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13-19-18-1 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is the concern regarding SSRI in conjunction with a triptan?

A

Serotonin syndrome

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2
Q

What SSRI should be avoided in pregnancy?

A

Paroxetine

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3
Q

What is akathisia?

A

Restlessness e.g. inability to sit still

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4
Q

What is tardive dyskinesia?

A

Repetitive, involuntary, writhing movements e.g. lip smacking, tongue protrusion

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5
Q

What is an acute dystonia?

A

Sustained muscle contraction e.g. torticollis or oculogyric crisis

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6
Q

How may you manage an acute dystonia?

A

Procyclidine

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7
Q

What are some of the symptoms related to Antipsychotics?

A

Antimuscarinic (SLUDGE)
Sedation
Weight gain
Galactorrhoea (raised PL)
IGT
Reduced seizure threshold
Prolonged QT
Neuroleptic malignant syndrome: pyrexia, muscle stiffness

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8
Q

What blood test should be conducted prior to starting clozapine?

A

FBC

Risk of agranulocytosis

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9
Q

What is the prime difference between mania and hypomania?

A

Duration and severity

Mania is 7 days cf hypomania is 3-4 days

Impact on function is seen more with mania

Flight of ideas
Pressured speech
Impulsive behaviour

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10
Q

What is the difference between baby blues and postnatal depression?

A

> 50% women in 1st week have baby blues

10% women have PND around 3 months after

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11
Q

What scoring criteria is used to assess post natal depression?

A

Edinburgh postnatal depression scale

> 10 = postnatal depression

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12
Q

What are some of the features of grief reaction?

A

DABDA

Denial
Anger
Bargaining
Depression
Acceptance

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13
Q

What is the choice of SSRI in young adults?

A

Fluoxetine

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14
Q

Which SSRI is the choice post-MI?

A

Sertraline

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15
Q

What is somatisation disorder?

A

Multiple physical symptoms for 2 years

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16
Q

What is hypochondriasis?

A

persistent belief in serious underlying disease

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17
Q

What is conversion disorder?

A

Loss of motor or sensory function

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18
Q

What is factitious disorder?

A

Munchausen’s syndrome - intentional production of physical/psychological symptoms

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19
Q

What is malingering?

A

Fraudulent simulation or exaggeration of symptoms with intention of financial or other gain

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20
Q

If someone is experiencing hypersomnolence on mirtazipine, what should you do?

A

Increase the dose as generally more sedating at lower doses

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21
Q

In alcohol withdrawal, when do symptoms appear?

A

6-12 hours

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22
Q

In alcohol withdrawal, when do seizures occur?

A

36 hours

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23
Q

Which SSRI is most likely to cause QT prolongation?

A

Citalopram

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24
Q

Which adverse effects do antipsychotics increase the risk of in elderly patients?

A

Stroke / VTE risk

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25
Q

What is the MOA of SSRI??

A

Block reuptake of serotonin in presynaptic neurone thus increased serotonin in synapse which boosts serotonin.

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26
Q

What are some side effects of SSRIs?

A

Headache
Sexual dysfunction
Hyponatraemia
Anxiety/agitation (first few weeks)
Increased suicidal thoughts
Risk of bleeding
GI symptoms

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27
Q

How long does it take for SSRIs to take effect?

A

2-4 weeks

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28
Q

When should you review a patient following commencing SSRIs?

A

1-2 weeks

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29
Q

When swapping antidepressants, how do you do so?

A

Check guidelines
Cross-taper over several weeks

e.g. Mirtazipine

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30
Q

Once starting antidepressants, how long should they be continued for?

A

6 months

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31
Q

What may happen if you abruptly stop antidepressants?

Give examples

A

Discontinuation syndrome

Flu-like symptoms
Electric shock-like sensations
Irritability
Insomnia
Vivid dreams

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32
Q

What are the features of serotonin syndrome?

A

Altered mental state
ANS hyperactivity
Neuromuscular hyperactivity

E.g. anxiety
tachycardia, hypertension, hyperthermia
Hyperreflexia
Tremor
Rigidity

33
Q

What is the reversal agent for paracetamol?

A

NAC

34
Q

What is the reversal agent for opioids?

A

Naloxone

35
Q

What is the reversal agent for benzodiazepines?

A

Flumazenil

36
Q

What is the reversal/treatment agent for Beta blockers?

A

Glucagon (HF or cardiogenic shock)

Atropine (symptomatic bradycardia)W

37
Q

What is the reversal/treatment agent for CCBs?

A

Calcium chloride

38
Q

What is the reversal/treatment agent for cocaine?

A

Diazepam

39
Q

What is the reversal/treatment agent for methanol?

A

Fomepizole
Ethanol

39
Q

What is the reversal/treatment agent for cyanide?

A

Dicobalt edetate

40
Q

What is the reversal/treatment agent for carbon monoxide?

A

100% oxygen

41
Q

What is the management for an acute manic episode?

