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MSRA- my cards > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What drugs are first line for rapid tranquillisation?

A

IM Haloperidol or IM Lorazepam
(Lorazepam used if cardiac history is unknown)

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2
Q

What is section 136?

A

Section 136 is used by the police to bring people who could be displaying signs of mental illness presenting a risk to themselves or others to place of safety.

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3
Q

What are the features of discontinuation of SSRI?

A

Electric shock pains, sweating, GI symptoms, mood changes, unsteadyness, dizzyness.

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4
Q

When is Clozapine indicated to be used?

A

When 2 or more antipsychotics have been unsuccessful.

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5
Q

What is the major side effect with Clozapine?

A

Agranulocytosis.

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6
Q

How do Benzodiazpines work?

A

Enhance GABA

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7
Q

What does section 3 allow?

A

Treatment for up to 6 months

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8
Q

What does section 4 allow?

A

Assessment order of 72 hours

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9
Q

Treatment resistant schizophrenia - use what drug?

A

Clozapine

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10
Q

What are the side effects with Clozapine?

A

Agranulocytosis, weight gain, neutropenia, myocarditis, arrhythmias

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11
Q

What is first line for panic disorder?

A

Sertraline

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12
Q

What does section 4 of the MH act do?

A

72 hours of assessment

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13
Q

What are the biochemical findings in anorexia.

A

Everything is low apart from the G’s and C’s which are raised. Eg raised cortisol/ raised GH.

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14
Q

What are examples of the atypical antipsychotics?

A

Clozapine/ Olanzapine

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15
Q

What score suggests dementia on the mini mental state exam?

A

Anything less than 24/ 30 suggests dementia.

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16
Q

What scores are recommended by NICE for dementia screening in GP setting?

A

6CIT and 10 CS (10 point cognitive screener)

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17
Q

What drug is first line in GAD?

A

Sertraline SSRI

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18
Q

What is the monitoring after prescribing an SSRI for GAD?

A

Review the effectiveness and side effects of the drug every 2 to 4 weeks during the first 3 months of treatment and every 3 months thereafter.

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19
Q

What are the first rank symptoms for schizophrenia? (4)

A

Auditory hallucinations
Thought disorder
Delusions
Passivity phenomena

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20
Q

What type of drug is Risperidone?

A

Atypical antipsychotic

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21
Q

What are the side effects of atypical antipsychotics?

A

weight gain, hyperprolactiaemia, and agranulocytosis with clozapine

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22
Q

What type of drug is Paroextine?

A

SSRI

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23
Q

What drug is used for the long term management of Bipolar?

A

Lithium

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24
Q

What does section 2 allow?

A

28 days assessment

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25
Q

What does section 3 allow?

A

Treatment for 6 months

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26
Q

What does section 4 allow?

A

Emergency assessment - 72 hours

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27
Q

What does section 5(2) allow?

A

Pt already in hospital- 72 hours assessment

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28
Q

What does section 136 allow?

A

Police to bring someone to hospital from a public space.

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29
Q

What are the first line drugs for Alzheimers?

A

Any of the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)

30
Q

What are the features of Neuroleptic malignant syndrome?

A

Fever, Autonomic instability, Rigidity and altered mental state. RAISED CK

*Starts 2-10 days after starting the antipsychotic**

31
Q

Management of Neuroleptic malignant syndrome?

A

IV Fluids
Dantrolene if severe

32
Q

What are some examples of atypical antipsychotics?

A

Clozapine, Olanzapine, Arirpiprazole, Quietapine, Risperidone

33
Q

What is important to know about Fluoxetine?

A

Long half life. If switching to another SSRI. Need to stop Fluoxetine and restart next one in 5-7 days.

34
Q

Switching SSRIs- general principles

A

Most SSRIs can switch between (direct switch). APART from fluoxetine which needs to be stopped and allow 5-7 days before starting next SSRI.

35
Q

Examples of SSRIs

A

Sertraline, Fluexoetine, Paroxetine, Citalopram, Escitolapram

36
Q

What is
- Delirium tremens
- Wernickes encephalopathy
- Korsakoffs

A

Delirium tremens- acute alcohol withdrawal.
Wernickes- COAT (confusion, opthalmoplegia, ataxia, thiamine deficiency)
Korsafkoffs - RACK (retrograde amnesia, anterograde amnesia, confabulation)

37
Q

How is Delirium tremens treated ?

A

Benzodiazepines (chlordiazepoxide or diazepam)

38
Q

How does Delirium tremens present?

A

tremor, sweating, tachycardia, anxiety
Seizures!

39
Q

What PHQ 9 indicates less severe/ more severe depression? and management ?

A

score of 16= less severe = behavioural therapies
Score >16= more severe= CBT + antidepressant

40
Q

What are the features of lithium toxicity?

