Psychiatry Flashcards
What drugs are first line for rapid tranquillisation?
IM Haloperidol or IM Lorazepam
(Lorazepam used if cardiac history is unknown)
What is section 136?
Section 136 is used by the police to bring people who could be displaying signs of mental illness presenting a risk to themselves or others to place of safety.
What are the features of discontinuation of SSRI?
Electric shock pains, sweating, GI symptoms, mood changes, unsteadyness, dizzyness.
When is Clozapine indicated to be used?
When 2 or more antipsychotics have been unsuccessful.
What is the major side effect with Clozapine?
Agranulocytosis.
How do Benzodiazpines work?
Enhance GABA
What does section 3 allow?
Treatment for up to 6 months
What does section 4 allow?
Assessment order of 72 hours
Treatment resistant schizophrenia - use what drug?
Clozapine
What are the side effects with Clozapine?
Agranulocytosis, weight gain, neutropenia, myocarditis, arrhythmias
What is first line for panic disorder?
Sertraline
What does section 4 of the MH act do?
72 hours of assessment
What are the biochemical findings in anorexia.
Everything is low apart from the G’s and C’s which are raised. Eg raised cortisol/ raised GH.
What are examples of the atypical antipsychotics?
Clozapine/ Olanzapine
What score suggests dementia on the mini mental state exam?
Anything less than 24/ 30 suggests dementia.
What scores are recommended by NICE for dementia screening in GP setting?
6CIT and 10 CS (10 point cognitive screener)
What drug is first line in GAD?
Sertraline SSRI
What is the monitoring after prescribing an SSRI for GAD?
Review the effectiveness and side effects of the drug every 2 to 4 weeks during the first 3 months of treatment and every 3 months thereafter.
What are the first rank symptoms for schizophrenia? (4)
Auditory hallucinations
Thought disorder
Delusions
Passivity phenomena
What type of drug is Risperidone?
Atypical antipsychotic
What are the side effects of atypical antipsychotics?
weight gain, hyperprolactiaemia, and agranulocytosis with clozapine
What type of drug is Paroextine?
SSRI
What drug is used for the long term management of Bipolar?
Lithium
What does section 2 allow?
28 days assessment
What does section 3 allow?
Treatment for 6 months
What does section 4 allow?
Emergency assessment - 72 hours
What does section 5(2) allow?
Pt already in hospital- 72 hours assessment
What does section 136 allow?
Police to bring someone to hospital from a public space.
What are the first line drugs for Alzheimers?
Any of the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
What are the features of Neuroleptic malignant syndrome?
Fever, Autonomic instability, Rigidity and altered mental state. RAISED CK
*Starts 2-10 days after starting the antipsychotic**
Management of Neuroleptic malignant syndrome?
IV Fluids
Dantrolene if severe
What are some examples of atypical antipsychotics?
Clozapine, Olanzapine, Arirpiprazole, Quietapine, Risperidone
What is important to know about Fluoxetine?
Long half life. If switching to another SSRI. Need to stop Fluoxetine and restart next one in 5-7 days.
Switching SSRIs- general principles
Most SSRIs can switch between (direct switch). APART from fluoxetine which needs to be stopped and allow 5-7 days before starting next SSRI.
Examples of SSRIs
Sertraline, Fluexoetine, Paroxetine, Citalopram, Escitolapram
What is
- Delirium tremens
- Wernickes encephalopathy
- Korsakoffs
Delirium tremens- acute alcohol withdrawal.
Wernickes- COAT (confusion, opthalmoplegia, ataxia, thiamine deficiency)
Korsafkoffs - RACK (retrograde amnesia, anterograde amnesia, confabulation)
How is Delirium tremens treated ?
Benzodiazepines (chlordiazepoxide or diazepam)
How does Delirium tremens present?
tremor, sweating, tachycardia, anxiety
Seizures!
What PHQ 9 indicates less severe/ more severe depression? and management ?
score of 16= less severe = behavioural therapies
Score >16= more severe= CBT + antidepressant
What are the features of lithium toxicity?
Tremors,
Polyuria
Confusion
Seizures
Increased reflexes
What is Cotard Syndrome?
