Psychiatry Flashcards
1
Q
What drugs are approved by NICE that can be used in the treatment for alcohol dependence to prevent relapses?
A
Acamprosate
Disulfiram
Naltrexone
2
Q
What personality disorder may display magical thinking?
A
Schizotypal PD
3
Q
What are the side effects of TCAs?
A
Have anti-muscuranic properties- ‘can’t see, can’t wee, can’t spit, can’t shit’
Dry mouth
Urinary retention
Blurry vision
COnstipation
4
Q
What is the Rx tx of GAD?
A
1st line- SSRI (sertraline), or SSNRI (Venlafaxine/duloxetine)
Tx of somatic symptoms- Propranolol
5
Q
List the prominent features of schizoid personality disorder?
A
The absence of close friends
Minimal contact with other people, including family
Insensitivity to social norms
Flattened affect
6
Q
Demonstrate the key features of Histrionic personality disorder?
A
Excessiev displays of emotion
Attention seeking behaviours
Sexually inappropriate
May consider relationships more intimate than they really are
7
Q
What is a somatic delusional belief?
A
This type of delusion relates to bodily function or bodily sensations. Often these patients are convinced there is something wrong with them and will focus on symptoms to a level that results in extreme distress and disrupts day to day living
8
Q
Within how many months of having a baby is Postpartum depression diagnosed?
A
Within 12 months of giving birth
9
Q
What is the first line pharmacological therpy for alzheimer’s disease?
A
AChE inhibitor- e.g. Donepezil, Galantamine, Rivastigmine
10
Q
What are the SE of AChE inhibitors?
A
Diarrhoea, Nausea, Vomiting, Bradycardia, Urinary incontinence, Increaved salivary production
11
Q
What is treatment-resistant schizophrenia (TRS) and what is its management?
A
TRS is a schizophrenia that does not repsond to 2 consecutive trials of antipsychotics
Tx- Clozapine
12
Q
What is the 1st line pharmacological tx of schizophrenia?
A
Oral atypical antipsychotics e.g. Risperidone
13
Q
Why are atypical antipsychotics preffered over typical antipsychotics?
A
Because typical antipsychotics e.g. Haloperidol have an increased risk of extr-pyrmaidal side effects
Extrapyramidal side effects:
Akathisia-refers to a feeling of restlessness and an irresistible urge to move
Dystonia- Involves involuntary muscle contractions that cause repetitive or twisting movements
Parkinsonism- Common symptoms include muscle stiffness, tremors or shaking, bradykinesia (slowness of movement), and a shuffling gait.
Tardive dyskinesia-repetitive, involuntary, and abnormal movements, such as lip smacking, tongue protrusion, grimacing, or jerking movements of the limbs.
14
Q
What is cotard delusion?
A
Patients believes they are dead or have had organs removed
15
Q
What are the features of delirium tremens?
A
Confusion
Hallucinations (particularly visual and tactile- insects crawling)
Sweating
Hypertnsion
Seizures (rare)
16
Q
Which type of dementia is described as a ‘stepwise deterioration’?
A
Vascular
17
Q
What is a section 5(2)?
A
An emergency holding order that can be implemented by hopsital doctor to keep patient in hospital when they are trying to leave.
Can last upto 72hours
18
Q
REMOVE CARD What is a characteristic feature of the illness which develops after any viral illness or vacicnation?
A
Demyelination
19
Q
Name a differential diagnosis in young people or adults presenting with an acute onset of new neurological or psychiatric symptoms without a past context of mental health problems?
A
Autoimmune encephalitis
20
Q
A) What is the first line Rx tretament for OCD?
B) What is the alternative tx?
A
A) Sertraline
B) Clomipramine (TCA)
21
Q
What are the features of neuroleptic malignant syndrome?
A
Confusion
Diaphoreiss
Lead pipe Rigidity **
Hyporeflexia **
hyperthermia
Pyrexia
Tachycardia/Tachypnoea
High blood pressure
22
Q
What is a complication of claozapine?
