Psychiatry Flashcards
when is postnatal depression seen to peak
3m after birth
what is the triad for postnatal depression
- low mood
- anhedonia (lack of pleasure in activities)
- low energy
how is moderate postnatal depression treated
SSRI + CBT
what is the screening tool for postnatal depression and what score is diagnostic
edinburgh postnatal depression scale (>10)
what syndrome can appear in a neonate if the mother was taking SSRI’s during pregnancy
neonatal abstinence syndrome (neonatal adaptation syndrome)
define bipolar disorder
extreme mood swing with combo of manic, hypomanic and depressive episodes
2 causes of bipolar disorder
- genetic
- medications (SSRI_
- no trigger
- high comorbidity with other mental illness
3 s/s of bipolar disorder
- mood swings
- manic episodes
- hypomanic and depressive episodes
what is the criteria for bipolar diagnosis (3)
>1 manic episode
symptoms affect day to day
not caused by other condition or substance
what is the medications given for bipolar disorder (2)
- atypical antipsychotics (olanzapine)
- mood stabilizers (lithium)
list 3 diagnostic criteria for depressive disorder(hint: SIG ED CAPS)
- sleep (up or down)
- interest: down
- guilt/worthlessness
- energy (low)
- depressed mood
- concentration low
- appetite and or weight increase/decrease
- psychomotor activity up or down
- suicidal ideation/ thought of death
3 symptoms of schizophrenia
- hallucinations
- delusions
- disorganised speech
- catatonic behaviour
what are the three phase cycles of schizophrenia
- prodromal (withdrawn)
- active (delusion/hallucination etc)
- residual phase (cognitive symptoms)
what must be present for an official diagnosis of schizophrenia (2)
at least 2 of
- delusions
- hallucinations
- disorganised speech/behaviour/ catatonic
- negative symptoms
(at least 1 has to be delusion/hallucinaion/ disorganised speech)
minimum 6m
what medication may be considered for schizophrenia
- antipsychotics (think SE)
2 symptoms of generalised anxiety disorder
- restlessness, difficult to concentrate, irritable
- muscle tension, fatigue, insomnia
how long must symptoms persist to be diagnosed as generalised anxiety disorder
>6m
3 medication choices for generalised anxiety disorder
- SSRI’s
- antidepressants
- benzodiazepines
1 cardiac and 1 endo complication of trisomy 21
cardiac - heart valve disease
endo - hypothyroidism/obesity
key sign of downs syndrome
brushfield spots
How is a diagnosis of down’s syndrome made prenatally
Nuchal translucency (week 11-14)
3 lab results in prenatal diagnosis of downs syndrome
- decreased pregnancy associated plasma protein A (PAPP-A)
- increase serum beta human chorionic gonadotropin (B-hCG)
- quadruple screen
how long do symptoms of ADHD have to be present for diagnosis?
>6m
what are the three types of ADHD
- inattentative
- hyperactive/impulse
- both
give six examples of what may beseen in inattentive ADHD
- careless mistakes
- struggles to focus
- doesnt appear to listen
- doesnt follow instruction
- poor organising
- avoids mentally engaging tasks
- loses things
- easily distracted
- forgetful
6 symptoms seen in hyperactive/impulsive ADHD
- fidgets
- struggles to stay sat
- restless
- struggles to keep quiet
- likes to keep moving
- doesnt like waiting
- interupts others
medication for ADHD
stimulants to slow release of neurotransmitter (eg amphetamines - adderall/methylphenidate = ritalin)
3 causes of OCD
genetic
environmental
issues with serotonin neurotransmitter
what is the medication option for OCD
SSRI, other antidepressants
3 s/s of panic disorder
- fast heartbeat
- dizziness
- trembling
- thinking about/ avoidance of public places
briefly define panic disorder
fear, avoidance of public places, individual refuses to leave place of safety or home
what type of anxiety is seen in panic disorder?
anticipatory anxiety
3 conditions panic disorder is associated with
- major depressive disorder
- generalised anxiety disorder
- OCD
3 s/s of panic disorder
- chest pain
- elevated heart rate
- sweating
- trembling
- sob
- nausea
- dizzy
define PTSD
memory of past traumatic event -> recurrent mental and physical stress
want antidepressants are especially effective in PTSD?
