Psychiatry Flashcards by Ella Weir

Why do patients need regular bloods on clozapine?

Risk of agranulocytosis and neurogenic sepsis

Pt needs weekly bloods for first 6m and fortnightly onwards

How well did you know this?

Not at all

Perfectly

CV drug increasing lithium toxicity

ACEi e.g. ramipril
Increases serum lithium level
Results in renal dyfunction -> dialysis req

How well did you know this?

Not at all

Perfectly

What do the different sections of the MHA mean?

Sec 2 = assessment order and lasts up to 28 days
Sec 3 = treatment order that can last for up to 6 months
Sec 5 (2) = emergency holding order to keep pt in hospital for 72h
Sec 136 = police officer can take pt with acute MH to place of safety

How well did you know this?

Not at all

Perfectly

Biochemistry and ABG changes in a purge

Hypokalaemia with metabolic alkalosis

How well did you know this?

Not at all

Perfectly

Vitamin deficiency in alcohol misuse

B1 (thiamine)

How well did you know this?

Not at all

Perfectly

Blurred vision can be caused by which type of antidepressant?

Tricyclic antidepressants

How well did you know this?

Not at all

Perfectly

Antipsychotic causing reduced libido, low mood, amennorhea

Risperidone
- hyperprolactinaemia secondary

How well did you know this?

Not at all

Perfectly

26yo 9 weeks gestation, depression well managed with venlafaxine, why would you not change meds in pregnancy?

well stabilised on venlafaxine
cardiac abnormalities caused by venlafaxine only occur within first 8w pregnancy

How well did you know this?

Not at all

Perfectly

What antidepressant should you avoid in first trimester of pregnancy?

Paroxetine
- can cause heart defects

How well did you know this?

Not at all

Perfectly

What antidepressant should be used in third trimester of pregnancy?

TCA (imipramine/amitryptiline)!

If SSRI necessary, use sertraline or fluoxetine

How well did you know this?

Not at all

Perfectly

Can you use benzos in pregnancy?

NOOOOOOOO
Potential fetal malformation risk (cleft palate), floppy baby syndrome, and breastmilk accumulation
- the only acceptable one is in withdawal as least bad option

How well did you know this?

Not at all

Perfectly

Sudden onset anterograde amnesia, with repetitive questioning and a preserved level of consciousness

Transient global amnesia
- up to 24 hours

How well did you know this?

Not at all

Perfectly

What type f psych drug causes hyperprolactinaemia?

Dopamine antagonist e.g. metoclopramide
(manage with dopamine agonist e.g. cabergoline)

How well did you know this?

Not at all

Perfectly

Which mood stabiliser can cause hypothyroidism?

Lithium
- e.g. bipolar pt presents with dry skin, fatigue and weight gain

How well did you know this?

Not at all

Perfectly

Main GI side effect of donepezil vs memantine

Donepezil (mild-mod) = diarrhoea
Memantine (severe) = constipation

How well did you know this?

Not at all

Perfectly

Anti-NMDA antibodies

Autoimmune encephalitis
- rapidly progressive cognitive decline and seizures (may not be noticed)
- manage with steroid and IVIG

How well did you know this?

Not at all

Perfectly

What type of psych med is contraindicated in Lewy Body Dementia?

Antipsychotics e.g. haloperidol
- worsens parkinsonism symptoms

How well did you know this?

Not at all

Perfectly

Thought blocking vs withdrawal

Stop in conversation for several minutes before speaking again
- blocking involves a change in conversation
- wihtdrawal pt believes thoughts are being taken from them

How well did you know this?

Not at all

Perfectly

Liver transplant criteria

Arterial pH < 7.3 after 24 hours
OR all 3 of the following:
PT > 100
Creatinine > 300
Grade III or IV hepatic encephalopathy

How well did you know this?

Not at all

Perfectly

MMSE grading for Alzheimer’s disease

<10 severe AD
10-20 moderate AD
21-26 mild AD

How well did you know this?

Not at all

Perfectly

First line for acute episode of mania in bipolar

Olanzapine
- or another suitable mood stab antpsychotic

How well did you know this?

Not at all

Perfectly

How long must symptoms be present for a PTSD diagnosis?

1 month
AND interfering with daily life

How well did you know this?

