Psychiatry Flashcards
1
Q
Which drug would cause:
Malaise, chest pain, sweating, neutropenia
A
Clozapine
2
Q
Schizophrenia management
A
Oral atypical antipsychotics are first like
3
Q
Side effects atypical antipsychotics
A
Metabolic side effects
4
Q
Examples of atypical antipsychotics
A
Olanzapine, clozapine, risperidone
5
Q
Side effects of risperidone
A
Galactorrhoea
6
Q
Examples of tricyclic antidepressants
A
Amitriptyline
7
Q
Side effects of tricyclic antidepressants
A
Dry mouth
8
Q
MOA typical antipsychotics
A
D2 antagonists
9
Q
Side effects typical antipsychotics
A
Extrapyramidial (Parkinson’s etc) and hyperptolactinaemia
10
Q
Examples of typical antipsychotics
A
Haloperidol and chlorpromazine
11
Q
Sx lithium toxicity
A
Tremor
Hyperreflexia
Seixure
Confusion
12
Q
Management lithium toxicity
A
Resuscitation with saline
Haemodialysis in severe cases
13
Q
Precipitating factors of lithium toxicity
A
Dehydration
Renal failure
Drugs (diuretics, ACEi, NSAIDs)
14
Q
How do you differentiate between depression and dementia?
A
Depression has a short, rapid onset and is associated with biological sx like weight loss
Pt is also aware of and worries about memory
Dementia causes recent memory loss, depression is global
15
Q
PTSD management
A
Watchful waiting if sx mild and less than 4 weeks
SSRI is first line after social therapies
16
Q
Which medication can counteract alcohol cravings?
A
Acamprostate
17
Q
Pt presents with these sx:
agitation/anxiety, insomnia, hallucinations spasms, dry mouth
A
Benzo withdrawal
18
Q
Tricyclic antidepressants MOA
A
Monoamine uptake inhibitors
19
Q
E.g tricyclic antidepressants
A
Amitriptyline
20
Q
S/e TCAs
A
Sedation, dry mouth hyponatraemia
21
Q
Withdrawal sx TCAs
A
Agitation, sweating, headache
22
Q
Positive sx schizophrenia
A
Delusions, hallucinations, thought disorder
23
Q
Schneider’s first rank sx of schizophrenia
A
Positive sx of schizophrenia
Primary decisions (appear with no precipitating event)
Persistent delusions (arise with period of perplexity)
Secondary delusions
24
Q
Negative sx of schizophrenia
A
Reduced function
Alogia - poverty of speech
Lack of emotion
Lack of interest in life, self care etc
25
Management schizophrenia
Atypical antipsychotics are first line
26
Sx PTSD
Flashbacks, hypervigilant
Avoidance behaviour
27
Treatment for PTSD
CBT
and SSRIs
28
Treatment for depression
SSRIs
29
E.g. anti-convulsant
Sodium valproate
30
Sx serotonin syndrome
Confusion, agitation, seizures
31
Herbal cause of serotonin syndrom
St John's Wort
32
E.g. SSRIs
Fluoxetine (children)
Seetraline
33
Sx SSRI discontinuation
Dizziness and vertigo
Electric-shock feelings
Flu sx
34
SNRI e.g.
Venlafaxine
35
Delerium tremens
Caused by increased alcohol
36
Sx delirium tremens
Tachycardia, sweating, hallucinations
37
Tx delerim tremens
Benzodiazepines and thiamine
38
Lewy Body Dementia sx
Steady decline and visual hallucinations
39
Tx Lewy Body Dementia
ACHEi - rivastigmine
40
Fronto-temporal dementia sx
Preserved memory but personality changes and metabolic disorders
41
Vascular dementia sx
Shuffling gait, neural infarcts
42
Risk factor vascular dementia
Stroke or TIA
43
Sx Alzheimer's
Tau tangles
Slowly progressive memory loss
44
Tx Alzheimer's
AChEi
RIvastigmine, donepezil
45
ADHD tx
Atomoxetine 0 noradrenaline reuptake inhibitor
46
Citalopram MOA
SSRI
47
Haloperidol MOA
Dopamine antagonist
48
First line therapy for ADHD
Methylphenidate - dopamine/norepinephrine reuptake inhibitor
49
Which antidepressants can you not eat with wine and cheese
MAOI
50
What happens when you eat wine/cheese when on MAOI
Tachycardia and headache
51
Schizoid personality disorder
Loss of interest and interaction with others - not related to delusions
52
First line anti-psychotic for schizophrenia
Risperidone
53
Is group or individual CBT offered first?