A
Agranulocytosis
23
Q
What is the the most appropriate managemnt steps in patient who presents with GAD?
A
CBT must be trailled in all patients before moving to Rx treatment
24
Q
What is De Clerambault’s syndrome?
A
Delusional disorder in which patient has a false belief that soemone in a higher position is in love with them
25
What appropriate parameter should be monitored after starting a patient on a SNRI?
Blood pressure (venlafaxine can ause high HR and BP)
26
What are schneider's first rank symptoms of schizophrenia?
Third person Auditory hallucinations
Thought disorder
Passivity phenomena (bodily sensations being controlled by external influence)
Delusional perceptions
27
What are the fetatures of avoidant personality disorder?
Fearful of criticism,
Being unliked,
Rejection
Ridicule
28
What factors are asscoaited with a poor prognosis of schizophrenia?
Strong family Hx
Gradual Onet
Low IQ
Prodromol phase of social withdrawal
Lack of obivious precipitant
29
What is facticious disorder?
AKA Munchausen's syndrome
The individual wishes to adopt the sick role in order to receive the care of a patient, for internal emotional gain
30
What is malingering?
Patient seeks advantageous consequences of being diagnosed with a medical condition. For instance, evading criminal prosecution or receiving government
31
What triad is associated with wernicke's encephalopathy?
Confusion
Ataxia
Opthalmoplegia
32
What are the features of Korsakoff's syndrome?
Anterograde amnesia
Retrograde amnesia
Confabulation- a patient unconsciously makes up stories to fill a gap in their memory
33
What is the guidelines regarding the usage of sertraline in pregnancy?
Shoudl weigh up the benefits and risk, however usage of sertraline in the 1st trimester gives a small increased risk of congenitak heart defects
34
What 'deterrent medication' used for alcohol detox when taken daily will cause vomiting when consuming alcohol?
Disulfiram (Antebuse)
35
What is the effects of acamprosate usage in alcohol detoxification?
Anti craving medication
36
What is the MOA of benzodiazepines?
Enhances the effect of GABA by increasing the frequency of chloride channels.
37
What is the treatment given to patients who have had a BZD overdose?
Flumazenil
38
What is clang asssociations?
A thought disorder characterised by ideas related only by rhyme or being similar sounding
39
1st line rx tx for PTSD
SNRI (venlafaxine), or SSRI (Sertraline)
40
What class of drugs should be avoided in patients taking a SSRIs?
Triptans
41
Where in the digestive system is the majority of alcohol consumed absorbed
The proximal small intestine
42
Which investigation/s should be performed before starting patient on lithium?
Thyroid function
43
What is Charles-Bonnet syndrome?
syndrome characteriesed by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment
44
What is the differece between mania and hypomania?
Hypomania is characterised by elevated mood, pressured speech and flight of ideas but without psychotic symptoms
Mania generally lasts for longer than 7 days and is more severe than an episode of hypomania. It can present with all the same symptoms as hypomania but also includes symptoms of psychosis such as hallucinations or delusions
45
What are the physiological abnormalities in a patient suffering form anorexia nervosa?
Hypokalaemia
Long QT syndrome
Low FSH, LH, oestrogen and Testosterone
Raised cortisol and growth hormone
Impaired glucose tolerance
Hypercholaestrameia
Hpercarotinaemia
Low T3
46
What additional medication should be prescribed to a patient taking an NSAID and SSRI?
A PPI e.g omeprazole becuase SSRI+NSAID increase riks of GI bleeds
47
What is the strongest risk factors for psychotic disorders?
Family History
48
Side effects of TCAs?
Dry Mouth
Weight Gain
Mydriasis
Blurred vision
Urinary retention
49
What is a characteristic side effect of Mirtazapine?
Increased appetite and Sedation
50
What are the different domains you are assessing in an MSE?
Appearance and behaviour
Speech
Mood and affect
Thoughts, delusions and hallucinations
Perceptions
Insights and judgement
Risk
51
What are the 3 characteristics of ADHD?
