Psychiatry Flashcards
Define an illusion
-A misrepresentation of a ‘real’ sensory stimulus - this interpretation contradicts objective ‘reality’
Define pareidolia
Imposing a meaningful interpretation on a nebulous stimulus, usually visual
Define a hallucination
An experience involving the apparent perception of something not present
Give 2 sensory deceptions
-Illusions
-Hallucinations
Give 4 sensory distortions
-Changes in intensity
-Changes in quality
-Changes in spatial form
-Distortions of experience of time
Give the 5 main types of hallucination
-Visual
-Auditory : 2nd or 3rd person
-Somatic and tactile
-Gustatory
-Olfactory
What are the 5 special kinds of hallucination ?
-Functional
-Reflex
-Extracampine
-Hypnagogic
-Hypnapompic
What is a functional hallucination ?
-An auditory stimulus causes a hallucination
What is a reflex hallucination?
-Stimulus in one sensory modality produces a sensory experience in another
what is an extracampine hallucination ?
-Hallucination that is outside the limits of the sensory field (e.g. hears voices talking in Paris when they are in sydney)
What is a hypnagogic and hypnapompic hallucination ?
-> Hypnagogic : occur when the subject is falling asleep
-> Hypnapompic : occurs when the patient is waking up
What are the 4 thought disorders
-Disorders of stream of thoughts
-Disorders of possession of thoughts
-Disorders of content of thoughts
-Disorders of Form of thought
Give 2 types of disorders of stream of thoughts
-Disorders of tempo : flight of ideas, inhibition or slowness of thinking and circumstantiality.
-Disorders of continuity of thought : perseveration and thought blocking.
What is flight of ideas?
-Thought disorder (disorder of stream)
-Continuous, rapid speech that changes focus from moment to moment.
What is circumstantiality?
-Thought disorder (disorder of stream)
-Circutious, indirect speech in which the individual digresses to give unnecessary and often irrelevant details before arriving at the main point.
What is perseveration ?
-Thought disorder (disorder of stream).
-Repetition of a particular response, such as a word, phrase or gesture, despite the absence or cessation of a stimulus.
What is thought block ?
-Thought disorder (disorder of stream).
-Sudden interruption in the the train of thought, leaving a blank.
Give 2 types of disorder of possession of thought
-Obsessions and compulsions
-Thought alienation : thought insertion, thought withdrawal and thought broadcasting
What is thought alienation?
A sense of loss of control or personal possession of thinking.
Define thought insertion, withdrawal and broadcasting?
-> Insertion : one’s thoughts are not their own, they belong to someone else and have been inserted into them
-> Withdrawal : their thoughts are being removed from their own mind
-Broadcasting : a person believes their own thoughts can be heard or known by people around them
What is an example of a disorder of content of thinking ?
Delusion
Define a delusion
False, unshakable belief that is out of keeping with the patient’s social and cultural background.
What is a persecutory delusion ?
-When someone believes others are out to harm them despite evidence to the contrary
What is a grandiosity delusion ?
-Larger-than-life feelings of superiority and invulnerability
-Exaggerated sense of their own importance, power, knowledge or identity.
What is a nihilistic delusion ?
-Patient denies the existence of their body, mind, loved ones and the world around them
What is a poverty delusion ?
-A person is convinced that they are impoverished and believe that destitution is facing them and their family.
Give an example of a disorder of form of thinking
-Loosening of association
What is loosening of association
-Thought disorder (disorder of form)
-There is a lack of connection between ideas, the speech may wander between trains or thought.
Loosening of association vs flight of ideas
In loosening of association there is an illogicality between speech often seen in schizophrenia where as flight of ideas characterises hypomania
Give 2 disorders of memory
-Dissociative amnesia
-Confabulation
What is dissociative amnesia
-Sudden amnesia that occurs during periods of extreme trauma and can last for hours or even days
What is confabulation
-Falsification of memory occuring in clear consciousness in association with organic pathology
-Creation of false memories in the absence of intentions of deception.
Define thought echo
-A person hears his or her own thoughts as if they were being spoken aloud
Define concrete thinking
-Thinking focused on immediate experiences and specific objects or events
What is flattening of affect
-Observable absence of emotional reactivity
-Includes : lack of facial expression, monotone voice, lack of eye contact and lack of body language.
Define blunted affect
-Reduced emotional response to an environmental stimulus.