Not at all

Perfectly

Anticholinergic side effects

Can’t see, pee, sh*t
+High HR

How well did you know this?

Not at all

Perfectly

What is perceptional delusion?

delusion that is formed in response to an external stimulus without any logical sense
- e.g. from a TV show which is real, but pt is creating grandiose delusions from it

How well did you know this?

Not at all

Perfectly

Management post partum psychosis

Almost always hospital admission if possible to mother and baby unit so they can bond while mum is treated

Short episodes of panic that feel like a heart attack but normal ECG

Panic disorder - long term management with SSRI first line

Prominent U waves in a pt who has recently been admitted to hospital to treat an eating disorder

Refeeding syndrome - caused by hypokalaemia

Acute confusion, impairment of short-term memory, seizures (often focal e.g. absence) and altered consciousness level

Limbic encephalitis

Investigations to rule out othwr causes of psychosis before diagnosing schizophrenia

Full blood count, serum electrolytes, liver function, urine drug screen, B12, folate and thyroid function tests + neuroimaging + ? HIV/syphilis

Antihistamine causing delirium in elderly

Chlorphenamine

How to diff between AI and viral encephalitis?

AI has normal MRI Viral would have hyperintense temporal lobe lesion

Management iatrogenic opioid overdose

Fuuuuulll dose naloxone - titrating dose risks further resp depression and hypoxic brain injury

3 key UEs changes in lithium toxicity

Incr creatinine Reduced eGFR Incr serum lithium

Metabolic acidosis, confusion, seizure, tachycardia, hypotension and dilated pupils in a suspected overdose...

Tricyclic antidepressant overdose - lots of anticholinergics - ECG may show prolonged QRS and QTc

When should duloxetine be taken?

In the morning to avoid insomnia

Mx Wernicke's encephalopathy

Pabrinex

Drug given in acute benzo OD

Flumenazil

Mx depression in bipolar

Fluoxetine + olanzapine or another atypical - never give SSRI on own to prevent mania

MoA of lithium in mania

Promotes GABAergic transmission

Management manic episode

Not on mood stab - stop antidepressant - start antipsych OR valproate OR lithium (if likely to adhere) - consider short acting benzo

3 key drug reactions with lithium

ACE inhib Thiazide diuretic NSAID

What effect does D&V (or other dehydration) have on lithium levels?

Depletes sodium -> hyponatraemia -> incr plasma lithium levels

Lithium target range

0.4-1.0* mmol/l

Medical management of depression

SSRI Different SSRI or SNRI Switch or augment - mirtazapine - bupropion - lithium Alt drugs - T3 - lamotrigine Alt drugs - TCA + something else

What class of psych drugs do SSRIs interact with?

SSRIs and MAOIs should never be combined as there is a risk of serotonin syndrome

What class is mirtazapine?

NaSSA

Drugs causing gynaecomastia

Digoxin, isoniazid, spironolactone, cimetidine and other (estrogens)

Metoclopramide and spironolactone have what effect on male breast tissue?

Meto = galactorrhoea (M for milk) Spiro = gynaecomastia (S for swelling)

Moans groans stones

Hypercalcaemia - short QT

Sweating, tremor, confusion and hyperreflexia

Serotonin syndrom

Hyperparathyroidism and hypercalcaemia after long term use of .....

Lithium

Medical management OCD

Sertraline Clomipramine if ^CI or not tolerated

Management of negative schizophrenia or treatment resistant schizophrenia symptoms

Clozapine

Schizoid vs schizotypal PD?

SchizOID = avOIDant behaviour SchizoTYPal = aTYPical (odd, eccentric) behaviour

Toxicity with tinnitus that goes from resp alkalosis -> metabolic acidosis

Aspirin overdose

Psych drug causing DI

Lithium

Dystonia, chorea and athetosis (involuntary writhing movements) caused by which neuro drug?

levodopa

Triptans and SSRIs?

Symptoms of SSRI discontinuation syndrome

Flu like symptoms Insomnia Restlessness Mood changes Sweating Tummy problems (pain, cramps, D&V) Off balance Parasthaesia

When is blood test for lithium monitoring done?

