Psychiatry Flashcards
First line medical treatment for depression
SSRIs = sertraline or citalopram
Can take 2-4 weeks before benefit
If not working, try a different SSRI
How long should antidepressants be taken for?
First episode = at least 6 months after full recovery without reducing the dose
More than one episode = continue for 1-2 years after full recovery without reducing the dose
Treatment for severe life threatening depresssion, particularly if psychotic symptoms present
Electroconvulsive therapy
Classifications of bipolar disorder
Bipolar 1 = have had a full manic episode meeting full criteria, may have had bouts of hypomanic and depressive episodes too.
Bipolar 2 (more common) = current or past hypomanic episode but never met full criteria. Also past of depressive episodes
How to treat an acute manic episode
If currently taking anti-depressants stop them
If currently taking lithium, valproate or a mood stabiliser as prophylaxis then check levels and maybe increase dose
If not on antipsychotics, offer haloperidol, respiridone or “-apines”
How to treat acute bipolar depression
Dont prescribe antidepressant without an antimanic drug
Avoid antidepressants in though with a recent hypo/mani episode or a history of rapid cycling
SSRIs usually fluoxetine
Maintenance therapy for bipolar disorder
Lithium is gold standard
Lamotrigine or valproate
Side effects of lithium
Dry mouth, strange taste, polydipsia and polyuria, tremor, hypothyroidism, renal problems, weight gain
Toxic effects: Vomiting, diarrhoea, ataxia, drowsiness, convulsions, coma
Requires a lot of monitoring
Mode of action of SSRIs and side effects
Selectively inhibits reuptake of serotonin (5-HT) from the synaptic cleft
SA = nausea, vomiting, anxiety, transient increase in self-harm particularly in young people, vivid dreams, sexual dysfunction, hyponatraemia
E.g. sertraline, citalopram, fluoxetine, paroxetine
MOA of tri-cyclic antidressants and side effects and examples
Block the uptake of monoamines serotonin and noradrenaline into presynaptic terminals
SA = anticholinergic effect as drugs block muscarinic receptors; blurred vision, dry mouth, contipation, urinary retention, arrhythmias
E.g. amitriptyline, imipramine, dosulepsin
Managment for anorexia nervosa
1st line is family-based therapy for children and young people
Also CBT
Never use just medications
What is Russels sign in bullimia nervosa?
Calluses on the back of hands due to self-induces vomiting
Management of bullimia nervosa
Individual or group CBT
High dose fluoxetine can reduce cravings for food
Describe 1st and 2nd generation antipsychotics
1st gen = haloperidol, chloropromazine
2nd gen = clozapine, risperidone, olanzapine
1st gen cause more extra-pyramidal side effects (can prescribe with an anti-cholinergic to help e.g. procyclicine)
2nd gen cause more weight gain, central obesity, type 2 diabetes
Usually start with 2nd gen and titrate up
Clozapine is best but not 1st line as can cause agranulocytosis (only use for resistant cases)
Management of general anxiety disorder (GAD)
CBT
SSRIs, SNRIs, pregabalin
Benzodiazepines should be avoided as it is a chronic condition
Management of panic disorder
CBT
SSRIs if long-standing or CBT not helping
Tricyclics
Benzodiazepines only for short-term use
Management of agoraphobia
CBT and exposure therapy
SSRIs if needed
Benzidiazepines for short-term only
Mode of action of benzodiazepines
Bind to GABAa receptors which causes a positive allosteric effect and makes GABA more likely to bind and the effect of GABA greater
GABA is the main inhibitory neurotransmitter in the brain and reduces the action of neurons in the amygdala (emotions and fear response) and in the cortico-striatal-thalamic-cortical circuit (worry, anxiety)
Type 1 and Type 2 trauma
Type 1: single event, sudden and unexpected
Type 2: repetitive, 3x high PTSD risk vs type 1
Broca’s area
Part of frontal cortex responsible for production of speech
Deactivated when remembering trauma
Wernicke’s area
Area in left temporal lobe responsible for comprehension of speech
How can you treat a drug poisoning or overdose within 1 hr?
Activated charcoal
Decreases gut absorption of some substances
Over 1hr since a paracetamol overdose, how to treat
N-acetyl cystine
Treatment for benzodiazepine overdose
IV flumazenil
Treatment for overdose of tricyclic antidepressants
Sodium bicarbonate
What is Wernickes Encephalopathy
thiamine deficiency that results in cytotoxic oedema in mamillary bodies
Symptoms: ocular dysfunction, ataxic gait and acute confusion
Treat with thiamine replacement
What is Korsakoffs syndrome?
Chronic thiamine deficiency where there is cerebral atrphy due to Wernickes encephalopathy
Presentation: Anterograde and retrograde amnesia, patient makes things up where there is a lapse in memory, lack of insight
Chance of recovery is low, need abstinence and nutrition
Episodic memory
Memory of your experiences
Semantic memory
Memory of facts - dont know where you learnt it but you know it
Procedural memory
Acquired memory through repeated tasks
Pharmocological treatment for moderate and severe ADHD
1st line - stimulants e.g. methyphenidate, dexamfetamine
2nd - SNRI e.g. atomoxetine
3rd - alpha agonists e.g. clinidine
4th - antidepressants, antipsychotics e.g. risperidone, imipramine
What would a PET scan of someone suffering from schizophrenia show?
Hypoactivity of prefrontal lobes
Enlarged cerebral ventricles
Definition of hallucination
A perception which occurs without an external stimulus that is experienced as if its really there.
Can be any sense
Is not subject to conscious manipulation
Definition of ideas of reference
Normal events being ascribed significant meaning
Thinking news is about them or talking to them, seeing meaning in gestures
Definition of delusions
A fixed, falsely held belief held with unshakeable conviction
Impervious to logical argument and unusual for the social, cultural, educational background of the patient
It is culturally defined
Primary - just appear in consciousness
Secondary - often attempts to explain hallucinations or depression etc.
Definition of thought disorder
Weird associations, rhyming, punning, making up their own words
Types of thought interference
Thought insertion = Belief that thoughts are being put inside your head
Thought withdrawal = belief that someone is taking thoughts out of your head
Thought broadcasting = belief that thoughts can be heard by everyone else
Thought blocking = get halfway through a thought then it dries up and they can’t think anything for a while
Definition of passivity
Belief that someone else is moving their arm or making them feel their emotions or urges
What sections can hold patients for what time frame?
72hrs = section 5, cannot be extended
28 days = section 2, cannot be extended
6 months = section 3, can be extended for another 6 months and then for a year
