Psychiatry Flashcards
1
Q
what are 6 features of ADHD?
A
very short attention span
quick moving from one activity to another
quickly losing interest in a task and not being able to persist with challenging tasks
constant moving or fidgeting
impulsive behaviour
disruptive or rule breaking
must be consistent across various settings and adversely affect person for at least 6 months
2
Q
what is the diagnostic criteria for ADHD?
A
A persistent pattern (e.g., at least 6 months) of inattention symptoms and/or a combination of hyperactivity and impulsivity symptoms that is outside the limits of normal variation expected for age and level of intellectual development
3
Q
what is the management of ADHD?
A
conservative - diet and exercise, food diary (causative links)
Medication - central nervous stimulants - methylphenidate (ritalin) [1st line] or lisdexamfetamine, dexamfetamine, atomoxetine
4
Q
what monitoring needs to be done for those on medication for ADHD?
A
height and weight measurements as reduces appetite (especially in children)
cardiovascular effects - BP and HR
5
Q
what are 6 common side effects of methylphenidate?
A
Decreased Appetite + Growth retardation
Headache
mood disturbance - agression, irritability, anxious, tense, depressed
insomnia
dry mouth
6
Q
What are the 5 Ps of formulation?
A
Presenting
Predisposing
Precipitating
Perpetuating
Protective
7
Q
what is psychological formulation?
A
the dynamic framework through which the connection between our individual characteristic, experiences and behaviours can be understood
8
Q
What are the 4 types of risk?
A
risk to self
risk to others
risk from others
risk to property
9
Q
what is a delusion?
A
Fixed false belief that is outside of cultural or religious norms
10
Q
what is an overvalued idea?
A
Delusional idea but held with less conviction when challenged than a delusion - the patient might accept there is a possibility that it is not real.
11
Q
What is the name of the delusional belief and it’s syndrome where you believe that someone important is in love with you?
A
erotomania
de clerambault’s syndrome
12
Q
What is the name of the delusion and its syndrome that there are bugs crawling on you skin all the time?
A
Paracitosis
Ekbom’s syndrome
13
Q
what is the name for a delusion shared by multiple people?
A
Folie à deux (or trois)
14
Q
what is the name for a delusions where you think that someone you know has been replaced by an imposter?
A
Capgras syndrome
15
Q
what is the name for a delusion where you think multiple people are actually a single person in disguise?
A
Fregoli’s syndrome
16
Q
what is the name for a delusion where you think you have special powers, wealth, a mission, intelligence or identity?
A
Grandiose delusions
17
Q
what is the name of delusions where you think there is something wrong with part or all of your body?
A
somatic delusions
18
Q
what is the name of delusions where you think that unrelated occurrences in the external world have special significance to you in particular?
A
delusion of reference
19
Q
what are delusions where you falsely think someone is out to get you?
A
Persecutory delusions
20
Q
what are delusions where you feel guilty for something you haven’t done?
A
delusions of guilt
21
Q
what is a delusional perception?
A
a true perception that a patient attributes false meaning to
22
Q
what is the name and syndrome of a delusion where you believe your partner is cheating on you?
A
Delusion of jealousy
Othello syndrome
23
Q
what is the name of the delusion where you believe you are dead or don’t exist?
A
nihilistic delusions
delires de negation
Cortards syndrome
24
Q
what is the name of the delusions where you believe your thoughts and actions are being controlled by an external force?
A
delusion of passivity/control
25
what is a hallucination?
a sensory perception in the absence of external stimuli
26
what is a somatic hallucination?
when you believe you can feel your internal organs moving or you heart beating out of chest
27
what is an extracampine hallucination?
one that is not possible due to geography
e.g. hearing the kings voice talking to you in sheffield from buckingham palace
28
what is a hallucination as you're falling asleep called?
hypnogogic
NORMAL
29
what is a hallucination as you're waking up called?
hyponopompic hallucinations
NORMAL
30
what are pseudohallucinations?
vivid mental images that though they sound like hallucinations are not EXTERNAL to the patient ie they're coming from within the patient's own head
31
what are illusions?
special perceptual experiences in which information arising from “real” external stimuli leads to an incorrect perception
eg monsters under bed is actually pile of washing
32
what is the old diagnostic criteria for schizophrenia?
schneider's first rank symptoms
33
what are schneider's first rank symptoms of schizophrenia?
