Psychiatry Flashcards
Switch fluoxetine to SSRI
leave gap of 4-7 days before starting new SSRI
Switch SSRI to TCA
cross tapering - slowly reduce SSRI whilst slowly increase TCA
exception Fluoxetine should be withdrawn completely prior to starting TCA
SSRI Interactions
NSAIDs - avoid, unless PPI cover
warfarin/ heparin - avoid, consider Mirtazepine instead
Triptans, MAOi - increase risk of serotonin syndrome
OCD Mx
1st - CBT
Venlafaxine (SNRI) when starting needs WHAT checking first
Blood pressure - associated with hypertension
Citalopram SE
Prolonged QT - needs ECG on initiation
SSRI Monitoring
UEs - hyponatraemia
ECG - prolonged QTC
Lithium monitoring (lithium levels)
weekly until in normal range
then every 3 months once stable
hoovers sign is..
Malingering non organic paresis - involuntary contralateral hip extension
Panic disorder Mx
1st - Paroxetine
2nd - Imipramine or clomipramine (after 12 weeks)
Lithium monitoring (biochemistry)
Renal, Calcium, thyroid and liver function every 6 months
Section 4 is…
Emergency detain patient for 72 hours
GP and AMHP
Section 2 is…
Admission with assessment up to 28 days
AMHP + one other doctor
treatment can be given against patient wishes
Section 3 is…
Admission up to 6 months
AMHP + 2 doctors (both must have seen patient within last 24 hours)
treatment can be given against patient wishes
Section 5(2) is…
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
Section 5(4)
similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
Section 17a
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
Section 135
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
Section 136
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
Alcohol deterrent medication (makes them vomit if drink alcohol)
Disulfiram (Antabuse)
Clozapine serious side effect
Agranulocytosis/ Neutropenia - check FBC
Alcohol withdrawal symptoms
symptoms: 6-12 hours - tremor, sweating, tachycardia
seizures: 36 hours
delirium tremens: 72 hours
Acute stress disorder Mx
focused CBT
First line medication for Children/ adolescent depression (to be started by psychiatry)
Fluoxetine
Acute stress disorder vs PTSD
AST <4 weeks
PTSD symptoms longer than 4 weeks
Cotard Syndrome
believing they are dead or non existent
OCD Mx
1st- CBT +ERP (exposure and response program)
2nd - SSRI or clomipramine
3rd - secondary care
Malingering
lying or exaggerating symptoms for personal gain
somatisation disorder
physical symptoms + refused to accept negative results
Illness anxiety (hypochondriasis) disorder
belief of serious disease + refused to accept negative results
Bipolar DVLA Mx
“unstable” (4+ episodes of mood swings within 12 months) - stop driving 6 months and inform DVLA
“stable - stop driving 3 months and inform DVLA
Capgras disorder
irrational delusion of misidentification where patients believe that a relative or friend has been replaced by an identical impostor
Anxiety Mx
1st- SSRI eg paroxetine, sertraline
2nd - Imipramine or clomipramine
Clozapine common side effect
hypersalivation
SSRI discontinuation syndrome
dizziness, electric shock sensation, anxiety
diarrhoea (GI upset)
Benzodiazepine withdrawal Mx
switch to equivalent Diazepam reduce 2mg every 2-3 weeks
Clozapine monitoring FBC
weekly first 18 weeks (4 months)
fortnightly up to one year
monthly for rest of duration
risk of agranulocytosis
Generalised anxiety disorder Mx
1st - low intensity psychological intervention
2nd - high intensity psychological intervention OR medication
Mediation
1 - Sertraline
2nd - alternative SSRI or SNRI
3rd - pregabalin
Acute stress disorder Fx
Acute stress reaction in first 4 WEEKS of traumatic event
(PTSD is >4 weeks)
Mx/
CBT trauma focused
Benzodiazepines PRN
Alcohol withdrawal Fx
6-12 hours symptoms start - tremor, sweating, palpitations, anxiety
36 hours - Seizures
48-72 hours - Delirium tremens - tremor, confusion, delusions, hallucinations
Alcohol withdrawal Mx
1st - Benzodiazepines (eg Chlordiazepoxide, diazepam).
- Lorazepam if hepatic failure
2nd - Carbamazepine
Typical Antipsychotic SE
eg Haloperidol, Chlorpromazine
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
Lithium SE
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
Lithium monitoring
12 hours post dose
Weekly until stable, then 3 monthly
TFT, LFT every 6 months
Generalised anxiety disorder Mx
1st - SSRI (eg sertraline)
2nd - SNRI (eg venlafaxine)
3rd - Pregabalin
Borderline personality disorder Mx
Dialectical Behavioural Therapy (DBT)
Antipsychotic monitoring
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
acute dystonia means
acute dystonia
sustained muscle contraction (e.g. torticollis, oculogyric crisis)
akathisia is
severe restlessness
Tardive dyskinesia is…
(late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
PTSD Mx
1 - trauma focused CBT
2nd - eye movement desensitisation and reprocessing EMDR
3 - Venlafaxine/ SSRI
hypermetropia (acute angle closure glaucoma) avoid what anti depressant
Mirtazipine
young people (under 18) depression Mx
1st- 2 weeks of watch and wait
2nd - psychological therapies (eg cbt)
3rd - CAMHS
Quitiapine monitoring
Lipids, weight, BP, prolactin
tourettes Mx
Haloperidol
