Psychiatry Flashcards
Class of Venlafaxine
SNRI
First line treatment for fibromyalgia?
Amytriptyline / citalopram / duloxetine / pre-gabalin
Memantine mechanism of action
NDMA Antagonist
What are the features of discontinuation syndrome?
Dizziness, electric shock sensations and anxiety are symptoms of SSRI discontinuation syndrome.
Common GI side effect of clozapine
Constipation
What is circumstantiality?
Circumstantialityis the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.
What is a word salad?
Word salad describes completely incoherent speech where real words are strung together into nonsense sentences.
What is knight’s move thinking?
Knight’s move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.
What are the first rank symptoms of schizophrenia?
First rank features:
Auditory hallucinations
Thought disorders
Delusional perceptions
Passivity phenomena
Side-effects of TCA’s?
Can’t see, can’t pee, can’t spit can’t shit!
A 45-year-old man with schizophrenia taking chlorpromazine develops an oculogyric crisis. What side-effect of antipsychotic medication is this an example of?
Acute dystonia (involuntary contractions)
Oculogyric crisis
Prolonged involuntary upward deviation of the eyes (painful and distressing)
Anti-psychotics in the elderly = increased risk of what?
Stroke
Full management of OCD:
- CBT and Exposure and response prevention.
- SSRI - 12 weeks before benefit, continue for a year. (FLuoxetine for body dysmorphia and children).
Management of panic disorder / GAD
SSRI first line drug. Then SNRI 2nd line.
Treatment in primary care - STEPWISE
NICE recommend either cognitive behavioural therapy or drug treatment
SSRIs are first-line. If contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered.
SSRI’s used in the first trimester of pregnancy are associated with what?
Cardiac defects
Blood changes seen in anorexia
Anorexia features
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
SSRI + NSAID = ?
= inc bleeding risk give a PPI
Clomipramine is what class of drug and has what common side effects?
Dry mouth (anticholinergic) and weight gain (antihistaminic) are side effects of clomipramine (TCAs)
Post MI antidepressant?
Sertraline
Citalopram is what class of drug?
SSRI
Bipolar type 1 vs type 2
Type 1 = psychotic symptoms
Type 2 = no psychotic symptoms
How to manage personality disorders?
Dialectical behaviour therapy
DBT is the mainstay in managing personality disorders.
MBT also sometimes used.
Triptans should be avoided in patients taking a SSRI
Triptans should be avoided in patients taking a SSRI
What type of therapy is offered for children with anorexia?
Anorexia focused family therapy is the first-line treatment for children and young people with anorexia nervosa.
Mirtazapine drug class?
Mirtazapine is a noradrenergic and specific serotonergic antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors
First line med for ptsd
Venlafaxine or an SSRI
Risperidone if these both fail
What key tetrad is seen in NMS?
Altered mental status, fever, rigidity and autonomic instability.
What is meant by autonomic instability aka dysautonomia?
Tachycardia, labile blood pressure, profuse sweating, arrhythmias.
Memantine what class?
Memantine = NDMA receptor antagonist
Before starting citalopram do what?
ECG to check for long QT
Serotonin syndrome - what electrolyte abnormality?
Low Na+!!
First line for acute dystonia?
Procyclidine (anti-muscarinic)
Serotonin syndrome tx
Benzo’s can treat agitation and provide symptom control
More severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine.
What is section 2?
28 days assessment section, tx can be given against.
Needs 1 doctor approved under MHA
What is section 3?
6 months, treatment order.
AMHP + 2 doctor`s
Section 4?
72hr assessment order in the ED
Section 5(2)?
Doctors power 72hr hold order
Section 5(4)
Nurses power 6hrs
Section 136
Police order take a patient from outside to a place of safety can hold for 24hrs until mental health assessment.
Section 135
Police can break into a home to remove a person to take them to a place of safety
A patient believes that everyone they meet is the same person but with different disguises.
Fregoli
Misidentification syndrome in which the patient believes that someone close to them has been replaced by a clone.
Caprgras
Invg before starting donepezil
ECG