Define pseudo-hallucination
-Involuntary sensory experience, vivid enough to be regarded as a hallucination. but is recognised as unreal by the person experiencing it
Define catatonia
Abnormality of movement and behaviour arising from a disturbed mental state
Define stupor
Unresponsiveness from which a person can be aroused only by vigorous physical stimulation
Define belle indifference
-Paradoxical absence of psychological distress despite having a serious medical illness or symptoms related to a health condition
Define incongruence of affect
When a patients observable mood differs from what they say and their actions
Define pressure of speech
When speech is accelerated or frantic and conveys urgency seemingly inappropriate to the situation
What is poverty of speech?
General lack of additional, unprompted content with brief replies and less spontaneous speech
What is poverty of thought?
-Reduced spontaneity and productivity of thought as evidenced by speech that is vague or full of simple of meaningless repetitions or stereotyped phrases
Define anhedonia
Inability to feel pleasure in normally pleasurable activities
Define akathisia
Intense sensation of unease or an inner restlessness
Define depersonalisation
when a person persistently or repeatedly has the feeling that they’re observing themselves from outside there body
Define derealisation
Mental state where are person feels detached from their surroundings, often to the point that they think the people and objects around them do not seem real
Define dissociation
Disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is
Define an obsession
-Repeated thoughts, urges or mental images that cause anxiety
-Unpleasant, repetitive, intrusive, irrational and recognised as the patients own thoughts.
Define a compulsion
-Repetitive behaviours or mental acts that person feels driven to perform in response to an obsession
Define delirium
‘Acute confusional state’ -> state of mental confusion that can happen when you become medically unwell
Define somatic passivity
Experience of bodily sensations imposed by an external agency
Define an overvalued idea
A solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preoccupying to the extent of dominating the suffer’s life
Define a stereotyped behaviour
A repetitive or ritualistic movement, posture or utterance
What are the 2 common characteristics of OCD?
-Obsessions
-Compulsions
-Can be either or both
How is OCD with mild functional impairment managed ?
-CBT including exposure and response prevention.
-If insufficient consider SSRI
How is OCD with moderate or severe functional impairment managed ?
-SSRI + more intensive CBT
Define acute stress disorder
-Acute stress reaction occurring within 4 weeks after a person has been exposed to a traumatic event
Give 5 features of acute stress disorder
-Intrusive thoughts : flashbacks, nightmares
-Dissociation : in a daze, time slowing
-Negative mood
-Avoidance
-Arousal : hyper-vigilance, sleep disturbance
How is acute stress disorder managed?
-Trauma based CBT
-Benzodiazepines for acute symptoms
When do symptoms of alcohol withdrawal start to show and what are they ?
- 6-12 hours
-Tremor, sweating, tachycardia, anxiety
When is the peak incidence of seizures in alcohol withdrawal ?
36 hours
(24-48hrs)
What is the peak incidence of delirium tremens ?
72 hrs
What are the 10 signs of delirium tremens ?
-Coarse tremor
-Confusion
-Delusions
-Auditory and visual hallucinations
-Fever
-Tachycardia
-Severe agitation
-HTN
-Ataxia
-Arrhythmias
What is the first line treatment for alcohol withdrawal ?
-long acting benzodiazepines
-Chlordiazepoxide o
-IV high dose B vitamines (pabrinex), followed by regular lower dose thiamine
what effect does alcohol have on the body?
-Stimulates GABA receptors in the brain
-GABA receptors have a ‘relaxing’ effect on the brain –Also inhibits NMDA-type glutamate receptors, having a further inhibitory effect on the electrical activity of the brain
What is the mechanism of alcohol withdrawal ?
-Decreased inhibitory GABA and increased NMDA glutamate transmission -> extreme excitability of the brain with excess adrenergic activity
Give 3 diagnostic criteria for anorexia
-Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health.
-Intense fear of gaining weight or becoming fat, even though underweight
-Disturbance in the way in which ones body weight or shape is experiences
What is the first line treatment for children and adolescents with anorexia?
-Focused family therapy
-CBT is second line
What are the treatment options for adults with anorexia ?
-CBT with eating disorder focus
-MANTRA
Give 4 physical features of anorexia
-Reduced BMI
-Bradycardia
-Hypotension
-Enlarge salivary glands
Give 7 physiological abnormalities in anorexia
-Hypokalaemia
-Low FSH, LH, oestorogens and testosterone
-Raised cortisol and growth hormone
-Impaired glucose tolerance
-Hypercholesterolemia
-Hypercarotinaemia
-Low Ts
-C’s and H’s increase, eveything else decreases
What is the mechanism of typical antipsychotics ?
