Psychiatry Flashcards
What is a delusion?
A fixed, firm, unshakeable belief held against the evidence, outside of social and cultural norms.
What is the first-line pharmacological management for ADHD?
Methylphenidate; a stimulant to stimulate frontal lobes.
With what presentation can you diagnose Tourette’s Syndrome?
More than a year’s history of multiple motor and phonic tics.
What will Section 136 of the MHA allow the police to do?
Detain a member of the public in a public place who is at risk to themselves or others.
What are tics?
Non-rhythmic, semi/involuntary motor or phonic verbalisations with discrete muscle groups.
Profanities as tics are rare.
With what presentation can you diagnose ADHD?
Inattention and/or hyperactivity-impulsivity, observable in two settings and onset before the age of seven, interfering with appropriate functioning.
What can antipsychotics in the elderly lead to?
Stroke and VTE
What are the core symptoms of depression?
- Persistent low mood, often worse in the morning.
- Loss of interest or pleasure in most activities.
- Low energy or persistent fatigue.
What are additional symptoms of depression?
- weight changes
- insomnia or hypersomnia
- psychomotor agitation
- decreased libido
- feelings of worthlessness
- concentration issues
- recurrent thoughts of death or suicide
How long do depressive symptoms have to last to have the diagnosis?
2 weeks
What are the categories of depression?
- Mild: Two core symptoms plus two additional symptoms.
- Moderate: Two core symptoms plus three or more additional symptoms.
- Severe: All three core symptoms plus four or more additional symptoms, possibly with psychotic features if severe.
What are the different medications available to treat depression?
- First line is self help resources and CBT
- Medication:
- 1st line is SSRI - e.g. sertraline
Other: - SNRIs e.g. reboxetine for major depression
- TCAs e.g. Amitriptyline for depressive disorder
- MAO e.g mocolbemide or selelgiline for depressive disorder
- NaSSA e.g. mirtazapine
- 1st line is SSRI - e.g. sertraline
Give are the side effects of TCAs?
-overdose → block Na+ channels → cardiac arrest
-Weight gain
-Sexual dysfunction
-Depersonalisation
-Antimuscarinic effects
-lengthening of QT interval
What are the side effects of SSRIs?
ADRs- citalopram
-QT interval prolongation
-sexual dysfunction
-sleep disorders
-GI disturbances
-
Contra
-If poorly controlled epileptic
-pre-existing long QT interval, or manic
- Avoid NSAIDs (or co-prescribe with PPI), avoid warfarin/heparin, avoid triptans and MAOIs (risk of serotonin syndrome)
- Avoid giving <18y as increases risk of suicide. If CBT failed then give fluoxetine
What are the side effects of SNRIs?
-Palpitations
-Sexual dysfunction
-Decreased appetite
-Nausea
-dry mouth
-dizziness
-excessive sweating
What are the side effects of MAOI?
-Irritability
-Sleep disorder
-Nausea + vomiting
- Can’t eat cheese, liver, wine (increase in tyramine → serotonin syndrome)
ADRs- moclobemide
-Confused states (agitation)
-Dizziness
-Dry mouth
Contra- moclobemide
-if thyrotoxicosis,
-if bipolar
What are the side effects of NaSSA?
-5HT3 antagonist: increased appetite
-H1 (histamine) antagonist: drowsiness, weight gain
What are the postiive symptoms of schizophrenia?
- Though echo/ insertion/ withdrawal/ broadcast
- Delusions of control and delusional perception
- Auditory hallucinations (3rd person, running commentary)
What are the negative symptoms of schizophrenia?
- Anhedonia - no pleasure
- Alogia - poverty of speech
- Avolition - poor motivation
- Apathy - lack of interest
- Blunted Affect - lack of emotion
What is the criteria to diagnose schizophrenia?
- at least 1 core symptom of thought disorder, delusions or hallucinations
- and 2 other sympotms
- All need to be present for at least 1 month
What are the 2 types of antipsychotics?
typical and atypical
What are examples of typical antipsychotics?