Impulsivity,
Hyperactivity
Inattention
52
What is the typical characteristics in ASD?
Impairment in
- social interactions
- communication
- repetitive/sterotyped behaviour, interests and activities
53
What are the features of anorexia nervosa?
Most things are low (FSH, LH, Potassium etc.)
Gs and Cs high (glucose, growth hormone, salivary glands, cortisol, cholesterol, caotinaemia)
54
Which instances is ECT recommended in according to NICE
Electroconvulsive therapy
E- Euphoria (MANIA)
C- Catatonia
T - Treatment resistnt depression
55
What parameter must be monitored when patient is on Venfalaxine?
BP as SNRIs are associated with HTN
56
What parameter must be monitored when using SSRIs?
Observe U&Es for hyponatraemia- check sodium levels 2-4 weeks prior and 3 months after starting
57
What parameters must be observed in the use of citalopram (SSRI)?
ECG monitoring and QT interval- at risk of long QT syndrome (Torsade de pointes)
58
What is cotards syndrome?
Person believes that they are or part of them are dead/non existent
59
What is Capgras delusion?
Irrational delusion of misidentification where patient believes relative/friend have been replaced by an identical impostor
60
What is de clerambaults delusion?
Patient believes another individual is infatuated with them
AKA erotomania
61
Name the extrapyramidal Sx that are associated with typical antipsychotic use?
Typical antipsychotics- haloperidol, chlorpromazine
Parkinsonism
Acute Daytonia
Akathisisa (severe restlessness)
Tardive dyskinesia
62
ASD has several associations, what are they?
ADHD
Epilepsy
Higher head circumference to brain volume ratio
63
What age is it appropriate to start Ritalin or any medication in children with ADHD?
Children must be older than 5
64
What is the triad that must be present in order to diagnose someone with a learning disability?
Low intellectual performance
Onset at birth or during early childhood
Wide range of functional impairment
65
What is the depression classification used by NICE 2022?
Less severe- PHQ-9 score of <16
More severe- PHQ-9 score of >16
66
What are the side effects associated with atypical antipsychotics?
Weight gain
Hyperprolactinaemia-lless common
impaired gluycaemic control
Dyslipidaemia
67
What is conversion disorder?
Neurological Sx presenting after a period of stress
68
What is factitious disorder?
Aka Munchausens
Feigning Sx in order to receive compassion from healthcare professional
69
What is malingering?
Fraudulent stimulation/exaggeration of Sx with intention of financial or other gain
70
What is somatisation disorder?
Multiple, recurring and frequently changing presenting complaint >2 years
71
What is echolalia?
Repetition of someone else's speech including questions being asked
72
What is neologism?
Formation of new words
73
What is perseveration?
Ideas and words repeated several times
74
What is clang association?
Uses words that rhyme with each other/sound similar
75
What is circumstantiality?
Gives excess or unnecessary detail but returns back to topic
76
What is tangentiality?
Wondering off topic WITHOUT returning back to topic
77
What is word salad?
Incoherent speech where real words strung along into nonsense
78
What is flight of ideas?
Feature of mania
Leaps from one topic to another with discernible link
79
What is knights move?
Feature of schizophrenia
Severe type of loosening associations where unexpected and illogical leaps from one idea to another
80
What are the 3 core symptoms of depression
Anhedonia
Anergia
Low mood
81
What is the choice of SSRI in adolescents and children?
Fluoxetine
82
What is acute dystonia?
An extra pyramidal se of typical antipsychotics
Acute dystonia- sustained muscle contraction. Should be managed with PROCYCLIDINE
83
What is the tetrad associated with neuroleptic malignant syndrome?
Hyperthermia
Muscle rigidity
Autonomic instability
Altered mental status
84
List 3 short term se of ECT?
Headaches
Nausea
Short term memory impairment
Cardiac arrhythmias
85
List 5 signs of alcohol dependence?
Cravings
Narrowed repertoire
Increased tolerance
Loss of control
Primacy
Rapid re-instatement
86
What are the invetsigations that can be done to show alcohol intoxication/dependence?