A - Auditory hallucinations (3rd person)
B - Broadcasting thoughts
C - Control delusions - thoughts (withdrawal, insertion, interruption) and actions controlled by someone else
D - Delusional perceptions
34
what are the 3 features of psychosis?
hallucinations
delusions
disorganised thinking and speech
35
What are 6 presentations of BPD?
Intense emotions/emotional instability
Impulsive/risky behaviour
Low self esteem
Difficulty maintaining relationships
Anger, violence and aggression
Self harm, suicide attempts
36
what are the 3 main categories of personality disorders?
Type A - Odd and eccentric
Type B - emotional and erratic
Type C - anxious and fearful
37
what is avoidant personality disorder?
severe anxiety about rejection or disapproval and avoidance of social situations due to this
38
what is dependent personality disorder?
heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach. Fear being left to care for selves
39
what is obsessive compulsive personality disorder?
unrealistic expectations of how things should be done by themselves and others, and catastrophising about what will happen is these expectations are not met
40
what is paranoid personality disorder?
Hypersensitivity and an unforgiving attitude when insulted
difficulty in trusting or revealing personal information to others
41
what is schizoid personality disorder?
lack of interest or desire to form relationships with others and feelings that this is of no benefit to them
Few friends and like being alone
42
what is schizotypal personality disorder?
unusual beliefs thoughts and behaviours, as well as social anxiety that makes forming relationships difficult
43
what is borderline personality disorder?
fluctuating strong emotions and difficulties with identity and maintaining healthy relationships
44
what is histrionic personality disorder?
the need to be at the centre of attention and having to perform for others to maintain that attention
Rapidly shifting shallow emotions
45
what is narcissistic personality disorder?
feelings that they are special and need others to recognise this or else they get upset. They put themselves first.
46
What is the management for personality disorders?
Dialectic behavioural therapy (DBT) and CBT
No medical (though there may be other co-existing psychiatric problems that can be dealt with medically)
47
what are 2 positive and 5 negative presentations of psychosis?
+ Hallucinations
+ Delusions
- Affect Flattening (lack of spontaneity or reactiveness)
- Avolition (lack of drive)
- Ahedonia
- Attention Deficit
- Impoverished speech or language
48
What is the prodromal period?
a period of subclinical signs and symptoms preceding the onset of psychosis that can last from a few days to around 18 months
49
what are 6 features of the prodromal period?
transient, low intensity psychotic symptoms
Reduced interest in daily activities
Problems with mood, sleep, memory, concentration, affect, motivation
Anxiety, irritability or depressive features
Incoherent or illogical speech
Positive family history
50
what are 8 risk factors for psychosis?
Genetics
Stressful life event
childhood adversity
Ethnicity - increase in south asian and african populations
Urban living
migration
cannabis and other substance use (including high dose corticosteroids)
Early life factors - maternal stress, nutritional deficiency, IUGR
51
what is the treatment for psychosis and schizophrenia?
Refer to early intervention in psychosis team/ crisis resolution team
Bio - Antipsychotics
psycho - CBT
Social - Family intervention, Care plan (crisis plan, advanced statement, key contacts), inform DVLA and don't drive during episodes
52
What are 12 first generation anti-psychotics?
Benperidol
Haloperidol
Chlorpromazine
Levomepromazine
Pericyazine
Perphenazine
Prochlorperazine
Promazine
Trifluperazine
Flupentixol
Zuclopenthixol
Pimozide
Sulpiride
53
What are 7 2nd generation (atypical) antipsychotics?
Olanzapine
Quetiapine
Clozapine - when 2 other anti-psychotics have failed
Paliperidone
Risperidone
Amisulpride
Aripirazole
54
What are antipsychotic side effects?
