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Psychiatry Flashcards

1
Q

What is the diagnosis for depression?

A

2+ weeks of low mood, low energy and anhedonia (loss of interest in things you’d normally enjoy)

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2
Q

Gender medicine: Who is at increased risk in depression (2)

A

females- getting it
males- being more suicidal when getting it

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3
Q

Characteristic of pseudodementia and how to differentiate with depression

A

depressive symptoms + difficulty with memory + cognition
‘i dont know answers’
normal MSE (over 25/30 is normal)

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4
Q

Risk factors for depression

A

chronic pain (bio)
abuse (psycho)
bereavement (social)

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5
Q

What are the symptoms of typical depression

A

SIGE CAPS
suicide/ selft harm
interest (reduced)
guilt/ worthlessness
energy (reduced)
concentration (reduced)
appetitie (reduced)
psychomotor retardation (slower speech, slower movement)
sleep (reduced)

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6
Q

What are the symptoms of atypical depression and tx for this

A

increased appetite
increased sleep
can have good mood on good occasians
catatonia (person is awake but don’t react/ respond)
very emotionally sensitive

Tx:
CBT
MAOI

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7
Q

2 ix for depression

A
  1. Questionnnaire PHQ 9 questionnaire, BDI-II, Edinburgh, HADS
  2. bloods: FBC (anaemia), U&E(electrolyte abnormality), TFT(hypothyroidism), B12/ folate (deficiency), prolactin
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8
Q

Tell me about the depression questionnaires

A

-> Patient Health Questionnaire 9: MC used in community
0-4= none, 5-9= mild, 10-14=mod, 15+= severe
-> Becks Depression Inventory-II: self reporting
-> EPDS: Edinburgh postnatal depression scale (11+ indicates depresssion/ anxiety)
-> HADS: hospital anxiety and depression scale: hospital use only

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9
Q

How is depression classified clinically into subclinical, mild, mod, severe and manangement for each

clincally= based on patient’s symptoms, not from questionnaire

A

subclinical= 4 or less SIGE CAPS
mild= 5+ SIGE CAPS and little functional impairment
-> psychotherapy and advice for 3/4 months (NICE says do not offer medication first line for mild depression unless it is patients request)
-> psychothereapy can be CBT or interpersonal therapy
-> then SSRI

mod= 5+ SIGE CAPS and marked functional impairment
-> SSRI and high intensity CBT

severe= 5+ SIGE CAPS and marker functional impairment (+/- psychosis)
-> SSRI and high intensity CBT
-> can consider electroconvulsive therapy

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10
Q

What are other forms of depression 2 and treatment

A

seasonal affective disorder: every winter
-> any form of psychotherapy (CBT, IPT), follow up in 2 weeks and mild SSRIs if needed
dysthymia: subclinical depression for 2+ years
-> low intensity CBT

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11
Q

what does NICE guidelines say about medical treatment of depression 2

A
  1. if severe depression, offer patient any treatment option first line
  2. always start with an SSRI first line when doing medical management
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12
Q

What are examples of self harm and rfx

A

eg: cutting, headbanging
rfx: female, depression, abuse

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13
Q

What are examples of suicide methods and rfx:

A

eg: overdose, jumping from height, hanging
rfx: SAD PERSONS
sex- male, age- old and teens, depression, phx suicide attempt, ethanol- alchohol, rational loss- ie psychotic, social support is low, organised plan, not married, sick- chronic illness

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14
Q

What indicates increased risk of suicide 4

A
  1. makes a conscious effort not be be found
  2. planing
  3. no regret after attempt
  4. sort out things in order and leaves a note
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15
Q

What can manage lower risks of suicide/ self harm

A

suicide: thinking about protective factors- family/ pets
self harm: rubber bands, calm harm app (DBT)
both: CBT

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16
Q

What SSRIs are preferred if breastfeeding 2

A

sertraline (first line for postnatal depression generally) or paroxetine

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17
Q

What are the types of bipolar disorder mean?

A

type 1: alternative mania and depression
type 2: alternating hypomania and depression
cyclomania: alternating hypomania and subclinical depression for 2+ years

-> to differentiate between hypomania and mania- mania has no insight, grandiosity and psychosis whereas hypomania you are still in touch with reality

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18
Q

What is rapid cycling with reference to bipolar

A

4+ manic episodes in a year

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19
Q

What can precipitate a manic episode 3

A

benzos
SSRI
alcohol

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20
Q

What is mania

A

7+ days of IDIG FAST sx (irritable, distractble, insomnia, grandiose delusions, flight of ideas, increased activity, increased speech, thoughtless behavior (increased risk taking))
-> can also have hallucinations/ psychosis

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21
Q

What is hypomania

A

4+ days of elevated mood, mild version of mania sx but no grandiose and no hallucinations
-> functional

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22
Q

How are referrals done for bipolar disorder?

A

mania= urgent community mental health team referral
hypomania= routine community mental health team referral

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23
Q

What is the management for bipolar disorder?

A

acute management of mania/hypomania
-> consider stopping antidepressant if the patient takes one
-> start antipsychotic therapy e.g. olanzapine or haloperidol

management of depression
talking therapies
fluoxetine

long term management
Mood stabiliser- Lithium
CBT

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24
Q

How is lithium monitored

A

monitor serum lithium post dose then weekly until stable and then 3 monthly
also monitor FBC, UE, TFT, eGFR, BMI and ECG

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25
Q

What is the MoA of lithium and its interactions

A

CAMP inhibitor
interactions: NSAIDs (leads to AKI), diuretics (increases dehydration), ACEi (renal failure and dehydration)

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26
Q

what are the symptoms of lithium toxicity and side effects of lithium

A

LITHIUMS
levels of 1.5mmol/L +
increased urination
thirst/ tremor
hair loss/ hypothyroidism
impaired memory
upset stomach
muscle weakness
skin conditions (acne)

(guy has a handful of lithium tablets and urinates himself, then he’s super thirsty so he drinks lots of water and when he tips his head back to drink the water, his hair falls out in clumps. He wants to go to the barber but he can’t remember where their shop is anymore and decided to stay home because his stomach hurts. So stressed he gets acne)

Above are all side effects. These are sx of toxicity:
* seizures
* course tremor (fine is seen in therapeutic levels)
* acute confusion

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27
Q

mx of lithium toxicity 4

A
  1. ABCDE
  2. supportive
  3. forced alkaline diuresis (IV Na2CO3)
  4. if above 3mmol then haemodialysis needed
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28
Q

What is an important thing to note about discontinuating lithium

A

months after stopping, can get neurological symptoms- SILENT (syndrome of irreversible lithium effectuated neurotoxicity)
sx: altered level consciousness, tremor, nystagmus, hyperreflexia
reduced conscious but everything else starts shaking

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29
Q

What type of index does lithium have and what are the values

A

narrow therapeutic index
0.4mmol/L - 1mmol/L

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30
Q

what are alternative mood stabilisers to lithium 2

A

carbimazole
valproate

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31
Q

Define schizophrenia

A

dissociation from reality for 28+ days (not associated with substance abuse)
if less than 28 days then it is called transient psychosis

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32
Q

What lobe is mainly affected in schizophrenia

A

temporal

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33
Q

What are the symptoms of schizophrenia

A

First rank sx: ABCDE
Auditory hallucinations
Broadcasting/insertion of thoughts
Cognitive sx= memory + attention + executive function issues (these present the earliest)
Delusional perceptions
External person controlling you (passivity)

Second rank sx: NIPP
indifferent responses
non auditory hallucinations (visual/ tactile)
poorly organised delusions
poorly organised speech

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34
Q

How to dx schizophrenia

A

1+ first rank sx for 28+ days
OR
2+ second rank sx for 28+ days

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35
Q

Risk factors of schizophrenia 2

A

cannabis use in childhood
first degree fhx

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36
Q

What indicates poorer prognosis of schizophrenia 3

A

-> low IQ
-> strong fhx
-> continuing substance misuse

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37
Q
  1. What is simple schizophrenia
  2. What is paranoid schizophrenia
  3. What is disorganised schizophrenia
A
  1. schizophrenia characterised by 2nd rank symptoms
  2. schizophrenia characterised by prominent paranoid delusions and auditory hallucinations
  3. schizophrenia characterised by disordered thought or affect (delusions/ hallucinations are less prominent)- usually in young patients
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38
Q

What is delusional disorder and mx

A
  • 3+ months of isolated delusion eg persecution
  • no psychosis
  • give CBT
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39
Q

What is late onsent schizophrenia and mx

A
  • older than 45 y/o with schizo
  • good prognosis with low dose antipsychotic
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40
Q

What is schizoaffective disorder and mx

A

schizophrenia + a mood disorder (eg depression/ bipolar)
mx- antipsch for schizo and treat mood disorder accordingly

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41
Q

What is management for schizophrenia

A
  • 1st line: start atypical antipsychotic 6-8 weeks trial eg risperidone/ aripiprazole (trial two then go to clozapine if they both fail)
  • offer CBT to all
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42
Q

If medication compliance is an issue for antipsychotics, what can be done?

A

change from oral to depot (injections)

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43
Q

What is generalised anxiety disorder and its symptoms

A

pervasive (means daily) persistant non specific anxiety for 6+ months (EGADS- excessive GAD for 6 months)

i’m MISERAble:
Muscle tension
Insomnia
Sweaty
Energy loss
Restlessness
Autonomic (palp, SOB, tremor)

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44
Q

What are the ix for GAD

A
  1. bloods: FBC, UE, TFT, urine tox (drugs)
  2. questionnaires
    -> GAD 7: generalised anxiety disorder 5-9 mild, 10-14 mod, 15+ severe
    -> HADS in hospital
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45
Q

What is mx for GAD 5

A

ladder management:
1. patient education
2. low intensity CBT
3. high intensity CBT + SSRI
4. refer to CMHT (comm MH team)
5. propanalol for muscle tension

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46
Q

What are phobias and what is their management

A

irrational extreme fear of particular things
eg spiders/ blood/ public speaking= social phobia

mx:
1. exposure and response prevention therapy (desentise)
2. consider SSRI

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47
Q

What is Panic disorder and sx

A

disorder for longer than a month with minimum of 4+ weekly panic attacks (that typically last up to 30 mins) of MISERAble sx + 3Cs: chills, chest pain, choking sensation

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48
Q

Investigations for panic disorder and mx

A

ix: panic disorder severity scale (PDSS) and PHQ- for panic disorder
mx:
1. self help CBT and education
2. step up to high intenstity CBT + SSRI

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49
Q

What is OCD and examples

A

at least 2 weeks where 4+ days/ week have obsessions that are only relieved by acting on these obsessions ie compulsions

(so obsession leads to compulsions which causes relief but then anxiety as obsessions build up again)

eg hand washing, cleaning

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50
Q

What is the ix and mx for OCD

A

ix: Yale Brown OCD scale

mx: exposure and response treatment therapy (ERP) in CBT
1st line med is SSRI (takes 3 months to start working- needs to take for this long AND take for a year after sx resolve)
2nd line is clomipramine TCA (clo mi pram mine)

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51
Q

What is PTSD and sx, who can get PTSD

A

28+ days of prolonged stress reaction to a traumatic event that happened in the past (after 4 weeks- before 4 weeks= acute stress reaction)
eg war veterans, rape victims

sx: HEAR
hypervigilance
emotional blunting
avoidance
reliving the experience (flashbacks, nightmares)

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52
Q

What is the ix and mx of PTSD

A

ix:
trauma screening questionnaire
mx:
* EMDR (eye movement desensitisation and reprocessing therapy)
* combat related trauma, in which case do truama focused CBT first line

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53
Q

Compare PTSD vs complex PTSD

A

Complex PTSD= PTSD plus
-feelings of worthlessness and guilt
-problems controlling emotions
-relationship problems/ struggling to connect to others

54
Q

What are the 5 Ps of formulation and examples

A

predisposing (risk factors eg childhood abuse)
precipitating (just before episode eg grief)
presenting (what pt presents with eg depression)
perpetuating (things that keep the pts presentation ongoing eg distorted body image/ in an abusive relationship)
protective (things that keep pt grounded eg pets/ kids)

55
Q

Explain the biopsychosocial model and examples

A

biological:
genetics, PMHx
psychological:
MHx conditions
social:
relationships, finances, stress, culture

56
Q

How to do an MSE

A

ASEPTIC acronym
appearance + behavior (dress, eye contact)
speech (rate, rhythm, tone, volume)
emotion (mood- asked directly + affect- congruent with mood or not)
perception (delusions, hallucinations)
thought (forms and thought stream)
insight (awareness of reality)
cognition (up or down)

57
Q

How to take a psychiatry history

A

Same medical history +
1. personal history (childhood to now)
2. suicide and self harm (history- how and when it was done, any regrets, any thoughts currently)
3. forensic hx (legal involvement)

58
Q

When does ADHD present and what are its characteristics

A

6-12 year old
triad of hyperactivity, impulsivity and attention deficit in 2+ environments
(hyperactivity more likely to be in male, deficit in females)

59
Q

What is the assessment for ADHD 2

A
  • DIVA-5 questionnaire: diagnostic interview for ADHD in adults
  • in kids= young DIVA 5 questionaire
60
Q

What is the treatment for ADHD 4

A
  1. trial of watch and wait for 2 months
  2. methylphenidate (amphetamine- CNS stimulant)
  3. lisdexamfetamine
  4. monitor growth on charts 6 monthly as methylphenidate decreases appetite and basline ECG due to risk of RBBB
61
Q

What is autism spectrum disorder (ASD) and what age and gender does it roughly manifest

A

spectrum of impaired communication and social interactions

more males, less than 3 years old

62
Q

What is the difference between ADHD and autism presentation

A

Autistic individuals fail to recognise social cues but individuals with ADHD can

63
Q

What are the symptoms of ASD 7

A

decreased speech S
decreased empathy E
isolation and decreased interest in shared play I
concrete thinking T (literal thinking eg think outside the box and they’d look for a box)
specific knowledge K
ritualistic behavior (repetitive, inflexible routine) R
decreased response to emotional cues
3E TRIKES (3 ASD boys sitting on trikes)

64
Q

What is the assessment for ASD 1

A

M-CHAT: modified checklist for autism in toddlers

65
Q

What is the management for ASD 3

A

supportive management
eg special needs teaching in school and
applied behavioral analysis therapy (ABA)

66
Q

What are causes of learning disabilities 4

A
  • ASD
  • genetic: downs and fragile x syndrome
  • TORCH
67
Q

What is the classification of learning disability

A

IQ over 100 is normal
50-70 is mild
35-49 moderate
20-34 severe
<20 profound

68
Q

What are the two types of tics and examples of them

A

simple: non goal oriented movement eg nose wrinkling/ moving head to side
complex:
echolalie-echoing others coprolalie-verbal swearing

69
Q

how is tourettes syndrome diagnosed

A

2+ motor tics AND 1+ vocal tic for 1 year minimum

70
Q

What is PANDAs

A

When a kid gets OCD/ TICS after a strep A infection

71
Q

What is insomnia and mx

A

3+ days a week struggling to sleep
mx: zopiclone

72
Q

What is the criteria for gender dysphoria dx

A

2+ of the following for 6+ months:
* strong desire to be opposite gender
* strong desire to have opposite gender’s genitals
* strong desire to be treated like opposite gender
* has feelings like opposite gender
* do not like how their physical appearance is

73
Q

How should antidepressants be taken 3

A
  • takes 4-6 weeks to start working
  • baseline monitor then weekly for 4 weekly (esp SSRIs increase suicidaility risk for under 30 Y/O) and then every fortnight
  • need to take for 6 months after sx have improved and wean over 4 weeks to prevent serotonin syndrome
74
Q

What is something important to consider when prescribing antidepressants under 30 years old 1

A

initially increases suicidality risk

75
Q

What are the 5 types of antidepressants

A

SSRI
SNRI
MAOI
TCA
mirtazipine

76
Q

What is the MoA of SSRI, examples and where relevant its uses and SEs

A

5-HT presynaptic reuptake inhibitor
* sertraline
* fluoxetine- prescribed in CAMHS
* paroxetine- safe for breastfeeding but has severe discontinuation side effects and causes severe congenital defects if taken during pregnancy 2/3rd tri
* citalopram- SE of QT interval prolongation >480ms (not short cutie, long cutie)

77
Q

What are the general SE of SSRIs 5

A

Stomach issues (n/v/pain)
Serotonin syndrome
Reduced sex drive/ ability to have an erection (libido/ erectile dysfunction)
Interactions: increases risk of GI bleed if in conjunction with NSAIDs (co-prescribe PPI!), lowers seizure threshold, decreases efficacy of triptans (RST)
Ssodium low (hyponatraemia)

78
Q

What are the risks of SSRIs when pregnant and which in particular increases risk of defects

A

1st trimester- congenital heart defect, cleft palate
2/3rd trimester- persistant pulmonary HTN of newborn (PPHN)
paroxetine has the highest association with congenital defects

79
Q

What is the MoA of SNRI, examples

A

noradrenaline and 5-HT reuptake inhibitor presynaptically
eg venlafaxine or duloxetine

80
Q

What are the SE of SNRIs

A

Nausea/ vomiting
No drooling (dry mouth)
No muscle (rhabdomyolysis)
No sodium (SIADH)
4Ns

81
Q

What is the MoA of MAO inhibitors and examples

A

monoamine oxidase inhibitor (prevents noradrenaline, 5-HT and Adrenaline breakdown in CNS)
eg phenelzine sulfate, isocarboxazid, selegilline
(i saw car (in a) box as is(d))

82
Q

What

What are SE of MAOIs

A

SE:
* cause hypertensive crisis with foods high in tyramine eg (cheese and 2+ glasses alcohol)
* cause serotonin syndrome if co-prescribed with an SSRI

83
Q

What is the MoA of TCAs, examples

A

5-HT and NAd reuptake inhibitor

eg amitryptilline (sedating), eg imipramine (non sedating)

84
Q

What are side effects of TCAs 4

A

can’t see (blurred vision)
can’t pee (urinary retention)
can’t spit (dry mouth)
can’t sh-t (constipation)

85
Q

What are the signs of TCA overdose, Ix and Tx

A

confusion
cardiotoxicity
colossal pupils (dilated pupils)
cracking skin (dry and hot)

Ix:
24 hour ECG:
wide QRS >100 and QT prolongation >480
Tx: IV sodium bicarbonate (if cardiac signs)

86
Q

What is the MoA of mirtazipine, SE

A

NASSA: noradrenergic and specific serotonergic antidepressant

SE: weight gain + sedation

87
Q

When does NICE recommend using mirtazipine? 2

A
  • first line as an antidepressant if patient on warfarin/ LMWH (dalteparin)
  • use in very skinny patients who struggle with sleeping
88
Q

compare serotonin syndrome and neuroleptic malignant syndrome (onset, cause, features)

A

SS: over hours
NMS: over days/ weeks

SS: antidepressants, opioids, illicit drugs
NMS: anti-psychotics and sudden stop of dopaminergic agents eg levodopa

SS: hyperreflexia, clonus, tremor, dilated pupils, diarrhoea, autonomic features (HTN, tachycardia)
NMS: hyporreflexia, lead-pipe rigidity, no eye or bowel signs, autonomic features (HTN, tachycardia)

89
Q

compare management of serotonin syndrome and neuroleptic malignant syndrome

A

SS:
1. stop SSRI
2. ABCDE
3. give chlorpromazine (typical antipsychotic which blocks 5HT receptors)

NMS:
1. stop antipsychotic
2. ABCDE
3. start dantrolene and bromocriptine

90
Q

What is the pathophysiology of addicative behaviors

A

mesolimbic reward pathway

91
Q

What defines alcohol dependance and according to what criteria

A

ICD 10
12 months history with 3+ dependance sx

92
Q

What is the effect of alcohol on the brain 1and body 4

A

GABAergic CNS retardant

increased cortisol
increased adipose mass
decreased resp rate
decreased co-ordination

93
Q

What are the features of alcohol intoxication 4

A

ataxia
slurred speech
change in GCS
vomiting

94
Q

What are the symptoms and timeframes of alcohol withdrawl

A

6-12 hours: anxiety and fine tremor
36 hours: seizures
72 hours: delirium tremens (course tremor, AMS, change in GCS)

95
Q

What is the illegal limit of alcohol for driving

A

0.08 + BAC (blood alcohol content)

96
Q

What are the investigations for alcohol abuse 3

A
  1. bloods (high GGT, high CDT, high ALP)
  2. screening questionnaires CAGE (2/4+) and Audit (8/10+)
  3. CIWA questionnaire for assessing severity of alcohol withdrawal
97
Q

What is the treatment for acute and long term withdrawal of alcohol

A

acute: IV chlordiazepoxide
long term:
naltrexone (opioid inh) to decrease pleasure
acamprosate (NDMA inh) to decrease cravings
disulfiram (AAD inh) to induce angover symptoms with alcohol- CI in pregnancy and alcohol use (can cause severe SE)

98
Q

What are the symptoms of opioid overdose 5

A

pain relief
constipation
euphoria
pinpoint pupils
respiratory depression

99
Q

What are the symptoms of opioid withdrawl

A

dilated pupils
yawning
rhinorrhoea
lacrimation
hot and cold flushes

100
Q

what is the management for opioid overdose 2

A

acute: IV 400mg naloxone
long term: methadone

101
Q

State the difference between substance misuse and substance abuse

A

misuse: prescription meds that are taken for a purpose that is not consistent with medical guidelines
abuse: drugs including alcohol are used to get high/ inflict self harm

102
Q

What is somatisation disorder

A

when individuals experience exaggerated anxiety about physical symptoms that restricts ADLs and daily functioning

103
Q

What are differential diagnoses for psychosis 4

A

-drug induced (cocaine, meth, steroids)
-schizophrenia/ schizoaffective
-depression (/post partum)
-Huntingtons

104
Q

What are personality disorders

A

chronic unwavering behavior pattern OVER age of 18+ years

105
Q

What are the subcategories of personality disorders

A

class A= mad
class B= bad (bad people to be around)
class C=sad

106
Q

Name and describe the class A personality disorders

A
  1. paranoid: sensitive, unforgiving, takes attacks on character seriously, persecutary delusions: Elsa
  2. schizotypal: inappropriate affect, magical thinking, odd behavior, ideas of reference: Willy Wonka
  3. schizoid: cold, solitude, decreased libido, thinks world is uncaring (think batman)
107
Q

Name and describe the class B personality disorders

A
  1. narcassistic: beleive lifes a competition, grandiose, entitled: Donald Trump
  2. histrionic: crave centre of attention, flirtacious, consider relationships closer than they are: Harley Quinn
  3. EUPD: crave sympathy, impulsive acts eg self harm, poor relationship hx: Pick Me
  4. antisocial: repeated unlawful violent acts eg arson, animal cruelty, no remorse (psycho- law involved, socio- no law involved): Scar from the lion king
108
Q

Name and describe the class C personality disorders

A
  1. anankastic (OCPD obsessive compulsive personality disorder): strict time regulation, inflexible, refuses to delegate, perfectionist: Sheldon Cooper
  2. avoidant: craves companionship and intimacy but fear of rejection
  3. dependant: wants others to make big decision with, submissive: Daphne Scooby Doo
109
Q

What are the investigations and management for personality disorders

A

Ix: Minnessota multiple personality inventory (MMPI)
Tx: CBT- DBT for EUPD to change thought perception
Behavioral Action therapy

110
Q

What is catatonia and what is it associated with 2

A

abrupt ceases in speech or movement

associated with mania and schizophrenia

111
Q

What is ECT, how is it done and what are the indications 3 and SE 2

A

electrode guided current to brain parenchyma
under general anaesthesia which causes a seizure

indicated in:
-severe life threatening or last resort depression
-resistant mania
-catatonic schizophrenai

SE: amnesia/ confusion

112
Q

What are the types of talking therapy 4 and explain how each works

A

CBT: changes negative thoughts by breaking them down into STEAP (situation/ thoughts/ emotions/ actions/ physical feelings)
DBT: changes negative thoughts and positively promotes acceptance, focuses on more emotional and social aspects of life than CBT
IPT: resolves relationship problems
couple/ family therapy: promotes communication, teaches how to support pt and modified dysfunctional behavior

113
Q

What is the function of hypnotics and anxiolytics, examples with class of drug

A

hypnotics: drugs used to induce sleep + maintain good sleep (for short term use in insomia)

MoA: GAGA agonist- zopiclone, lorazepam, both benzodiazepine

114
Q

What are the two psych emergencies regarding chronic alcohol overuse

A

wernickes encephalopathy
korsakoffs pyschosis

115
Q

What is wernickes encephalopathy caused by, is it reversible, what areas of the brain does it affect, symptoms, investigation with results, and treatment

A

B1 thiamin deficiency due to chronic alcoholism (alcohol reduced thiamin absorption in body)
reversible
thalamus + hypothalamus
sx: nystagmus, ataxia, altered mental state
MRI: reversible cytotoxic odema
Tx: ABCDE then IV pabrinex 500mg TDS 3 days then 250mg for 5 days (pabrinex given immediately on suspicion of condition)

116
Q

What is korsakoff psychosis caused by, is it reversible, symptoms, investigation with results, and treatment

A

progression of wernickes encephalopathy
irreversible brain damage
wernicke’s symptoms plus confabulation
MRI: mammilary body and thalamic atrophy
Tx: oral pabrinex for 2 years

117
Q

What are the different types of delusions and explain each one 6

A
  1. nihallistic (belief that life has no meaning)
  2. persecutory (belief someone is trying to harm them)
  3. grandiose (mania sx where pt believes they have made important discover/ have great undiscovered talent)
  4. eromatic (belief that a celebrity is in love with them)
  5. jealous/ othello (believes partner is cheating)
  6. mixed (characteristics of multiple
118
Q

What does the mental health act 1983 entail

A

principles for individuals: least restriction to ensure pt safety and wellbeing and give the most effective treatment

for detaining: evidence of mental health incident, risk to society, whether they will benefit from admission and if there is availability of treatment

119
Q

Explain the difference between mental health act 1983 and mental capacity act 2005

A

MHA are the rights for individuals with MH problems that are sectioned under the act
MCA applied to individuals with a MH problem which assesses capacity to make decisions
The MHA can override the MCA and pts can be detained even if they have capacity

120
Q

Explain sections 2 and 3 in the mental health act 1983 and where is this relevant

A

2) section for 28 days for investigations for section 12, required by 2 drs and a social worker (AMHP). Non renewable

3) section for 6 months for Tx, required by 2 drs and a social worker (AMHP). Renewable 6 monthly

for community

121
Q

Explain section 5 in the mental health act 1983 and where is this relevant

A

5.2) 72 hour dr has holding power to wait for section 12 and AMHP

5.4) nurse holding power to wait for doctor

inpatient

122
Q

Explain section 135 and 136 in the mental health act 1983 and where is this relevant

A

135) Police have 24-36 hour pt admission to access home

136) Police have 24-36 hour pt admission with suspected mental health incident in public place

police in community

123
Q

What is the MoA of antipsychotics and how do they work

A

dopamine 2 receptor antagonist which affect mesolimbic pathway and therefore reduce positive symptoms

124
Q

What are two important things to note with taking antipsychotics: reviews and stopping

A
  1. have 12 monthly review of FBC, U/E, Hba1c, LFT, prolactin and BMI
  2. to stop, there needs to be a gradual reduction over a period of 3+ months to prevent relapse
125
Q

Give examples of typical antipsychotics, what generation and what are they associated with

A

haloperidol and chlorpromazine

1st generation (older)

extrapyramidal side effects (due to their effect inhibiting the nigrostriatal pathway)

126
Q

What are the extrapyramidal symptoms of typical antipsychotics 4 and their treatments

A

Parkinsonisms (bradykinesia, rigidity, resting tremor)
mx: levodopa

acute dystonia (inv contractions of muscles of extremities)
mx: IV/IMprocyclidine (anti Ach) and switch to 2nd gen antipsychotic

akathisia (severe restlessness)
mx: oral propanalol

tardive dyskinesia (inv movements of the face and jaw- occur years after)
mx: oral tetrabenazine (VMAT2 inh) and switch to 2nd gen antipsychotic if on one currently

127
Q

Give examples of atypical antipsychotics, what generation and what are they associated with

A

risperidone, olanzapine, aripiprazole, clozapine

2nd generation (newer)

metabolic syndromes: (cushings/T2DM/ hyperprolactinaemia) and weight gain

128
Q

Explain hyperplactiniaemia sx as a SE of atypical antipsych

A

Hyperprolactinaemia

Sx: lactation
decreased libido
infertility

129
Q

What is unique about aripiprazole

A

only forms a partial dopamine blockade so has reduced side effects

130
Q

What is the indication for clozapine and how is it monitored

A

last line, after trialling 2 different antipsychotics for treatment resistant schizophrenia

med reviews + monitoring:
* first 18 weeks, weekly
* then 16 weeks, every fortnight
* then monthly
* FBC, BP, BMI, checking for SE

131
Q

what are the SE of clozapine
what are the requirements for taking clozapine

A

agranulocutosis: sore throat, fever, mouth ulcers

general SE: CLOzapine
constipation, lots of saliva, overweight

need to retitrate if dose missed for over 48 hours or if smoking status changes (smoking increases metabolism which decreases bioavailability of clozapine)

132
Q

What is the only antipsychotic that has proven to treat negative symptoms and where does it act

A

clozapine
mesocortical pathway

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