psychiatry Flashcards
1
Q
What is an addictive behaviour?
A
repeated behaviours
that dominate the patient’s life to the detriment of social, occupational,
material and family values and commitments
2
Q
What is the mechanism of SSRIs?
A
inhibit the reuptake of serotonin from
presynaptic serotonin pumps
3
Q
What are SSRIs indicated in?
A
depression, anxiety, OCD, bulimia nervosa
4
Q
Give 5 examples of SSRIs
A
sertraline, fluoxetine, paroxetine, citalopram,
escitalopram
5
Q
which SSRI should be used in under 18s?
A
fluoxetine
6
Q
what are the side effects of SSRIs?
A
GI symptoms, anxiety/agitation, insomnia,
sweating, sex (anorgasmia)
associated with increased suicidality, can
cause hyponatraemia, cytochrome-mediated interactions
(fluoxetine)
7
Q
what can SSRI withdrawal cause?
A
dizziness, headache, tremor, agitation, GI issues ~
especially paroxetine and sertraline
8
Q
what is the mechanism of action of SNRIs?
A
presynaptic blockade of both noradrenaline and serotonin reuptake
pumps (in high doses also blocks dopamine reuptake); low effects on muscarinic,
histaminergic and alpha-adrenergic receptors.
9
Q
what are SNRIs indicated for use in?
A
depression and anxiety
10
Q
what are the side effects of SNRIs?
A
dizziness, dry mouth, constipation, hot flushes
11
Q
what is the mechanism of action of NaSSAs?(Noradrinergic and Specific Serotonergic Antidepressants)
A
presynaptic alpha2 blockage -> increased noradrenaline and
serotonin from presynaptic neurons; histamine antagonist
12
Q
give an example of an NaSSA
A
mirtazapine
13
Q
what are the side effects of NaSSAs?
A
sedation and weight gain (blocking histamine), headache, postural
hypotension, dizziness, tremor
14
Q
what is the mechanism of action of tricyclic antidepressants?
A
blockade of both noradrenaline and serotonin reuptake pumps (also
dopamine to a small extent). Muscarinic, histaminergic, alpha-adrenergic.
15
Q
give an example of a tricyclic antidepressant
A
amitryptyline
16
Q
what are tricyclic antidepressants indicated in?
A
depression, anxiety, OCD, chronic pain (much lower dose),
nocturnal enuresis
17
Q
when are tricyclic antidepressants contraindicated?
A
IHD, arrhythmias, severe liver disease, overdose risk
18
Q
what are the three main groups of side effect in tricyclic antidepressants?
A
anticholinergic
antiadrinergic
antihistaminergic
19
Q
what are anticholinergic effects?
A
dry mouth, constipation,
blurred vision, urinary retention
20
Q
what are antiadrinergic side effects?
A
postural hypotension, dizziness and syncope
21
Q
what are antihistaminergic side effects?
A
sedation and weight gain
22
Q
what are the cardiac side effects of tricyclic antidepressants?
A
prolonged QT, heart block, arrhythmias, palpitations
23
Q
what are the side effects of MAOIs?
A
risk of overdose
hypertensive crisis with cheese (high levels of tyramine)
24
Q
give 2 examples of MAOIs
A
isocarboxazid, phenelzine
25
what is lithium licensed for use in?
mania (acute/prophylaxis), treatment-resistant depression,
aggression and impulsivity, mood stabilisation
26
how is lithium metabolised and excreted?
renally- avoid NSAIDs, ACEi and diuretics
27
what baseline blood tests should be done before starting lithium?
FBC, U&E, Ca2+, PO4*3, thyroid, ECG, pregnancy
28
what are the ranges of lithium?
normal: 0.5-1
signs of toxicity: 1.5-2
signs of severe toxicity: >2
29
what are the side effects of lithium
polyuria, polydipsia, weight gain, oedema, fine tremor
serious side effects: coarse tremor, ECG changes, arrhythmias, nystagmus, dysarthria, brisk reflexes, impaired consciousness
teratogenic
30
what congenital abnormality does lithium cause?
