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AA Y4 Finals cards NE > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

what is the 1st line treatment of psychotic illnesses?

what class of medication is this?

A

olanzipine

atypical antipsychotic

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2
Q

what is 1st line tx for tx resistant schizophrenia?

A

clozapine

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3
Q

which classes of drug all reduce the action of lithium?

what can this cause?

A

NSAIDs

can cause lithium toxicity

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4
Q

which antipsychotic can cause weight gain?

A

olanzipine

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5
Q

in which group are rates of completed suicide the highest?

A

older, single males who have previously self harmed

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6
Q

what is the strongest risk factor for suicide?

A

previous history of deliberate self harm

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7
Q

what is the main difference between an emergency detention and short term detention order?

A

emergency detention can detain for 72 hours, short term for 28 days

ED does not allow treatment

importantly, ED cannot be appealed and does not need to be approved by a psychiatrist- avoids the delays that come with a short term detention

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8
Q

why do you check TFTs in a person with suspected depression?

A

hypothyroidism can be a cause of depression

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9
Q

name the 3 core symptoms of depression?

A
  • low mood (worse in mornings)
  • anhedonia
  • anergia
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10
Q

how long must at least 2 of the core symptoms be present for to consider a depression diagnosis?

A

present for at least 2 weeks

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11
Q

which SSRI is cardioprotective and so should be used post MI?

A

sertraline

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12
Q

which SSRI affects the QT interval?

A

citalopram

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13
Q

which SSRI is 1st choice for using in children?

A

fluoxetine

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14
Q

which 2 drug classes should be avoided when using SSRIs?

why?

A
  • triptans
  • monoamine oxidase inhibitors

they can increase the risk of serotonin syndrome

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15
Q

why must PPIs be taken along with NSAIDs if the patient is already taking SSRIs?

A

SSRI + NSAID increases the risk of a GI bleed

must take PPI in combination

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16
Q

what class of drug can cause hyponatremia and falls in the elderly patients?

A

SSRIs

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17
Q

which class of drug primarily work by blocking reuptake of noradrenaline and serotonin by blocking their transporters?

A

tricyclics (TCAs)

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18
Q

which class of antidepressant is associated with anti-cholinergic side effects?

A

TCAs

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19
Q

name the ABCD of anti-cholinergic side effects?

A

Anorexia
Blurred vision
Constipation, confusion and urinary retention
Dry mouth

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20
Q

which antidepressant is considered the most efficacious?

A

venlafaxine

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21
Q

which antidepressant should be used in patients where weightloss and poor sleep is an issue?

A

mirtazapine

its side effect profile includes weight gain and sedation

it is a NASSA

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22
Q

what class of drug is moclobemide?

A

monoamine oxidase inhibitors

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23
Q

what does blockage of monoamine oxidase cause?

A

it prevents the breakdown of serotonin and noradrenaline

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24
Q

what can the patient be at risk of if a MAOI is started when they are still on SSRI/SNRI?

A

a hypertensive crisis - patient must be off SSRI/SNRI for weeks before starting MAOI

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25
Q

in which antidepressant class must foods such as cheese, red wine and soy be avoided?

A

irreversible MAOI

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26
Q

how long does it take for most antidepressants to start working?

A

4-6 weeks

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27
Q

in which patient group should SSRIs be avoided? why?

A

the elderly

SSRIs can cause hyponatraemia, falls and GI bleeds

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28
Q

how is suspected serotonin syndrome investigated?

A

toxicology screen

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29
Q

describe the cognitive, autonomic and somatic symptoms seen in serotonin syndrome?

A

cog: confusion, headache, agitation, coma
autonomic: hypertension, shivering, hyperthermia, tachycardia, N&V, dilated pupils
somatic: myoclonus, tremor, hyperreflexia

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30
Q

what can be given in cases of serotonin syndrome to calm and sedate the patient?

A

benzos

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31
Q

which adverse effect do antipsychotics increase risk of in elderly patients?

A

stroke and VTE

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32
Q

what is the most common presentation of tardive dyskinesia?

A

chewing and pouting of jaw

tardive dyskinesia is an extrapyramidal side effect that can be caused by typical antipsychotics

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33
Q

what is the most common type of bipolar?