*GGT*, AST, ALT levels
Carbohydrate deficient transferrin (CDT)
87
Formulation: what are the 5 P's?
Presenting problem.
Predisposing factors.
Precipitating factors.
Perpetuation factors.
Protective factors.
88
Define illusion.
A misperception of real external stimuli.
89
What is a hallucination?
Perceptions occurring in the absence of an external physical stimulus. Can be auditory, visual or olfactory.
90
Define delusion.
A fixed false belief which is firmly held despite evidence to the contrary and goes against individuals normal and cultural belief system
91
Thoughts are a common psychiatric sign. Name 5 types of thoughts patients may report/describe.
Thought insertion.
Thought withdrawal.
Thought broadcast.
Thought echo.
Thought block.
92
List 3 positive and 3 negative sx of schizophrenia?
Positive:
-Third person auditory hallucinations
-Delusional perceptions
-Thought dsorders
-Passivity phenomenon
Negative:
-Alogia (poverty of speech)
-Anhedonia
-Avolition (poor motivation)
-Neologisms
-Incongruity/Blunting of affect
93
List the 5 factors of schizophrenia that are associated with a poor prognosis
1. Low IQ
2. Strong FHx
3. Gradual onset
4. Prodromal phase of social withdrawal
5. Lack of obvious percipitant
94
What is the 1st line mx of schizoprenia?
Oral atypical antipsychotic e.g. Risperidone, Clozapine(preffered in young people and children)
95
Give 3 signs/symptoms of mania.
Pressured speech.
Lots of projects/things going on.
Delusions.
Increased energy/activity.
Overfamiliarity.
Impulsivity.
96
Give 3 symptoms often seen in bipolar disorder.
Increased energy.
Pressured speech.
Recklessness.
Impaired judgement.
Inflated self-esteem.
Elevated mood.
97
Give 2 examples of affective disorders.
Bipolar disorder
Depression
98
List the cluster A personality disorders.
Paranoid
Schizoid
Scizotypal
99
List the cluster B personality disorders.
Antisocial
Borderline (EUPD)
Histrionic
Narcissitic
100
List the cluster C personality disorders
Avoidant
Obsessive compulsive
Dependent
101
What is the GS mx of EUPD?
Dialectical Behavioural Therapy (DBT)
102
Presentation: describe incongruity of affect.
A Emotional responses that seem grossly out of tune with the situation or subject being discussed.
103
Presentation: what is blunting of affect?
An absence of normal emotional responses.
104
Presentation: what is depersonalisation?
Feelings of detachment from one’s own body; the patient feels like a spectator of his own activities.
105
What is confabulation?
Giving a false account to fill a gap in memory. This is often seen in dementia patients.
106
What are the essential diagnostic features of a personality disorder?
1. Impairments in self and interpersonal functioning.
2. Impairments in personality functioning.
3. Impairments are relatively stable across time and consistent across situations.
107
What is somatisation disorder?
- multiple physical SYMPTOMS present for at least 2 years
- patient refuses to accept reassurance or negative test results
108
What is illness anxiety disorder?
AKA Hypochondriasis
- Persistent belief in the presence of undelrying serious disease.
- Patient refuses to accept reassurance or negative test results
109
What is anorexia nervosa?
An eating disorder characterised by restrivction of caloric intake leading to
- low body weight (BMI <17.5)
- an intense fear of gaining weight
- body image disturbance
110
What BMI/percentile is indicative of anorexia?
<17.5 in adults
and under 5th percentile in children and adolescents
111
Give 5 signs/symptoms of anorexia?
Languno hair
Amenorrhoea
Low body weight
Hypotension
Enalrged salivary glands
Bradycardia
112
List 5 phsyiological abnormlaities present in a patient with anorexia
hypokalaemia
low FSH, LH, oestrogens and testosterone
impaired glucose tolerance
low T3
raised cortisol and growth hormone
hypercholesterolaemia
hypercarotinaemia
113
What is Bullimia nervosa?
an eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours
114
List 5 signs/sx of bulimia
Russell's sign- scarring on knuckles
Parotid gland swelling
Dental erosison
Purging
Binge eating
115
What is suicide?