Ebstein's anomaly- congenital malformation of tricuspid valve
31
what is sodium valproate indicated for?
mood stabiliser, anticonvulsive, migraine
32
what are the side effects of sodium valproate?
weight gain, dizziness, hair loss, n+v, tremor, deranged LFTs
33
what are benzodiazepines indicated for use in?
anxiety (short term in extreme cases only), mania, psychosis,
alcohol withdrawal, insomnia, acute agitation/aggression, epilepsy, acute back pain
34
what is the mechanism of action of benzodiazepines?
bind to GABA receptor -> neuronal inhibition
35
give some examples of benzodiazepines
lorazepam (short acting), diazepam (longer acting), midazolam, chlordiazepoxide
36
what are the cautions with benzodiazepines and when should they be avoided?
can be addictive if taken long term, resp and CNS depressant effects (so
check if other CNS depressants being taken eg xs alcohol or antipsychotics)
Avoid in neuro disease, severe resp disease
37
what are Z-drugs used for and what are some examples?
used to initiate sleep e.g. zopiclone
38
how do Z-drugs work?
stimulate GABA receptor
39
what are the risks with Z drugs?
similar to benzos, can become dependant, cautioned against in resp and neuro disease
40
what are antipsychotics indicated for use in?
psychosis, mania, depression, refractory anxiety, PTSD,
behavioural challenges in dementia, tourettes, rapid tranquilisation
41
what is the mechanism of typical antipsychotics and how do these lead to side effects?
antagonise D2 receptors involved in: mesolimbic (delusions and hallucinations), mesocortical (negative symptoms), substantia nigra (movement, blocking -> extrapyramidal side effects), tuberoinfundibular (prolactin secretion -> sexual function and libido), chemoreceptor trigger zone (n+v)
42
what are some examples of typical antipsychotics?
haloperidol, chlorpromazine, flupentixol
43
what is the mechanism of atypical antipsychotics and how does this lead to side effects?
block 5HT2 receptor ->
metabolic side effects (eg weight gain,
impaired glycaemic control, lipid elevation)
44
what are some examples of atypical antipsychotics?
risperidone, olanzapine, quetiapine,
aripiprazole, clozapine
45
what are the side effects associated with clozapine?
hypersalivation, constipation, myocarditis,
cardiomyopathy, neutropenia and
agranulocytosis!
46
give two possible oral substitution therapies for opiates
methadone and buprenorphine
47
what is methylphenidate used for?
ADHD management
48
how does methylphenidate work
inhibits reuptakes of dopamine and noradrenaline, increasing levels in synaptic cleft
49
what are he side effects of methyphenidate?
anxiety, inc BP, arrhythmias, appetite loss
50
when can a patient be detained?
They have a mental disorder that poses significant
risk to themselves or others, and treatment in the
community is not possible because of this.
51
which sections of the mental health act don't require a MHA?
Section 5(4) and section 5(2)
52
which sections of the mental health act require a MHA assessment?
Section 2 and 3
53
What is a section 5(4)?
MH Nurse HP: can stop psychiatric patient leaving a ward up to 6hrs to allow for assessment by a doctor
54
What is a section 5(2)?
Doctor HP: can stop a patient leaving any ward up to 72hrs to allow for MHA to be organised
55
What is a Section 2?
Power to detain for 28 days for assessment (and treatment)
56
What is a Section 3?
Power to detain for up to 6 months for treatment- patient has a right to appeal.
57
Who can perform a section 2 or 3?
Needs a mental health assessment- 1 AMHP and 2 Section-12-approved doctors
58
What is a section 136?
Police powers to take someone from a public place to a place of safety- if they believe they are mentally unwell.
59
What is a Section 135?
Police power to enter someone's property to take them to safety, if there is reason to believe mental illness is involved- power needs magistrate approval.
60
what is a Section 4?
Emergency detainment for 72 hours, needs 1 doctor and 1 AMHP
61
what evidence is needed for a Section 4?
1.Mental disorder present
2.For patient’s safety or protection of others
3.Not enough time for 2nd doctor to attend
62
what are the criteria for dependance?
