Psychiatry Flashcards
Typical vs atypical antipsychotics
examples of each
Typical (block dopamine D2 receptors)
- Haloperidol
Atypical (block dopamine D2 receptors AND some serotonin receptors)
- Risperidone
- clozapine
- Quetiapine
- Olanzapine
- aripiprazole
Why would you use a typical vs an atypical antipsychotic
Typical (block dopamine receptors):
- treat positive symptoms of schizophrenia (hallucinations, delusions, disorganized thinking), but less effective at addressing negative symptoms (apathy, lack of motivation)
Atypical: good at both positive and negative symtpoms, also good for mood stabilisation
Antipsychotic SE’s
Typical vs atypical
TYPICAL
Extrapyramidal symptoms (EPS)
Neuroleptic malignant syndrome:
Sedation
antimuscarinic
Haloperidol: prolonged QT
ATYPICAL
Metabolic side effects: Weight gain, increased blood sugar, and increased cholesterol levels, which can lead to diabetes and cardiovascular issues.
Less EPS: as serotonin helps modulate the affect of dopamine
High prolactin levels
reduced seizure threshold
antimuscarinic
Clozapine: agranulocytosis, bowel obstruction/toxic megacolon, myocarditis
Aripiprazole: most tolerable side effect profile, esp w prolactin
Extra pyramidal side effects (EPS)
Akithesia: inner restlessness and an uncontrollable urge to move.
Dystonia: sudden movements
Tardive dyskinesia: involuntary, repetitive movements that usually affect the face, mouth, and tongue
Parkinsonism
What is neuroleptic malignant syndrome
rare but serious condition causing muscle stiffness, fever, and altered mental status.
how does anorexia impact blood results and obs
most things low (potassium, FSH/LH, oestrogen/testosterone, TFTs, HR, BP, BMI)
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Thyroid function tests (T3 reduced with malnutrition)
Creatinine kinase (elevated in excessive exercise).
Bicarbonate (elevated with purging, reduced with laxatives)
Side effects of antidepressant mirtazapine
Fewer side effects compared to other antidepressants
Sedation (worse at lower doses)
Increased appetite
good for elderly with low appetite and insomnia
Alcohol screening test for teens vs adults
Teens: SACs
Adults: AUDIT C
Questions to screen for alcohol misuse or addiction
When you stop drinking, do you develop any withdrawal symptoms, for example tremors, sweating, nausea, or anxiety?
Have you ever had a seizure or delirium tremens (DT)?
Has anyone ever raised concerns about your drinking?
Do you have to have a drink in the morning?
Do you ever have a drink overnight?
What sections of the 1992 mental health act do we need to know about in particular
Section 8a – Application for assessment (anyone)
Section 8b – Certificate supporting an application for assessment (Doctor or nurse)
Section 9 – Notice to attend an assessment examination (Mental health specialist)
Lithium side effects
Dose dependent: Fine tremor and nausea (pass after 1-2 days)
fine hand tremors, polyuria, polydipsia (nephrogenic diabetes insipidus)
ECG: T wave flattening/inversion
Weight gain
Hypothyroidism
hyperparathyroidism (causing high Ca)
Toxicity: Coarse tremor, GI symptoms, a metallic taste in the mouth, and a reduction in the sensitivity of the abdomen (central obtunding), ataxia, dysarthria
increased risk of manic relapse if suddenly stopped,
Avoid NSAIDs, ACE/ARBs, diuretics
How to monitor lithium levels, and what do the levels indicate
Serum concentration should be measured five to seven days after dose initiation or dose change,** then every six months**
blood sample should be taken 12 hours after dosing.
0.6 – 0.8 mmol/L - for stable patients
0.8 – 1.0 mmol/L - for acute mania or relapse
> 1.2 mmol/L - toxic
> 2.0 mmol/L - medical emergency
Pharmacologic Treatment for Bipolar disorder
Acute vs chronic
Chronic: anti-depressant + mood stabiliser (lithium, valporate, carbamazapine)
Acute: mood stabiliser is good but takes 5-10 days to take effect, bridge with benzos +/- atypical antipsychotics in the interim
Electroconvulsive therapy can be used for treatment-resistant pts (preg)
other bloods to monitor when on lithium
UES, TFTs: baseline then 6-monthly
Ca, ECG: baseline then yearly
What % of people with depression also have anxiety?