Extrapyramidal - first gen - abnormal movements and pseudoparkinsonisms, restlessness, tardive dyskinesia
Diabetic type effects - Weight Gain, dyslipidaemia, impaired glucose tolerance
Hormonal - galactorrhoea, amenorrhoea, gynaecomastia
Anticholinergic effects
Neurological - Seizures, stroke risk, neuroleptic malignant syndrome
Cardiac - QT prolongation, cardiomyopathy, myocarditis, cutaneous vasculitis
Haematological - Neutropenia, VTE, hypotension
55
What are the 3 core symptoms of autism ?
social interaction problems
communication problems
behavioural problems
56
what are 6 features of social interaction deficits in autism?
lack of eye contact
delay in smiling
avoids physical contact
unable to read non-verbal cues
difficulty establishing friendships
not displaying a desire to share attention
57
what are 4 features of communication deficits in autism?
Delay, absence or regression in language development
lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interests
Difficulty with imaginative or imitative behaviour
repetitive use of words or phrases
58
What are 6 behavioural deficit features in autism?
Greater interest in objects, numbers or patterns than people
Stereotypical repetitive movements - self stimulating repetitive movements to comfort self
Intensive and deep interests that are persistent and rigid
repetitive behaviours and fixed routines
Anxiety and distress with experiences that are outside their normal routine
Extremely restricted food preferences
59
What are 5 psychiatric emergencies?
Suicide, harm to self, harm to others
Substance intoxication and withdrawal
Overdose of psychoactive drug
Neuroleptic malignancy syndrome
Serotonin syndrome
60
what is neuroleptic malignant syndrome?
High fever, muscle stiffness, altered mental status and autonomic dysfunction (BP swings, excessive sweating, excessive salavating)
Caused by antipsychotics
61
what is serotonin syndrome and symptoms?
Neuromuscular excitation - Rigidity, hyperreflexia, myoclonus
Autonomic system excitation - increased HR + BP, hyperthermia, diaphoresis, dilated pupils, headache, diarrhoea and vomiting
Altered mental status and seizures
caused by too much serotonin => can lead to death
62
What are 6 symptoms of alcohol withdrawal?
Tremors
sweating
tachycardia
GI disturbance
Anxiety and irritability
Headache
63
what is alcohol detoxification treatment?
water
vitamins - B1 (IM if preventative or IV if symptomatic)
Food - high protein, high calorie
Benzos - chlordiazepoxide 5-20mg QDS
64
what medications are used for relapse prevention in alcoholics?
Disulphram - become unwell if drink
Naltrexone - opiate blocker that helps cravins
Acamprisate - helps with craving
65
what is the advise for an alcoholic if they want to cut down themselves?
safe to cut down 10%every day for 10 days
66
what are the serious side effects of alcohol withdrawal?
24-48 hours
Grandmal seizures
Wernicke's encephalopathy
Delerium tremens
confusional state
67
what causes Wernicke's encephalopathy?
B1 (thiamine) deficiency
68
what are 4 symptoms of Wernicke's encephalopathy?
Ataxia
Confusional state
Eye signs - palsy of lateral rectus or internuclear opthamloplegia, pupillary changes
69
What are 5 signs of opiate withdrawal?
running - eyes and nose
GI cramping and upset
Deep muscular pain into bones
Goosebumps
70
What are 2 opiate substitution options?
Methadone - green liquid, once a day
Buprenorphine - partial agonist
71
what is the antidote to opiates?
Naloxone
72
what medication can be used for relapse prevention in opiate addiction?
Naltrexone - take every day - if take normal dose of heroine then it's blocked
73
What are the questions in the CAGE questionaire?
Ever thought of cutting back?
Annoyed when anyone else tells you to cut back?
Ever felt guilty abut drinking?
Eye opener?
74
what are the 7 different types of anxiety disorders?
Generalised anxiety disorder
Panic disorder
PTSD
OCD
Social anxiety
Phobia
Acute stress disorder
75
what is the diagnostic criteria for Generalised Anxiety Disorder?
