psychiatry Flashcards
what is the mechanism of action of typical antipsychotics?
Dopamine D2 receptor antagonists
Which drugs are typical anti-psychotics?
Haloperidol, chlorpromazine
Which medications are atypical antipsychotics?
clozapine, risperidone, olanzapine
what adverse effects do you get with typical antipsychotics?
extrapyramidal side effects and hyperprolactinaemia
What adverse effects do you get with atypical antipsychotics?
metabolic dysfunction
How would you manage acute dystonia?
procyclidine
What are the main side effects of tricyclic anti-depressants?
dry mouth and weight gain, blurred vision, constipation, urine retention
Name some TCAs
Amitryptiline, clompramine, imipramine
What can precipitate lithium toxicity?
dehydration, renal failure, diuretics, ACE-I/ARBs, NSAIDs, metronidazole
What are the features of lithium toxicity?
a course tremor, hyperreflexia, acute confusion, polyuria, seizure, coma
What is the management of lithium toxicity?
fluid resuscitation, haemodialysis
Which anti-depressant commonly causes QT prolongation and Torsades de pointes?
CitaloPRAM (babies are QTs)
Which anti-depressant is given to post-MI patients?
sertraline
Which anti-depressant is usually given in children and adolescents?
fluoxetine
What are the most common side effects of SSRIs?
GI upset
GI bleeding - must take PPI if taking with NSAIDs
Which drugs should you not take with SSRIs?
NSAIDs, warfarin/heparin, aspirin, triptans and MAOIs (^risk of serotonin syndrome)
When should patients be reviewed after starting an SSRI?
2 weeks
unless high suicide risk or under 25 - 1 week
What are the features of serotonin syndrome?
Sweating, tremor, confusion and hyperreflexia
What is the management of serotonin syndrome?
- IV fluids
- benzodiazepines
- senotonin antagonists - chlorpromazine
What is the first line medical management of chronic insomnia?
Short acting benzodiazepines (zopiclone) or zolpidem
What is cotard and capgras syndrome?
Cotard - patient believes they are dead or a part of them is dead
Capgras - patient believes someone they know has been replaced with an imposter
What are Schneider’s first rank symptoms?
Auditory hallucinations, thought disorders, passivity phenomenon and delusional perceptions
What are the typical types of auditory hallucinations experienced by people with schizophrenia?
Two or more voices discussing the patient in the third person, thought echo, voices commenting on the patient’s behaviour
which SSRI should be started post MI?
Sertraline
Which SSRI should be used in children and adolescents?
Fluoxetine
What is the management of someone on an SSRI who develops mania?
Stop SSRI, start anti-psychotic such as risperidone
What is the definition of chronic insomnia?
If someone has trouble falling or staying asleep for 3+ nights a week for more than 3 months
Which benzodiazepine is used to manage alcohol withdrawal in liver cirrhosis?
Lorazepam
What is the management of OCD?
Mild - CBT, ERP
Moderate - SSRI or more intense CBT
Severe - refer to secondary care mental health team for assessment - offer combined SSRI and CBT while waiting
What is the difference between mania and hypomania?
Mania - > 7days, severe functional impairment, psychotic symptoms
hypomania - < 7days, can be high functioning, no psychotic symptoms
What is the first line management of generalised anxiety disorder?
- guided self help
- Sertraline or CBT
then can change to different SSRI or SNRI
What is the management of panic disorder?
CBT or SSRIs, if no response after 12 weeks offer imipramine/clomipramine
What is the management of schizophrenia?
1st line: oral atypical antipsychotics
and CBT
Which SSRIs are used first line in depression?
Citalopram and fluoxetine
Which SSRI is used post MI?
sertraline
Which SSRI is used in children?
Fluoxetine
Which drugs should not be given with SSRIs?
NSAIDs (unless with PPI if needed), warfarin/heparin, aspirin, triptans, MAOIs
What are the discontinuation symptoms of SSRIs?
restlessness, difficulty sleeping, sweating, GI pain, diarrhoea, vomiting
Give examples of MAOIs
Rasagiline and selegiline
What are the side effects of lithium?
Lethargy, Insipidus, Tremor, Hypothyroid, Insides (GI), Urine (increased), metallic taste. IIH, hyperparathyroid and hypercalcaemia
How often should lithium levels be monitored?
Every 3 months when established, weekly when changing dose or starting.
Sample should be taken 12 hours post dose
What effects do SSRIs have in pregnancy?
1st trimester - congenital heart defects
3rd - persistent pulmonary hypertension
What is the management of PTSD?
CBT/EMDR
2nd line: venlafaxine or SSRI
What are the features of alcohol withdrawal and at which times?
6-12hrs: tremor, sweating, anxiety
36hrs: seizures
48-72hrs: delirium tremens, course tremor, confusion, delusions, auditory and visual hallucinations, fever
How long must symptoms last for to be counted as a depressive episode?
2 weeks
What are the physiological abnormalities seen in anorexia nervosa?
enlarged salivary glands, hypokalaemia, low FSH, LH and testosterone, raised cortisol and GH, raised glucose, raised cholesterol, low T3
What are the poor prognostic indicators of schizophrenia?
strong family history, gradual onset, low IQ, prodromal social withdrawal, lack of precipitant
What is tardive dyskinesia?
abnormal, involuntary movements - chewing, pouting of jaw after taking anti-psychotics for a long time
What is De Clerambault’s syndrome?
the delusion that a famous person is in love with them inn the absence of other psychotic symptoms
What is De Fregoli syndrome?
The delusion of identifying a familiar person in various people they encounter
What is the difference between functional neurological disorder and somatisation disorder?
Somatisation - Range of physical complaints and is preoccupied by them despite negative evaluations, persistent symptoms for 2+ years and refusal to accept reassurance
FND - neurological symptoms, patients are indifferent to disorder
How long is the stopping period for an SSRI?
4 weeks