1. a strong desire or compulsion to take the substance
2. difficulty controlling substance taking behaviour
3. a physiological withdrawal state
4. evidence of tolerance
5. progressive neglect of other pleasures
6. persisting with misuse despite harmful consequences
3+ must have been present together in the last year
63
What medication can be given to ease symptoms of alcohol withdrawal?
Chlordiazepoxide 20-40mg QDS over the first few days
Oxazepam in patients with hepatic impairment/ elderly
64
what can Naltrexone be used for?
its an opiate blocker that makes alcohol less enjoyable.
side effects: nausea and vomiting, decreased appetite, pain at injection site, increased liver enzymes
CI in opiate use and liver failure
65
what can acamprosate be used for?
increases GABA, decreases excitatory glutamate which reduces cravings.
Good side effect profile and well tolerated.
66
what does Disulfiram do?
inhibits acetaldehyde dehydrogenase which causes accumulation of acetaldehyde with alcohol.
this causes unpleasant symptoms such as flushing, sweating, headache nausea and vomiting, arrhythmias and hypotensive collapse.
67
what cautions should patients get when staring disulfiram?
Avoid alcohol 24 hours before starting and 1 week after stopping drug.
Avoid all contact with alcohol (e.g. sanitiser etc) when on drug.
68
Who is disulfiram contraindicated in?
patients with heart disease, psychosis, and those at high risk of suicide
69
What withdrawal symptoms could be expected 6-12 hours from alcohol cessation?
tremors and autonomic arousal (tachycardia, fever, pupillary dilation, increased sweating)
70
What withdrawal symptoms could be expected 12-48 hours from alcohol cessation?
alcohol hallucinosis (usually auditory or tactile)
71
What withdrawal symptoms could be expected 72-96 hours from alcohol cessation?
delirium tremens- altered mental status, agitation and tactile hallucinations.
72
What is Wernicke-Korsakoff syndrome?
Alcohol prevents absorption of thiamine, causing deficiency.
Wernicke encephalopathy= ataxia, confusion and opthalmoplegia.
Korsakoff= Wernicke + short-term memory loss and hallucinations.
73
what is the treatment (+prevention) of Wernicke-Korsakoff syndrome?
IV Thiamine (e.g. pabrinex)
74
What are the physiological effects of opioids?
euphoria, reduced pain, sedation, respiratory depression, miosis, constipation, skin warmth and flushing
75
what are the psychological effects of opioid use?
apathy, disinhibition, drowsiness, impaired judgment and attention, slurred speech
76
what can opioid withdrawal cause?
increased sympathetic nervous system activity causes rhinorrhoea, lacrimation, diarrhoea, pupillary dilation, piloerection, tachycardia, and hypertension.
77
what is a personality disorder?
An enduring long-term pattern of inner experience and behaviour
that deviates markedly from cultural expectations (of the individual) and
leads to significant distress or impairment to self or others.
78
Which disorders come into the Cluster A group?
Paranoid, Schizoid, Schizotypal
79
What are the risk factors for personality disorder?
Socioeconomic status, positive family history, poor parenting,
attachment issues in childhood, childhood abuse/neglect/deprivation.
80
Which disorders come into the Cluster B group?
Antisocial, EUPD, Histrionic and Narcissistic
81
Which disorders come into the Cluster C group?
Avoidant, Dependant, OCD (anankastic)
82
What is anxiety?
a subjective, unpleasant sense of unease and worry of something bad happening
83
what is generalized anxiety disorder?
Generalised anxiety disorder (GAD) is a mental health condition that causes excessive and disproportional anxiety and worry that negatively impacts the person’s everyday activity. Symptoms should be persistent, occurring most days for at least six months, and not caused by substance use or another condition.
84
what are the secondary causes of anxiety?
Substance use (e.g., caffeine, stimulants, bronchodilators and cocaine)
Substance withdrawal (e.g., alcohol or benzodiazepine withdrawal)
Hyperthyroidism
Phaeochromocytoma
Cushing’s disease
85
what scoring system is used to assess anxiety and what are the boundaries?
