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Med Prep > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What antipsychotics are used in schizophrenia?

A
  • risperidone
  • ziprasidone
  • ariprapazole
  • quetipine
  • amisulpride

RAAQ’Z

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2
Q

What drugs are used for acute mania?

A

lithium

Anticonvulsant - valproate, carbamazepine

1st generation Antipsychotic - chlorpromazine, haliperidol

2nd generation Antipsychotic - risperidone, ariprapazole, quetipine etc

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3
Q

What is SIGECAPS?

A
  • symptoms of depression

S - sleepiness
I - loss of interest
G - guilt
E - reduced energy
C - reduced concentration
A - appetite reduced
P - psychomotor retardation
S - suicidal thoughts

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4
Q

What is the management plan for MDD?

A
  • PACE

1) psychological = lifestyle change, CBT etc

2) Antidepressants

3) Combination AD’s plus others e.g. antipsychotics

4) Electroconvulsive therapy

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5
Q

Examples of when ECT is indicated?

A
  • severe depression refractory to pharmacotherapy
  • Severe psychomotor retardation e.g. self neglect, refusal to eat
  • substantial suicide risk
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6
Q

What SSRI’s may be used in MDD?

A
  • Citalopram
  • Escitalopram
  • Paroxetine
  • Fluoxetine
  • Sertraline
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7
Q

What SNRI’s may be used in MDD?

A
  • Duloxetine
  • venlafaxine
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8
Q

What atypical AD is used for MDD?

A
  • mirtazipine
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9
Q

What personality disorders arise in cluster A?

A
  • paranoid
  • schizoid
  • Schizotypal
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10
Q

What personality disorders arise in cluster B?

A
  • Borderline
  • histrionic
  • narcissistic
  • Antisocial
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11
Q

What personality disorders arise in cluster C?

A
  • Obsessive compulsive personality disorder
  • Dependent
  • Avoidant
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12
Q

Pneumonic for personality disorders?

A
  • pAss = A
  • bahn = B
  • doa = C
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13
Q

What is paranoid PD?

A
  • in cluster A
  • distrust and suspiciousness
  • mistrustful and suspicious of other peoples and actions
  • are often secretive and isolated
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14
Q

What is Schizoid PD?

A
  • Cluster A
  • emotionally detached
  • the “loner” personality → rather stay at home than come out
  • excessive avoidance of the company of others

avoids relationships and DOES NOT want it

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15
Q

What is Schizotypal PD?

A
  • eccentric and magical thinking
  • possibility to develop into schizophrenia → schizotypal “type of schizophrenia
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16
Q

What is borderline PD?

A
  • Cluster B
  • see the world as good or bad
  • mood swings
  • high risk non suicidal self injury e.g. cutting
  • when stressed can become psychotic
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17
Q

What is antisocial PD?

A
  • continuous antisocial or criminal acts, inability to
    conform to social rules
  • no regards for others
  • sociopaths or criminals, violent
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18
Q

What is histrionic PD?

A
  • highly attention seeking and outwardly emotional
  • have to be the centre of attention
  • inappropriate dress

sense for media → think LOVE ISLAND actors LOOOOOOOOL

*A patient with a histrionic personality needs to be the centre of attention and may behave in seductive ways in an attempt to keep the clinician entertained and engaged

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19
Q

What is Narcissistic PD?

A
  • lack of empathy and is envious of others
  • grandiose
  • feel personally attacked when challenged

e.g. Donald Trump

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20
Q

What is obsessive compulsive PD?

A
  • everything has to be perfect kind of person
  • overly rigid and like to control -> has to be done my way
  • ego-syntonic -> the person knows they have this and are fine with it
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21
Q

What is avoidant PD?

A
  • want a relationship but is scared or fears criticism and has low confidence
  • hypersensitive to rejection
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22
Q

What is dependent PD?

A
  • rely on others for emotional support and validation
  • may tolerate abusive relationships
  • often always in a relationship
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23
Q

According to PD clusters, what are their respective associated conditons?

A
  • A : schizophrenia
  • B : mood disorders
  • C : anxiety
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24
Q

What is the mainstay of treatment for personality disorders?

A
  • CBT and psychotherapy
  • Symptomatic medical therapy according to PD

e.g. anxiety -> SSRI

antipsychotics for any delusions

mood stabilisers e.g. valproate, topiramate and lamotrigine

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25
Q

Difference between typical and atypical APM?

A

Typical: block mainly dopamine receptors mainly -> treat positive symptoms
- have many side effects

Atypical: block dopamine, along side serotonin receptors -> treat positive and negative symptoms
- have fewer side effects

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26
Q

What are some general groups of side effects with APM?

A

Sedation: due to antihistaminic activity

Hypotension: effect is due to alpha-adrenergic blockade and is most common with lowpotency APMs.

