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psychiatry Flashcards

1
Q

what is the mechanism of action of typical antipsychotics?

A

Dopamine D2 receptor antagonists

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2
Q

Which drugs are typical anti-psychotics?

A

Haloperidol, chlorpromazine

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3
Q

Which medications are atypical antipsychotics?

A

clozapine, risperidone, olanzapine

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4
Q

what adverse effects do you get with typical antipsychotics?

A

extrapyramidal side effects and hyperprolactinaemia

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5
Q

What adverse effects do you get with atypical antipsychotics?

A

metabolic dysfunction

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6
Q

How would you manage acute dystonia?

A

procyclidine

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7
Q

What are the main side effects of tricyclic anti-depressants?

A

dry mouth and weight gain, blurred vision, constipation, urine retention

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8
Q

Name some TCAs

A

Amitryptiline, clompramine, imipramine

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9
Q

What can precipitate lithium toxicity?

A

dehydration, renal failure, diuretics, ACE-I/ARBs, NSAIDs, metronidazole

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10
Q

What are the features of lithium toxicity?

A

a course tremor, hyperreflexia, acute confusion, polyuria, seizure, coma

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11
Q

What is the management of lithium toxicity?

A

fluid resuscitation, haemodialysis

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12
Q

Which anti-depressant commonly causes QT prolongation and Torsades de pointes?

A

CitaloPRAM (babies are QTs)

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13
Q

Which anti-depressant is given to post-MI patients?

A

sertraline

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14
Q

Which anti-depressant is usually given in children and adolescents?

A

fluoxetine

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15
Q

What are the most common side effects of SSRIs?

A

GI upset
GI bleeding - must take PPI if taking with NSAIDs

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16
Q

Which drugs should you not take with SSRIs?

A

NSAIDs, warfarin/heparin, aspirin, triptans and MAOIs (^risk of serotonin syndrome)

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17
Q

When should patients be reviewed after starting an SSRI?

A

2 weeks
unless high suicide risk or under 25 - 1 week

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18
Q

What are the features of serotonin syndrome?

A

Sweating, tremor, confusion and hyperreflexia

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19
Q

What is the management of serotonin syndrome?

A
  • IV fluids
  • benzodiazepines
  • senotonin antagonists - chlorpromazine
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20
Q

What is the first line medical management of chronic insomnia?

A

Short acting benzodiazepines (zopiclone) or zolpidem

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21
Q

What is cotard and capgras syndrome?

A

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

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22
Q

What are Schneider’s first rank symptoms?

A

Auditory hallucinations, thought disorders, passivity phenomenon and delusional perceptions

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23
Q

What are the typical types of auditory hallucinations experienced by people with schizophrenia?

A

Two or more voices discussing the patient in the third person, thought echo, voices commenting on the patient’s behaviour

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24
Q

which SSRI should be started post MI?

A

Sertraline

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25
Which SSRI should be used in children and adolescents?
Fluoxetine
26
What is the management of someone on an SSRI who develops mania?
Stop SSRI, start anti-psychotic such as risperidone
27
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
28
Which benzodiazepine is used to manage alcohol withdrawal in liver cirrhosis?
Lorazepam
29
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
30
What is the difference between mania and hypomania?
Mania - > 7days, severe functional impairment, psychotic symptoms hypomania - < 7days, can be high functioning, no psychotic symptoms
31
What is the first line management of generalised anxiety disorder?
1. guided self help 2. Sertraline or CBT then can change to different SSRI or SNRI
32
What is the management of panic disorder?
CBT or SSRIs, if no response after 12 weeks offer imipramine/clomipramine
33
What is the management of schizophrenia?
1st line: oral atypical antipsychotics and CBT
34
Which SSRIs are used first line in depression?
Citalopram and fluoxetine
35
Which SSRI is used post MI?
sertraline
36
Which SSRI is used in children?
Fluoxetine
37
Which drugs should not be given with SSRIs?
NSAIDs (unless with PPI if needed), warfarin/heparin, aspirin, triptans, MAOIs
38
What are the discontinuation symptoms of SSRIs?
restlessness, difficulty sleeping, sweating, GI pain, diarrhoea, vomiting
39
Give examples of MAOIs
Rasagiline and selegiline
40
What are the side effects of lithium?
Lethargy, Insipidus, Tremor, Hypothyroid, Insides (GI), Urine (increased), metallic taste. IIH, hyperparathyroid and hypercalcaemia
41
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
42
What effects do SSRIs have in pregnancy?
1st trimester - congenital heart defects 3rd - persistent pulmonary hypertension
43
What is the management of PTSD?
CBT/EMDR 2nd line: venlafaxine or SSRI
44
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
45
How long must symptoms last for to be counted as a depressive episode?
2 weeks
46
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
47
What are the poor prognostic indicators of schizophrenia?
strong family history, gradual onset, low IQ, prodromal social withdrawal, lack of precipitant
48
What is tardive dyskinesia?
abnormal, involuntary movements - chewing, pouting of jaw after taking anti-psychotics for a long time
49
What is De Clerambault's syndrome?
the delusion that a famous person is in love with them inn the absence of other psychotic symptoms
50
What is De Fregoli syndrome?
The delusion of identifying a familiar person in various people they encounter
51
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
52
How long is the stopping period for an SSRI?
4 weeks
53
SNRIs require which type of monitoring during initiation and dose changes?
BP as can cause hypertension
54
SSRIs can cause which electrolyte imbalance?
hyponatraemia
55
What can be used instead of an SSRI for OCD?
Clomipramine (TCA)
56
What are the negative symptoms of schizophrenia?
blunting of affect, anhedonia, alogia (poverty of speech), avolition (poor motivation), social withdrawal
57
What is the management of PTSD?
CBT/EMDR if not working trial venlafaxine/SSRI
58
Long-term lithium use can lead to which electrolyte abnormality?
Hypercalcaemia due to hyperparathyroidism
59
What are the types of bipolar?
Type 1 = mania and depression Type 2 = hypomania and depression
60
Which medications can be used to treat alcohol dependance?
Disulfiram - makes people very sick when they drink alcohol Acamprosate - stops alcohol cravings
61
What is formication?
A type of paraesthesia that feels like insects crawling on the skin. differs from delusional parasitosis due to insight
62
Which medication can be used to treat acute dystonia secondary to antipsychotics?
Procyclidine
63
What can be used to treat tardive dyskinesia?
Tetrabenazine
64
What are the features of neuroleptic malignant syndrome?
fever, altered mental status, autonomic dysfunction, and lead-pipe rigidity, fluctuating blood pressure
65
What is an abnormal grief reaction?
Psuedohallucinations > 6 months after grief
66
What is the difference between dystonia and dyskinesia?
Dystonia = oculogyric crisis, torticollis/trismus, sustained action Dyskinesia = repetitive movement - pouting
67
When would you use activated charcoal vs gastric lavage?
gastric lavage if cannot protect airway and if life-threatening overdose
68
What is the management of a tricylic (imipramine) overdose?
IV bicarbonate, if hypotension or arrythmias

Finals passmed (23 decks)

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