A fatal act of self harm initiated with the intention of endings one's own life
116
List 5 risk factors of suicide?
Lack of social support
depression
male
occupation
mental health diorder
Alcohol use
Recent life crisis
117
List 4 protective factors of suicide?
children
pregnancy
religion
fear of act of sucide
118
What is catatonia
Abnormality of tone, posture or movement arising from a disturbed mental state, typically
schizophrenia. Can be excessive or decreased motor activity.
119
What principles underly the Mental Health Act?
1. Respect for patients’ wishes and feelings.
2. Minimise restrictions on liberty.
3. Public safety.
4. Patient well-being and safety,
5. Involving patients in planning, developing and delivering care.
120
What is the main investigative screening tool used for dementia?
ACE-III screening tool
AMT-10.
121
Dementia: what 5 cognitive domains does the ACE-III screening tool assess?
Attention.
Memory.
Fluency.
Language.
Visiospatial.
122
What drugs can be used in the treatment of dementia?
Acetylcholinesterase inhibitors e.g. Donepezil, Rivastigimine.
NMDA antagonist e.g. Memantine.
RF reduction in vascular dementia is important too.
123
Give one way that you could distinguish between pseudo-dementia and dementia.
Patients with pseudo-dementia will use ‘don’t know’ answers whereas those with dementia will make up answers - confabulation.
124
What is pseudo-dementia?
Cognitive impairments secondary to a mental illness e.g. depression/anxiety.
125
What is delirium?
Delirium is an acute fluctuating change in mental status, with inattention, disorganised thinking and altered levels of conciousness
126
Give 3 causes of delirium.
Infection e.g. UTI.
Dehydration.
Iatrogenic e.g. medication changes or surgery.
Constipation.
Urinary retention.
127
Lithium is an effective treatment for many psychiatric conditions including mania, bipolar disorder, depression etc. Why should it be used with care?
Lithium has a narrow therapeutic range which can lead to renal failure.
128
What is the therapeutic index for Lithium?
0.4-1 mmol/L
129
List 5 adverse effects of lithium
Fine tremor *
Hypothyroidism *
Leucocytosis *
Hypercalcaemia *
Hyperparathyroidism
Weight gain
N/V/D
130
What are the sx of lithium toxicity
Coarse tremor
Hyperreflexia
Confuison
coma
Polyuria
Ataxia
131
What is bipolar I and Bilpolar II?
Bipolar I- Mania and depression
Bipolar II- Hypomania and depression
132
What is the mx of mania
w/o agitation- Oral monotherphy with antipsychotic
w/ agitation- IM Haloperidol or Benzos
133
What is the harmful metabolite that is produced in Paracetamol overodose?
NAPQI
134
What rx can be given to treat moderate/severe tardive dyskinesia?
Tetraebnazine
135
What rx can be given to treat akathiasis
Propanolol/Procyclidine
136
What rx can be given to treat acute dystonia
Procyclidine
137
What is the most appropriate antipsychotic that has the least se and can combat sx of hyperprolactinameia
Aripiprazole
138
Describe Section 2 of the MHA - purpose, duration, professionals involved.
Purpose: assessment, treatment can be given without consent.
Duration: 28 days.
Professionals involved: 2 doctors, AMHP.
139
Describe Section 3 of the MHA - purpose, duration, professionals involved.
Purpose: treatment.
Duration: 6 months.
Professionals involved: 2 doctors, AMHP.
140
Describe Section 4 of the MHA - purpose, duration, professionals involved.
Purpose: emergency order.
Duration: 72 hours.
Professionals involved: 1 Dr and 1 AMHP.
141
Describe Section 5(2) of the MHA-purpose, duration, professionals involved.
Purpose: Holding
Duration- 72 hours
Profesisonals- Doctor
142
Describe Section 5(4) of the MHA-purpose, duration, professionals involved.