SSRI
define somatic symptom disorder
extended periods of unexplainable physical symptoms
difference between somatic symptom disorder and factitious disorder
somatic - patient not faking symptoms
first line treatment for delerium tremens and preventing seizures
chlordiazepoxide
The treatment of acute dystonia
anti-cholinergic procyclidine
long term antipsychotic SE (2)
polyuria and polydipsia due to glucose dysregulation and diabetes
what SSRI is most likely to cause QT prolongation and torsades de pointes
Citalopram
risk of SSRI usage in the third trimester of pregnancy
persistant pulmonary hypertension of the newborn
peak incidence of delerium tremens following alcohol withdrawel
72 hrs
3 cardiac complications of alcohol use disorder
dilated cardiomyopathy
arrhythmia
stroke
3 liver related complications of alcohol use disorder
steatosis
steatohepatosis
fibrosis
cirrhosis
3 s/s of alcohol withdrawal
- anxiety
- depression
- irritability
- fatigue
- clammy skin
- tremor
- DELERIUM TREMENS (72HRS)
what is the triad of wernicke-korsakoff syndrome
Confusion
Ataxia
Nystagmus
(tip: CANs of beer)
what 3 medications may be used for alcohol use disorder and what is their purpose
- naltrexone (reduces cravings)
- acamprosate (stabilize withdrawal)
- disulfiram (increases ethanol sensitivity)
4 symptoms of wernickes encephalopathy
confusion
opthalmoplegia
ataxia
thiamine tx
4 symptoms of korsakoffs psychosis
retrograde amnesia
anterograde amnesia
confabulation
korsakoff psychosis
how does alcohol affect the medulla
affects autonomic functions
- breathing
- consciousness
- body temp
3 complications of cocaine dependence
- hyopthermia
- seizures
- brain haemorrhage
- heart attack
- death by overdose
medication used for cocaine dependence
modafinil (stimulates, reduces cravings)
immediate medication for cocaine overdose
give sedative
- diazepam
- lorazepam
3 medications used for opiod overdose
naloxone (blocks opiods)
naltrexone
methadone (opiod for maintenance/tapering consumption)
buprenorphine
half-life of nicotine
1-2 hours
treatment for acute intoxication of cocaine
benzodiazepines
treatment for acute intoxication of benzodiazepines
activated charcoal
flumazenil
briefly describe serotonin syndrome
excessive presence of serotonin overactivation of central serotonin receptors -> clinical manifestations related to mental status, neuromusclar excitation and autonomic excitation
3 complications of serotonin syndrome
- ventricular dysrrhythmia
- rhabdomyolysis -> renal failure
- metabolic acidosis
- acute respiratory distress syndrome
3 main signs of serotonin syndrome
- neuromuscular excitation (hyperreflexia, tremors, clonus, rigidity)
- autonomic nervous system hyperactivity (vomit, diarrhoea, htn, tachy)
- altered mental status (anxiety, agitation, confusion)
lab results for serotonin syndrome (3)
increased wbc count
increase creatine phosphokinase
decrease serum bicarbonate
diagnostic criteria for serotonin syndrome
hunter serotonin toxicity criteria
antidote for serotonin syndrome
cyproheptadine (H1,5 HT2 antagonistic affects)
when do personality disorders typically arise and what clusters are they classified in to
arise in adolescence or early adulthood
cluster A,B,C
3 examples of type A personality disorders
(odd or eccentric thinking or behaviour)
- paranoid personality disorder
- schizoid personality disorder
- shizotypal personality disorder
what are cluster A personality disorders highly linked to
higher rates of schizophrenia (and visa versa)
genetic assocation between schizophrenia and Cluster A personality disorder
what is the immediate treatment given in delerium tremens/alcohol withdrawel
chloridazepoxide or diazepam
common s/e of clozapine
constipation/intestinal obstruction
S/E of atypical anti-psychotics
weight gain
risk of atypical antipsychotics in the elderly?
increased risk of VTE and stroke
what dementia is diagnosed via a SPECT scan
fronto-temporal dementia
what is pseudodementia
cognitive impairment secondary to mental illness
what warrant allows police to enter a home if a person is at serious risk of harming themselves or others
section 135 warrant
how long may a person be detained under a section 135
up to 24 hours
If the police find you in a public place and you appear to have a mental disorder and are in need of immediate care or control, they can take you to a place of safety and detain you. this is what sectioning?
under section 136
what detainment can a nurse use to keep a patient until doctor/deputy attend and review?