Excessive anxiety and worry about a variety of topics, events or activities for >6 months
3 of the following:
- Edginess/restlessness
- Fatigue
- Impaired concentration/mind going black
- Irritability
- Difficulty sleeping
- Increased muscle aches or soreness
76
what is the diagnostic criteria for panic disorder?
presence of reoccurring unforeseen panic attacks followed by at least one month of persistent worry about having another panic attack and it's consequences
Need to have at least 2 unexpected panic attacks
77
What is the management of anxiety disorders?
1 - CBT or cognitive therapies
OR
1- SSRIs
78
what are the withdrawal symptoms from SSRIs?
Dizziness, numbness and tingling, GI disturbance, headache, sweating, anxiety and sleep disturbance
79
what is phobia?
intense fear of specific objects or situations
80
what are 3 risk factors for phobia?
somatisation disorder
anxiety disorders
mood disorders
81
what is the treatment for phobia?
Education, CBT, exposure therapy
82
What are 4 manifestations of PTSD?
Intrusion symptoms (flashbacks, reactivity, dreams)
Avoidance symptoms
Negative alterations in cognition and mood
Alterations in arousal and reactivity (hyper-vigilance, exaggerated startle response, irritability)
83
what is the management of PTSD?
1 - trauma focused CBT
1 - eye movement desensitisation and reprocessing
2 - other psychological therapy
2 - pharmacological management (SSRIs)
84
what scale can be used to grade OCD severity?
Yale-Brown obsessive compulsive scale
85
what is the management of OCD?
1 - CBT, exposure and response prevention
2 - Pharmacotherapy - 1 - SSRIs or 2 - clomipramine
combine if severe
86
what is somatisation disorder?
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
87
what conditions can ECT treat?
severe depression - if preferred by patients, need rapid response or other treatment hasn't worked
severe/long lasting mania
Catatonia
88
what is ECT?
electroconvulsive therapy
89
what are hypnotics?
medications used to treat insomnia
90
what medications are hypnotics?
benzodiazepines
zolpidem and zopiclone - non-benzo hypnotics
Clomethiazole
antihistamines
91
which hypnotic benzos have a hangover effect that can cause drowsiness the next day?
nitrazepam
flurazepam
92
which 3 hypnotic benzos are shorter acting so cause no hangover?
Loprazolam
lormetazepam
temazepam
93
what is bipolar I?
manic episode of abnormal persistent, elevated, expansive or irritable mood with abnormally and persistently increased energy or activity lasting for at least one week. Has had at least one other episode of mania, hypomania or depression in the past
94
what is bipolar II?
current or past hypomanic episode and current or past major depressive episode.
Hypomania presents similarly to mania but causes less impairment and lasts at least 4 days
95
What is the chronic treatment of Bipolar?
1 - mood stabiliser (lithium) or antipsychotic (halporidol, olanzapine, quetiapine, risperidone, valporate***)
*not women of childbearing age
96
what are the monitoring requirements for lithium and range?
has narrow therapeutic index so levels must be monitored regularly (3-6 monthly) - should be between 0.4-1mmol/L
97
what are 3 core symptoms of depression?
Persistent Low mood
Anergia (low energy)
Anhedonia
for 2 weeks+
98
what are 6 cognitive symptoms of depression?
Processing
- reduced concentration
- reduced memory
- reduced processing speed
Thought
- self confidence reduced
- ideas of guilt and worthlessness
- thinking it will never get better
99
what are 4 biological symptoms of depression?
sleep disturbance
changes in appetite and weight
loss of libido
somatic complaints
100
what are 6 symptoms of antidepressant withdrawal?
- unsteadiness, vertigo, dizziness
- altered sensations
- restlessness/agitation
- Problems sleeping
- Abdo symptoms
- palpitations, tiredness, headaches, muscle and joint aches, sweating
101
what is the last line medication for depression?
vortioxetine - used if 2 prev antidepressants have not been responded to
102
what is cyclothymia?
A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify other diagnosis
103
what are 2 of the most common causes of general cognitive impairement?
