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FLASH FINALS > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Acute stress vs PTSD - timing:

A

<4 weeks

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2
Q

Alcohol withdrawal:
6-12 hours:
Peak seizure incidence:
Peak incidence of DT:

A

Tremor, sweating, tachycardia, anxiety

36 hours

48-72 hours

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3
Q

First line Tx. alcohol w/drawal:

A

CHLORDIAZEPOXIDE or diazepam (long acting benzos)

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4
Q

Tx. Alcohol w/drawal if hepatic impairment:

A

LORAZEPAM

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5
Q

Typical antipsychotics MoA

A

D2 receptor antagonists

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6
Q

Atypical antipsychotics MoA

A

Act on a variety of receptors (D2,D3,D4,5-HT)

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7
Q

Hyperprolactinaemia - more common w/ which antipyschotics

A

Typical

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8
Q

Acute dystonia:

Treat with:

A

Sustained muscle contraction (torticolis, oculogyric crisis)

PROCYCLIDINE

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9
Q

Tardive dyskinesia:

A

Late on-set choreoathetoid movements, abnormal involuntary - chewing and pouting of the jaw

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10
Q

CV side effects of anti-psychotics:

A

Increased risk of stroke

Increased risk of VTE

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11
Q

Other side effects of antipsychotics:

A

Impaired glucose tolerance
Reduced seizure threshold (greater w/ atypicals)
Prolonged QT interval (particularly haloperidol)

antimuscarinic, weight gain, galactorrhoea, neuroleptic malignant syndrome

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12
Q

Antipsychotic monitoring: bloods

A

U&Es, FBCs, LFTs at start of therapy, annually

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13
Q

Which antipsychotic requires weekly FBCs initially

A

Clozapine

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14
Q

Other monitoring with antipsychotics (5)

A

Lipids/weight - at start of therapy, 3 months, annually

Fasting blood glucose, prolactin - at start of therapy, 6 months, annually

Blood pressure - baseline, during dose titration

Electrocardiogram - baseline

CV risk assessment - annually

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15
Q

Adverse effects of atypical antipsychotics

A

Weight gain
Clozapine assoc. w/ agranulocytosis
hyperprolactinaemia

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16
Q

Anti-psychotic w/ higher risk of dyslipidaemia and obesity

A

Olanzapine

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17
Q

Anti-psychotic w/ good side effect profile, particularly for prolactin elevation:

A

Aripiprazole

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18
Q

Clozapine side effects:

A 
Agranuloctytosis/neutropenia 
Reduced seizure threshold 
CONSTIPATION
Myocarditis: ECG to be done prior to treatment 
Hypersalivation
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19
Q

What social activity may require clozapine dose to be altered:

A

Smoking

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20
Q

Clozapine may be started when:

A

Schizophrenia is not controlled despite sequential use of two or more anti-psychotic drugs, each for at least 6-8 weeks.

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21
Q

BZPs act on which channels

A

Increase FREQUENCY of Chloride channels to produce sedative effect (enhance GABA)

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22
Q

Symptoms of BZP w/drawal:

A 
Insomnia
Irritability 
Anxiety 
Tremor 
Loss of appetite 
Tinnitus 
Perspiration
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23
Q

Barbiturate’s effect on chloride channels:

A

Increase DURATION of chloride channel opening

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24
Q

Type I bipolar:

type II bipolar:

A

Mania and depression

Hypomania and depression

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25
Q

Hypomania vs mania

A

Hypomania = altered function for 4 days or more

Mania = Severe functional impairment or psychotic symptoms for 7 days

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26
Q

Key differentiator between mania and hypomania:

A

Psychotic symptoms

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27
Q

Mood stabilizer of choice:

A

Lithium

Valproate also used

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28
Q

Management of mania/hypomania

A

consider stopping antidepressant

Antipsychotic - olanzapine or haloperidol

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29
Q

Bipolar: Depression Mx. of choice

A

FLUOXETINE

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30
Q

Referral
Hypomania
Mania

A

Routine referral to CMHT

URGENT referral to CMHT

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31
Q

Charles-Bonnet syndrome:

A

Persistent complex hallucinations occurring in clear consciousness that may be assoc. with a pre-established visual impairment

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32
Q

De-Clarembault syndrome:

A

Erotomania: paranoid delusion that a famous person is in love with them.
Usually affects females