- Chlorpromazine
- Haloperidol
What are common side effects of typical antipsychotics?
- Weight gain
- Movement disorder
- Extrapyramidal symptoms e.g. Parkinsonism
- Tardive dyskinseisa (restlessness)
- Hyperprolactinemia
What are examples of atypical antipsychotics?
- Olanzapine
- Risperidone
- Aripiprazole
What are the side effects of atypical antipsychotics?
- VERY FEW EXTRAPYRAMIDAL SIDE EFFECTS
- LESS SIGNIFICANT HYPERPROLACTINEMIA (risperidone)
- HIGH RISK OF METABOLIC SYNDROME
- PROLONGED QT INTERVAL
- SEDATION (anti-H1)
- CLOZAPINE: agranulocytosis, myocarditis,
cardiomyopathy - RISK OF NEUROLEPTIC MALIGNANT SYNDROME
What antipsychotic is known to cause weight gain and insomnia as a side effect?
Olanzapine
What are common side effects of olanzapine, clozapine and quetiapine?
- QT prolongations
- Weight gain
- Sexual dysfunction
What is the difference between typical and atypical side effects?
Typical meds target dopamine by decreasing it which decreases positive symptoms but not negative ones.
Atypical meds block D2 receptors reduce dopamine in the mesolimbic pathway -> reduces positive symptoms. AND Serotonin release inhibits dopamine release. Inhibiting serotonin receptors increases dopamine release
This increases dopamine in the mesocortical pathway
This reduces negative symptoms
What pathway in the brain is involved in creating positive symptoms in schizophrenia?
Hyperactivation of mesolimbic and nigrostriatal pathways
What pathway in the brain is involved in creating negative symptoms in schizophrenia?
Hypoactivation mesocortical pathway
What pathway is indirectly targeted by antipsychotic meds which leads to hyperprolactinemia + amenorrhoea + galactorrhoea?
Tuberoinfundibular pathway. When antipsychotics are given, there is an decrease in dopamine in this pathway, which leads to an increase in prolactin causing these symptoms
What is the difference between psychosis and schizophrenia?
- Schneider first rank symptoms of schizophrenia. If they have these sympotms then schiz.
- In psychosis, they will not have the criteria to diagnose schiz but they will have some symptoms of it.
What are the 2 types of psychosis?
- Acute -> a sudden case usually due to a trigger
- Chronic -> always has psychosis
What are the triggers of psychosis?
- Drug-Induced Psychosis: Substances such as cannabis, amphetamines, cocaine, LSD, and alcohol can trigger psychotic episodes.
- Sudden withdrawal of drugs and alcohol
- Medications: steroids or anticholinergics
What are the symptoms of serotonin syndrome?
- Side effects of antidepressants
- Excess serotonergic activity in CNS
- Hyperreflexia, autonomic dysfunction, altered mental status
- Onset within 24h
What bloods are done for serotonin syndrome?
Non-specific bloods
What is treatment for serotonin syndrome?
IV cyprohepatadine
What are the symptoms of Neuroleptic malignant syndrome?
- Side effect of antipsychotics
- Excess D2-blockade in CNS
- Muscle rigidity, hyperthermia, akinesia (loss or impairment of the power of voluntary movement), tremor, altered mental status
- Onset over days/weeks
What bloods are done for Neuroleptic malignant syndrome?
Raised creatine kinase
What is management of Neuroleptic malignant syndrome?
dantrolene
What are symptoms of Extrapyramidal syndrome?
EXTRAPYRAMIDAL SYMPTOMS: Acute Dystonia (painful spasms), Akathisia (movement disorder- can’t stay still), Parkinsonism, irreversible Tardive dyskinesia “ADAPT”
* HYPERPROLACTINEMIA
* PROLONGED QT INTERVAL
* (block repolarisation of K+ channels in
myocardium)
* RISK OF NEUROLEPTIC MALIGNANT
SYNDROME
What anti-depressants can be given during pregnancy?
SSRIs - fluoxetine, sertraline, citalopram and escitalopram can be sued in pregnancy