Anticholinergic Symptoms: dry mouth, blurred vision, urinary hesitancy, constipation, bradycardia, confusion, and delirium

Endocrine Effects: gynecomastia, galactorrhea, and amenorrhea

Movement related disorders

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27
Q

What is neuroleptic malignant syndrome?

A
  • most common cause is 1st gen antipsychotics
  • 2nd gen can also lead to
  • possible genetic predisposition is suspected
  • potentially life-threatening condition characterized by
    muscular rigidity, hyperthermia, autonomic instability, and delirium

Tx:
Immediate discontinuation of the medication and physiologic supportive
measures; dantrolene or bromocriptine may be used

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28
Q

Why should clozapine be monitored?

A
  • gold standard for Schizophrenia but not first-line
  • can cause agranulocytosis
  • WBC must be monitored
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29
Q

RIsk factors of risperidone?

A
  • hyperprolactinemia
  • milk discharge
  • switch to quietipine and slowly taper off risperidone
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30
Q

Risk factors of quetipine?

A
  • lowest risk of movement disorders
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31
Q

Risk factors of Olanzapine?

A

increased risk of weight gain, metabolic syndrome, diabetes, etc

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32
Q

What is the first line for psychotic syptoms?

A
  • atypical APM
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33
Q

Difference between Delirium and Neurocognitive disorder

A

Delirium
- acute
- lasts days to weeks
- recent memory problem
- fluctuating course
- possible hallucinations
- disorientated/ altered mental status
- symptom reversible

NCD
- insidious onset
- lasts months to years
- chronic course
- no disorientation or altered mental status

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34
Q

Causes of delirium

A

Etiology:

  • Metabolic
    • DKA
    • Hyponatremia
    • Hypoxia
  • Infectious
    • UTI in elderly patients
  • Substance abuse
  • Post-operative from major surgery
  • Trauma
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35
Q

Investigation for delirium

A

Clinical diagnosis

  • CBC
  • electrolytes
  • urinalysis
  • serum glucose

Cause related investigation:

  • Intracranial lesion → presents with focal neurological deficits → brain CT or MRI
  • cardiac → chest pain → ECG
  • infectious → fever or sepsis suspicion → blood cultures
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36
Q

What function are impaired in neurocognitive disorders?

MMALT

A
  • language (aphasia)
  • memory (especially recent memory)
  • Agnosia : unable to recognise people
  • Apraxia (failure of ability to execute complex motor behaviors)
  • Impairment in the ability to think abstractly and
    plan such activities as organizing, shopping etc

MMALT - memory, movement, agnosia, language, thinking

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37
Q

Supportive drugs used in Alz D?

A
  • Long acting cholinesterase inhibitors:
  • Rivastigmine
  • Donepezil
  • Galantine

NMDA Antagonist
- memantine

*Antipsychotic medications may be helpful when psychotic symptoms present but contraindicated to control behavior.

38
Q

MRI for Alz D?

A

Neuroimaging MRI:
- cortical atrophy
- flattening of sulci
- enlarged ventricles

39
Q

DSM 5 Criteria for Alz D?

A

Causative gene mutation on chromosome 21 or all of the following:

  • memory and learning decline plus one other cognitive domain*
  • steady gradual cognitive decline
  • no evidence of mixed etiology aka absence of any other disease or condition which may lead to cognitive decline

*other domains: agnosia, apraxia etc (MMALT)

40
Q

What conditions make up neurocognitive disorders?

A
  • Alz
  • Parkinson’s
  • Huntington’s
  • Pick’s
  • Lewy body Dementia
41
Q

What are other causes may lead to neurocognition decline?

A
  • CerebroV disease -> multi-infarct neurocognitive disorder
  • Nutritional deficiency -> g beriberi (thiamine [vitamin B1] deficiency), pellagra (niacin deficiency), and/or pernicious anemia (cobalamin [vitamin B12] deficiency)
  • Seizure disorders, metabolic disorders e.g. Wilson
42
Q

What is pick’s diease?

A
  • frontotemporal NCD/dementia
  • cause unknown -> fhx +
  • pick cells (swollen neuron) and pick bodies on histo
43
Q

CF of picks d?

A
  • inability to observe social etiquette e.g. inappropriate language or touching
  • apathy
  • hyperphagia
  • hyper-sexuality
44
Q

Management of Picks?

A
  • cholinesterase inhibitors
  • Depression -> SSRI
  • Agitation, hallucinations -> antipsychotics atypical
45
Q

What gene is affected in HD?

A
  • chromosome 4
  • autosomal dominant
  • increased number of CAG trinucleotide repeats
46
Q

pathophys of HD?