Generalised Anxiety Disorder Questionnaire (GAD-7)
5-9 indicates mild anxiety
10-14 indicates moderate anxiety
15-21 indicates severe anxiety
86
how can mild anxiety be managed?
Mild anxiety may be managed with active monitoring and advice about self-help strategies (e.g., meditation), sleep, diet, exercise and avoiding alcohol, caffeine and drugs.
87
How can moderate/ severe anxiety be managed?
Cognitive behavioural therapy
Medication
88
what is the first line medication for GAD and panic attacks?
SSRIs (particularly sertraline)
other options: SNRIs (e.g. venlafaxine) and pregabalin
89
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is at the extreme end of “hyperactivity” and inability to concentrate (“attention deficit“). It affects the person’s ability to carry out everyday tasks, develop normal skills and perform well in school.
90
what are the features of ADHD? (6)
Very short attention span
Quickly moving from one activity to another
Quickly losing interest in a task and not being able to persist with challenging tasks
Constantly moving or fidgeting
Impulsive behaviour
Disruptive or rule breaking
91
what is the management of ADHD?
establishing a healthy diet and exercise
a food diary can help identify triggering food
medication
92
what medications can be used in ADHD?
Methylphenidate (“Ritalin“)
Dexamfetamine
Atomoxetine
93
what are the three categories of features of autism?
social interaction, communication and behaviour
94
what are the features of autism that affect social
interaction?
Lack of eye contact
Delay in smiling
Avoids physical contact
Unable to read non-verbal cues
Difficulty establishing friendships
Not displaying a desire to share attention (i.e. not playing with others)
95
what are the features of autism that affect communication?
Delay, absence or regression in language development
Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interest
Difficulty with imaginative or imitative behaviour
Repetitive use of words or phrases
96
what are the features of autism that affect behaviour?
Greater interest in objects, numbers or patterns than people
Stereotypical repetitive movements. There may be self-stimulating movements that are used to comfort themselves, such as hand-flapping or rocking.
Intensive and deep interests that are persistent and rigid
Repetitive behaviour and fixed routines
Anxiety and distress with experiences outside their normal routine
Extremely restricted food preferences
97
who would be involved in the management of autism?
Child psychology and child and adolescent psychiatry (CAMHS)
Speech and language specialists
Dietician
Paediatrician
Social workers
Specially trained educators and special school environments
Charities such as the national autistic society
98
what are obsessions?
Obsessions are unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore.
99
What are compulsions?
Compulsions are repetitive actions the person feels they must do, generating anxiety if they are not done. Often, these compulsions are a way for the person to handle their obsessions.
100
what is the OCD cycle?
Obsessions
Anxiety
Compulsion
Temporary relief
101
what scale can be used to assess the severity of OCD symptoms?
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
102
what treatment can be used for mild OCD?
education and self help resources
103
what treatment can be used for more significant OCD?
Cognitive behavioural therapy (CBT) with exposure and response prevention (ERP)
SSRIs
Clomipramine (a tricyclic antidepressant)
104
what is PTSD?
Post-traumatic stress disorder (PTSD) is a relatively common mental health condition resulting from traumatic experiences, with ongoing distressing symptoms and impaired function.
105
what are the symptoms of PTSD?
Intrusive thoughts relating to the event
Re-experiencing (experiencing flashbacks, images, sensations and nightmares of the event)
Hyperarousal (feeling on edge, irritable and easily startled)
Avoidance of triggers that remind them of the event (e.g., people, places or talking about the event)
Negative emotions (e.g., fear, anger, guilt or worthlessness)
Negative beliefs (e.g., the world is dangerous)
Difficulty with sleep
Depersonalisation (feeling separated or detached)
Derealisation (feeling the world around them is not real)
Emotional numbing (unable to experience feelings)
106
what screening tool can be used for PTSD?
The Trauma Screening Questionnaire (TSQ)
107
what are the management options for PTSD?
Psychological therapy (e.g., trauma-focused CBT)
Eye movement desensitisation and reprocessing (EMDR)
Medication (e.g., SSRIs, venlafaxine or antipsychotics)
108
