Psychiatry Flashcards
Which SSRI most commonly causes QT prologation?
Citalopram?
What is common side effect of TCAs?
Overflow incontinence (anticholinergic effect)
What are the extrapyramidal side-effects of some antipsychotics?
1) Parkinsonism
2) Acute Dystonia
3) Akathisia
4) Tardive dyskinesia
Outline timeline of side effects during alcohol withdrawal.
1) symptoms: 6-12 hours
2) seizures: 36 hours
3) delirium tremens: 72 hours
What is the management of alcohol withdrawal?
Admit if coplex history of withdrawal
1st line long-acting benzodiazepine (e.g. chlordiazepoxide or diazepam)
If history of liver impairment: lorazepam
What is the management of acute dystonia secondary to antipsychotics?
Procyclidine
Which antipsychotic has the most tolerable side effect profile?
Aripiprazole
What risk do antipschotics increase in the elderly?
Increased stroke and VTE risk
What is the management of acute stress disorder?
1st line: trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
also: benzodiazepines
What are atypical antipsychotics?
1) clozapine
2) olanzapine: higher risk of dyslipidemia and obesity
3) risperidone
4) quetiapine
5) amisulpride
6) aripiprazole: generally good side-effect profile, particularly for prolactin elevation
What is best antidepressant post-MI?
SSRI
How often do you need to do FBC monitoring for Clozapine?
1) Weekly for 18 weeks
2) Fortnightly for up to one year
3) Monthly thereafter
Why should you be careful prescribing triptans in someone taking an SSRI?
Increased risk of seretonoin syndrome
What is Cotard syndrome?
Cotard syndrome is characterised by a person believing they are dead or non-existent
What is erotomania?
Erotomania is a delusional disorder characterised by the mistaken perception that another person is infatuated with them.
Affected patients often exhibit ‘stalking’ behaviour, and targets are classically socially unattainable, such as celebrities.
What is Charles Bonnet syndrome?
A phenomenon in which patients with severe visual impairment report vivid hallucinations.
What is Capgras syndrome?
Capgras syndrome is a neuropsychiatric phenomenon in which patients believe that a partner/family member/friend has been replaced by an imposter.
What is Orthello syndrome?
Othello syndrome, also known as delusional jealousy, is a delusional disorder with male preponderance in which patients hold a firmly held belief that their partner is unfaithful, in the absence of proof.
What are the side effects of TCAs?
Anticholinergic:
Blurred vision
Dry mouth
Constipation
Urinary retention
Also:
Postural hypotension
Lengthening of QT interval
Drowsiness
What is the SSRI of choice in children and adolescents?
Fluoxetine
What factor can cause a rise in clozapine levels after them being stable for a while?
Smoking cessation
Stopping drinking
What are symptoms of SSRI discontinuation syndrome?
Dizziness, electric shock sensations and anxiety
Which side-effect is more common with atypical than conventional anti-psychotics?
Weight gain
What is the management of alcohol withdrawal?
first-line: long-acting benzodiazepines e.g. chlordiazepoxide or diazepam
Also: carbamazepine and phenytoin for alcohol withdrawal-related seizures
What is the physiology of the neuroreceptors in alochol withdrawal?
Decreased inhibitory GABA Increased NMDA glutamate transmission
What is the management of PTSD?
for mild symptoms can watch and wait
1st line: trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy
2nd line: Venlafaxine or SSRI
3rd line: In severe cases risperidone
What is the drug management of generalised anxiety disorder?
NICE suggest sertraline should be considered the first-line SSRI
What are the 4 key features in the ICD-11 classification of a personality disorders?
1) Persistent attern
2) Impairment
3) Duration
4) Distress or dysfunction
What is somatisation disorder?
- multiple physical SYMPTOMS present for at least 2 years
- patient refuses to accept reassurance or negative test results
What is Illness anxiety disorder (hypochondriasis)?
- persistent belief in the presence of an underlyingserious DISEASE, e.g. cancer
- patient again refuses to accept reassurance or negative test results
What is Functional neurological disorder (conversion disorder)?
- typically involves loss of motor or sensory function
- the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
- patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
What is Dissociative disorder?
- multiple personality disorder
- dissociation is a process of ‘separating off’ certain memories from normal consciousness
- in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
What is Factitious disorder (Munchausen’s syndrome)?
- the intentional production of physical or psychological symptoms
What is Malingering?
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
What is the management of schizophrenia?
1st line: Atypical antipsychotic
All patients: CBT