Group - lower intensity
54
Opiate overdose
Decreased consciousness, decreased HR, RR etc
55
Withdrawal sx opiate
agitation, goose skin, increased hr and bp
56
What is acute stress disorder?
Reaction to a traumatic event <4 weeks ago
57
Difference between PTSD and ACD
PTSD is longer than 4 weeks, ACD is less
58
Sx acute stress disorder
Intrusive thoughts
Dissociation
-ve mood
Sleep disturbance
59
Treatment ACD
* CBT
Benzodiazepines
60
What is agoraphobia?
Fear of open spaces
61
Diagnosing anorexia
DSM 5 criteria: restriction of energy intake, intense fear of gaining weight, disturbed vision of body
62
Adult treatment for anorexia
- *CBT-ED
- Maudsley Anorexia Nervosa Treatment
63
Child treatment for anorexia
- *Anorexia focussed family therapy
- CBT
64
which antipsychotic has increased risk of long QT?
haloperidol
65
Why is it dangerous to give typical antipsychotics in the elderly?
Increased risk of VTE and stroke
66
What is aphonia?
Inability to speak
67
How do benzodiazepines work?
Binds to GABAa receptor to increase frequency of Cl- channels
68
Uses benzodiazepines
sedation, anti-convulsant, muscle relaxation
69
How to withdraw from benzodiazepine
Reduce dose and switch to diazepam
70
Difference between hypomania and mania
Mania is 7+ days, hypomania is 4+ days
Psychotic sx indicate mania
71
Type 1 bipolar disorder
mania (delusions/hallucinations) and depression, lasting for 7+ days
72
Type 2 bipolar disorder
hypomania and depression, lasting for 4+ days
73
Treatment for bipolar disorder
Treat symptoms
74
BPD mood stabiliser
Lithium
75
BPD mania/hypomania tx
haloperidol/olanzapine
76
BPD depression tx
Talking therapies/fluoxetine
77
What is Charles bonnet syndrome?
Visual impairment + visual/auditory hallucinations
78
What is Cotard's syndrome?
Pt believes body parts are dead
79
De Clerambault's syndrome
Single female pt believes a famous person is in love with her
80
What is delusional parasitosis
Pt believes they are infected with parasites
81
Absolute contraindication to electroconvulsive therapy
Increased ICP
82
what is GAD?
Excessive worry and heightened tension
83
Causes of GAD
Hyperthyroidism/cardiac disease/medication
84
Medications causing GAD
Salbutamol, theophylline, caffeine
85
Treatment GAD
- 1 = education and monitoring
- 2 = low-intensity psychological interventions
- 3 = high-intensity psychological interventions (CBT) + drug treatment
86
Drug ladder for GAD
- Sertraline SSRI
- Alternative SSRI or SNRI (duloxetine or venlafaxine)
- Pregabalin
87
Treatment for panic disorder
CBT or drugs (SSRI first line but if contra-indicated/no response after 12 weeks then give imipramine)
88
What are the stages of grief?
Denial - anger - bargaining - depression - acceptance
89
What is Othello's syndrome?
Pathological jealousy where a person is convinced that their partner is cheating on them with no real proof
90
What is OCD?
A combination of obsessions (unwanted intrusive thoughts) and compulsions (repetitive behaviours)
91
Treatment for mild OCD
CBT (including exposure and response prevention) or SSRI
92
Treatment for moderate OCD
intensive CBT (inc. ERP) or SSRI (fluoxetine for body dysmorphia)
93
SSRI for body dysmorphia
fluoxetine
94
Treatment for severe OCD
intensive CBT + SSRI
95
Treatment for PTSD if CBT ineffective?
SSRI or venlafaxine
96
Characteristics of PTSD
Sx present for more than a month
97
Sx PTSD
intrusive images, flashbacks, avoidance, irritability
98
Management for PTSD
CBT or SSRI/venlafaxine if severe
99
SSRI giving high risk of long QT
citalopram
100
SSRI for post-MI
sertraline
101
SSRI for kids or body dysmorphia
fluoxetine
102
How do you prescribe SSRI if pt taking NSAIDs
Add PPI
103
Over which time period should you withdraw a SSRI
4 weeks
104
Why does fluoxetine have a reduced frequency of side effects
Longer half life
105
How do you transfer from fluoxetine to another SSRI
Wait a week after finishing fluoxetine
106
Medication causing urinary retention
TCA - amitriptyline
107
What is akathisia?