A

Antipsychotic

42
Q

What is the long-term management of mania?

A

LithiumW

43
Q

What are the potential adverse effects of lithium?

A

Fine tremor

Weight gain

CKD
Hyperparathyroidism
Nephrogenic diabetes insipidus

44
Q

What criteria/scoring system may be used to assess severity of symptoms?

A

GAD-7

10-14 = moderate anxiety

15-21 = severe anxiety

45
Q

What is the first-line therapeutic treatment for Anxiety?

A

Sertraline

46
Q

What are the features of PTSD?

A

TRAUMA

Traumatic event
Re-actualisation
Arousal
Unpleasant thoughts/emotions
eMotional numbing
Avoidance of triggers

47
Q

What is the management of PTSD?

A

EMDR and CBT

48
Q

If drug treatment is used as therapy has failed in PTSD, what is used?

A

SSRI

49
Q

What is the primary differentiation between OCD and obsessive compulsive personality traits?

A

OCD is the more severe, minimal insight

50
Q

What is catatonia?

A

Abnormal movement, communication and behaviour

51
Q

What is reactive attachment disorder?

A

results from severe neglect and trauma in early childhood. This results in emotional withdrawal and inhibition, sadness, fearfulness, irritability and impaired cognition. They struggle to form close relationships or attachments and do not respond well to affection or discipline

52
Q

What is Cotard syndrome?

A

Delusion that they are dead / dying

53
Q

What is Capgras syndrome?

A

False delusion that identical duplicate has replaced someone

54
Q

What is Alice in Wonderland Syndrome?

A

Incorrect perception of size of body parts or objects being large or small

55
Q

What is Fregoli syndrome?

A

Delusion that different people are the same person, changing disguise

56
Q

What are the key features of Schizophrenia?

A

Psychosis

Positive and Negative symptoms

Thought disruptions
Hallucinations
Reality disrupted
Emotional alterations
Auditory hallucinations
Delusions

Alogia
Anhedonia
Avolition
Affective flattening

57
Q

What is the management for Schizophrenia

A

Symptoms must be present for at least 1 month within overall 6 months

Antipsychotic medication

CBT

58
Q

What are the monitoring requirements for commencing an antipsychotic?

A

Weight
Blood pressure and HR
FBC, HbA1c, Lipids, PL
ECG

59
Q

A patient presents with muscle rigidity, hyperthermia, altered consciousness and autonomic dysfunction (slow reflexes and rigidity) after commencing Antipsychotics, what is your diagnosis?

A

Neuroleptic malignant syndrome

60
Q

What are the key differences between serotonin syndrome and neuroleptic malignant syndrome?

A

Trigger: SSRI vs Antipsychotic

Onset is quicker for Serotonin syndrome

Reflexes increased in SSRI and in Neuroleptic malignant syndrome, rigidity, hyporeflexia

Tx with Chlorpromazine in SS vs Dantrolene in NMS

61
Q

What are the features of Wernicke’s encephalopathy?

A

Confusion
Oculomotor disturbances
Ataxia

62
Q

What are the features of Korsakoff syndrome?

A

Memory impairment
Behavioural changes

63
Q

What are the features of Autism Spectrum Disorder?

A

Deficits in social interaction + deficits in communication + behaviour

64
Q

What criteria is used for ADHD?

A

ASRS

65
Q

What is the management for ADHD?

A

Supportive measures +/- Methylphenidate

66
Q

What are the features of Anorexia Nervosa?

A

Weight loss
Amenorrhoea
Lanugo hair
Hypothermia
Mood changes

67
Q

Why does amenorrhoea occur in Anorexia?

A

HPG axis dysfunction thus reduced LH and FSH

68
Q

What are the features of bulimia?

A

Erosion of teeth
Salivary gland enlargement
Mouth ulcers
GORD
Russell’s sign

Period of purging with binge eating

69
Q

What is Refeeding syndrome?

A

Nutritional deficiencies begin eating with electrolyte derangements such as hypokalaemia, hypophosphataemia, hypomagnesaemia, fluid overload

70
Q

Which dementia is related strongly to Parkinson’s disease?

A

Lewy Body dementia

71
Q

What deficiency causes Pellagra?

What are the features?

A

Nicotinic acid

3Ds
Dermatitis
Diarrhoea
Dementia

72
Q

What are the key features of frontotemporal dementia?

A

Socially unhinged
Poor judgment
Impulsive

73
Q

What are the key features of Alzheimer’s dementia?

A

Gradual onset
Memory loss for recent events
Rapid forgetting
late-onset aggression

74
Q

What are the key features of vascular dementia?

A

Abrupt onset/step-wise deterioration

Focal neurological signs
Signs of vascular disease

75
Q

What are the key features of Lewy body dementia?

A

Hallucinations
Parkinsonian features

76
Q

How would you help a lady come off her Temazepam when addicted? Initially it was prescribed as a hypnotic.

A

Diazepam, over 2 months

77
Q
A

13-19-18-1 (6 decks)

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