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Phase 3A Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Side effects of SSRIs?

A

Nausea, headache, GI upset (5-HT3)
Agitation, akathisia, anxiety (5-HT2)
Sexual dysfunction (5-HT2)
Insomnia (5-HT2)
Hyponatraemia (SIADH)

? ^suicide risk <18 yrs

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2
Q

List some SSRIs

A

Fluoxetine
Citalopram
Paroxetine
Sertraline

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3
Q

Describe the mechanism of SSRIs and SNRIs?

A

Inhibits reuptake of certain neurotransmitters from synaptic cleft

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4
Q

Describe the mechanism of MAOIs?

A

Inhibit breakdown of serotonin at synapse by inhibiting the enzyme MAO-A

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5
Q

Example of MAOIs?

A

Moclobemide, phenelzine, tranylcypromine

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6
Q

Example of Tricyclics?

A

Amitriptyline, Dothiepin, Imipramine, Lofepramine

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7
Q

Triad of serotonin sydrome?

A

Neuromuscular abnormalities
Altered mental state
Autonomic dysfunction

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8
Q

Positive symptoms of Sz?

A

Delusions
Hallucinations
Disorganised speech

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9
Q

Negative symptoms of Sz?

A

Flattened affect
Reduced speech
Avolition- loss of motivation
Anhedonia- loss of pleasure

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10
Q

What is the mesolimbic pathway involved in?

A

Dopaminergic patheway central in REWARD and MOTIVATION and PLEASURE

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11
Q

What parts of the brain does the mesolimbic pathway involve?

A

Ventral tegmental area projects dopaminergic ction potentials to the nucleus cumbens

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12
Q

What affect does antagonising the D2 receptors in the mesolimbic pathway have in schizophrenia?

A

Treats the positive symptoms

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13
Q

What is the mesocortical pathway involved in?

A

Thought to be involved in executive function and cognitive control of emotions

Projects from VTA to prefrontal cortex

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14
Q

How is the mesolimbic pathway involved in schizophrenia?

A

Hyperactivity of dopamine mediates positive psychotic symptoms

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15
Q

How is mesocortical pathway involved in schizophrenia?

A

Decreased dopamine is thought to be responsible for negative and depressive symptoms of Sz

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16
Q

How is the nigrostriatal pathway involved in Sz?

A

Responsible for motor mediation. Blocking Dopamine D2 recpeots can lead to dystonia, parkinsonian symptoms and akathisia

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17
Q

How is the tuberoinfundibular pathway involved in Sz?

A

Inhibits prolactin release - blocking D2 receptors can lead to hyperprolactinemia leading to amenorrhoea, galactorrhoea and sexual dysfunction

18
Q

How is salience linked to Sz?

A

Associated with aberrant attribution of salience
-tendency for irrelevant stimuli to be attributed to have motivational significance

19
Q

Fetaures of neuroleptic malignant syndrome?

A

Tremors, muscle cramps, fever, autonomic instability, delirium, rigidity
RAISED CK (if not rasied CK not NMS)

Adverse reaction to antipsychotics- medical emergency
Treated with dopamine agonists

20
Q

When is clozapine offered?

A

Ater 2 or more treatments have been unsuccessful

Only drug to demonstrate superior efficacy to others but potentially dangerous side effects

21
Q

What is the serious side effect of clozapine?

A

Agranulocytosis - severe neutropenia
Monitoring ++++++++
(also hypersalivation, constipation, weight gain)

22
Q

Example of atypical antipsychotics?

A

clozapine, risperidone, quetiapine, olanzapine, aripiprazole, ziprasidone

23
Q

Example of typical antipsychotics

A

chlorpromazine, fluphenazine, trifluoperazine
haloperidol
flupentixol
zuclopenthixol

24
Q

What side effects are seen more in atypical antipsychotics?

A

Metabolic- weight gain (olanzapine and clozapine), impared glucose tolerance (T2DM), dyslipidemia

25
Q

What side effects are seen more in typical antipsychotics?

A

Antidopaminergic-parkinsonism, akathisia, dystonia, ^ muscle tone, tardive dyskinesia, hyperprolactinemia

26
Q

General antipsychotic side effects?

A

Pro-longed QT interval arrythmias (ECGs)
Anticholinergic- dry mouth, urinary retention, constipation
NMS
Antiandrenergoc- postural hypotension, impotence

27
Q

What is dementia?

A

Umbrella term for generalised decline in cognitive function- loss of memory, ability to perform daily activities, thinking

28
Q

Diagnosing dementia?

A

Medical history, exclude differentials- bloods, MRI/CT, DaT/SPECT

29
Q

First line medication for treating dementia?

A

Acetylcholinesterase inhibitors e.g. donepezil, galantine, rivastigmine
Contraindicated if bradycardic

30
Q

Example of NMDA receptor antagonist and what does it treat?

A

Memantine
Dementia

31
Q

What is delirium?

A

An acute, transient and reversible state of confusion. Usually result of other organic processes

32
Q

Causes of delirium?

A

PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment

33
Q

What is Section 2 of MHA?

A

Detaining a patient in hospital for assessment of their mental health disorder for up to 28 days. Non-renewable.

34
Q

What is Section 3 of MHA?

A

Detaining a patient in hospital for treatment of their mental health disorder for up to 6 months- renewable.

35
Q

What is Section 4 of MHA?

A

Emergency admission for assessment whilst waiting for Section 2/3 for up to 72 hrs

36
Q

What is Section 5(2) of MHA?

A

Emergency order on an inpatient detained for up to 72 hrs by one doctor

37
Q

What is Section 5(4) of MHA?

A

Emergency order on an inpatient detained for up to 72 hrs by a nurse.

38
Q

What is Section 135 of MHA?

A

Court order allowing police to enter private property by force, to remove a person suffering from a mental health disorder and detain them in a place of safety (ED or psychiatry hosp. suite) for up to 72 hrs.

39
Q

What is Section 136 of MHA?

A

Allows police officers to detain someone suffering from a mental health disorder from public place to place of safety, without a warrant, for up to 24 hrs waiting for medical assessment.

40
Q

Who needs to be present for a MHA assessment?

A

A Section 12 approved doctor
Responsible clinician of patients care
Approved mental health professional (AMHP)
Nearest relative can be

41
Q

What is Section 131 of MHA?

A

Informal, voluntary admission of a patient suffering with a mental health disorder.

Phase 3A Medicine (5 decks)

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