Down's syndrome
Foetal Alcohol syndrome
104
what are 6 specific learning difficulties without generalised cognitive impairement?
Dyslexia
Dyscalculia
ADHD
Specific language impairment
Central auditory processing disorder
Dyspraxia
105
What are 11 genetic disorders that can cause cognitive impairment?
Down's syndrome
Fragile X
Prader-willi syndrome
Angelman's syndrome
15q11 duplication syndromes
William's syndrome
Rett's syndrome
Turner's syndrome
Tuberous sclerosis
DiGeorge syndrome
16p11.2 deletion syndrome
106
what are 5 intra-uterine infections or drugs that can cause cognitive impairement?
Cytomegalovirus
Toxoplasmosis
Rubella
Foetal alcohol syndrome
Teratogenic drugs
107
What are 2 perinatal events that can cause cognitive impairmenent?
Extreme prematurity
Perinatal hypoxia
108
What are 6 CNS disorders that can cause cognitive impairment?
Bacteria meningitis
encephalitis
tumour
trauma
hypoxia
Seizures
109
what is the definition of a cognitive impairment?
IQ <70
110
what is schizoaffective disorder?
a combination of mood and psychotic symptoms lasting at least one month. Bipolar type has manic symptoms and can also have depressive ones. Depressive type has psychosis and depressive symptoms only.
111
what section of the mental health act allows police to enter private property and take someone to a place of safety for assessment?
section 135
112
what section of the mental health act allows police to pick someone up of the street and take them to a place of safety for assessment?
section 136
113
How long can you detain someone under section 135/6 of the MHA?
25 hours (up to 36 if still waiting for assessment)
114
what sections of the MHA allow doctors or nurses to detain a patient?
section 5 (2) - doctors for 72 hours
Section 5 (4) - nurses for 6 hours
115
How long can you detain someone for under section 2 of the MHA?
28 days
116
How long can you detain someone for under section 3 of the MHA?
6 months with further renewals
117
what section of the mental health act allows patients to go on leave?
section 17
118
what are the 5 core principles of the mental capacity act?
1 - assume capacity until proven otherwise
2 - Use all means necessary to allow people to make their own decisions
3 - people are allowed to make unwise decisions
4 - all actions must be in the patients best interest
5 - treat in the least restrictive way possible
119
What is CBT?
focuses on what you believe and how you think and tests you on these behaviours in order to develop the ability to self test thoughts and change behaviours
120
what are 7 risk factors for suicide?
Prev Hx of suicide/mental illness
Chronic illness
criminal/legal/financial problems
Substance use
impulsive/aggressive tendencies
Fhx
isolation
121
what is anorexia nervosa?
an eating disorder characterised by restriction of calorific intake leading to low body weight, an intense fear of gaining weight and body image disturbances
122
what are the 2 types of schizoaffective disorder?
depressive type - more common in older patients
bipolar type - more common in younger people
123
what are the 2 types of schizoaffective disorder?
depressive type - more common in older patients
bipolar type - more common in younger people
124
what is the management for medically stable anorexia nervosa?
structured eating plan with oral nutrition
psychotherapy - CBT ED focused
125
what are the 3 most common physical signs of bulimia nervosa?
parotid hypertrophy
dental erosion
Russell's sign - scaring on dorsum of hands from teeth scraping when inserted into mouth
126
What is the management of bulimia nervosa?
1st line - CBT
2nd - SSRis (fluoxetine 20mg OD)
127
What are the 3 things necessary for capacity?
ability to understand relevant information
ability to retain information
ability to weigh up information and communicate a decision
128
What is the therapeutic range of lithium?
0.4-1.0 mmol/L
129
what is dysthymia?
A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder
130
what is hypomania?
persistent mild elevation of mood, increased energy and activity but does not affect function.
4 days or less
131
what is mania?
elevated mood with increased energy, overactivity, pressure of speech and decreased need to sleep. Attention cannot be sustained, grandiosity, loss of normal social inhibitions and alteration of function
lasting 1 week+
132
what is dementia?
a chronic progressive syndrome due to disease of the brain in which there is disturbance of multiple higher cortical functions including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement
133
what counts as early onset dementia?
