psychiatry Flashcards
give 4 side effects of SSRI’s
GI side effects
Hyponatremia
increased anxiety and agitation after starting SSRI
increased QT interval ( Citalopram)
which medications should be avoided when commencing an SSRI
NSAID’s ( co-prescribe PPI)
Warfarin / Heparin *consider Mirtazapine
Aspirin
Triptans
which medication has a higher risk of discontinuation syndrome ?
Which SSRI does not need to be gradually reduced ?
Paroxetine
Fluoxetine
What are the symptoms of discontinuation syndrome
increased mood changes
restlessness
difficulty sleeping
unsteadiness
sweating
GI symptoms
Paraesthesia
how long should patients be continued on an SSRI if good response has been made
6 months
what factors are shown to be associated with an increased risk of suicide
male
self harm
alcohol or drugs
history of mental illness
chronic disease
age
unemployment
unmarried / divorced / widowed
what factors are associated with an increased risk of completed suicide at a future date
efforts to avoid discovery
planning
leaving a note
final acts
violent method
what factors reduce the risk of suicide
family
kids
religion
what are the cluster A , B and C personality disorders ?
Cluster A
Paranoid
Schizoid
Schizotypal
Cluster B
Antisocial
Borderline
Histrionic
Narcissistic
Cluster C
OCD
Avoidant
Dependant
what is the different between schizoid and schizotypal personality disorder ?
schizoid ( alone)
solitary activities, lack of interest in companionship, sex, few interests, friends, emotional coldness.
Schizotypal ( odd)
lack of close friends. odd beliefs + magical thinking, ideas of reference, odd perceptions
how are personality disorders managed
dialectical behavioural therapy
treatment of co-existing psychiatric conditions
what factors are raised in anorexia nervosa
G’s and C’s
growth hormone
glucose
salivary Glands ( enlarged)
Cortisol
Cholesterol
Carotinaemia
what factors are reduced in anorexia
BMI
Heart rate
Blood pressure
Hypokalaemia
FSH, LH, Oestrogen, Testosterone
T3
which is the SSRi of choice in children
Fluoxetine
what are the risks of prescribing SSRI in pregnancy
small risk of congenital heart defects in first trimester
persistent pulmonary HTN in newborn if used in 3rd trimester
Paroxetine increases risk of congenital malformations in 1st trimester
give examples of typical and atypical antipsychotics
typical
Haloperidol
Chlorpromazine
Atypical antipsychotics
clozapine
Olanzapine
Risperidone
which medications are likely to cause extra-pyramidal side effects? what are they?
Parkinsonism
Acute dystonia : sustained muscular contraction ( torticollis, oculogyric crisis)
Akathisia ( severe restlessness)
Tardive dyskinesia ( abnormal involuntary movements like chewing and pouting of jaw)
how is acute dystonia managed
Procyclidine
what are metabolic side effects of typical antipsychotics
antimuscarinic
sedation
weight gain
raised prolactin
impaired glucose tolerance
prolonged QT interval
what are the warnings given when antipsychotics are used in elderly patients
stroke and VTE
what factors suggest a diagnosis of depression over dementia
short history with a rapid onset
patient worried
sleep disturbance, weight loss
upset with results
variable MMSE
global memory loss instead of recent memory loss as seen with dementia
what is the management of alcohol withdrawal? how do you manage in patients with hepatic failure?
first line : chlordiazepoxide
lorazepam
what is the timeline of symptoms of alcohol withdrawal
symptoms : 6-12 h
seizures : 36 h
delirium tremens 72h
what are the two types of bipolar
Type 1 : Mania and depression
Type 2 : Hypomania and depression
how long do symptoms need to be present for a diagnosis of PTSD to be made ?
one month
what are the 4 features of PTSD
Reexperiencing
Avoidance
Hyperarousal / hypervigilance
Emotional numbing
give step wise treatment of PTSD
Trauma based CBT
eye movement and desensitisation ( EMDR)
venlafaxine / SSRI
what is the most appropriate SSRi to be used in someone with IHD
Sertraline
__________________ is the most common cause of admissions to child and adolescent psychiatric wards.
Anorexia Nervosa
what is the first line management of anorexia in
- Adults
- Children
- Individual eating disorder focussed CBT
- Anorexia focussed family therapu=y
what physical features may be seen in a patient suffering from Bulimia
Erosion of teeth
Russell’s sign : calluses on the knuckles / back of the hand due to repeated self induced vomiting
what factors are associated with a poor prognosis of schizophrenia
strong FHx
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
which SSRI is most likely to cause Torsades De Pointes
Citalopram