A

Bipolar 1 - one episode of mania +/- depression

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34
Q

describe bipolar 2?

A

one episode of hypomania +/- depression

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35
Q

how many mood disturbances are needed in 1 year for it to be classed as rapid cycling?

A

4 or more episodes of mood disturbances in 1 year

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36
Q

what is type 3 bipolar?

A

mania induced by an antidepressant

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37
Q

what is the 1st line tx for mood stabilisation?

A

lithium

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38
Q

how often must lithium levels be checked?

A

every week until levels are stable then every 3 months after that

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39
Q

how long should antidepressants be continued to reduce risk of relapse?

A

continue for 6 months from the point at which remission is achieved

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40
Q

if a patient is already on warfarin/heparin but needs an antidepressant, what should be offered?

A

mirtazapine

NICE recommend avoiding SSRIs due to interactions

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41
Q

why should SSRIs be stopped over a 4 week period?

A

they may get SSRI discontinuation syndrome

dizziness, electric shock sensations and anxiety

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42
Q

what are the 4 1st rank symptoms of schizophrenia?

A
  • auditory hallucinations
  • thought disorders
  • passivity phenomena (bodily sensations being controlled by others)
  • delusional perceptions
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43
Q

which atypical antipsychotic is known to reduce seizure threshold?

A

clozapine

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44
Q

name 2 significant side effects to be aware of in clozapine?

A
  • agranulocytosis

- reducing the seizure threshold

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45
Q

give examples of disinhibition?

A
  • increased sexuality
  • increased spending
  • taking unusual risks
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46
Q

what is the difference between schizoid and schizotypal PDs?

A

schizoid: lack of interest in having sex or being in relationships, emotional coldness (it presents with only the negative symptoms of schitzophrenia)
schizotypal: usual beliefs and behaviours

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47
Q

what is the classic triad seen in wernickie’s encephalopathy?

A
  • ophthalmoplegia (LR palsy or horizontal nystagmus)
  • confusion
  • ataxia
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48
Q

what factors are specific to Korsakoff’s syndrome compared with wernickie’s encephalopathy?

A

anterograde amnesia, confabulation

49
Q

what can present in a patient who has been taking an antipsychotic for a long period of time?

A

tardive dyskinesia

50
Q

what is the next step in mx of a px with GAD who’s SSRI is not effective?

A

next step: switch them to another SSRI or SNRI

51
Q

what can long term lithium use result in?

A

hyperparathyroidism and resultant hypercalcemia

52
Q

what is the difference in somatisation and hypochondria disorder?

A

somatisation: patient experiences symptoms and no organic causes can be found
hypochondria: persistent belief that they have a SERIOUS underlying disease (eg- cancer)

53
Q

which symptom indicates mania rather than hypomania?

A

presence of auditory hallucinations

presence of psychotic symptoms is what differentiates them

54
Q

what is the definition of acute dystonia?

A

sustained muscle contractions

eg- torticollis - unilateral pain and deviation of the neck, with restricted ROM

oculogyric crisis- sustained upwards deviations of the eye , clenched jaw and hyperextension of the back/neck

55
Q

acute dystonia can be a side effect of commencing what type of drug?

A

anti-psychotic

56
Q

long term anti psychotic therapy can cause which 2 movement disorders?

A

tardive dyskinesia - characterised by uncontrolled facial movements like lip smacking

akathisia- severe restlessness

57
Q

which SSRI can be given to children? which SSRI can be given to breastfeeding mothers?

A

children: fluoxetine
breastfeeding: sertraline

58
Q

what is the only absolute contraindication for ECT?

A

raised ICP

59
Q

which SSRI is used post MI?

A

sertraline

60
Q

what is the most common side effect of SSRIs?

A

GI upset

61
Q

which SSRI is associated with QT interval prolongation?

A

citalopram

62
Q

PTSD cannot be diagnosed immediately after the event;

how many weeks after the event must PTSD be diagnosed?

A

> 4weeks after the event

if someone presents with PTSD-like symptoms <4weeks, it is acute stress disorder

63
Q

what is the most common endocrine disorder developing due to lithium toxicity?

A

hypothyroidism

64
Q

which class of drug has an increased VTE risk in the elderly?

