Psychiatry Flashcards
What things can precipitate lithium toxicity?
Renal failure - so think things that could cause this eg dehydration, NSAIDs, diuretics, ARB and ACE-i
Metronidazole can also induce
What are the features of lithium toxicity?
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
How do you manage lithium toxicity?
mild-moderate toxicity may respond to volume resuscitation with normal saline
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
What is the management of PTSD?
trauma-focused CBT/ eye movement desensitisation and reprocessing (EMDR)
drugs not routine 1st line:
If used –> venlafaxine/ SSRI
severe cases –> risperidone
Which anti-depressant is most likely to prolong the QT interval?
Citalopram is the most likely SSRI to lead to QT prolongation and Torsades de pointes
Best anti-depressant for <18s? Best anti-depressant for post-MI? Best for breastfeesing?
children (fluoxetine)
post MI (sertraline)
Breastfeeding (sertraine or parozetine)
Section 2 vs 3 vs 4?
Section 2 - for 28 days. Not renewable. For assessment.
section 3 - Up to 6 months, can be renewed. For treatment.
Both involve approved mental health professional + 2 drs
section 4 - 72 hr assessment - emergency and then usually changed to section 2 in hospital - done by a GP and an AMHP or NR
Section 5(2) vs 5(4)?
Section 5(2) - a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
Section 5(4) - allows nurse to detain a patient who is voluntarily in hospital for 6 hours
section 17 (a) vs section 135 vs 136
Section 17a - Supervised Community Treatment (Community Treatment Order) - can recall patient if dont comply with meds
Section 135 - a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
Section 136 - someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
What are the 4 key presentations of PTSD?
re-experiencing
avoidance
hyperarousal
emotional numbing
What are the first rank sx of schizophrenia?
auditory hallucinations
thought disorders
passivity
delusional perceptions
Tardive dyskinesia vs acute dystonia?
Tardive dyskinesia - occurs with long term use of antipsychotics
involuntary, repetitive movements that can affect any part of the body but are most commonly seen in the face and tongue.
Acute dystonia- starts days of starting or increasing the dose of an antipsychotic.
It involves sustained muscle contractions leading to abnormal postures
How does dosage of mirtazapine correlate to sedation?
Mirtazapine is generally more sedating at lower BNF doses (e.g. 15mg) than higher doses (e.g. 45mg)
Social anxiety disorder vs avoidant personality disorder?
AVoidant PD: extreme version of SAD. Will be pervasive from childhood. Will feel inadequate and be very sensitive to criticism. Avoid all new situations
Which antipsychotic is most associated with high lipids and obesity?
olananzapine
Which antipsychotic has a generally good side-effect profile, particularly for prolactin elevation?
aripiprazole
Dementia with lewy bodies vs parkinsons disease dementia?
Parkinsonisms start BEFORE dementia in parkinsons disease dementia.
Lewy body have REM sleep disorders and nightmares
RF for suicide?
male
history self-harm
alcohol/ drugs
history MH
chronic disease
old unemployed
live alone
single
Fregoli vs capgras syndrome?
Fregoli - delusion that various people you meet are the same person
capgras - delusion that someone you know has been replaced by an idential imposter
How do alcool and smoking effect clozapine?
Smoking cessation can cause a significant rise in clozapine levels, and so it should be discussed with a psychiatrist before stopping smoking. Starting smoking, or smoking more, can reduce clozapine levels. Stopping drinking can also reduce levels, as alcohol binges can increase the level. Omitting doses will cause a reduction in clozapine levels, and stress and weight gain won’t have significant effects on the level.
What is the biggest RF for psychotic disorders?
Family history is the strongest risk factor for psychotic disorders
affect vs mood?
Affect is the current, observed emotional state of the patient (what you see), whereas mood is the more pervasive, predominant state over a longer period (what you ask about)
When should N-acetylcysteine be given for paracetamol OD?
-If paracetamol levels above treatment line
-staggered OD >1 hour taken
- 8-24 hoursafter ingestion of an acute overdose of more than 150 mg/kg of paracetamol
- > 24 hoursif they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal
serotonin syndrome vs neuroleptic malignant syndrome?
serotonin syndrome -acute, hyperreflexia, clonus, diarrhoea, dilated pupils. Mx with chlorpromazine
neuropletic malignant syndrome - slower onset, just started treatment, hyporeflexia, pupils normal, lead pipe rigidity, bradykinesia, raised WCC, rhabdomyolysis, mx with dantrolene
Both: HTN, tachy, fever
When can you use activated charcoal in OD?
within 1 hr of OD
Anorexia nervosa features on blds/ obs
hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3
bradycardia and hypothermia
Typical vs atypical antipsychotic examples
Typical - Chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, pimozide, thiothixene, and trifluoperazine
atypical - clozapine, olanzapine,
risperidone, quetiapine. amisulpride. aripiprazole
These have less extra pyramidal SE, less high prolactin but more wt gain
Features of discontinuation of SSRI
Discontinuation symptoms
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
First line Mx of mild (less severe( depression?
Less severe depression (PHQ of <16) if managed by referral for psychological therapies first line
2nd line mx for ADHD?
lisdexamfetamine
bipolar I vs bipolar II?
bipolar I - mania - increased risk taking, grandiose delusions, non-functioning
bipolar II - hypomania
what is the PHQ9 cut off for more severe vs less severe depression?
‘Less severe depression’ — this encompasses subthreshold and mild depression, defined as depression scoring less than 16 on the PHQ-9 scale.
‘More severe depression’ — this encompasses moderate and severe depression, defined as depression scoring 16 or more on the PHQ-9 scale.
Which SSRIs/ SNRIs cause the worst withdrawal on stopping treatment?
venlafaxine
paroxetine
When should paracetamol levels be taken in OD?
Paracetamol OD - A serum paracetamol level should be taken immediately on presentation and at 4 hours post-ingestion. If the serum paracetamol level is below the nomogram line no medical treatment will be required.
pSychosis vs schizophrenia?
Psychosis = <1month, schizophrenia = >1month of at least 2 or more first rank sx
two core sx of depression?
Depression = low mood and anhedonia as two core sx
In the exam when will they want you to diagnose depression and not psychosis?
Severe depression can present with psychotic features, so if primarily presenting with depression diagnose that over schizo if features of auditory and visual hallucinations