A
  • rare, progressive neurodegenerative disease that involves loss of GABA-ergic neurons
    of the basal ganglia
47
Q

Investigation for HD?

A
  • genetic testing via PCR
  • MRI -> atrophy of striatum in caudate nucleus
  • enlargement of nucleus
48
Q

What is dementia with lewy bodies?

A
  • if onset of cognitive and motor symptoms is within 1 year

dementia secondary to parkinson’s if cognitive symptoms after 1 year after onset of motor symptoms

49
Q

Cf of LB dementia?

A
  • parkinsonism
    extrapyramidal symptoms of bradykinesia, rigor, etc
  • dementia
  • visual hallucination and paranoid episodes

-episodic impairment of cognition

50
Q

MRI findings for LB D

A
  • cerebral atrophy, particularly frontal lobe
51
Q

What is Wernicke encephalopathy?

A
  • XS alcohol related B1 (thiamine) deficiency
  • acute and REVERSIBLE
52
Q

Triad of Wern E

A
  • confusion
    -oculomotor dysfunction
  • gait ataxia -> wide based small steps

sen in 1/3 of patients

COG

WERNicke -> kinda like weener -> Cock -> COG

53
Q

What is korsakoff syd?

A

chronic progression of thiamine deficiency

especially in alcohol abuse patients

IRREVERSIBLE

54
Q

thiamine deficiency causes?

A
  • Wern and Korsako -> chronic alcohol use
  • malabsoroption
  • thiamine deficient diet
  • anorexia, starvation
55
Q

Wern vs Korsakoff

A

Wernicke -> reversible
- Confusion
- oculomotor dysfunction
- gait ataxia

Korsakoff
- chronic and irreversible
- confabulation
- anterograde and retrograde amnesia
(anterograde more common)

  • personality changes e.g. apathy, reduce executive function

hallucination and disorientated

56
Q

What are defense mechanisms?

A
  • way and means that the ego wards off anxiety and controls
    instinctive urges and unpleasant emotions
57
Q

What are the mature defense M

A
  • Altruism: giving away to charity to feel good
  • Sublimation (most mature): change in object or aim for impulse gratification that is acceptable e.g. taking all anger out on a punching bag
  • Suppression: telling yourself consciously, you are not in a specific situation
  • Humour: use of humour to forget negative news

(SASHA is a MATURE adult)

58
Q

What are the immature defense mechanisms?

A
  • Blocking
  • Acting out
  • Regression
  • Introjection
  • Passive aggression
  • Sensitization
59
Q

What are the anxiety disorders?

A
  • GAD
  • adjustment
  • panic
  • PTSD
  • OCD
  • phobic

POP GAP

60
Q

GAD diagnosis

A

More than 6 months

3 of mentioned symptoms e.g. worry, reduced concentration and irritability

Distress in social or professional life

No other relation to other conditions

61
Q

Treatment of anxiety disorders (generally)

A

CBT and SSRI’s e.g. paroxetine, fluoxetine or SNRI e.g. venlafaxine or duloxetine

62
Q

What is PTSD and acute stress disorder?

A

Severe anxiety following a threatening event which caused fear, helplessness or horror

PTSD
>1 months of anxiety following stressful event

Acute stress disorder
< 1 months but more than 2 days of anxiety following a stressful event with symptoms occurring within 1 month of the event

63
Q

What is Obsessive Compulsive Disorder (OCD)?

A
  • e.g. did I lock the door or did I turn off the hob??? (Obsession)

This leads to distress, this then leads to compulsion. This is the repetitive task of relieving the obsession

EGO dystonic, they know they have this and are not happy about it

64
Q

What is panic disorder?

A

Recurrent unexpected panic attacks, these are attacks of intense anxiety

Can involve physical symptoms e.g. tachycardia, hyperventilating, sweating and dizziness

Attacks, followed by 1month of no attacks, change in behaviour e.g. avoiding public places in case you have a panic attack

65
Q

What is adjustment disorder

A

Anxiety with 3 months of identifiable stressor, but less than 6 e.g. 5 months

adJUST 5 months

66
Q

What are phobic disorders?

A

Irrational fear or avoidance of objects and situations

Specific phobia: fear from object e.g. animal or situation e.g. heights or darkness

Social Anxiety Disorder: fear of humiliation or embarrassment in general or specific social situations e.g. presentation

67
Q

CF of Schizophrenia?

A

(+) Symptoms:
- delusions
- hallucination
- disorganised speech aka jumbling words
- disorganised behaviour

(-) Symptoms:
- disorganised thoughts
- loss of pleasure from activities
- lack of motivation
- one worded answers
- flat effect -> absent emotional expression

Cognitive symptoms:
- literal thinking, no abstract thinking
- memory effected
- learning effected

68
Q

Phases of Shizophrenia?