section 5(4)
how long can a person be detained under a sectio 5(4)
up to 6hrs
what sectioning gives doctors right to detain someone for up to 72hrs
section 5 (2)
how long can a person be detained for under a section 2 and a section 3
section 2 up to 28 days
section 3 up to six months with further renewals
can you be treated against your will if detained under the mental health act
yes, MHA deems you not to have capacity
if a patient is able to leave hospital for a period of time whilst detained under the mental health act what is this called
section 17 leave
3 conditions where lithium is contraindicated
- cardiac disease associated with rhythm disorders
- clinically significant renal impairment
- untreated or untreatable hypothyroidism
- low sodium levels
- addisons disease
3 S/E of lithium
- diarrhoea
- nausea
- vertigo
- muscle weakness
3 signs of lithium toxicity
- diarrhoea
- anorexia
- muscle weakness
- ataxia
- blurred vision
- drowsiness
what to do if lithium toxicity suspect
- immediate lithium levels
- secondary care
- supportive treatment and checking lithium every 6-12hrs
briefly describe Neuroleptic Malignant Syndrome
- reaction to antipsychotics that is life-threatening
muscle rigidity
fevers
altered mental status
autonomic dysfunction
3 most common medications to cause Neuroleptic Malignant Syndrome
first gen neuroleptic
- haloperidol
- fluphenazine
- chlorpromazine
3 complications of Neuroleptic Malignant Syndrome
- rhabdomyolysis, renal failure
- seizures
- encephalopathy, coma
- cardiac arrhythmia
- disseminated intravascular coagulation
3 main s/s of Neuroleptic Malignant Syndrome
altered mental status (confusion)
muscular abnormalities (leadpipe rigidity)
hyperthermia
lab results in Neuroleptic Malignant Syndrome
- severe increase creatinine kinase
- decrease calcium/magnesium/increase pottasium
- increase wcc
- decrease serum iron
2 medications that may be administered in Neuroleptic Malignant Syndrome
dantrolene (muscle relaxant)
bromocriptine (dopamine agonist)
what are the 4 dopamine pathways
- mesolimbic (motivation and desire)
- mesocortical (emotions)
- nigrostriatal (invol movement and co-ordination)
- tuberofundibular (releases dopamine to limit orolactin)
3 high potency typical antipsychotics
- haloperidol
- trifluoperazine
- fluphenazine
3 lower potency typical antipsychotics
- thioridazine
- chlorpromazine
- tiotixine
3 SE of antipsychotics
stimulate release of prolactin -> oligomenorrhea, galactorrhoea and gynaecomastia
what is dystonia and how long after starting anti-psychotic medication may this symptom occur
few hours to days
muscle spasms of the tongue, face, neck and back
define an oculogyric crisis and what medication may cause this
spasm of the extraocular muscles, caused by anti-psychotics
what is akathisia and what medication may cause this
restlessness and urge to move limbs typically caused by anti-psychotics
antipsychotics may cause tardive dyskinisia - what is this?
constant involuntary rhymic movement
what is the most dangerous SE of antipsychotic medication and what are the symptoms
NMS
confusion, coma, agitation, muscle rigidity, seizures, and hyperthermia.
what does NMS present almost identically too and what causes that condition
serotonin syndrome - caused by SSRI
differentiates between NMS and serotonin syndrome
serotonin syndrome - hyperreflexia and dilated pupils
treatment of neuroleptic malignant syndrome?
dantrolene (muscle relaxant)
how may antipsychotics affect an ECG
prolongation of the QT interval
specific SE of chlorpromazine
corneal deposits
3 conditions which may be treated by ECT
mod-severe depression last resort
catatonia
severe/long-lasting episode of mania
when is ECT not recommended (x2)
- ongoing management of schizophrenia
- routine treatment of mild-mod depression
key potential SE of ECT
memory loss
usually short term but can be long term
define anhedonia - what is it a typical symptom of
inability to feel pleasure - depression
define belle indifference
absence of psychological distress despite having serious mental illness/symptoms related to a health condition
define catatonia
lack of mobility, erratic and extreme movement
define flight of ideas and two times where this may be seen
someone talking rapidly and erratically jumping between ideas ans thoughts
seen in mania, psychosis and some neurodevelopmental conditions
what is seen in a patient with Vascular dementia post-mortem?
widespread infarcts
what type of medication can cause ED in a psychiatric Hx
SSRI (e.g. citalopram)
first line treatment of autoimmune encephalitis
steroids and IV immunoglobulins (if doesnt work add rituximab)
rare but life-threatening SE of Clozapine
Agranulocytosis - get an FBC