-Dopamine receptor (D2) antagonists blocking dopaminergic transmission in the mesolimbic pathways
What are 2 common adverse effects of TYPICAL antipsychotics ?
-Extrapyramidal SE
-Hyperprolactinaemia
What is the mechanism of action of ATYPICAL antipsychotics ?
-Act on various receptors (D2, D3, D4, 5-HT)
what are the common adverse effects of ATYPICAL antipsychotics ?
-Metabolic effects
Give the 4 extrapyramidal SE of typical antipsychotics
-Acute dystonia
-Tardive dyskinesia
-Parkinsonism
-Akathisia
what is acute dystonia ?
-Sustained muscle contraction (toricollis, oculogyric crisis)
How can acute dystonia be managed ?
-Procyclidine
What is tardive dyskinesia ?
-Abnormal, involuntary movements (e.g. chewing and pouting of jaw)
What are the risks of antipsychotics in the elderly ?
-Increased risk of stroke
-Increased risk of venous thromboembolism
Give 5 common side effects of tricyclic antidepressants (e.g. amitriptyline)
Anticholinergic : can’t see, can’t pee, can’t spit, can’t shit
-Dry mouth
-Hesitancy
-Blurred vision
-Constipation
-Weight gain
What are 2 common SE of haloperidol and citalopram on ECG?
-QT interval elongation
-Torsades de pointes (VT)
What is a benefit of atypical compared to typical antipsychotics?
-Reduction in extrapyramidal side effects
Give 6 examples of atypical antipsychotics
-Clozapine
-Olanzapine : higher risk of dyslipidemia, dysglycaemia, DM and obesity
-Risperidone
-Quetiapine
-Aripiprazole : good SE profile, esp for prolactin elevation
When should clozapine be introcued for management of schizophrenia?
-If it is not controlled despite sequential use of 2 or more antipsychotic drugs (of which one is second-generation), each for at least 6-8 weeks
Give 5 SE of clozapine
-Agranulocytosis, neutrpaenia
-Reduced seizure threshold
-Constipation
-Myocarditis : baseline ECG should be done before commencing treatment
-Hypersalivation
How often does clozapine require FBC monitoring ?
-Weekly for first 18 wks
-Fortnightly for next 38wks
-After that, monthly monitoring
What is the diagnostic criteria for insomnia ?
-Trouble falling asleep or staying asleep on at least 3 nights a week for at least 3 mnths
Give 7 symptoms of SSRI discontinuation syndrome
-GI symptoms : pain, cramping, D&V
-Increased mood change
-Restlessness
-Difficulty sleeping
-Unsteadiness
-Sweating
-Parasthesia
What is the action of benzodiazepines ?
-Enhance the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the FREQUENCY of chloride channels
Give 5 functions of benzodiazepines
-Sedation
-Hypnotic
-Anxiolytic
-Anticonvulsant
-Muscle relaxant
What time period are benzodiazepines recommended to be prescribed for and why ?
-2-4 wks
-People develop a tolerance and dependence to them
How should a benzodiazepine be withdrawn?
-Withdrawn in steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight
What are the 8 features of benzodiazepine withdrawal
6 of which involve the letters of benzodiazepines an two T’s
-Insomnia
-Irritability
-Anxiety
-Tremor
-Loss of appetite
-Tinnitus
-Perspiration
-Perceptual disturbance
-Seizures
Define bipolar
-Chronic mental health disorder characterised by periods of mania/hypomania and depression.
What is bipolar type 1?
-Mania and depression
What is bipolar type 2?
-Hypomania and depression
What is mania ?
-Abnormally elevated mood or irritability
-Lasts for at least 7 days
-Severe functional impairment in social and work setting
-May present with psychotic symptoms
-In an exam, with mania there will often be psychotic symptoms
what is hypomania ?
-Abnormally elevated mood or irritability
-Decreased or increased function for 4 or more days
-No psychotic symptoms
-Causes less functional impairment to work or social settings
What is first line for long term treatment of bipolar ?
-Lithium + psycholoigcal intervention
What can be used to treat bipolar long term if lithium is ineffective ?
-Valporate
How is an episode of mania/hypomania in bipolar managed?