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33
Q

Depression vs. dementia

Factors favouring depression:

A

Short history, rapid on-set
Biological symptoms - wt. loss sleep disturbance
pt. worried about poor memory - global memory loss

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34
Q

Depression switching anti-depressants:

Switching SSRIs:

A

First SSRI is to be withdrawn gradually : before the next one started

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35
Q

Switching from fluoxetine to another SSRI

A

w/draw gradually then leave gap of 4-7 days before starting next SSRI

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36
Q

Switching from SSRI to TCA

A

Cross tapering recommended

Not w/ fluoxetine - should be withdrawn prior to TCAs

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37
Q

Switching from SSRI to SNRI

A

Cross-taper

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38
Q

ECT adverse effects:

A

Headache, nausea, short term memory impairment, cardiac arrhythmia

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39
Q

Medical tx. of choice in GAD
2nd line
3rd line

A

SERTRALINE

another SSRI or SNRI

Pregabalin

40
Q

Chronic insomnia diagnosis requires:

A

difficulty sleeping for at least 3 nights/week for 3 months

41
Q

Commonly prescribed medication that may cause insomnia:

A

Corticosteroids

42
Q

When should hypnotics be considered for insomnia

A

Only if daytime somnolence is SEVERE

43
Q

Hypnotics in insomnia:

A

Should be short acting BZPs or non-BZPs (Zopiclone, zolpidem)

If no response to hypnotic DO NOT prescribe another

44
Q

Lithium therapeutic range (mmol/L)

A

0.4 - 1

45
Q

Lithium is excreted by which organs:

A

Kidneys

46
Q

Adverse effects of lithium

A

‘LITHIVM’

Leukocytosis
Insipidus (diabetes)
Tremor 
Hypothyroidism
Increased WEIGHT 
Vomiting/nausea, diarrhoea 
Misc. - Hypercalcaemia,
47
Q

Lithium monitoring:

A

Sample should be taken 12 hours post dose.
Then weekly/after each dose until levels are stable.

Once stable: every 3 months

TFT and RFT should be checked 6 monthly

48
Q

Knight’s move thinking vs Flight of ideas

A

Flight of ideas has discernible links.

49
Q

Mirtazapine MoA

A

Blocks a2 adrenergic receptors

50
Q

OCD tx.
Mild functional impairment:
Moderate functional impairment:
Severe:

A

CBT w/ ERP
SSRI (Fluoxetine for body dysmorphic disorder)
SSRI and CBT w/ ERP

51
Q

If SSRI is effective in controlling OCD how long should it be continued for

A

12 months

52
Q

Othello syndrome:

A

Convinced partner is cheating on them

53
Q

PDs: Cluster A

A

Odd and eccentric:
Paranoid
Schizoid
Schizotypal

54
Q

PDs: Cluster B

A 
Dramatic emotional and erratic: 
Antisocial 
Borderline 
Histrionic 
Narcissistic
55
Q

PDs: Cluster C

A

Anxious and fearful:

Obsessive compulsive
Avoidant
Dependent

56
Q

Drug treatments for PTSD:

A

Venlafaxine or Sertraline - Not first-line management of PTSD

57
Q

Strongest risk factor for developing a psychotic disorder

A

Family history

58
Q

Shneider’s first-rank symptoms:

mnemonic

A

‘At The Police Department’

Auditory hallucinations
Thought disorder - insertion, w/drawal, broadcasting
Passivity phenomena
Delusional perception

59
Q

Schizophrenia management:

A

CBT offered to all patients

Atypical antipsychotics are first-line

60
Q

Schizophrenia: which system should be paid close attention, with risk factors modified to improve outcomes :

A

Cardiovascular disease - linked to antipsychotic medication and high smoking rates)

61
Q

Schizophrenia: poor prognostic indicators:

A 
Strong family history
Gradual onset 
Low IQ 
Prodromal phase of social withdrawal 
Lack of obvious precipitant
62
Q

Which SSRI is known to increase QT interval:

A

CITALOPRAM - should not be used in long QT syndrome or in combination with medications which prolong QT interval.