<65 years
134
what is vascular dementia?
dementia as the result of infarction of the brain due to vascular disease. Tends to have stepwise deterioration due to series of infarcts
135
what is vascular dementia?
dementia as the result of infarction of the brain due to vascular disease. Tends to have stepwise deterioration due to series of infarcts
136
what is fronto-temporal dementia?
a progressive dementia usually commencing in early age with slow progressive changes of character and social deterioration followed by impairment of intellect, memory and language functions with apathy euphoria and occasionally extrapyramidal phenomena
137
what is delirium?
disturbance of attention, orientation and awareness that develops within a short period of time typically presenting as significant confusion or global neurocognitive impairment with transient symptoms that may fluctuate
138
what are the causes of delerium? (mneumonic)
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
139
what is dementia with lewy bodies?
dementia caused by protein deposits called lewy bodies that can cause visual hallucinations, pankinson like movement disorders, poor regulation of autonomic nervous system, conitive problems, sleep difficulty and fluctuating attention
140
what medications shouldnt be used in peopel with lewy body dementia?
1st gen antipsychotics
141
what is classed as a mild learning disability?
IQ 50-69
Some learning difficulties at school but can generally work and function independently
142
what is classed as a moderate learning disability?
IQ 35-49
marked developmental delays in childhood but can learn some level of independence will probably need support in the community
143
what is classed as a severe learning disability?
IQ 20-34
likely to need continuous support in all things
144
What is classed as a profound learning disability?
IQ <20
severe limitation in self-care, continence, communication and mobility
145
what is the 4 essential diagnostic criteria for schizophrenia?
At least one of :
- persistent delusions
- persistent hallucinations
- disorganised thinking
- Experiences of influence, passivity or control
must be experienced for at least a month
146
what is the 3 none essential diagnostic criteria of schizophrenia?
- negative symptoms
- grossly disorganised behaviour
- psychomotor disturbances
147
what are 5 negative symptoms of schizophrenia?
affect flattening
alogia (poverty of speech)
avolition (lack of motivation)
anhedonia
social withdrawal
148
what scale can be used for depression questionnaire in elderly?
Geriatric depression scale questionnaire
149
where in the body are the most serotonin receptors?
GI tract
150
what depression scale can be used in patients with dementia?
cornell depression scale
151
what electrolyte disturbance can SSRIs cause?
hyponatraemia
152
4 As of dementia
aphasia
amnesia
apraxia (loss of learned tasks)
agnosia (inability to recognise objects/people)
153
How long do dementia symptoms have to be present for diagnosis?
6 months
154
what gene increases risk of dementia?
apolipoprotien (APOE) E4
155
what is the second line management of panic disorder?
if SSRIs/SNRIs ineffective after 12 weeks try imipramine or clomipramine
156
what questionnaire can be used in depression?
PHQ-9
157
what is a less severe depression score on PHQ-9?
<16
158
what is a more severe depression score on PHQ-9?
>16 inclusive
159
what are 6 biological features of anorexia nervosa?
Gs and Cs raised
Growth hormone
Glucose
Salivary Glands
Cortisol
Cholesterol
Carotinaemia (oranging of skin)
160
when do alcohol withdraw symptoms start?
6-12 hours after last drink
161
when is the peak incidence of seizure in alcohol withdrawal?
36 hours
162
when is the peak incidence of delirium tremens?
48-72 hours
163
What are the symptoms of delirium tremens?
coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
164
what medication is given first line in management of alcohol withdrawal?
Chlordiazepoxide (or diazepam)
165
what medication is given to prevent wernikes in people with alcohol withdrawl?
Thiamine - Vitamin B1 => Pabrinex
166
what are 5 side effects of ECT?