Purpose: Holding
Duration- 6 hours
Profesisonals- Nurse
143
Describe Section 135 of the MHA-purpose, duration, professionals involved.
Purpose- Police to break into property to remove person to plce of safety
Duartion- 72 hours
Professionals- Magistrate/Police officer
144
Describe Section 136 of the MHA-purpose, duration, professionals involved.
Purpose- Someone found in public place appering to ahve a mental disorder can be taken by police to place of safety
Duartion- 72 hours
Professionals- Police officer
145
What type of delusional disorder is most common in episodes of mania?
Grandeaur delusions
146
How long should sx of depression be present for before a diagnosis?
2 weeks
147
List 5 sx of opioid withdrawal
Diarrhoea
Dilated pupils
runny nose
yawning
muscle aches
insomnia
Agitation and anxiety
148
What test should be regulary done if a person is on SSRIs?
U&Es beuase SSRIS can cause hyponatraemia
149
Which of the lowering alcohol dependency drugs cause a patient to be violently sick if they drink alcohol
Disulfiram (Antebuse)
150
How does acaprosate work in order to stop alcohol dependence
anti craving
151
SE of clozapine
Constipation
Agranulocytosis
Reduces seizure threshold
152
What is a se of citalopram
Long QT --> Trosade de pointes
153
What is the mx of lithium toxicity?
mild-moderate toxicity- IV fluid resuscitation
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion
154
List the metabolic side effects of antiphyschotics
Dysglycaemia
Dyslipidaemia
diabetes mellitus
155
What combination of electrolyte abnormalities is most likely to be seen in refeeding syndrome?
Hypomagnesaemia, hypokalaemia, hypophosphataemia
156
What is the mx of Neuroleptic malignant syndrome?
Stop antipsychotic
Iv fluids
Dantrolene
Bromocriptine
157
What is the mx of serotonin syndrome?
Stop seratonergic drug
Iv fluids and cooling
Benzodiazepines
Cryoheptadine
158
What iS the difference in pupils in NMS and serotonin syndrome?
NMS- Pupils normal
SS- Pupils dilated
159
What area of the brain is affected in ADHD?
Frontal lobe- decreased activity
160
What is the management of ADHD?
Behavioural and educational support
1st line- Methylphenidate
2nd line- Atomoxetine/Lisdexamfetamine
3rd- Dexamfetamine
161
List 3 features of ASD?
Prefer to play alone- avoids eye contact
Speech and language delay
narrowed interets/ritualistic behaviours, sterotypical movemnts
Learning disability
162
What tool can be used to assess patients with acute alcohol withdrawal?
CIWA-Ar questionnaire
163
List 5 sx of alcohol withdrawal 6-12 hours post drink
Insomnia
agiitation
tremor
anxiety
N+V
Sweating
Palpitations
164
Which area of the brain is affected in wernickes encephalopathy?
Mammilsry bodies
165
List the 2 specific signs of dependence related to alcohol?
Rapid re-instatement- person gets back to previous drinking levels quite rapidly
Narrowing of repetoire-
166
What is the MOA of N-acetylcysteine?
Replenishes gluthathione stores
167
What blood gas would be seen in a paracetamol overdose?
Metabolic acidoisis
168
list 2 short term and long term SE of ECT?
LT- Perisistent memory loss, damage to mouth and teeth, riks of death, cardiac arrhythmia
ST- Headaches, N+V, memory loss
169
List the causes of anterograde and retrograde amnesia?
anterograde- Benzos, WE, KS
retrograde- ECT
170
List the ICD-10 criteria for delirium?
Impairmnet of conciousness
Global disturbance in cognition
Pschomotor disturbance
Disturbance in sleep/wake cycle
Emotional distress
171
What factors may prompt refferal to a mother and babay inpatient mental health unit in someone with PPD?
high risk of harm to baby or mother (thoughts of harming baby)
High level suicidality
inability to care for baby
Lack of support around mother
Psychotic symptoms present
172
What are the key environmental RF for schizophrenia?
