Psychiatry Flashcards
1
Q
What antipsychotics are used in schizophrenia?
A
- risperidone
- ziprasidone
- ariprapazole
- quetipine
- amisulpride
RAAQ’Z
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
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
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
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
6
Q
What SSRI’s may be used in MDD?
A
- Citalopram
- Escitalopram
- Paroxetine
- Fluoxetine
- Sertraline
7
Q
What SNRI’s may be used in MDD?
A
- Duloxetine
- venlafaxine
8
Q
What atypical AD is used for MDD?
A
- mirtazipine
9
Q
What personality disorders arise in cluster A?
A
- paranoid
- schizoid
- Schizotypal
10
Q
What personality disorders arise in cluster B?
A
- Borderline
- histrionic
- narcissistic
- Antisocial
11
Q
What personality disorders arise in cluster C?
A
- Obsessive compulsive personality disorder
- Dependent
- Avoidant
12
Q
Pneumonic for personality disorders?
A
- pAss = A
- bahn = B
- doa = C
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
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
15
Q
What is Schizotypal PD?
A
- eccentric and magical thinking
- possibility to develop into schizophrenia → schizotypal “type of schizophrenia
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
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
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
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
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
21
Q
What is avoidant PD?
A
- want a relationship but is scared or fears criticism and has low confidence
- hypersensitive to rejection
22
Q
What is dependent PD?
A
- rely on others for emotional support and validation
- may tolerate abusive relationships
- often always in a relationship
23
Q
According to PD clusters, what are their respective associated conditons?
A
- A : schizophrenia
- B : mood disorders
- C : anxiety
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
25
Difference between typical and atypical APM?
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
26
What are some general groups of side effects with APM?
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
27
What is neuroleptic malignant syndrome?
- 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
28
Why should clozapine be monitored?
- gold standard for Schizophrenia but not first-line
- can cause agranulocytosis
- WBC must be monitored
29
RIsk factors of risperidone?
- hyperprolactinemia
- milk discharge
- switch to quietipine and slowly taper off risperidone
30
Risk factors of quetipine?
- lowest risk of movement disorders
31
Risk factors of Olanzapine?
increased risk of weight gain, metabolic syndrome, diabetes, etc
32
What is the first line for psychotic syptoms?
- atypical APM
33
Difference between Delirium and Neurocognitive disorder
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
34
Causes of delirium
Etiology:
- Metabolic
- DKA
- Hyponatremia
- Hypoxia
- Infectious
- UTI in elderly patients
- Substance abuse
- Post-operative from major surgery
- Trauma
35
Investigation for delirium
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
36
What function are impaired in neurocognitive disorders?
MMALT
- 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
37
Supportive drugs used in Alz D?
- 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
MRI for Alz D?
Neuroimaging MRI:
- cortical atrophy
- flattening of sulci
- enlarged ventricles
39
DSM 5 Criteria for Alz D?
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
What conditions make up neurocognitive disorders?
- Alz
- Parkinson's
- Huntington's
- Pick's
- Lewy body Dementia
41
What are other causes may lead to neurocognition decline?
- 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
What is pick's diease?
- frontotemporal NCD/dementia
- cause unknown -> fhx +
- pick cells (swollen neuron) and pick bodies on histo
43
CF of picks d?
- inability to observe social etiquette e.g. inappropriate language or touching
- apathy
- hyperphagia
- hyper-sexuality
44
Management of Picks?
- cholinesterase inhibitors
- Depression -> SSRI
- Agitation, hallucinations -> antipsychotics atypical
45
What gene is affected in HD?
- chromosome 4
- autosomal dominant
- increased number of CAG trinucleotide repeats
46
pathophys of HD?
- rare, progressive neurodegenerative disease that involves loss of GABA-ergic neurons
of the basal ganglia
47
Investigation for HD?
- genetic testing via PCR
- MRI -> atrophy of striatum in caudate nucleus
- enlargement of nucleus
48
What is dementia with lewy bodies?
- 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
Cf of LB dementia?