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia
167
what is a contraindication to ECT?
raised ICP
168
what is an obsession?
an unwanted intrusive thought, image or urge that repeatedly enters the person's mind
169
what is a compulsion?
repetitive behaviours or mental acts that the person feels driven to perform
170
which SSRI has a long half life?
fluoxetine
fully withdraw fluoxetine and wait a few days when switching antidepressants
171
when is gastroprotection needed with SSRI?
if use NSAIDs - add PPI
172
what medications when taken with SSRIs increase risk of serotonin syndrome?
Triptans
St john's wart
Monoamine oxidase inhibitors
amphetamines and ecstasy
173
what is the management of serotonin syndrome?
Supportive
Benzodiazepines
If severe - Serotonin antagonists – cyproheptadine, chlorpromazine
174
what is the management of neuroleptic malignant syndrome?
supportive
Dantrolene in severe cases
175
what are 9 side effects of lithium?
Nausea, vomiting, diarrhoea
Fine tremor
Nephrotoxicity secondary to diabetes insipidus
Thyroid enlargement => hypothyroidism
ECG - T wave flattening/inversion
weight gain and idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism => raised calcium - bones, stones, groans, moans
176
when should lithium levels be taken?
12 hours post dose
177
how often should lithium levels be monitored?
weekly until at stable dose
then 3 monthly once stable
178
what are 2 monoamine oxidase inhibitors?
tranylcypromine
phenelzine
179
what can't monoamine oxidase inhibitors be taken with?
tyramine containing foods
cheese, pickled herring, Bovril, Oxo, Marmite, broad beans
can cause hypertensive reaction
180
what is the management of acute mania?
antipsychotics - olanzapine, haloperidol
181
what are 5 side effects of clozapine?
- Agranulocytosis
- Reduced seizure threshold
- Constipation
- Myocarditis
- Hypersalivation
182
which antipsychotic is most likely to cause dyslipidaemia and obesity?
olanzapine
183
what antipsychotics are most likely to cause extra pyramidal side effects?
1st generation antipsychtics - haloperidol, chlorpromazine etc
184
what are extrapyramidal side effects of antipsychotics?
Parkinsonism
Acute dystonia
Sustained muscle contraction
Akathisia – severe restlessness
Tardive dyskinesia - Choreoathetoid abnormal, involuntary movements
185
what is the management of sustained muscle contraction due to antipsychotics?
procyclidine
186
what is acute dystonia?
involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx in either sustained or intermittent patterns that lead to abnormal movements or postures due to medications usually antipsychotics
187
which non-antipsychotic can cause acute dystonia?
metoclopramide - antiemetic
188
what is the management for acute dystonia?
IV anticholinergics - benzotropine
IV Benzodiazepines
189
what are 5 side effects of lithium toxicity?
COARSE tremor (fine is side effect of normal lithium level)
Ataxia
slurred speech
seizure
vomiting
190
what is the diagnostic criteria for delirium? (5)
1.) Impairment of consciousness and attention
2.) Global disturbance in cognition
3.) Psychomotor disturbance
4.) Disturbance of sleep-wake cycle
5.) Emotional disturbances
191
what is the MOA of benzodiazepines?
They facilitate and enhance the binding of GABA to the GABAA receptors
192
what is the MOA of antipsychotics?
block the postsynaptic dopamine D2 receptors
193
what are 4 blood results for neuroleptic malignant syndrome?
Raised CK (creatine kinase) --> due to muscle rigidity
Raised white cell count
Deranged LFT’s
Acute renal failure --> abnormal U&E’s
Metabolic acidosis --> low pH, low HCO3
194
what are the hallucinations like in schizophrenia?
3rd person auditory
external to patient
thought echo
running commentary
multiple voices talking about the patients amongst themselves
195
what is hypochondriasis?
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results
196
what is conversion disorder?
typically involves loss of motor or sensory function
the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
197
what is factitious disorder?
aka Muchausen's syndrome - intentional production of physical or psychological symptoms
198
what is malingering?
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
199
How often is monitoring for clozapine?
weekly for 18 weeks then fortnightly till one year then every month
200
what is the name for severe restlessness in antipsychotic use?
akathisia