A

atypical antipsychotics

65
Q

What is the 1st line treatment for panic disorder or GAD?

A

SSRI

66
Q

which personality disorder displays the negative symptoms of schizophrenia?

A

schizoid PD

67
Q

what class of drug commonly causes anti-muscarinic/cholinergic side effects?

give some examples of anti-muscarinic/cholinergic side effects

A

TCAs

Anorexia
Blurred vision
Constipation/urinary retention
Dry mouth

68
Q

what is the 1st line treatment for borderline personality disorder?

A

dialectical behavioural therapy

not CBT!

69
Q

name the 3 metabolic side effects of antipsychotics?

A
  • hyperglycaemia
  • hypercholesterolemia
  • weight gain
70
Q

what is the 1st line treatment for delirium tremens and alcohol withdrawal?

A

chlordiazepoxide

71
Q

what medication is used to prevent the development of wernicke’s encephalopathy?

A

IV pabrinex

72
Q

which SSRI has an increased risk of congenital malformations during pregnancy?

A

paroxetine

73
Q

what is used 1st line in the acute phase of bipolar disorder?

A

quetiapine

73
Q

what is used 1st line in the acute phase of bipolar disorder?

A

quetiapine

74
Q

name 3 symptoms that may be seen in SSRI discontinuation syndrome?

A
  • diarrhoea
  • vomiting
  • ab pain
75
Q

when is the peak incidence of delirium tremens following alcohol withdrawal?

A

72 hours

76
Q

which is the only SSRI that when stopping it, does not need to be withdrawn gradually over 4 weeks?

A

fluoxetine - it has a longer 1/2 life

77
Q

can metformin cause hypoglycaemia?

A

no, it can’t

78
Q

which class of psychiatric drugs are associated with hyponatremia?

A

SSRIs

79
Q

are visual hallucinations a 1st rank symptom of schizophrenia?

A

no

only auditory hallucinations are 1st rank symptoms

80
Q

what measurement must be monitored prior to administration or SNRIs?

A

blood pressure

SNRIs can cause hypertension

81
Q

what must be monitored in patients taking SSRIs?

A

sodium levels in pxs on SSRIs must be monitored

SSRIs can cause hyponatraemia

this is done via U&Es

82
Q

what should be monitored prior to starting citalopram?

A

ECG

citalopram can cause QT interval prolongation

83
Q

what is the mechanism of action of temazepam (benzos)?

A

enhance the effect of GABA

84
Q

which antidepressant causes weight gain and sedation?

A

mirtazapine

olanzipine causes weight gain but not sedation

85
Q

what is the 1st line pharmacological treatment for GAD if patient education and psychological intervention haven’t been successful?

A

sertraline

86
Q

which of the atypical antipsychotics has the most tolerable side effect profile?

A

aripriprazole

87
Q

which psychiatric condition can circumstantiality be a sign of?

A

anxiety disorders or hypomania

88
Q

what should be used 1st line for acute stress disorders?

A

trauma focused CBT

89
Q

how is acute dystonia secondary to antipsychotics usually managed?

A

managed with procyclidine

90
Q

which class of anti psychotics are:

a) aripriprazole
b) olanzipine, risperidone
c) haloperidol, chlorpromazine

A

a) 3rd generation APs
b) 2nd generation APs
c) 1st generation APs

91
Q

which condition typically involves loss of motor or sensory function? it has an inorganic underlying cause and may be precipitated by stress?

A

conversion disorder

92
Q

what is the risk to baby of using SSRIs during the 3rd trimester of pregnancy?

A

persistent pulmonary hypertension of the newborn

93
Q

describe features seen in a paranoid PD?

A

overly sensitive, unforgiving if insulted and question the loyalty of those around them. also reluctant to confide in others

94
Q

which 2 antidepressants should never be combined due to the risk of serotonin syndrome?

A

SSRIs and MAOIs should never be combined

increased risk of serotonin syndrome

SSRIs+ NSAIDs can increase risk of gastric ulcer - co-prescribe a PPI

95
Q

name the 3 most common features of PTSD?

