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Year 4 PassMed Incorrect Qs > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

Discontinuation symptoms of SSRIs (7)

A

Discontinuation symptoms
- increased mood change
- restlessness- akethesia! cant sit still
- difficulty sleeping
- unsteadiness
- sweating
- GI symptoms: pain, cramping, diarrhoea, vomiting
- paraesthesia

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2
Q

What is Cotard syndrome?

A

CotarD= Death (think they’re dead)

Cotard syndrome is a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.

Cotard syndrome is associated with severe depression and psychotic disorders.

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3
Q

Features of Korsakoff’s syndrome (3)

A

Features
- anterograde amnesia: inability to acquire new memories
- retrograde amnesia
- confabulation

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4
Q

What is the choice of antidepressant in children and adolescents? First line

A

Fluoxetine is the choice of antidepressant in children and adolescents

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5
Q

What drugs interact with SSRIs and what are they at an increased risk of causing? (5) Think side effects

A
  1. Triptans for migrains- they increase serotonin sydrome
  2. NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor. GI bleed?
  3. warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine. GI bleed risk?
  4. aspirin- antiplatlet and SSRIs interect with platelet aggregation
  5. monoamine oxidase inhibitors (MAOIs) eg. Phenelzine, Selegiline they increase risk of serotonin syndrome
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6
Q

What drug class do you use in alcohol withdrawl syndrome?

2 egs from this class

2 other egs and why you would give it in this particular case.

A

Benzos

chlordiazipoxide regimen or diazepam

Use lorazepam or oxezepam if known alcoholic liver disease (deranged LFTs)

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7
Q

Acute stress reaction manangemt

  • First line
  • What can be used in acute symptoms?
A
  • First line = trauma-focused cognitive-behavioural therapy (CBT)

benzodiazepines
sometimes used for acute symptoms e.g. agitation, sleep disturbance
should only be used with caution due to addictive potential and concerns that they may be detrimental to adaptation

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8
Q

3 Common features of PTSD

A
  1. re-experiencing e.g. flashbacks, nightmares
  2. avoidance e.g. avoiding people or situations
  3. hyperarousal e.g.hypervigilance, sleep problems (startling at noises which wouldn’t usually scare)
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9
Q

What can long term lithium use result in? and how does it happen?

How would it present? (4)

Investigations for diag? (2)

A

Hyperparathyroidism and resultant hypercalcaemia.

Remember the mnemonic: ‘stones, bones, abdominal moans, and psychic groans’.

This is postulated to occur by altering the homeostatic regulation of calcium, leading to parathyroid hyperplasia.

  • U&Es
  • parathyroid hormone levels (PTH)
    are useful investigations to establish the diagnosis.
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10
Q

How does Tardive dyskinesia present? 3 common 2 rogue

A

Patients most typically develop lip-smacking, jaw pouting or chewing
however repetitive blinking or tongue poking (lizard) can also occur.

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11
Q

GAD management - principles (3)

A

Try SSRI

Try another SSRI

Switch to SNRI

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12
Q

MOA of Disulfiram aka antabuse

How often is it taken and how long does it last?

Why would it NOT be recommnded? (4 conditions)

A
  • Irreversible inhibitor of acetaldehyde dehydrogenase
    therefore casues a build up acetaldehyde
  • Results in unpleasant symptoms, including facial flushing and nausea and vomiting

It is taken once daily and its effects last seven days, working as a deterrent to prevent alcohol relapse

Not recommended for patients with underlying frailty, neurological, cardiac or hepatic conditions -Due to the reaction potentially being life-threatening

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13
Q

MOA/ How does it make the patient feel of Acamprosate aka Campral

How often is it taken?

Is it safe with alcohol?

A

Described as an ‘anti-craving’ medication and the underlying mechanism of action remains unclear.

Taken three times a day

Yes

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14
Q

Name of the drug used as a replacement therapy for opioid addiction

1) Comes in liquid form
2) Comes in sublingual form

A

1) Comes in liquid form- Methadone
2) Comes in sublingual form- Burprenorphine

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15
Q

SI of a antipsychotics in elderly?

A

Stroke or VTE risk

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16
Q

What is the sign used to differenciate non-organic from organic paresis in the lower limb?

A

Hoover’s sign

Ask patient to straight leg raise against resistance, place hand under the opposite heel as she does this, and feels pressure under his hand.

In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension

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17
Q

What is the management for someone who is hypomanic in primary care?

A

Symptoms of hypomania in primary care: routine referral to CMHT

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18
Q

After a change in dose, when should lithium levels next be checked?