63
Q

SSRI which is most useful post MI -

A

Sertraline - best cardiac profile

64
Q

SSRI of choice in younger adults:

A

Fluoxetine

65
Q

Common side effects in SSRIs

A

GI symptoms are most common

Increased risk of GI bleeding (give omeprazole if already on NSAID)

66
Q

Maximum dose of citalopram:

A

40 mg - 20mg if >65 yrs

67
Q

SSRI interactions to be aware of (4)

A

NSAIDs - in general do not offer but if must, give with PPI
Triptans - Increased risk of serotonin syndrome
MAOis - increased risk of serotonin syndrome
Warfarin/herparin - do not give SSRI - consider mirtazapine

68
Q

After initiation of SSRI, pts. should be reviewed after:

A

2 weeks

If <30, 1 week

69
Q

If good response to SSRI, how long should treatment continue for

A

6 months

70
Q

Discontinuing SSRI - w/drawn over

A

4 weeks - not necessary with fluoxetine

71
Q

Discontinuation syndrome - SSRIs

A

Increased mood change
restlessness, difficulty sleeping
Sweating
GI symptoms - pain cramping, diarrhoea

72
Q

SSRI in pregnancy: potential side effects
1TM
3TM

A

1TM: Congenital heart defects

3TM: Persistent pulmonary hypertension of newborn

73
Q

Which SSRI has increased risk of congenital malformation, thus should be avoided in pregnancy

A

Paroxetine

74
Q

Sleep paralysis tx. if troublesome symptoms:

A

Clonazepam

75
Q

Common side effects of TCAs:

A 
Drowsiness 
Dry mouth 
Blurred vision 
Constipation 
Urinary retention 
Lengthening of QT interval
76
Q

More sedative TCAs:

Less sedative TCAs:

A

More sedative:
Amitriptyline, clomipramine, dosulepin, trazadone

Less sedative
Imipramine, lofepramine, nortryptiline

77
Q

Somatisation disorder:

A

Multiple physical SYMPTOMS present for at least 2 years

pt. refuses to accept reassurance or negative results

78
Q

Conversion disorder:

A

Involves loss of motor or sensory function

No psychiatric symptoms otherwise

79
Q

Dissociative disorder:

A

Process of separating off certain memories from normal consciousness

80
Q

Factitious disorder vs malingering:

A

Factitious = intentional production of real symptoms

Malingering = Fraudulent simulation of symptoms for gain

81
Q

Adverse effects of ‘Z’ drugs

A

Similar to BZPs

increased risk of falls in the elderly

82
Q

Emergency detention - duration:

Does it allow treatment:
Who can issue one:

A

72 hours

No treatment

F2 or above

83
Q

Short term detention:
duration:

Treatment?

Who can issue:

requires consent of:

A

28 days

Yes

Applied for an approved by 2 medical practitioners, one which must be a psychiatrist

MHO

84
Q

Compulsory treatment order:
Max duration:

Who can issue:

A

6 months

Applied for by MHO with supporting letters from 2 doctors: one being the psychiatrist

85
Q

Serotonin syndrome: px:

A

Myoclonus (twitching), tremor rigidity, hyperreflexia

Headache, hallucinations, agitation
Autonomic: Shivering, sweating hyperthermia

86
Q

Bipolar is associated strongly with which syndrome:

A

DiGeorge syndrome

87
Q

What kind of hallucinations are classical of schizophrenia:

A

3rd person auditory

88
Q

Antipsychotic to give when pt. could do with losing weight:

A

Haloperidol

Aripiprazole

89
Q

BZP overdose is tx. w/

A

Flumazenil

90
Q

Flight of ideas is more assoc. w/

Knight’s move thinking is more assoc. w/

A 
FoI = Mania 
KMT = Schizophrenia
91
Q

Long term usage of antipsychotics may cause:

A

Glucose dysregulation and diabetes

92
Q

Two classes of anti-depressants that should never be prescribed together:

A

SSRI and MAOIs - risk of serotonin syndrome

93
Q

ECT causes what kind of memory loss?

A

Retrograde amnesia

94
Q

Anorexia nervosa: what is raised

A

Gs and Cs

GH
Glucose
Salivary Glands

Cortisol
Cholesterol
Carotinaemia

95
Q

TCAs - anticholinergic side-effects w/ what difference:

A

Weight GAIN rather than anorexia

96
Q

Personality disorders broader treatment strategy

A

Dialectical behavioural therapy

FLASH FINALS (34 decks)

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