A
  • Prodromal: negative symptoms kinda like withdrawal
  • Active: more positive symptoms
  • Residual: cognitive features and withdrawal again
69
Q

DSM 5 criteria for schizophrenia?

A

2 of the following:
- delusion
- hallucination
- disorganised speech
- disorganised behaviour/ catatonic behaviour

Negative symptoms

*cognitive symptoms not needed for dx

*signs must be for at least 6 months with 1 month in active phase

*must not be related to any other condition

70
Q

1st line management of Schizo

A

Atypical APM

e.g:
- risperidone
- quetipine
- aripripazole
- Ziprasidone

71
Q

When is clozapine indicated and what SE?

A
  • resistant schizophrenia
  • se: agranulocytosis
72
Q

How are APM managed?

A

Continue treatment for at least 2-5 years → when discontinuing → slowly taper over at least 3-6 months

73
Q

Non-pharmacological Tx for Schizo?

A
  • CBT
  • Psychoeducation
  • cognitive remediation
  • social skills training
74
Q

Define bipolar disorder

A

swinging between opposite poles of elevated mood and depression

with return to normal function between episodes

75
Q

Symptoms of Mania

A

DIGFAST

distractibility

irritability

grandiose

flight of ideas

activity increase -> bouncing between activities and no completion

sleep deficit -> need for LESS sleep

talkativeness -> rapid speech

76
Q

Symptoms of depression

A

SIGECAPS

sleep (insomnia or hypersomnia)
interest loss (Anhedonia)
guilt
energy reduces
concentration reduced
appetite decrease or over
psychomotor agitation
suicidal

77
Q

BPD 1 vs 2

A

BPD 1:
- manic episode +/- depressive episode
- presence of manic episode is enough for dx
- 4 from 7 DIGFAST
- MANIA is 1 fun week -> 7 days

BPD 2:
- hypomanic episode +/- depressive episode
- no manic or psychosis
- hypoma3a: hypo 4 letters -> lasts 4 days and 3 more 3/7 sx from DIGFAST

78
Q

What is Cyclothymia?

A
  • alternating or cycling and thymia refers to mood → occurring for at leat 2 years
  • hypomania and dysthymia cycling
79
Q

Number of features for hypomania & dysthymia?

A

hypomania -> 3 of 7 DIGFAST

dysthymia -> 2-4 of SIGECAPS and not meeting criteria for MDD

80
Q

DSM 5 for BPD?

A

Bipolar I disorder: ≥ 1 confirmed episode of mania

Bipolar II disorder: ≥ 1 confirmed episode of hypomania AND ≥ 1 major depressive episode AND absence of any manic episodes

81
Q

Examples of DIGFAST actions in BPD

A
  • Intense prolonged happiness (e.g., for several days)
  • Irritability
  • Overconfidence, risky behavior (e.g., overspending money)
  • Decreased need for sleep
  • Hypersexuality
  • Psychotic features -> only during manic episodes
82
Q

Lithium use in pregnancy?

A
  • patient wishing to conceive must seek assistance and should be consulted about risks and benefits
  • lithium use is associated with ebstein anomaly, but may have been over estimated as a risk
  • have their lithium gradually withdrawn before conception occurs
  • Lithium may be reinstated after cardiogenesis, about 50 days postconception

More frequent blood tests for kidney function and serum lithium concentration are recommended, especially for women who have hyperemesis or vomiting.

83
Q

SSRI leading to hyponatremia

A

sertraline ->SIADH -> hyponatremia

84
Q

Side effect of chlorpromazine?

A
  • side effect of antipsychotic medication, such as chlorpromazine, is characterised by the presence of a resting tremor, bradykinesia (slowness of movement), rigidity and postural instability
  • due to the dopamine-blocking effects
85
Q

Risk associated with NSAID and SSRI?

A

Increased risk of GI bleeding

  • give PPI
86
Q

What is tardive dyskinesia?

A

-Tardive dyskinesia is a side effect of long-term use of antipsychotic medications, especially the typical ones like chlorpromazine

87
Q

Side effectof lorazepam?

A
  • anterograde amnesia
88
Q

What would be the most appropriate antidepressant to start after MI?

A

Sertraline

89
Q

What is oculogyric crisis?

A

An oculogyric crisis is a further example of an acute dystonia.

Patients experience sustained upward deviation of the eyes, clenched jaw and hyperextension of the back/neck with torticollis

90
Q

Olanzapine common side effect?

A

weight gain

91
Q

What is CBT?

A

CBT is recommended for all people with schizophrenia.

This form of therapy helps patients deal with their symptoms by changing the way they think and behave. It can reduce the severity of symptoms and improve quality of life.

92
Q
A

Med Prep (7 decks)

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