-Stop antidepressant
-Give antipsychotic : olanzapine, haloperidol
How is an episode of depression in bipolar managed ?
-Psychological therapy + antidepressant (fluoxetine is first line)
What 2 co-morbidities are people with bipolar at risk of?
-DM and cardiovascular disease
Define bulimia
-ED characterised by episodes of binge eating, followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising
Give the 5 criteria in the DSM 5 for a diagnosis of bulimia ?
-> Recurrent episodes of binge eating
-> A sense of lack of control over eating during the episode
-> Recurrent inappropriate compensatory behaviour in order to prevent weight gain
-> The binge eating and compensatory behaviours occur at least once a week for 3 mnths
-> Self-evaluation is unduly influenced by body shape and weight
How is bulimia managed ?
-In children : family therapy
-CBT-ED
-Fluoxetine has a limited role
What is Charles-Bonnet syndrome (CBS) ?
-Persistent and recurrent complex hallucinations, occurring in clear consciousness
Give 5 RF for CBS
-Advanced age
-Peripheral visual impairment
-Social isolation
-Sensory deprivation
-Early cognitive impairment
Give 3 characteristics of CBS
-There is generally a background of visual impairment
-Insight is usually preserved
-Must be an absence of any other significant neuropsychiatric disturbance
What is the most common opthalmological condition associated with CBS?
-Age-related macular degeneration
-Glaucoma
-Cataract
Define Cotard syndrome
-Rare disorder where a person believes that they (or in some cases just part of their body) is either dead or non-existent
What is De Clerambault’s syndrome ?
-Form of paranoid delusion where a person believes a famous person is in love with them
-also known as erotomania
What is delusional parasitosis ?
-Where a person has a delusion that they are infested by bugs
What 6 factors would suggest a diagnosis of depression over dementia ?
-Short Hx, rapid onset
-Biological Sx : weight loss, sleep disturbance
-Patient worried about poor memory
-Reluctant to take tests, disappointed with results
-MMS exam score : variable
-Global memory loss
What kind of memory loss does dementia characteristically cause ?
-Recent memory loss
What are the 9 criteria in the DSM 5 for depression
- Depressed mood, most of the day, nearly every day
- Markedly dimished interest or pleasure in activities
- Significant weight loss/gain or appetite increase/loss
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue
- Feelings of worthlessness, excessive or inappropriate guilt
- Diminished ability to think or concentrate
- Recurrent thoughts of death, suicidal ideation, suicide attempts
What 2 assessment tools are used to diagnose depression ?
-HAD scale
-PHQ-9
What is the management of subthreshold depressive symptoms or mild depression ?
-CBT
What is the management of moderate/severe depression ?
-SSRI
-CBT
According to the IDC-10, how long must an episode last to be classed as depression ?
2 wks
When is ECT used ?
-Patients with severe depression, refractory to medication (e.g. catatonia)
What is an absolute contraindication for ECT?
-Raised ICP
Give 5 short term side effects of ECT
-Headache
-Nausea
-Short term memory impairment
-Memory loss of events prior to ECT
-Cardiac arrhythmia
What is one reported long term side effect of ECT?
-Impaired memory
Define anxiety
-Excessive worry about a number of different events associated with heightened tension
What are alternative causes of anxiety?
-Hyperthyroid
-Cardiac disease
-Medication induced anxiety
What medications can trigger anxiety?
-Salbutamol
-Theophylline
-Corticosteroids
-Antidepressants
-Caffeine
Explain the step-wise approach to managing GAD
- Education about GAD + active monitoring
- Low intensity psychological interventions
- High intensity psychological interventions or drug treatment
What is the 1st line drug treatment for GAD?
-Sertraline
-If ineffective try alternative SSRI or SNRI (e.g. duloxetine, venlafaxine)
How is panic disorder managed?
-CBT or drug Tx
-SSRI’s are 1st line but if ineffective after 12 wks try imipramine or clomipramine (tricyclic)
What characteristics are often seen in both mania and hypomania ?
-Mood : predominately elevated, possible irritable
-Speech & thought : pressured, flight of ideas, poor attention
-Behaviour : insomnia, loss of inhibitions, increased appetite
Give 2 features of an atypical grief reaction
-Delayed grief : more than 2 weeks passes before grieving begins
-Prolonged grief : normal grief reactions may take up to and beyond 12 mnths
Define chronic insomnia
-Trouble falling or staying asleep at least 3 nights per week for 3 mnths or longer
Give 3 short term management options for insomnia
-Identify potential causes
-Advise good sleepy hygiene : no screens, limit caffeine, fixed bed times etc
-Hypnotics : ONLY if daytime impairment is severe
Give 6 RF for insomnia
-Female
-Older
-Lower educational attainment
-Unemployment
-Economic inactivity
-Widowed, divorced or separated
What hypnotics are recommended for treating insomnia ?
