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Medicine > Psychiatry > Flashcards

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
Q

When should lithium levels be measured?

A

12 hours post dose, then every 3 months

Checked weekly after each dose change until concentrations stable

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26
Q

Side effects of lithium

A 
GI - nausea, vomiting, diarrhoea 
Fine tremor
Nephrotoxicity - polyuria
Hypothyroidism 
ECG - T wave inversion / flattening 
Weight gain 
IIH
Leucocytosis
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27
Q

What should be monitored in patients taking lithium?

A

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

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28
Q

Examples of extra-pyramidial side effects of anti-psychotics

A

Parkinsonism
Acute dystonia (sustained muscle contraction)
Akathisia (severe restlessness)
Tardive dyskinesia (abnormal, involuntary, repetitive movements) - chewing of jaw, excessive blinking

29
Q

SSRI discontinuation symptoms

A 
Diarhoea 
Increased mood change 
Restlessness 
Unsteadiness
Sweating 
GI - pain, cramping, vomiting, diarrhoea
30
Q

Indication and side effects of electroconvulsive therapy

Contraindications

A

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
Q

How should benzo’s be withdrawn

A

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
Q

Management of an acute dystonia

A

Procyclidine

33
Q

Features of anorexia neevosa

A

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
Q

Management of anorexia nervosa

A

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
Q

Symptoms of mania what should you do?

A

Refer urgently to CMHT

36
Q

How do anti-psychotics work?

A

Inhibit dopaminergic transmission (overactivation of mesolimbic pathway associated with schiz)

37
Q

What is an acute dystonia, what is it associated with?

A

Involuntary contractions of muscles of extremities, face, neck, pelvis - either sustained or intermittent pattern leading to abnormal movements or postures

38
Q

What medications are associated with increased risk of VTE and stroke in the elderly?

A

antipsychotics

39
Q

What is a tardive dyskinesia?

A

Involuntary neurological movement disorder that results in repetitive body movements e.g. sticking out the tongue

40
Q

What is acute dystonia?

A

I

41
Q

What is bulimia neevosa?

A

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
Q

What is the BMI like in bulimia?

A

Normal or above normal

43
Q

Management of bulimia

A

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
Q

Management of generalised anxiety disorder

A

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
Q

Management of severe OCD

A

SSRI and CBT (exposure and response prevention)

46
Q

What should be monitored at initiation and during SNRIs such as venlafaxine?

A

Blood pressure

Theyre associated with HTN

47
Q

What should be done at commencement of sertraline?

A

ECG (for long QT)

48
Q

Initial therapy for OCD

A

Exposure and response prevention therapy

49
Q

Common features of PTSD

A

Re-experiencing - flashbacks, nightmares
Avoidance - avoiding people of situations
Hyperarousal - hypervigilance, sleep problems

Also, emotional detachment

50
Q

When can lithium be measured 3 monthly?

A

When levels have stabilised (measured weekly until then) - also 12 hours after initiation and dose changes

51
Q

Whats measured 6 monthly in patients on lithium?

A

TFTs and U&Es

52
Q

What should you rule out before a diagnosis of GAD is made?

A

Hyperthyroidism

53
Q

What is malingering?

A

Fraudualtn simulation or exaggeration of symptoms with the intention of financial or other gain

54
Q

What is somatisation disorder?

A

Multiple physical symptoms for at least 2 years

Patient refuses to except reassurance or negative test results

55
Q

What is conversion disorder?

A

Loss of motor or sensory function

They don’t consciously feign symptoms or seek gain

56
Q

What is Munchausen’s syndrome?

A

Also called fictitious disorder, intentional production of symptoms

57
Q

What is cotard syndrome?

A

Patient believes they are dead or non-existant

Associated with severe depression and psychotic disorders

58
Q

Long-term complications of antipsychotics

A

Diabetes

59
Q

Features of Neuroleptic Malignant syndrome

A

Confusion, fever, rigidity

Dysautonomia (autonomic instability)

  • tachycardia
  • liable BP
  • profuse BP
  • sweating
  • arrhythmia
60
Q

What is the major risk factor for neuroleptic malignant syndrome

A

Antipsychotic use

61
Q

Management of neurleptic malignant syndrome

A 
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
Q

Features of serotonin syndrome

A

Altered mental status
Autonomic hyperactivity
Neuromuscular abnormalities - rigidity, clonus, hyperreflexia
Also - fever, sweating, vomiting, dilated pupils

63
Q

What medications cause serotonin syndrome?

A 
SSRIs - most commonly 
MOAIs 
Amphetamines
Ecstasy 
Cocaine 
SNRIs
TCAs 
Lithium
64
Q

Management of serotonin syndrome

A

Largely supportive

  • managing complications
  • providing organ support
  • stopping serotoniergic therapy
  • cardiac monitoring

Medical therapy

  • benzos- help improve agitation
  • cyproheptadine - histamine receptor antagonist
65
Q

What does section 2 of the mental health act mean?

A

Admission for assessment for up to 28 days, not renewable

Treatment can be given against a patients wishes

66
Q

What does section 3 of the mental health act mean

A

Admission for treatment for up to 6 months, can be renewed

67
Q

Section 5(2) mental health act

A

A patient who is voluntarily in hospital can be detained for 72 hours

68
Q

Section 136 mental health

A

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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