A

should be taken a week later and weekly until the levels are stable

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19
Q

Indications for ECT (4)

A
  • Treatment resistant severe depression
  • Manic episodes
  • An episode of moderate depression know to respond to ECT in the past
  • Life threatening catatonia
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20
Q

Which drug may cause anterograde amnesia (memory recall and the creation of new memories is significantly impaired)

A

Lorazepam (Benzo)

21
Q

What class of medication is Dosulepin?

How does it present in overdose? (4)

MOA?

REVISIT AS UNSURE

A

TCA-Tricyclic anti-dep

  1. seizures
  2. ventricular dysrhythmias
  3. mydriasis (dialted pupil)
  4. urinary retention

Tricyclics mediate their cardiotoxic effects via blockade of myocardial fast sodium channels (e.g. QRS prolongation, tall R wave in aVR), inhibition of potassium channels (e.g. QTc prolongation), and direct myocardial depression.

REVISIT AS UNSURE

22
Q

SSRI use in preg, increase risk of what?

First trimester-
Third trimester-

Which specific SSRI has an increased risk of congenital malformations, particularly in the first trimester?

A

First trimester- small increased risk of congenital heart defects
Third trimester- persistent pulmonary hypertension of the newborn

Paroxetine

23
Q

What type of urinary incontinence is the most associated with amitriptyline?

A

Tricyclic antidepressants can cause overflow incontinence (anticholinergic effect)

24
Q

What is Folie à deux?

A

AKA induced delusional disorder, is a type of delusion whereby a partner develops their partner’s delusion. There is usually an ‘inducer’, or person with a primary psychotic disorder (such as schizophrenia) who has a delusional belief and then influences another person in such a way that they eventually share the delusional belief.

25
Q

SSRI discontinuation syndrome

Symptoms 5/7

SSRI should be discontinued over how long? Apart from which SSRI?

Which SSRI has highest risk of discontinuation syn?

A

Symptoms
1. increased mood change
2. restlessness- akethesia! cant sit still
3. difficulty sleeping
4. unsteadiness
5. sweating
6. gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
7. paraesthesia

Dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine).

Paroxetine has a higher incidence of discontinuation symptoms.

26
Q

Which drugs interact with SSRIs? 5

A
  1. NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
    (increased bleed risk from ulcer)
  2. warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine (Antiplatelet)
  3. aspirin: see above
  4. triptans - increased risk of serotonin syndrome
  5. monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
27
Q

Which type of amnesia is a more common SE with ECT?

other SE?
Short-term 4/6
Long-term 3/5

A

Retrograde amnesia (Because it’s a RETRO form of treatment!!)
(remembering events prior to the insult) is far more common that anterograde amnesia (loss of ability to form new memories after the insult)

Short term:
Drowsiness
Confusion
Headache
Nausea
Aching muscles
Loss of appetite

Long-term
Apathy- decreased interest
Anhedonia
Difficulty concentrating
Loss of emotional responses
Difficulty learning new information

28
Q
  1. Switching SSRIs- from citalopram, escitalopram, sertraline, or paroxetine to another SSRI
  2. # Switching from fluoxetine to another SSRI
  3. # from a SSRI to a tricyclic antidepressant (TCA)** exception! (1)
  4. Switching from fluoxetine to venlafaxine
A
  1. Anything but Fluoxetine to another SSRI
    = Gradually reduce until stop then start the new one
  2. From fluoxetine = withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI
  3. SSRI -> TCA
    = cross-tapering is recommend
    ** except for fluoxetine! (should be fully withdrawn before starting TCA)
  4. Switching from fluoxetine to venlafaxine
    withdraw and then start venlafaxine at 37.5 mg each day and increase very slowly
29
Q
  1. Switching SSRIs- from citalopram, escitalopram, sertraline, or paroxetine to another SSRI
  2. # Switching from fluoxetine to another SSRI
  3. # from a SSRI to a tricyclic antidepressant (TCA)** exception! (1)
  4. Switching from fluoxetine to venlafaxine
A
  1. Anything but Fluoxetine to another SSRI
    = Gradually reduce until stop then start the new one
  2. From fluoxetine = withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI
  3. SSRI -> TCA
    = cross-tapering is recommend
    ** except for fluoxetine! (should be fully withdrawn before starting TCA)
  4. Switching from fluoxetine to venlafaxine
    withdraw and then start venlafaxine at 37.5 mg each day and increase very slowly
30
Q

Presentation of serotonin syndrome (7)

How does this differ compared to neuroleptic malignancy syndrome?