- parkinsonism
extrapyramidal symptoms of bradykinesia, rigor, etc
- dementia
- visual hallucination and paranoid episodes
-episodic impairment of cognition
50
MRI findings for LB D
- cerebral atrophy, particularly frontal lobe
51
What is Wernicke encephalopathy?
- XS alcohol related B1 (thiamine) deficiency
- acute and REVERSIBLE
52
Triad of Wern E
- confusion
-oculomotor dysfunction
- gait ataxia -> wide based small steps
sen in 1/3 of patients
COG
WERNicke -> kinda like weener -> Cock -> COG
53
What is korsakoff syd?
chronic progression of thiamine deficiency
especially in alcohol abuse patients
IRREVERSIBLE
54
thiamine deficiency causes?
- Wern and Korsako -> chronic alcohol use
- malabsoroption
- thiamine deficient diet
- anorexia, starvation
55
Wern vs Korsakoff
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
What are defense mechanisms?
- way and means that the ego wards off anxiety and controls
instinctive urges and unpleasant emotions
57
What are the mature defense M
- 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
What are the immature defense mechanisms?
- Blocking
- Acting out
- Regression
- Introjection
- Passive aggression
- Sensitization
59
What are the anxiety disorders?
- GAD
- adjustment
- panic
- PTSD
- OCD
- phobic
POP GAP
60
GAD diagnosis
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
Treatment of anxiety disorders (generally)
CBT and SSRI’s e.g. paroxetine, fluoxetine or SNRI e.g. venlafaxine or duloxetine
62
What is PTSD and acute stress disorder?
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
What is Obsessive Compulsive Disorder (OCD)?
- 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
What is panic disorder?
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
What is adjustment disorder
Anxiety with 3 months of identifiable stressor, but less than 6 e.g. 5 months
adJUST 5 months
66
What are phobic disorders?
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
CF of Schizophrenia?
(+) 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
Phases of Shizophrenia?
- Prodromal: negative symptoms kinda like withdrawal
- Active: more positive symptoms
- Residual: cognitive features and withdrawal again
69
DSM 5 criteria for schizophrenia?
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
1st line management of Schizo
Atypical APM
e.g:
- risperidone
- quetipine
- aripripazole
- Ziprasidone
71
When is clozapine indicated and what SE?
- resistant schizophrenia
- se: agranulocytosis
72
How are APM managed?
Continue treatment for at least 2-5 years → when discontinuing → slowly taper over at least 3-6 months
73
Non-pharmacological Tx for Schizo?
- CBT
- Psychoeducation
- cognitive remediation
- social skills training
74
Define bipolar disorder
swinging between opposite poles of elevated mood and depression
with return to normal function between episodes
75
Symptoms of Mania
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
Symptoms of depression
SIGECAPS
sleep (insomnia or hypersomnia)
interest loss (Anhedonia)
guilt
energy reduces
concentration reduced
appetite decrease or over
psychomotor agitation
suicidal
77
BPD 1 vs 2
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
What is Cyclothymia?
- alternating or cycling and thymia refers to mood → occurring for at leat 2 years
- hypomania and dysthymia cycling
79
Number of features for hypomania & dysthymia?
hypomania -> 3 of 7 DIGFAST
dysthymia -> 2-4 of SIGECAPS and not meeting criteria for MDD
80
DSM 5 for BPD?
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
Examples of DIGFAST actions in BPD
- 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
Lithium use in pregnancy?
- 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
SSRI leading to hyponatremia
sertraline ->SIADH -> hyponatremia
84
Side effect of chlorpromazine?
- 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
Risk associated with NSAID and SSRI?
Increased risk of GI bleeding
- give PPI
86
What is tardive dyskinesia?
-
-Tardive dyskinesia is a side effect of long-term use of antipsychotic medications, especially the typical ones like chlorpromazine
87
Side effectof lorazepam?
- anterograde amnesia
88
What would be the most appropriate antidepressant to start after MI?
Sertraline
89
What is oculogyric crisis?
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
Olanzapine common side effect?
weight gain
91
What is CBT?
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