-Short acting benzos (not diazepam)
-Non-benzodiazepines (zopiclone, zolpidem, zaleplon)
What causes wernicke-korsafoff syndrome ?
-Alcohol excess
-This leads to thiamine (vit B1 deficiency)
-Wernicke’s comes first and leads to Korsakoff’s if untreated
Give 3 features of wernicke’s encephalopathy
-Confusion
-Oculomotor disturbances
-Ataxia
Give 2 features of Korsakoff’s syndroime
-Memory impairment (anterograde and retrograde). Anterograde : inability to acquire to new memories
-Behavioural changes
When do hallucinations in alcohol withdrawal begin?
12-24 hrs
What is lithium?
-Mood stabilising drug used in bipolar disorder
Give 6 adverse effects of lithium
-GI : N&V, diarhoea, weight gain
-Leucotysosis
-Thyroid enlargement -> hypothyroidism
-Idiopathic intracranial HTN
How can lithium effect an ECG?
-T wave flattening/inversion
How can lithium effect levels of parathyroid hormone
-Increase the levels
-leading to hypercalcaemia
How can lithium effect the kidneys ?
-Nephrotoxicity -> polyuria, secondary to nephrogenic diabetes insipidous
When should lithium levels be checked ?
-12 hrs post dose
How often should lithium levels be checked?
-Weekly when first commenced or changing dose
-Then checked every 3 mnths
Give 7 symptoms of lithium toxicity
TOXICCC
T : Tremor (coarse)
O : Oliguric renal failure
X : ataXia
I : Increased reflexes
CCC : Convulsions, Coma, Consciousness reduced
What blood level of lithium defines toxicity
-1.5mEq/L or higher
-Severe once at 2.0mEq/L or above
Give 3 risk factors for OCD
-Genetics
-Psychological trauma
-Paediatric autoimmune neuropsychiatric associated with streptococcal infections (PANDAS)
Give 4 conditions associated with OCD
-Depression
-Schizophrenia
-Tourette’s
-Anorexia
What is Othello’s syndrome ?
-A person is convinced their partner is cheating on them
Give 5 features of a paranoid personality disorder
-Hypersensitifity and an unforgiving attitude when insulted
-Unwarranted tendency to question loyalty of friends
-Reluctance to confide in others
-Preoccupation with conspirational beliefs and hidden meaning
-Unwarranted tendency to perceive attacks on their character
Give 7 features of schizoid personality disorder
-Indifference to praise and criticism
-PREFERENCE FOR SOLITARY ACTIVITIES
-LACK OF INTEREST IN SEXUAL INTERACTIONS
-Lack of desire for companionship
-Emotional coldness
-Few interests
-Few friends or confidants other than family
Give 8 features of a schizotypal
personality disorder
-Ideas of reference
-ODD BELIEFS and magical thinking
-Unusual perceptual disturbances
-Paranoid ideation and suspiciousness
-Odd, eccentric behaviour
-LACK OF CLOSE FRIENDS other than family members
-Inappropriate affect
-Odd speech without being incoherent
Give 8 features of an antisocial personality disorder
-Failure to confirm to social norms + law breaking behaviour
-Men>women
-Deception
-Impulsiveness or failure to plan ahead
-Irritability and aggressiveness
-Reckless disregard for the safety of self or others
-Consistent irresponsibility
-Lack of remorse
Give 9 features of EUPD
-Efforts to avoid real or imagined abandonment
-Unstable interpersonal relationships which alternate between idealisation and devaluation
-Unstable self image
-Impulsivity
-Suicidal behaviour
-Affective instability
-Chronic feelings of emptiness
-Difficulty controlling temper
-Quasi psychotic thoughts
Give 6 features of a Histrionic personality disorder
-Inappropriate sexual seductiveness
-Need to be centre of attention
-Shallow expressions of emotion
-Suggestibility
-Self dramatisation
-Physical appearance used for attention seeking
Give 8 features of a narcissistic personality disorder
-Grandiose sense of self importance
-Sense of entitlement
-Taking advantage to achieve own needs
-Lack of empathy
-Excessive need for admiration
-Chronic envy
-Arrogant and haughty attitude
-Preoccupation with fantasies of unlimited success, power or beauty
