
Sexual dysfunction
Galaxtorrhoea
Serious- tremors, muscle problems, reduced seizure threshold (citalopram), myocarditis

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17
Q

Sfarr investigation and monitoring of anti-psychotics

A 
Baseline:
Weight 
Waist circumference 
Pulse and BP
Fasting glucose, lipid and prolactin levels 
ECG 
Monitoring:
Response to treatment 
Emergence of movement disorders 
FBC (nutrapenia), U+Es, LFT (annual) 
Lipids - weekly for 6 weeks, 3 months, yearly
Prolactin, - start, 6 months, yearly
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18
Q

Examples of typical anti-psychotics, why they not used much?

A

Haloperidol, chlorpromazine

Greater association with extrapyramidial movement disorders

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19
Q

Adverse effects of clozapine

A 
Agranulocytosis 
Nutrapenia 
Reduced seizure threshold 
Constipation 
Myocarditis 
Hypersalivarion
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20
Q

What is borderline personality disorder?

A

Condition that affects how you think, feel and interact with others

Efforts to avoid real or imagined abandonment 
Unstable interpersonal relationships 
Unstable self image 
Impulsivity 
Chronic feelings of emptiness
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21
Q

Obsessive compulsive disorder management

A

Mild functional impairment- low intensive CBT, ERP, if not work = SSRI
Moderate - more intensive CBT or SSRI
Severe - combined treatment

ERP = exposure response prevention
- exposing to trigger and stopping their usual response

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22
Q

Management of PTSD

A

Watch and wait for mild symptoms <4 weeks
Trauma-fpcused CBT or eye movement desensitisation reprocessing therapy
Drug treatments if unsuccessful - veneflaxine or SSRI

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23
Q

Features of alcohol withdrawal

A 
Symptoms start 6-12 hours - tremor, sweating, tachycardia, anxiety 
Seizures at 36 hours 
Delirium tremens 48-72 hours 
-tremor
-confusion
-delusions
-visual and auditory hallucinations (crawling under skin, insects) 
-fever 
-tachycardia
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24
Q

Management of alcohol withdrawal

A

Admit if history of complex withdrawal
First line pharm - long acting benzodiazepines (chlordiazepoxide, diazepam)
Carbmazepine also effective

