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AKT > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Switch fluoxetine to SSRI

A

leave gap of 4-7 days before starting new SSRI

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2
Q

Switch SSRI to TCA

A

cross tapering - slowly reduce SSRI whilst slowly increase TCA

exception Fluoxetine should be withdrawn completely prior to starting TCA

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3
Q

SSRI Interactions

A

NSAIDs - avoid, unless PPI cover
warfarin/ heparin - avoid, consider Mirtazepine instead
Triptans, MAOi - increase risk of serotonin syndrome

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4
Q

OCD Mx

A

1st - CBT

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5
Q

Venlafaxine (SNRI) when starting needs WHAT checking first

A

Blood pressure - associated with hypertension

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6
Q

Citalopram SE

A

Prolonged QT - needs ECG on initiation

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7
Q

SSRI Monitoring

A

UEs - hyponatraemia
ECG - prolonged QTC

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8
Q

Lithium monitoring (lithium levels)

A

weekly until in normal range
then every 3 months once stable

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9
Q

hoovers sign is..

A

Malingering non organic paresis - involuntary contralateral hip extension

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10
Q

Panic disorder Mx

A

1st - Paroxetine
2nd - Imipramine or clomipramine (after 12 weeks)

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11
Q

Lithium monitoring (biochemistry)

A

Renal, Calcium, thyroid and liver function every 6 months

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12
Q

Section 4 is…

A

Emergency detain patient for 72 hours
GP and AMHP

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13
Q

Section 2 is…

A

Admission with assessment up to 28 days
AMHP + one other doctor
treatment can be given against patient wishes

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14
Q

Section 3 is…

A

Admission up to 6 months
AMHP + 2 doctors (both must have seen patient within last 24 hours)
treatment can be given against patient wishes

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15
Q

Section 5(2) is…

A

a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

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16
Q

Section 5(4)

A

similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

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17
Q

Section 17a

A

Supervised Community Treatment (Community Treatment Order)
can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication

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18
Q

Section 135

A

a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety

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19
Q

Section 136

A

someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety

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20
Q

Alcohol deterrent medication (makes them vomit if drink alcohol)

A

Disulfiram (Antabuse)

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21
Q

Clozapine serious side effect

A

Agranulocytosis/ Neutropenia - check FBC

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22
Q

Alcohol withdrawal symptoms

A

symptoms: 6-12 hours - tremor, sweating, tachycardia
seizures: 36 hours
delirium tremens: 72 hours

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23
Q

Acute stress disorder Mx

A

focused CBT

24
Q

First line medication for Children/ adolescent depression (to be started by psychiatry)

A

Fluoxetine

25
Q

Acute stress disorder vs PTSD

A

AST <4 weeks
PTSD symptoms longer than 4 weeks

26
Q

Cotard Syndrome

A

believing they are dead or non existent

27
Q

OCD Mx

A

1st- CBT +ERP (exposure and response program)
2nd - SSRI or clomipramine
3rd - secondary care

28
Q

Malingering

A

lying or exaggerating symptoms for personal gain

29
Q

somatisation disorder

A

physical symptoms + refused to accept negative results

30
Q

Illness anxiety (hypochondriasis) disorder

A

belief of serious disease + refused to accept negative results

31
Q

Bipolar DVLA Mx

A

“unstable” (4+ episodes of mood swings within 12 months) - stop driving 6 months and inform DVLA

“stable - stop driving 3 months and inform DVLA

32
Q

Capgras disorder

A

irrational delusion of misidentification where patients believe that a relative or friend has been replaced by an identical impostor

33
Q

Anxiety Mx

A

1st- SSRI eg paroxetine, sertraline
2nd - Imipramine or clomipramine

34
Q

Clozapine common side effect

A

hypersalivation

35
Q

SSRI discontinuation syndrome

A

dizziness, electric shock sensation, anxiety
diarrhoea (GI upset)

36
Q

Benzodiazepine withdrawal Mx

A

switch to equivalent Diazepam reduce 2mg every 2-3 weeks

37
Q

Clozapine monitoring FBC

A

weekly first 18 weeks (4 months)
fortnightly up to one year
monthly for rest of duration
risk of agranulocytosis

38
Q

Generalised anxiety disorder Mx

A

1st - low intensity psychological intervention
2nd - high intensity psychological intervention OR medication

Mediation
1 - Sertraline
2nd - alternative SSRI or SNRI
3rd - pregabalin

39
Q

Acute stress disorder Fx

A

Acute stress reaction in first 4 WEEKS of traumatic event
(PTSD is >4 weeks)

Mx/
CBT trauma focused
Benzodiazepines PRN

40
Q

Alcohol withdrawal Fx

A

6-12 hours symptoms start - tremor, sweating, palpitations, anxiety

36 hours - Seizures

48-72 hours - Delirium tremens - tremor, confusion, delusions, hallucinations

41
Q

Alcohol withdrawal Mx

A

1st - Benzodiazepines (eg Chlordiazepoxide, diazepam).
- Lorazepam if hepatic failure

2nd - Carbamazepine

42
Q

Typical Antipsychotic SE
eg Haloperidol, Chlorpromazine

A

Extrapyramidal side effects - parkinsonism, dystonia 9sustained muscle contraction), akathisia (restless)

Increased risk of VTE, Stroke

Other:
Antimuscarinic - dry mouth, dry eyes, constipation
weight gain, sedation
raised prolactin
impaired glucose tolerance
neuroleptic malignant syndrome
prolonged QT
reduce seizure threshold

43
Q

Lithium SE

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

44
Q

Lithium monitoring

A

12 hours post dose
Weekly until stable, then 3 monthly
TFT, LFT every 6 months

45
Q

Generalised anxiety disorder Mx

A

1st - SSRI (eg sertraline)
2nd - SNRI (eg venlafaxine)
3rd - Pregabalin

46
Q

Borderline personality disorder Mx

A

Dialectical Behavioural Therapy (DBT)

47
Q

Antipsychotic monitoring

A

Bloods (FBC, UE, LFT) - initiation, then annually

Lipids, weight - initiation, at 3 months, annually

Fasting blood glucose, prolactin - Initiation, at 6 months, annually

Blood pressure, ECG - Initiation

Cardiovascular risk assessment - Annually

48
Q

acute dystonia means

A

acute dystonia
sustained muscle contraction (e.g. torticollis, oculogyric crisis)

49
Q

akathisia is

A

severe restlessness

50
Q

Tardive dyskinesia is…

A

(late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

51
Q

PTSD Mx

A

1 - trauma focused CBT
2nd - eye movement desensitisation and reprocessing EMDR
3 - Venlafaxine/ SSRI

52
Q

hypermetropia (acute angle closure glaucoma) avoid what anti depressant

A

Mirtazipine

53
Q

young people (under 18) depression Mx

A

1st- 2 weeks of watch and wait
2nd - psychological therapies (eg cbt)
3rd - CAMHS

54
Q

Quitiapine monitoring

A

Lipids, weight, BP, prolactin

55
Q

tourettes Mx

A

Haloperidol

56
Q
A

AKT (21 decks)

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