Give 7 features of an OCD persoanlity disorder
-Occupied with details, rules, lists, order
-Demonstrates perfectionism that hampers with completing tasks
-Extremely dedicated to work and efficiency to the elimation of spare time activities
-Is meticulous, scrupulous and rigid about etiquettes of morality, ethics or values
-Not capable of disposing worn out or insignificant things even if they have no sentimental meaning
-Unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
-Takes on stingy spending style towards self and others, shows stiffness and stuborness
Give 7 signs of an avoidant personality disorder
-Avoidance of occupational activities which involve significant interpersonal contact due to fear of criticism or rejection
-Unwillingness to be involved unless certain of being liked
-Preoccupied with ideas that they are being criticised or rejected in social situations
-Restraint in intimate relationships due to fear of being ridiculed
-Reluctance to take personal risks due to fear of embarrassment
-Views self as inept and inferior to others
-Social isolation accompanied by craving for social contact
Give 8 signs of a dependent personality disorder
-Difficulty making everyday decisions without excessive reassurance from others
-Need for others to assume responsibility for major ereas of their life
-Difficulty in expressing disagreement with others due to fear of losing support
-Lack of initiative
-Unrealistic fears of being left to care for themselves
-Urgent search for another relationship as a source of care and support when a close relationship ends
-Extensive efforts to obtain support from others
-Unrealistic feelings that they cannot care for themselves
What is the first line psychological therapy for personality disorders
Dialectical behaviour therapy
Give features post-concussion syndrome
-Headache
-Fatigue
-Anxiety/depression
-Dizziness
How long do symptoms have to be present for a diagnosis of PTSD
A month
Give 4 features of PTSD
-> Re-experiencing : flashbacks, nightmares, repetitive and distressing intrusive images
-> Avoidance : avoiding people, situations or circumstances resembling or associated with the event
-> Hyperarousal : hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
-> Emotional numbing : lack of ability to experience feelings, feeling detached
How is PTSD managed ?
-Trauma focused CBT
-Venlafaxine or SSRI such as sertraline if needed
What is the strongest risk factor for developing schizophrenia?
Family history
Monozygotic twins - 50%
Give 5 factors favouring delirium over dementia
-Impairment of consciousness
-Fluctuation of symptoms : worse at night, periods of normality
-Abnormal perceptions (e.g. illusions and hallucinations)
-Agitation, fear
-Delusions
What needs to be monitored when a patient is on and SSRI?
U&E’s - risk of hyponatraemia
what needs to be monitored particularly when taking citalopram ?
ECG - risk of QT interval elongation
What kind of medication is venlafaxine and what needs to be monitored when taking it
SNRI - serotonin and noradrenaline
Blood pressure - increased risk of HTN
what needs to be monitored if a patient is taking mirtazapine ?
BMI - weight gain association
What SSRIs is preferred generally, post MI and in children and adolescents ?
-Generally : citalopram and fluoxetine
-Post MI : sertraline
-Children and adolescents : fluoxetine
What is the most common SE of SSRI’s
-GI symptoms
-If patient also requires NSAIDs they should be given a PPI due to increased risk of GI bleeding
Give 5 SSRI interactions
-NSAIDs : co prescribe PPI
-Warfarin/heparin (consider metazapine instead)
-Triptans ! Increased risk of serotonin syndrome
-MAOIs
When should people be reviewed when prescribed SSRIs and how long should they be continued following remission
-2 wks after initiation
-Continue for 6 mnths following remission
what antidepressant can be helpful in the elderly who also suffer from insomnia and poor appetite?
