Psychiatry Flashcards
Mneumonic for 1st rank schizophrenia symptoms
A - Auditory Hallucinations.
B - Broadcasting of Thought.
C - Controlled Thought (delusions of control).
D - Delusional Perception
Effect of mesolimbic dopamine pathway?
DA overactivity associated with positive symptoms.
Effect of mesocortical dopamine pathway?
DA underactivity associated with negative symptoms.
Effect of nigrostriatal dopamine pathway?
D2 blockade by antipsychotic Px associated with Parkinsonian side-effects.
Effect of tuberoinfundibular dopamine pathway?
D2 blockade by antipsychotic Px leads to increased Prolactin levels and Hyperprolactinaemia.
Clinical features of serotonin syndrome
Rpid onset
Mental status change
Autonomic dysfunction- Dilated pupils, diaphoresis, tachycardia, hyperthermia, hypertension, D and V
Neuromuscular dysfunction- Tremor, hyperreflexia and myooclonus
Pathophysiology of neuroepleptic malignant syndrome
Unknown
Causes of neuroleptic malignant syndrome
Antipsychotic drugs
Dopaminergic drugs
Clinical features of neuroeptic malignant syndrome
Gradual onset
Mental state change
Autonomic dysfunction
Neuromuscular dysfunction- severe rigitidy, tremor, hyperreflexia
What is conversion disorder?
Involves loss of motor function
What is Charles- Bonnett syndrome?
characterised by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis). Insight is usually preserved. This must occur in the absence of any other significant neuropsychiatric disturbance.
Most common opthalmic condition associated with Charles Bonett?
Age related macular degeneration
How to treat schizophrenia if severe functional impairment
Refer to secondary care
Offer CBT and SSRI while waiitng
How many months does insomnia have to last to be chronic?
3 months or longer
What medication can be used to reduce alcohol cravings?
Acamprostate
What medication can be used to reduce pleasurable effects of alcohol
Naltrexon
What medication can be used to increase sensitivity to alcohol?
Disulfram
What is the peak incidence of delerium tremens following alcohol withdrawl?
72 hours
TCA side effects
Drowsines
Dry mouth
Blurred vision
Constipation/retention
Worsening of QT interval
What is akasthia?
Inner restlessness and inability to keep still
SSRI of choice in children and adolescents
Fluoxetine
Which atypical antipsychotics has the best side effect profile, particularly for prolactin elevation?
Aripiprazole
Adverse side effects of clozapine?
Agranulocytosis
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation
Side effects of mirtazapine that can be helpful in older people?
Sedation and an increased appetite
When checking lithium levels when should the sample be taken?
12 hours post last dose
Side effects of TCAs?
Drowiness
Dry mouth
Blurred vision
Constipation
Urinary retention
Legnthening of QT interval
What is brief psychotic disorder?
Episode of psychosis lasting less than a month with a subsequent return to baseline functioning.
What happens when triptans are used alongside SSRIs?
Increases risk of serotonin syndrome
What is circumstantiality?
inability to answer a question without giving excessive, unnecessary detail
What is tangentiality?
Wandering from a topic without returning to it
What is an oligouric crisis?
Prolonged involuntary upward deviation of the eyes
What do benzodiazepines do?
Inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels
Mneumonic for atypical antipsychotics
CORQA
Clozapine
Olanzapine
Risperidone
Quetiapine
Aripiprazole
What should patients have monitored when starting on an SNRI?
BP
Over how many weeks should an SSRI be gradually withdrawn?
4 weeks
How long after onset can PTSD be diagnosed?
4 weeks
What warnings are there for antipsychotic use in the eldrly?
Increased risk of stroke and VTE
What is agranulocytosis?
Lowering of the white blood cell count, primarily neutrophils
How long should antidepressants be continued after remission? Why?
For at least 6 months to decrease risk of relapse
What should be prescribed if patient taking SSRI and NSAID?
PPI
Difference between knights move and flight of ideas?
Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
Management of mania/hypomania in bipolar?
consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
Mneumonic for SSRI side effects
SSSSRIs
Stomach upset
Sexual dysfunction
Sodium low
Serotonin syndrome
Anorexia features
Most things low
G and C raised: Growth hormone, glucose, salivary glands, cortisol, cholstreol, carotinaemia
Side effects of clozapine?
weight gain
excessive salivation
agranulocytosis
neutropenia
myocarditis
arrhythmias
SSRI use in third trimester of pregnnacy?
Can cause persistent pulmonary hypertension of the newborn
What is procyclidine?
anticholinergics that work by blocking acetylcholine. This helps decrease muscle stiffness, sweating, and the production of saliva, and helps improve walking ability in people with Parkinson’s disease.
Lithium side effects
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia
What is Korsakoff’s syndrome?
anterograde amnesia: inability to acquire new memories
retrograde amnesia
confabulation
First line for children with ED?
Family based therapy
First line for GAD?
Sertraline
What antipsychotic reduced the seizure threshold?
Clozapine
TCA side effects
drowsiness
dry mouth
blurred vision
constipation
urinary retention
lengthening of QT interval
What is delusional parasitosis?
Patient with a fixed, false belief (delusion) that they are infested by ‘bugs
Core depression symptoms
Anhedonia, anergia or low mood
Lithium mneumonic
LITHIUM
L- leucocytosis
I - increased urine
T - Tremors
H - hypothyroid
I - increased thirst
U - underactive memory
M - myoclonus
What are Z drugs?
similar effects to benzodiazepines but are different structurally. They act on the α2-subunit of the GABA receptor.
What are the 3 groups of Z drugs?
Imidazopyridines: e.g. zolpidem
Cyclopyrrolones: e.g. zopiclone
Pyrazolopyrimidines: e.g. zaleplon
q
What are the adverse effects of Z drugs?
similar to benzodiazepines
increase the risk of falls in the elderly
What is de Clerambault’s syndrome?
form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.
Alternative first line to SSRI in OCD?
clomipramine