12h post dose every 3 months - also 1 week after a dose has been changed

Key side effect of long term use of atypical antipsychotics

Impaired glucose tolerance - polyuria and polydipsia

Oculogyric crisis is assoc with which type of antipsychotic

First gen - chlorpromazine Manage with procyclidine

Name 3 foods you can't have with MAO inhibitors

Cheese (MAOuse) Bovril Marmite - precipitates severe hypertensive crisis

Which atypical has th most tolerable side effects?

Aripiprazole

How to diff between tardive dyskinesia and acute dystonia?

Tardive dyskinesia - Taking antipsychotics -> Tetrabenezine acute dySTonia - STarting antipsychotics -> procyclidine

If pt needs to be on both NSAID and SSRI, what drug should be given as well?

Omeprazole/PPI - to reduce risk of GI bleeding

4 key S side effects of SSRIs

Stomach Upset Sexual Dysfunction Sodium Low Serotonin Syndrome

Name an MAOi

Rasagiline - as well as being used in depression it's used for Parkinson's but is one that can induce the gambling/binging habits

Antipsychotics in elderly key adverse effect?

Stroke or VTE

Tardive vs akithisia?

Tardive - repetitive invol movements e.g. smacking lips, blinking Akithisia - internal sense of restlessness causing repetitive movement e.g. bouncing leg

SSRI of choice in CAMHS

Fluoxetine

ECG changes with citalopram

Prolonged QT Torsades de pointes (as a result of long QT)

Alcohol sobriety maintenance drug that causes vomiting when alcohol is ingested

Disulfiram

Anti craving drug used in long term alcohol sobriety, safe when consumed with alcohol

Acamprosate

2nd line opioid antagonist that is a tablet that goes under the tongue

Buprenorphine

Complication of Wernicke's encephalopathy presenting with anterograde amnesia, retrograde amnesia, and confabulatio

Korsakoff syndrome

Sudden loss of motor or sensory function, positive Hoover sign

Conversion disorder (type of FND)

What happens to sertraline dose before pt starts ECT?

Reduce dose but don't stop

Cholesterol in anorexia?

Hypercholesterolaemia

What are the two R parkinson's drugs?

Rasigiline Ropinirole - both caution for impulsivity, gambling, binging etc

First line in acute stress disorder/reaction

(Trauma-focussed) CBT

78yo, post hip replacement opioid overdose, RR 8 breaths/min, what's the management?

Naloxone, titrated - full dose at this age and with this much pain is mad

Confusion, ataxia and bone marrow suppression are side effects of which antipsych?

Carbamazepine

Monitoring for venlafaxine

Blood pressure

4 components of a delirium diagnosis

1) acute onset with fluctuating course, 2) inattention, 3) disorganised thinking, 4) altered level of consciousness

Define circumstantiality

The patient moves onto different topics but there is a train of thought that can be followed. She eventually returns to answer the original question

Mechanism behind the seizure, behaviour change symptoms of auotimmune encephalitis

Demyelination

Patient has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning.

Somatisation disorder

Anxiety med likely to cause peptic ulcer disease

SSRI sertraline

Most common side effect of clozapine

Constipation

FL for delirium tremens

Oral lorazepam

Management of acute opioid withdrawal

Treat symptoms e.g. constipation = loperamide e.g. agitation = benzos

Restlessness, diaphoresis, clonus, hyperthermia, rigidity, hyperreflexia - taken amphetamine today and symptoms have come on in 4 hours

Serotonin syndrome

Tetrad of: hypertonia, hyperthermia, autonomic instability and mental state change in the context of an anti-psychotic medication over the course of 4 days

Neuroleptic malignant syndrome

Lab findings in NMS

Incr creatine kinase Incr AST and ALT Incr white cells

Two symptoms in SS that you don't get in NMS

ClonuS GI Upset (shitting)

Management of dementia with long QT and chronic diarrhoea and urge incontinence

Cog stimulation therpy - or memantine if more severe dementia - can't give anticholinesterases as they will make his symptoms wors e

FL management for agitated patient with falls risk

One-to-one nursing and re-orientation

Intention or resting tremor in parkinson'

Resting tremor

Most common cause of postural hypotension in the elderly

Dehydration

Management of OCPD

DBT

Indication for ECT

catatonia a prolonged or severe manic episode severe depression that is life-threatening treatment resistant depression

Key feature of weakness in FND/conversion disorder

does not correspond to a dermatomal distribution