A
  1. re-experiencing: flashbacks and nightmares
  2. avoidance: people or situations
  3. hyperarousal: hyper vigilance, sleep problems
96
Q

compare the medications used to treat:

a) acute dystonia
b) akathisia
c) tardive dyskinesia

A

a) acute dystonia= procyclidine and benztropine
b) akathisia= propranolol
c) tardive dyskinesia= tetrabenazine

97
Q

compare the type 1 and type 2 bipolar. Which is associated with manic episodes and which is hypomanic?

A

type 1 BP: manic

type 2 BP: hypomanic

both have depression

98
Q

what is the antidepressant of choice in BPAD?

A

fluoxetine

99
Q

what is the name of the syndrome that presents with a paranoid delusion that a famous person is in love with them, with the absence of other psychotic symptoms?

A

de clerambault’s syndrome (erotomania)

Othello syndrome is a delusion of sexual infidelity on the part of a sexual partner

100
Q

a positive hoover’s sign would be indicative of which movement disorder?

A

it would be indicative of a conversion disorder - loss of motor function in the absence of an organic cause

101
Q

which form of amnesia is most common following ECT therapy?

what’s the difference between the 2 forms?

A

retrograde amnesia is most common following ECT (remembering events prior to the insult)

antegrade amnesia is the inability to form new memories following the insult

102
Q

which endocrine disorder can occur due to anorexia?

A

hypothyroidism

103
Q

what is the 1st line therapy for anorexia treatment?

A

1st line: anorexia focused family therapy

2nd line: CBT

104
Q

compare the acute and longterm treatment of mania in BPAD?

A

acute Tx: a rapidly acting antipsychotic or benzodiazepine. stop their antidepressant at this point if they’re taking one.

long term prophylaxis: give lithium (a mood stabiliser)

105
Q

how frequently are lithium levels checked following a change in dose?

A

checked 12 hours following change

then checked weekly until levels are stable

then checked every 3 months once they are stable

106
Q

compare the roles of pabrinex and chlordiazepoxide in the Tx of delirium tremens/alcohol withdrawal?

A

chlordiazepoxide/diazepam: used to treat acute alcohol withdrawal (hypertension, sweating, pyrexia, tachycardia)

pabrinex: used to prevent the development of wernicke’s encephalitis, but it does not have any affect on the symptoms of delirium tremens

107
Q

when a patient is about to start ECT, what should be done about their antidepressant medication?

A

it should be reduced but not stopped when a patient is about to commence ECT

108
Q

what additional features must be present for a patient to be diagnosed from Korsakoff’s syndrome, rather than just wernickes encephalopathy?

A

in addition to the:

  • ophthalmoplegia
  • confusion
  • ataxia/ other cerebellar signs

one must ALSO have:
-amnesia and confabulation

109
Q

what makes Korsakoff’s syndrome different from wernicke’s Encephalopathy?

A

korsakoffs also has amnesia and confabulation

110
Q

which antipsychotic is least likely to cause hyperprolactinemia?

A

aripriprazole

nearly all typical and some atypical APs cause hyperprolactinemia

111
Q

which class of psychiatric drugs cause anterograde amnesia?

A

benzodiazepines

112
Q

name the 2 typical antipsychotics?

A

haloperidol

chlopromazine

113
Q

which medication can cause hypercalcemia? how does this happen?

A

lithium

it can cause hyperparathyroidism, which causes hypercalcemia

114
Q

name the 3 metabolic side effects of antipsychotics?

A
  • hyperglycemia
  • hypercholesterolemia
  • weight gain
115
Q

describe the features of a patient with avoidant PD?

A

they are fearful of criticism, being unliked, rejection and ridicule

associated with social isolation and avoidance of activities

116
Q

compare common side effects seen with:

a) SSRIs
b) SNRIs
c) antipsychotics

what screening tests would you perform?

A

a) SSRIs - hyponatremia (do U&Es)
b) SNRIs - hypertension (do BP)
c) antipsychotics: hyperglycaemia, hypercholesterolemia, weight gain

117
Q

compare flight of ideas and knights move thinking. which is seen in which condition?

A

flight of ideas: seen in mania. patient jumps between topics but there is a link between each

knights move: seen in schizophrenia. jumping between topics with no clear link. known as loosening of association

AA Y4 Finals cards NE (40 decks)

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