**35 to 50% **of people with major depression also meet the criteria for GAD
Having both depression and anxiety indicates a more severe anxiety disorder with a poorer prognosis
If anxiety symptoms arise as a consequence of depression, effective treatment of the depression will often relieve the anxiety symptoms
ADHD scoring questionnaires
Child Behavior Checklist (CBCL): ages 6 to 18
Conners-Wells’ Adolescent Self-Report Scale: for teenagers
SNAP-IV: ages 6 to 18
(NICHQ) Vanderbilt Assessment Scale: 6 to 12
Conners Comprehensive Behavior Rating Scale (CBRS): 6 to 18
Adult ADHD Self-Report Scale (ASRS)
Adult ADHD Clinical Diagnostic Scale (ACDS)
Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS)
ADHD Rating Scale-IV (ADHD-RS-IV)
Is anxiety or depression more common in NZ
Anxiety (21%)
Depression (18%)
Anxiety is more common in women, however some subtypes (OCD) are more common in men
Is psychological or drug therapy better for anxiety
they are equally effective, however psychological has lower relapse rates
ideally use them together!
Why are SSRIs first line drugs
when should you reassess for efficacy after starting
they are generally well tolerated and can be used long term without the risk of tolerance or abuse (compared to tricyclics)
Treat for 12 weeks before assessing efficacy.
Treatment may need to continue for 6–12 months after symptoms of anxiety have resolved
Describe CBT in patient friendly way
a form of psychological therapy
helps people be aware of how their thoughts affect their behaviour
patient identifying specific problems or difficult situations they face.
They are then guided to examine how they think, feel and act in response to those problems or situations and recognise if their thinking is unhelpful or if they act in ways which make them feel worse.
General definition of ADHD
inattention, hyperactivity or impulsiveness that is pervasive (over 6 months)
Starts before 7 years old
Impacts at least two areas of a patients life (usually home and school)
DDx for ADHD
Hearing or vision problems
chaotic family situations
Seizures
Medications or asthma
When should you try and stop stimulants for ADHD
Annually (ideally in school term)
20% will be able to stop at the one year mark
Risk factors for perinatal depression
Previous mental health issues
Severe premenstrual syndrome (PMS)
FHx: Mental health issues
Partner with depression
Māori + PI
Low income or unemployment
Reduced education
Experiences of discrimination or racism
Unplanned pregnancies
Teenage pregnancies
Loss of pregnancy
What are “baby blues”
Transient feeling of anxiety, unhappiness and fatigue
Due to rapid drop in oestrogen
80% of new mothers
Between 3-14 days post partum
if >2 weeks likely post partum depression
What is the major risk factor for post partum psychosis
how do you manage p-p pscyhosis
Thought to be a variant of ‘Bipolar disease’
women with bipolar need to be closely monitored
As a medical emergency
Acute referral to maternal mental health for immediate assessment
Do not give antidepressants
When should you refer a women with post partum depression to secondary care (maternal mental health)
A history of severe mental illness
A recent significant deterioration in mental state
Thoughts of harm to self or the baby, or suicidal thoughts
Psychotic or manic features
otherwise consider non-pharmacological interventions (CBT, support groups, exercise, etoh/smoking reduction, HIP) or SSRIs
sertraline, citalopram or escitalopram are 1st line options whilst breas
how long should patients be on antidepressants for
It is recommended that antidepressants are continued for at least one year following a single episode of depression or for at least three years following recurrent episodes
SE of SSRIs
- Sexual dysfunction (30%)
- GI upset (10-30%)
- CNS sx (agitation, fatugue, anxiety (10-30%)
- Suicidal ide