Traumatic events in childhood
Heavy cannabis use in childhood
Maternal poor health
Birt trauma
Living in the city
173
What are the examples of negative sx in schizophrenia
Alogia (poverty of speech)
Anhedonia
Incongruity/blunting of affect
Avoliton (Poor motivation)
174
What is the risk of schizo in a patient whose parent or sibling has the disorder
0.1
175
Whta ix are indicated in a patient with a fist episode of psychosis?
CT/MRI Head
HIV and SYphyllis screen
Drug tetsing
FBC/U&Es and TFTs
176
WHta conditons can mimic schizophrenia?
Substance induced pyscotic disorders
Organic psychosis caused by infection, brian injury and CNs disease e.g wilsons disesase
Hyperthyroidism/Hyperparathyroidism
Dementia and Depression
177
List the auditory hallucinations in schizo
3rd person auditory hallucinations
Thought echo
Voices commenting on patients behaviour
178
Management of lithium toxicity?
Stop lithium
Iv fluids
Maintain electorlytes
Haemodialysis if severe
179
What are thr triggers for a manic episode in bipolar disorder?
Stress
lack of sleep
stopping meds
Relationship breakdown
180
What are the features of PTSD?
Rexperiencing
Avoidance
Hyperarousal
Emotinal numbning
181
WHat is the definition of a staggered overdose?
First and last paracetamol more than 1 hour apart
182
When on Ritalin what needs to be monitored and how often?
Pulse/BP/Symptoms/Appetite/Weight and Height
At the start
Every 6 months atleast
+following dosage changes
183
Tx for acute dystonia
Procyclidine or Benzatropine
184
What is the MOA of Disulfiram?
Causes ACh buildup upon alcohol drinking --> unpleasant side effects anxiety, flushing, headaches
185
What is the MOA of Acamprosate?
Enhances GABA transmission- reduces cravings
186
What is the MOA of Naltrexone?
Blocks opiod receptors- reduces pleasurable effects
187
What is the reversal agent for TCA overdose?
Sodium Bicarbonate
188
What does SSRI discontinuation syndrome present with?
Restlessness, Sweating, Diarrhoea, Vomiting and Abdominal Pain,
189
When checking lithium levels, when should a sample be taken?
12 hours post-dose
190
What is the initial management of delirium tremens?
Benzodiazepines such as Lorazepam.
Chlordiazepoxide can be used for simple withdrawals
191
Which specific ECG change is associated with Haloperidol use?
Prolongation of QT interval
192
What is the most likely sign of acute methodone overdose?
Decreased respiratory rate
193
Common symptoms of serotonin syndrome?
Hyperreflexia
Tremors
Hyperthermia
Agitation
Autonomic instability
Altered mental status
194
How long after starting Sertraline should a under 25 and over 25 be reviewed?
Under 25 - 1 week
Over 25 - 2 week
195
What are the features of Anorexia?
G's and C's raised
Growth hormone
Glucose
Salivary glands
Cortisol
Cholesterol
Carotinaemia
196
What are the symptoms of SSRI discontinuation syndrome?
Dizziness
Electric shock sensations
Anxiety
197
How is OCD differentiated from psychosis?
Level of insight into their actions
198
Define a panic attack?
Sudden episodes of intense fear or discomfort that peak within minutes and have physical symptoms such as palpitations, sweating, trembling and SOB
199
Risk factors of panic disorder?
Female
White ethnicity
Family history
Major life stressors
Asthma
Recent trauma
200
What is the Mx of Panic disorder?
SSRI
If no response try Clomipramine or Imipramine
201
What is the non-pharmacological Mx of OCD?
CBT including Exposure and Response Prevention
202
What is the risk of giving Zopiclone to elderly?
Increased risk of falls
203
What is the Mx of Alcoholic ketoacidosis?
IV thiamine and IV saline
204
What is signs of opioid overuse?
205
What is signs of benzodiazepine overuse?
206
What is signs of cocaine overuse?
