Psychiatry Flashcards
how can we differentiate sever depression from dementia
severe depression results in GLOBAl memory loss whereas Dementia is just short term memory loss
OCD
1) CBT+ Exposure and response prevention (ERP)
2) SSRI or clomipramine
3)refer to secondary mental health team
which SSRI is best for people with cardiac problems
Sertraline
side effects and names of Atypical Antipsychotics
- clozapine , olanzapine , aripiprazole, quetiapine
side effects of Atypical antipsychoticcs:
+ metabolic side effects ie : weight gain , hyperprolactinaemia ( Arip = least side effects )
+ increased risk of stroke and venous thromboembolisms in the elderly
clozapine side effects
name the main ones
- Agranulocytosis and neutropenia ( monitor FBC)
- Reduced seizure threshold
- constipation
-Myocarditis ( DO ECG BEFORE )
-hypersalivation
TCA side effects
increases serotonin levels by decreasing serotonin uptake
Noradrenaline , blocks the re uptake of NA increasing NA levels too = INCREASED MOOD
- blockade of histamine receptors = drowsiness
- anti muscarinic = can’t see , pee , shit or climb a tree
- anti - adrenergic = postural hypotension
+ LENGTHENING OF QT
MORE SEDATIVE : amitrtyline , clomipramine
LESS sedative : Imipramine
management of GAD
1) Education and self monitoring
2) low intensity psychological intervention like groups and self help guides
3) CBT
4) drugs - sertraline , or SNRI ie : duloxetine and venlafaxine
in patient with depression with reduced appetite and poor sleep what is the drug of choice
Mirtazipine
SSRI in pregnancy risks
1st - increased risk of congenital abnormality
3rd - persistent pulmonary hypertension
SSRI side effects and preferred drugs ?
Reviews ?
1) preferred is Citalopram ( lengthens QTC) and Fluoxetine (children )
2) sertraline post MI
Reviews :
- patients under 25 = every week
- patients older= very 2 week
due to increased risk of suicide
SIDE EFFECTS:
- GI upset, bleed so give omeprazole with them pls
- Hyponatremia so monitor U&E
how long should SSRI be continue after its achieved its goal
6 months and stop slowly over 4 weeks
SSSRI mnemonic for serotonin syndrome with SSRIs
SSRI
S- Suicide risk increased
S-slow onset and taper off
S- Serotonin syndrome risk ! sweaty hot fever
R-Rigid muscles and agitation
I - increased HR
Duloxetine uses ?
DUAL- oxetine
1) Depression
2) Fibromyalgia
Knights move thinking vs flight of ideas
Knight move = no link between them = Schizophrenia
Flight of ideas= weak links, BIPOLAR disorder
De Clerambaults syndrome
1- believes famous person is in love with them
ECT indications
severe depression with catatonia
- manic episode
-
Diagnosis of chromic insomnia
has to be present for 3 months ( eat least 3 nights per week)
Alcohol withdrawal
6-12 hrs = tremors , sweating and tachycardia
36hrs = seizures
72hrs= delirium tremens
What is Acute Stress disorder
acute stress reaction that occurs in 4 weeks after the traumatic event as opposed to PTSD which is diagnosed after 4 weeks
management of alcohol withdrawal
1) long acting benzodiazepine = chlordiazepoxide or Diazepam
2) carbamazepine
how often should we monitor lithium after a dose change
every 1 week until stable , once stable then every 3 months
Blood test should be 12 hrs post dose
Obsessive compulsive Personality disorder ?
Rigid with respect to morals , ethics and values and are reluctant to surrender work to others ( lists, details , rules etc)
+ meticulous with things too
Anorexia features
most things low but
Gs and Cs raised :
Growth hormone , glucose , salivary Glands rasied
Cortisol, Cholesterol , Carotinaemia
Mania treatment
stops the SSRIs and start the anti psychotics
PTSD treatment
- venlafaxine ( SNRI)
-If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI
