Psychiatry Flashcards by jenn martin

Genetics, Age (15-35), FHx and childhood abuse are all risk factors for the development of schizophrenia, name 5 more.

Neurochemical imbalances
Neurodevelopmental issues (obstetric complications)
Extremes of parental age (<20 or >35)
Substance misuse
Low socioecocomic background

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3rd person auditory hallucinations and passivity phenomenon are two of Schneider’s first rank sx, name 2 others.

Delusions (bizarre often paranoid and persecutory)
Thought interference (withdrawal, broadcasting and insertion).

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Avolition, alogia and attention deficit are 3 negative symptoms of schizophrenia, name 3 more.

Antisocial
Affect blunted
Anhedonia
(Catatonia)

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Gradual onset and low IQ are 2 poor prognostic factors for schizophrenia, name 3 more.

No obvious precipitant
Strong family history
Premorbid withdrawal

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Paranoid, undifferentiated and Hebephrenic are 3 types of schizophrenia, name 4 more.

Simple
Catatonic
Post-schizophrenic depression
Residual

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Negative symptoms and catatonia are 2 group B symptoms of schizophrenia, name 2 more.

Hallucinations of other modalities (not 3rd person auditory)
Thought disorganisation (neologisms, loosening of associations).

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How should a person with schizophrenia be managed?

Bio-Pscyho-Social Model
Bio:
- Antipsychotic medication, firstline = atypical antipsychotics.
- Clozapine for treatment resistant (previous 2 antipsychotics were not successful).
- Adjuvants: mood stabilisers (lithium) or antidepressants.
- ECT (catatonic)
Psycho:
- CBT
- Family intervention
- Art therapy
- Social skills building
Social:
- Support groups
- Peer support
- Support with employment

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Haloperidol and Chlorpromazine are 2 typical antipsychotics, name 3 more.

Flupentixol
Sulpiride
Fluphenazine

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Olanzapine and Quetiapine are 2 atypical antipsychotics, name 4 more.

Risperidone
Amisulpiride
Aripiprazole
Clozapine

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Dystonias and Parkinsonism are 2 side effects of typical antipsychotics, name 2 more.

Akasthisia
Tardive dyskinesia

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Weight gain and hypercholesterolaemia are 2 side effects of atypical antipsychotics, name 4 more.

Visual disturbance
Urinary retention
Dry mouth
Constipation

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Which typical antipsychotic is associated with QT prolongation?

Haloperidol

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Which side effects are specific to clozapine and what monitoring is needed?

Hypersalivation
Agranulocytosis

Differential WBC monitoring weekly for 18 weeks, then fornightly up to one year and then monthly whilst taking clozpine.

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FBC, U+Es, LFTs and blood glucose need monitoring for patients taking antipsychotics, name 6 more things that must be monitored for these patients (and when they should be monitored).

ECG - before initiation
Lipids - before intiation, at 3 months and then yearly.
Blood pressure - before intiation and frequently during titration of doses.
Prolactin - before initiation, at 6 months and then yearly.
Weight - before initiation, frequently for 3 months and then yearly.
Creatine Phosphokinase - before initiation and then if NML is suspected.

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Genetics, personality type and divorce are 3 risk factors for developing generalised anxiety disorder, name 3 more.

Childhood upbringing
Living alone/Single parenting
Low socioeconomic status

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What investigations would you do for a patient presenting with GAD?

Bedside:
- bloods: FBC (anaemia and infection), TFTs (hyperthyroidism), glucose (hypoglycaemia).
- ECG: sinus tachy or arrhythmias
- Questionnaires: GAD-2, GAD-7 and Beck’s anxiety inventory

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What are the psychiatric differenitals for GAD?

Other neurotic disorders
Depression
Schizophrenia
Personality disorders

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What are the organic differentials for GAD?

High caffeine or alcohol intake
Withdrawal from drugs
Anaemia
Hyperthyroidism
Phaeochromocytoma
Hypoglycaemia

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What is the medication pathway for GAD?

SSRI -> SNRI -> pregablin
Benzodiazepines should not be used unless this is for short-term measures during crises.

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Family history and low socioecomic status are 2 risk factors for personality disorders, name 2 more.

Dysfunctional family - poor parenting or parental deprivation.
Abuse during childhood - physical, sexual (particularly eupd) and emotional.

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What are the cluster A personality disorders?

Paranoid
Schizoid

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What are the cluster B personality disorders?

Emotionally unstable
Dissocial
Histrionic

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What are the cluster C personality disorders?

Avoidant
Dependent
Anankastic (obsessional)

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What is the biological management for personality disorders?

Atypical antipsychotics
Mood stabilisers (eupd)
Small role for SSRIs

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Which form of therapy is most appropriate for a patient with eupd?

Dialectical behavioural therapy

Amitriptyline, clomipramine and nortriptyline are 3 tricylic antidepressants, name 4 more.

Dosulepin Doxepin Imipramine Lofepramine

TCAs are indicated in depressive disorders, name 3 other indications.

Nocturnal enuresis in children, neuropathic pain and migraine prophylaxis.

Dry mouth, constipation, urinary retention and blurred vision are 4 side effects of TCAs, name 5 more.

Arrhythmias Postural hypotension Urticaria Hypomania Increased appetite and weight gain.

Cardiac disease, pregnancy, breast-feeding and hepatic impairment are 4 reasons for caution with TCAs, name 4 more.

History of epilepsy Thyroid disease Phaeochromocytoma History of mania

Recent MI and arrhythmias are 2 contraindications for TCAs, name 2 more.

Agranulocytosis Severe liver disease

What features must obsessions and compulsions have for a diagnosis of OCD?

Failure to resist Originate from the patient's mind Repetitve and distressing Carrying out the obsessive thought is not pleasurable but reduces anxiety levels.

What are the potential differentials for OCD?

Obsessions and Compulsions: - Eating disorders - Anankastic PD - Body dysmorphia Primarily Obsessions: - Anxiety - Depression - Schizophrenia - Hypochondrial Primarily Complusions: - Tourette's syndrome - Kleptomania Organic: - Head injury - Dementia - Epilepsy

What is the bio-pyscho-social management for OCD? Then the order of the treatments.

Bio: SSRIs, TCAs. Addition of antipyschotic in some cases. Treatment of co-morbid depression. Psycho: CBT (ERP), psychoeducation. Social: Self-help books. Mild: CBT Moderate: CBT or SSRI Severe: CBT + SSRI

Citalopram, Fluoextine and sertraline are 3 SSRIs, name 3 more.

Paroxetine Escitalopram Fluvoxamine

Depression, Panic disorder, GAD and OCD are 3 indications for the use of SSRIs, name 3 more.

Bulimia nervosa Social phobia PTSD

Nausea, dyspepsia, diarrhoea and constipation are 4 side effects of SSRIs, name 4 more.

Sweating Tremor Rashes Sexual dysfunction

For what condition are SSRIs contraindicated?

Mania

How long should SSRIs be gradually reduced before stopping?

4 weeks

How long should patients be advised to continue taking SSRIs for after they begin to feel the benefits?

6 months

Early twenties, anxiety disorders and strong family history are 3 risk factors for Bipolar disorder, name 3 more.

Substance misuse Stressful life events Depression

What is bipolar 1 vs bipolar 2?

1. Mania + depression 2. Hypomania + severe depression

What is the treatment for an acute manic episode?

Antipsychotic (faster acting) Mood stabiliser (lithium) Benzodiazepines (sleep and reduce agitation) Rapid tranquilisation with haloperidol or lorazepam (violent)

What is the treatment of a bipolar depressive episode?

STOP antidepressants Atypical antipsychotic - olanzapine or quetiapine Mood stabiliser (lamotrigene)

What is the longterm management of bipolar?

Lithium firstline 4 weeks after acute episode. If lithium ineffective consider addition of valproate, olanzapine or quetiapine.

Bipolar disorder is an indication for the use of lithium, name 2 more indications.

Acute manic episode (if antipsychotic ineffective) Depression (prevent antidepressant-induced hypomania)

Gi disturbances, fine tremor, polydypsia and polyuria are 4 of the side effects of lithium, name 7 more.

Leucocytosis Impaired renal function Teratogenic Hypothyroidism Hair loss Increased weight Fluid retention Metallic taste

A coarse tremor and decreased consciousness are two of the symptoms of lithium toxicity, name 7 more.

Oligouria Ataxia Increased reflexes Coma Convulsions Nystagmus Hypotension

What is the therapeutic range for lithium?

0.4-1mmol/L

When does lithium begin to become toxic?

>1.5mmol/L >2mmol/L (severely toxic)

What should be checked before initiating a patient on lithium?

U+Es and EGFR (renallly excreted and can cause renal impairment). Pregnancy test (teratogenic) - advise contraception. Baseline ECG (QT prolongation)

How often should lithium levels be checked once a patient is on a stable therapeutic dose?

Every 3 months.

How often should U+Es and TFTs be monitored for a patient on lithium?

U+Es every 6 months TFTs every 12 months

How long must a patient be on lithium to see a clear benefit?

At least 18 months.

When is lithium normally taken?

At night - makes testing the levels 12 hours after the dose change more convinient for the patient.

What is the minimum length of time that sx need to be present in order for a diagnosis of PTSD to be made?

4 weeks

Which drugs should not be prescribed with SSRIs as they can precipitate serotonnin syndrome when taken together?

Triptans Monoamine Oxidase Inhibitors

What are the four cardinal features of PTSD?

Avoidance Reliving Emotional numbing Hyperarousal

How long must sx persist for it to be classed as PTSD? What timeframe must these sx occur?

4 weeks Within 6 months

What is the mx of PTSD for sx present within 3 months of trauma?

Watchful waiting sx lasting <4 weeks Trauma focused CBT once a week 8-12 weeks Short term drug treatment for sleep disturbance Risk assessment

What is the mx of PTSD for sx present for more than 3 months following trauma?

Trauma focused psychological intervention - CBT - Eye movement desensitisation and reprocessing Drug treatment considered when little benefit from psychological therapies, patient preference or co-morbid depression/severe hyperarousal.

What medications are licensed for treatment of PTSD?

Paroxetine Mirtazapine Amitriptyline Phenelzine

SSRIs are one of the causes of serotonin syndrome, name 3 other drugs that can cause serotonin syndrome.

Monoamine oxidase inhibitors Amphetamines Ectasy

Hyperreflexia, confusion and sweating can be features of serotonin syndrome, name 3 more.

Hypoclonus Rigidity Hypothermia

What is the mx of serotonin syndrome?

IV fluids Benzodiazepines Serotonin antagonists - cyproheptadine and chlorpromazine

How long after his first drink does delirium tremens start?

48-72 hours

What medication can be used to treat moderate-severe tardive dyskinesia?

Tetrabenazine

What is the difference between circumstantiality and tangentiality?

circumstantiality - return to the question tangentiality - do not return to the question

When do the seizures typically begin after acute alcohol withdrawal?

36 hours.

Is Paraoxetine safe in pregnancy?

No, increases the risk of congenital malformations.

What are the features associated with Korsakoff's syndrome?

Anterograde amnesia, retrograde amnesia, and confabulation

What is the risk of using SSRIs in the first trimester?

Small risk of congenital heart defects

What needs to be monitored before starting SNRIs?

Blood pressure

GI upset and mood change are two of the sx of discontinuation syndrome associated with SSRIs, name 5 more.

Dizziness Electric shock sensations Restlessness Difficulty sleeping Sweating