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25
When should lithium levels be measured?
12 hours post dose, then every 3 months | Checked weekly after each dose change until concentrations stable
26
Side effects of lithium
``` GI - nausea, vomiting, diarrhoea Fine tremor Nephrotoxicity - polyuria Hypothyroidism ECG - T wave inversion / flattening Weight gain IIH Leucocytosis ```
27
What should be monitored in patients taking lithium?
Iithium levels (every 3 months after level stabilisation) Thyroid and renal function every 6 months Monitor weight and eGFR Assess renal, thyroid and cardiac function before commencement
28
Examples of extra-pyramidial side effects of anti-psychotics
Parkinsonism Acute dystonia (sustained muscle contraction) Akathisia (severe restlessness) Tardive dyskinesia (abnormal, involuntary, repetitive movements) - chewing of jaw, excessive blinking
29
SSRI discontinuation symptoms
``` Diarhoea Increased mood change Restlessness Unsteadiness Sweating GI - pain, cramping, vomiting, diarrhoea ```
30
Indication and side effects of electroconvulsive therapy | Contraindications
Severe depression refractory to medications (catatonia) those with psychotic symptoms SEs: - headache - nausea - short term memory loss - cardiax arrhythmia CI: Raised ICP Recent MI Brain aneurysm
31
How should benzo's be withdrawn
1/8 of daily dose every 2 weeks Switch patients to equivalent dose of diazepam Reduce dose in steps of 2-2.5 mg every 2-3 weeks
32
Management of an acute dystonia
Procyclidine
33
Features of anorexia neevosa
Main: Persistant restriction of energy intake leading to significant low body weight Intense fear of gaining weight Disturbance in the way the body shape or weight is experienced Also: bradycardia Hypotension Enlarged salivary glands ``` Physiological abnormalities: Hypokalaemia Low FSH, LH, oestrogen and testosterone Raised cortisol and GH Hypercholestrolaemia Low T3 ``` Most low, G's and C's high
34
Management of anorexia nervosa
One of - individualised eating disorser focused CBT Specialist supportive clinical management Maudsley anorexia nervous treatment Children- family focused therapy Dietary advice - dietician, supplements, structured earing plan Other - electrolyte correction, potassium repletion, fluids Bone health - risk of osteoporosis (bisphosphates)
35
Symptoms of mania what should you do?
Refer urgently to CMHT
36
How do anti-psychotics work?
Inhibit dopaminergic transmission (overactivation of mesolimbic pathway associated with schiz)
37
What is an acute dystonia, what is it associated with?
Involuntary contractions of muscles of extremities, face, neck, pelvis - either sustained or intermittent pattern leading to abnormal movements or postures
38
What medications are associated with increased risk of VTE and stroke in the elderly?
antipsychotics
39
What is a tardive dyskinesia?
Involuntary neurological movement disorder that results in repetitive body movements e.g. sticking out the tongue
40
What is acute dystonia?
I
41
What is bulimia neevosa?
Recurrent episodes of binge eating - eating in a specific period of time (e.g. within a 2 hour period) an amount of food that is too large to be normal + feeling lack of self control Recurring compensatory behaviour to prevent weight gain - self-induced vomiting, misuse of laxatives, diuretics etc. BMI IS HEALTHY OR ABOVE NORMAL
42
What is the BMI like in bulimia?
Normal or above normal
43
Management of bulimia
Refer to specialist care Bulimia-nervosa-focused guided self-help for adults If ineffective - eating-disorder-focused CBT Plus nutritional and meal support Adjuvant SSRI and SNRI - fluoxetine is licenced in bulimia
44
Management of generalised anxiety disorder
Look for a potential cause - hyperthyroidism, cardiac disease, drugs - educate GAD and active monitoring - low-intensity psychological interventions - high-intensity psychological intervention (CBT) OR DRUG TREATMENT Drug treatment: - serialise as first-line SSRI - If ineffective - another SSRI or SNRI - if cannot tolerate these - try pregabalin
45
Management of severe OCD
SSRI and CBT (exposure and response prevention)
46
What should be monitored at initiation and during SNRIs such as venlafaxine?
Blood pressure | Theyre associated with HTN
47
What should be done at commencement of sertraline?
ECG (for long QT)
48
Initial therapy for OCD
Exposure and response prevention therapy
49
Common features of PTSD
Re-experiencing - flashbacks, nightmares Avoidance - avoiding people of situations Hyperarousal - hypervigilance, sleep problems Also, emotional detachment
50
When can lithium be measured 3 monthly?
When levels have stabilised (measured weekly until then) - also 12 hours after initiation and dose changes
51
Whats measured 6 monthly in patients on lithium?
TFTs and U&Es
52
What should you rule out before a diagnosis of GAD is made?
Hyperthyroidism
53
What is malingering?
Fraudualtn simulation or exaggeration of symptoms with the intention of financial or other gain
54
What is somatisation disorder?
Multiple physical symptoms for at least 2 years | Patient refuses to except reassurance or negative test results
55
What is conversion disorder?
Loss of motor or sensory function | They don't consciously feign symptoms or seek gain
56
What is Munchausen's syndrome?
Also called fictitious disorder, intentional production of symptoms
57
What is cotard syndrome?
Patient believes they are dead or non-existant | Associated with severe depression and psychotic disorders
58
Long-term complications of antipsychotics
Diabetes
59
Features of Neuroleptic Malignant syndrome
Confusion, fever, rigidity Dysautonomia (autonomic instability) - tachycardia - liable BP - profuse BP - sweating - arrhythmia
60
What is the major risk factor for neuroleptic malignant syndrome
Antipsychotic use
61
Management of neurleptic malignant syndrome
``` Supportive care - stop anti-psychotic - cardiac monitoring - IV fluids Treat specific complications - electrolyte imbalance - AKI - Rhabdomyolysis Severe disease may need organ support - intubation - ventilation - haemofiltration Medical therapy - dantrolene - causes skeletal relaxation (helps with hyperthermia and rigidity) - bromocriptine - dopamine agonist (antipsychotics block dopamine) ```
62
Features of serotonin syndrome
Altered mental status Autonomic hyperactivity Neuromuscular abnormalities - rigidity, clonus, hyperreflexia Also - fever, sweating, vomiting, dilated pupils
63
What medications cause serotonin syndrome?
``` SSRIs - most commonly MOAIs Amphetamines Ecstasy Cocaine SNRIs TCAs Lithium ```
64
Management of serotonin syndrome
Largely supportive - managing complications - providing organ support - stopping serotoniergic therapy - cardiac monitoring Medical therapy - benzos- help improve agitation - cyproheptadine - histamine receptor antagonist
65
What does section 2 of the mental health act mean?
Admission for assessment for up to 28 days, not renewable | Treatment can be given against a patients wishes
66
What does section 3 of the mental health act mean
Admission for treatment for up to 6 months, can be renewed
67
Section 5(2) mental health act
A patient who is voluntarily in hospital can be detained for 72 hours
68
Section 136 mental health
Someone in a public place who appears to have a mental health disorder can be taken by police to a place of safety Can only be used for up to 24 hours

Medicine (25 decks)

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