Mirtazapine
Its a sedative and increases appetite
Blocks alpha2-adrenergic receptors
what are monoamine oxidase inhibitors and how do they work
-Block monoamine oxidase in the presynaptic cell that breaks down serotonin and noradrenaline
-E.g. tranylcypromine, phenelzine
What are SE of monoamine oxidase inhibitors (phenelzine)
-Hypertensive crisis associated with certain ripe cheese
Define section 2
Admission for up to 28 days, not renewable
Requires 2 doctors (one section 12 approved) & AMHP
Treatment given with patients wishes
Define section 3
Admission for up to 6 mnths, can be renewed
AMHP + 2 doctors (one section 12 approved)
Treatment can be given against patients wishes
Define a section 4
72 hr assessment order
Used as emergency when section 2 would involve a delay
a GP, AMHP, NP
Often changed to section 2 on arrival to hospital
Define section 5(2)
Patient who is a voluntary pt in hospital can be detained by doctor for 72 hrs
Define section 5(4)
Allows a nurse to detain a patient who is voluntarily in hospital for 6 hrs
Define a section 17a
-Community treatment order
-Can be used to recall a pt to hospital for treatment if they do no comply with conditions in the community (e.g. complying with medication
Define a section 135
court order can be obtained to allow police to break into a property to remove a person to place of safety
Define section 136
-Someone in a public place who appears to have a mental disorder can be taken by police to a place of safety
-Used for up to 24 hrs
What are the 1st rank symptoms of schizophrenia
-Auditory hallucinations (2 or more voices discussing pt in third person, thought echo, commenting on patietns behaviour)
-Thought alienation
-Somatic passivity/passivity phenomenon
-Delusion perceptions
Give 6 second rank symptoms of schizophrenia
-Impaired insight
-Negative symptoms : blunting of affect, anhedonia, alogia, avolition
-Decreased speech
-Neologisms
-Catatonia
what is 1st line management of schizophrenia
Oral atypical antipsychotics
what 7 factors are associated with poor prognosis in schizophrenia
Gradual onset
Strong family history
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
Male
Teenage onset
what is schizoaffective disorder
Presence of schizophrenia symptoms concurrent with mood symptoms (depression or mania)
Give 3 psychotic features
Hallucinations
Delusions
thoughts disorganisation
Give 4 associated features of psychosis
-Agitation / aggression
-Neurocognitive impairment (memory, attention or executive functioning)
-Depression
-Thoughts of self harm
-multiple physical SYMPTOMS present for at least 2 yrs
-patient refuses to accept reassurance or negative test results
somatisation disorder
Persistent belief in the presence of an underlying serious DISEASE (e.g. cancer)
Patient refuses to accept reassurance or negative test results
Hypochondriasis
Loss of motor or sensory function (NEUROLOGICAL SYMPTOMS)
La belle indifference
Conversion disorder
Intentional production of physical or psychological symptoms
Factitious disorder / Munchausen’s syndrome
Fradulent simulation or exaggeration of symptoms for financial or other gain
Malingering
what is capgras syndrome
false belief that an identical duplicate has replaced someone significant to the patient
What is neuroleptic malignant syndrome
Life threatening reaction to antipyschotics
What are the 6 signs and symptoms of neuroleptic malignant syndrome
-High fever
-Muscle rigidity
-Altered mental status
-Autonomic nervous system dysfunction
-Tachycardia
-Tachypnoea
How does serotonin syndrome present ?
-Within 2 wks of starting medication : SSRI/SSNRI, opioid, MAOI, lithium
-Psychiatric : confusion, hallucinations
-Peripheral : tremor, shaking, hyperreflexia,
-Autonomic : HTN, tachycardia, hyperthermia, swaeting, shivers
define echolalia
repetition of someone else’s speech, including the question that was asked
define copropraxia
involuntary performing of obscene or forbidden gestures or inappropriate touching
define echopraxia
meaningless repetition or imitation of the movements of others
define palilalia
automatic repetition of one’s own words, phrases or sentances
what can cause a rise in clozapine levels
smoking cessation
if clozapine doses are missed for more than 48hrs what is the best course of action to address the missed doses?
re-titrate the doses again slowly
what does zopiclone increase the risk of in the elderly
falls
what medication will cause facial flushing, N&V if alcohol is drank
Disulfiram
what medication reduces alcohol cravings
acamprosate
what medication is given as a sublingual tablet as an alternative to methadone in opioid dependence
buprenorphine
what are the management options for ADHD
-Conservative : healthy diet and exercise
-Medication : CNS stimulants
1st : methyphenidate
2nd : dexamfetamine
3rd : atomexetine
what is the treatment for deliriumn tremens
IV pabrinex or Lorazepam
Long acting benzo (chlordiazepoxide)
If psychotic features : IM haloperidol (CI in LBD or PD)
what can be used in SSRI overdose
-> activated charcoal
what is the difference in WBC count between SS and NMS
SS : normal
NMS : high
what medication reduces pleasure in alcohol
Naltrexone