Severe restlessness
108
Disulfarim function
makes pt sick if they drink alcohol
109
Disulfarim MOA
inhibitor of acetaldehyde dehydrogenase
110
Paranoid personality disorder
Hypersensitivity and lack of forgiveness
Questions loyalties of friends
111
Schizoid personality disorder
Indifference to praise or criticism
Prefers solitary activities
Lack of desire/interest/emotion
112
Schizotypal personality disorder
Odd beliefs and magical thinking
Paranoid and suspicious
113
Peak incidence of delirium tremens after alcohol withdrawal
72h
114
How to switch from SSRI to TCA
cross-tapering is recommended
115
What is the difference between echolalia and palilalia?
Palilalia is repeating your own words, echolalia is repeating someone else's
116
Paranoid personality disorder
hypersensitive, questions loyalty of friends, reluctant to confide in others, preoccupation with conspirational beliefs, imagined attacks on their character
117
Schizoid personality disorder
indifference to praise/criticism, prefers solitary activities, lack of interest in relationships/life, emotionally cold, few confidants
118
Schizotypal personality disorder
odd beliefs and magical thinking, eccentric behaviour, lack of close friends beyond family, odd speech
119
Antisocial personality disorder
fails to conform to norms, deceiving, impulsiveness, aggressive, disregard of safety, lack of remorse
120
Borderline personality disorder
efforts to avoid abandonment, unstable relationships, unstable self-image, recurrent suicidal behaviour, feelings of emptiness
121
Histrionic personality disorder
sexually inappropriate, attention seeking, dramatic
122
Narcissistic personality disorder
sense of self-importance and entitlement, excessive need for admiration
123
Obsessive-compulsive personality disorder
meticulous and scrupulous, unwilling to pass tasks to other people, stiffness and stubbornness
124
Avoidant personality disorder
avoids activities due to fear of rejection, fear of embarrassment, fear of not being liked, social isolation
125
Dependent personality disorder
fear of looking after themselves, excessive effort to obtain support from others, need reassurance from others
126
Features of psychosis
hallucinations, delusions, thought disorganisation, agitation, depression
127
What is SAD?
Mild depression in winter months
128
Treatment for SAD
Treat the same way as mild depression - start with CBT and follow up in 2 weeks. If deterioration, prescribe SSRI
129
Somatisation disorder
physical symptoms present for 2+ years with no explanation
130
Hypochondriasis
patient believes presence of disease
131
Conversion disorder
loss of motor/sensory function
132
Dissociative disorder
‘separating’ certain memories from real consciousness (involves psychiatric sx)
133
Factitious disorder
also known as Munchausen’s, intentional production of physical/psychological sx (normally for emotional need)
134
Malingering
exaggeration of sx for financial or other gain
135
Strongest risk factor for schizophrenia
Family history
136
First rank sx for schizophrenia
- Auditory hallucinations
- Thought disorder
- Passivity phenomena (sensations controlled by external influence)
- Delusions
137
Negative sx schizophrenia
- Blunting of affect
- Anhedonia
- Alogia
- Avolition
138
TReatment schizophrenia
CBT and atypical antipsychotics
139
Section 2 of MHA
<28 days, AMHP and relative detain pt for tx
140
Section 3 of MHA
<6 months, AMHP and 2 doctors, for tx
141
Section 4 of MHA
72h assessment - emergency
Normally followed by 2
142
Section 5(2) of MHA
Detain pt who is in hospital for 72h
143
Section 5(4) of MHA
Doctor detains hospital pt for 6h
144
Section 17a of MHA
Recalls pt for tx if they don't comply with previously agreed meds plan
145
Section 135 of MHA
Police break into house to remove pt
146
Section 136 of MHA
police detain pt in public
147
How long after starting treatment with SSRI should you be reviewed if you are 43 with no other relevant conditions?
2 weeks
148
How long after starting treatment with SSRI should you be reviewed if you are <30 or at high risk ?
1 week
149
How long should you take SSRIs for after resolution of sx
6 months
150
Over how long should you withdraw SSRIs?
4 weeks
151
Side effect zopiclone elderly
Increased fall risk
152
Medications you should avoid if taking SSRI
Triptans
MAOis
Warfarin/heparin
153
sx SSRI discontinuation syndrome
dizziness, anxiety, electric shock sensations
154
which drugs cause hyponatraemia?
SSRI
155
Which drugs cause hypertension?
SNRI
156
Stages of alcohol withdrawal and timing
sx between 6-12h
seizures 36h
delirium tremens 72h
157
How often do you check renal and thyroid function when taking lithium?
6 monthly
158
when taking a blood sample of a pt on lithium, how long should you wait before taking sample after pt has had lithium dose?
12h
159
when changing lithium dose, how often should you monitor?
check weekly until stable then 3 monthly