  • Drugs which cause?
  • Onset?
    Present (3 different + 5 similar)
A

Sertonin - Faster onset! (hours)
1. Agitation
2. Akethesia
3. sweat increases
4. muscle fasciculations
5. Clonus
6. Hyperrefelxia
7. Hyperthermia
8. Mydriasis (dilated pupils)

Neuroleptic malig:
- Obvs caused by antipsychotics
- Slower onset (hours-days)
Presentation
Diff
- lead pipe rigidity
- decrease reflexes
- normal pupils
Same
- tachy
- sweating
- Increase BP
- Rigidity
- pyrexia

31
Q

Management of serotonin syndrome?
Standard (2)
Severe (1) + eg

Management of neuroleptic malignancy syndrome?
Standard (2)
Severe (1) eg

A
  1. supportive including IV fluids
  2. benzodiazepines
    Severe- serotonin antagonists such as cyproheptadine and chlorpromazine

Neurleptic malig
1. supportive including IV fluids
2. benzodiazepines
Severe- Dantrolene

32
Q

What is Erotomania (De Clerambault’s syndrome)

A

a delusion that a famous is in love with them, with the absence of other psychotic symptoms

33
Q

histrionic personality disorder? (1)

A

excessively attention-seeking.

34
Q

Which is which? Section 135 and 136

A

135- ‘from inside’- allows police to enter and remove to a place of safety

136- ‘from the sticks’- person is already outside/not at home, can be removed to place of safety

35
Q

What is the best SSRI choice if post-MI?

A

Sertraline

36
Q

How is catonia managed?
1)
2) Sometimes…

Why would it be bad if the diagnosis was infact Delerium?

A
  1. Benzo
  2. ECT

Benzos make delerium worse!

37
Q

Antipsychotics in the elderly - increased risk of

A

stroke and VTE

38
Q

Def of Brief psychotic disorder

A

describes an episode of psychosis lasting less than a month with a subsequent return to baseline functioning.

39
Q

Unexplained symptoms
General symptoms =
Condition specific =

A

General symptoms = Somatisation
Condition specific = hypoChondria

40
Q

Define each

Type 1 bipolar
Type 2 Bipolar
Cyclothymia

Mania (3) vs hypomania (4)

A

Type 1 bipolar - mania and depression (most common)
Type 2 Bipolar - episodes of hypomania and severe depression

Cyclothymia - mild symptoms of hypomania and depression for at least two years

mania- there is severe functional impairment or psychotic symptoms for 7 days or more

hypomania-
- Increased mood
- doesn’t impact function of daily living
- for 4 days or more
- NO PSCHOTIC FEATURES

41
Q

What should be done to anti-depressant medication before undertaking ECT?

A

should be reduced but not stopped when a patient is about to commence ECT treatment. DONT SUDDENLY STOP!

42
Q

Management of acute dystonia?

A

anti-cholinergic procyclidine
can take effect within 5-minutes

43
Q

Chronic Lithium use can cause what endocrine dysfunction?

It may also cause

A

Hypothyroidism is the most common

hyperparathyroidism and resultant hypercalcaemia

44
Q

Alcohol withdrawal
symptoms:
seizures:
delirium tremens:

A

Alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

45
Q

Othello syndrome -
Fregoli syndrome -
Folie deux -
Erotomania AKA ‘De Clerambault’s’ -
Factitious disorder -

A

Fregoli syndrome - believing that two or more people are the same person changing their appearance to deceive you
Folie deux - shared hallucinations/delusions between individuals
Erotomania AKA ‘De Clerambault’s’- excessive sexual desire
Factitious disorder - consciously pretending that you have a mental illness, or physical illness??

46
Q

Anorexia features

Low (6)
High (6)

A

most things low
- hypokalaemia
- low FSH, LH, oestrogens and testosterone
- low T3

G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

47
Q

factors shown to be associated with an increased risk of suicide (7/9)

A
  1. male sex (hazard ratio (HR) approximately 2.0)
  2. history of deliberate self-harm (HR 1.7)
  3. alcohol or drug misuse (HR 1.6)
  4. history of mental illness
    - depression
    - schizophrenia: NICE estimates that 10% of people with schizophrenia will complete suicide
  5. history of chronic disease
  6. advancing age
  7. unemployment or social isolation/living alone
  8. being unmarried, divorced or widowed
48
Q

Monitoring patient on lithium

How many hours post dose?

How often and when?

1…. when starting
2….. after….
3….. until stable
4. Once stable……
5. thyroid and renal every….

A

12 hours

  • One week after starting treatment
  • One week affter every dose change
  • weekly until stable
  • Once stable- every 3 months
    5. thyroid and renal every 6 months
49
Q

Adverse effects of lithium

A
  1. nausea/vomiting, diarrhoea
  2. fine tremor
  3. nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
  4. thyroid enlargement, may lead to hypothyroidism
  5. ECG: T wave flattening/inversion
  6. weight gain
  7. idiopathic intracranial hypertension
  8. leucocytosis
    9 hyperparathyroidism and resultant hypercalcaemia

Year 4 PassMed Incorrect Qs (37 decks)

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