A

Tremors,
Polyuria
Confusion
Seizures
Increased reflexes

41
Q

What is Cotard Syndrome?

A

Delusion that part of the body is rotten or dead.
Cotard = Corpse

42
Q

What is Capers Syndrome?

A

A familiar person has been replaced with an identical imposter!

Closely Associated Person Got Replaced And Switched

43
Q

What is Fregoli Syndrome?

A

Different people they see are actually the same person in lots of disguises.

44
Q

What is De Clerambault Syndrome?

A

Someone who is a celebrity is secretly in love with them.

45
Q

What is Otello syndrome?

A

Pathological delusions that your partner is cheating

46
Q

What is the treatment of depression in Bipolar disorder?

A

Quetiapine (atypical antipsychotic) alone, or
Fluoxetine (SSRI) combined with olanzapine (antipsychotic), or
Olanzapine alone, or
Lamotrigine alone.

47
Q

Acamprosate, Disulfram, Naltrexone are used how?

A

Alcohol excess- “problem drinking”
Mild Alchohol dependence

Disulfram- promotes absistance
Acamprosate- reduces cravings. NMDA antagonist
Naltrexone- opiod antagonist

48
Q

Adverse effects of Cocaine

A

Coronary artery spasm
Hypertension
Tachycardia/ bradycardia
Seizures
Hyper-reflexia
Agitation
Psychosis
Bugs crawling under the skin

49
Q

Management of cocaine toxicity?

A

Benzodiazepines are first line in most examples of cocaine toxicity

50
Q

What are the symptoms of discontinuation of a SSRI?
- Which SSRI has the highest risk of discontinuation syndrome?

A

increased mood change
restlessness
DIFFICULTY SLEEPING!
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

Paroxetine is the highest risk!

51
Q

Treatment of ADHD in children?

A

Methylphenidate AGED OVER 5 (six week trial)

52
Q

What needs to be done before starting ADHD medication?

A

ECG prior

53
Q

What tests need to be done prior to starting an antipsychotic?

A

Bloods: Full blood count (FBC), urea and electrolytes (U&E), liver function tests (LFT)
Lipids, WEIGHT
Fasting blood glucose, prolactin
Blood pressure
ECG
CVS risk assessment

54
Q

Mania vs Hypomania in Bipolar- how long do symptoms need to last for to classify as an episode?

A

Hypomania- 4 days
Mania- 7 days

55
Q

Which antipsychotic is exclusively monitored by secondary care?

A

Clozapine (risk of agranulocytosis)

56
Q

Ecstasy (MDMA) toxicity? and mangement

A

Hyponatraemia
Tachycardia
Hypertension
Neurological- anxiety/ sweating

Mx) supportive but Dantrolene if required

57
Q

Side effects of Lithium?

A

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

58
Q

What are the tools for screening for depression?

A

HAD
PHQ-9

59
Q

What SSRI for breastfeeding mothers (if initiating)?

A

Paroextine or Sertraline

60
Q

Amitryptilline overdose presents with?

A

Anticholinergic side effects
Dry mouth/ blurred vision/ Prolonged QRS interval

61
Q

Aspirin overdose- does what to do the ABG?

A

Initially respiratory alkalosis followed by metabolic acidosis

62
Q

What are the risk factors for Schizophrenia?

A

Black
Urban populations
Migrants
Exposure to Toxoplasmosis

63
Q

Malingering vs Facticious disorder?

A

Malingering- external reward eg disability payments
Factious disorder- internal gains ‘sick role’

64
Q

What are the extrapyramidal side effects of antipsychotics?

A

Acute dystonia (torticillis/oculogyral crisis)
Akathesia - restlessness
Tardive dyskinesia
Parkinsonism

65
Q

What is the difference between Akathesia and Restless leg syndrome?

A

Akathesia is in response to antipsychotic
Restless leg syndrome - Inability to sleep

66
Q

What drug is contraindicated with prescription of SSRI?

A

MAO inhbitors are contraindicated.
Increased the risk of serotonin syndrome
Triad of autonomic instability/

67
Q

Tamoxifen cannot be co prescribed with which SSRIs?

A

Fluoxetine and Paroextine

68
Q

Features of borderline personality disorder

A

Frequent episodes of self harm
Unstable/ intense relationships
(Most common type of personality disorder)

69
Q

What is an example of a TCA antidepressant? and how does it present in overdose? and what is the antidote?

A

Amitriptylline
Overdose: antimusclarnic effects - dry mouth/ blurred vision/ ARRYTHMIAS!

IV Bicarbonate and need ECG monitoring

70
Q

What is the 6 monthly monitoring for Lithium?

A

Thyroid and Renal tests every 6 months

71
Q

What is a “brief psychotic disorder”

A

Episode of psychosis
Less than a month
NOT substance related/ induced

72
Q
A

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