Delusion that part of the body is rotten or dead.
Cotard = Corpse
What is Capers Syndrome?
A familiar person has been replaced with an identical imposter!
Closely Associated Person Got Replaced And Switched
What is Fregoli Syndrome?
Different people they see are actually the same person in lots of disguises.
What is De Clerambault Syndrome?
Someone who is a celebrity is secretly in love with them.
What is Otello syndrome?
Pathological delusions that your partner is cheating
What is the treatment of depression in Bipolar disorder?
Quetiapine (atypical antipsychotic) alone, or
Fluoxetine (SSRI) combined with olanzapine (antipsychotic), or
Olanzapine alone, or
Lamotrigine alone.
Acamprosate, Disulfram, Naltrexone are used how?
Alcohol excess- “problem drinking”
Mild Alchohol dependence
Disulfram- promotes absistance
Acamprosate- reduces cravings. NMDA antagonist
Naltrexone- opiod antagonist
Adverse effects of Cocaine
Coronary artery spasm
Hypertension
Tachycardia/ bradycardia
Seizures
Hyper-reflexia
Agitation
Psychosis
Bugs crawling under the skin
Management of cocaine toxicity?
Benzodiazepines are first line in most examples of cocaine toxicity
What are the symptoms of discontinuation of a SSRI?
- Which SSRI has the highest risk of discontinuation syndrome?
increased mood change
restlessness
DIFFICULTY SLEEPING!
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
Paroxetine is the highest risk!
Treatment of ADHD in children?
Methylphenidate AGED OVER 5 (six week trial)
What needs to be done before starting ADHD medication?
ECG prior
What tests need to be done prior to starting an antipsychotic?
Bloods: Full blood count (FBC), urea and electrolytes (U&E), liver function tests (LFT)
Lipids, WEIGHT
Fasting blood glucose, prolactin
Blood pressure
ECG
CVS risk assessment
Mania vs Hypomania in Bipolar- how long do symptoms need to last for to classify as an episode?
Hypomania- 4 days
Mania- 7 days
Which antipsychotic is exclusively monitored by secondary care?
Clozapine (risk of agranulocytosis)
Ecstasy (MDMA) toxicity? and mangement
Hyponatraemia
Tachycardia
Hypertension
Neurological- anxiety/ sweating
Mx) supportive but Dantrolene if required
Side effects of Lithium?
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia
What are the tools for screening for depression?
HAD
PHQ-9
What SSRI for breastfeeding mothers (if initiating)?
Paroextine or Sertraline
Amitryptilline overdose presents with?
Anticholinergic side effects
Dry mouth/ blurred vision/ Prolonged QRS interval
Aspirin overdose- does what to do the ABG?
Initially respiratory alkalosis followed by metabolic acidosis
What are the risk factors for Schizophrenia?
Black
Urban populations
Migrants
Exposure to Toxoplasmosis
Malingering vs Facticious disorder?
Malingering- external reward eg disability payments
Factious disorder- internal gains ‘sick role’
What are the extrapyramidal side effects of antipsychotics?
Acute dystonia (torticillis/oculogyral crisis)
Akathesia - restlessness
Tardive dyskinesia
Parkinsonism
What is the difference between Akathesia and Restless leg syndrome?
Akathesia is in response to antipsychotic
Restless leg syndrome - Inability to sleep
What drug is contraindicated with prescription of SSRI?
MAO inhbitors are contraindicated.
Increased the risk of serotonin syndrome
Triad of autonomic instability/
Tamoxifen cannot be co prescribed with which SSRIs?
Fluoxetine and Paroextine
Features of borderline personality disorder
Frequent episodes of self harm
Unstable/ intense relationships
(Most common type of personality disorder)
What is an example of a TCA antidepressant? and how does it present in overdose? and what is the antidote?
Amitriptylline
Overdose: antimusclarnic effects - dry mouth/ blurred vision/ ARRYTHMIAS!
IV Bicarbonate and need ECG monitoring
What is the 6 monthly monitoring for Lithium?
Thyroid and Renal tests every 6 months
What is a “brief psychotic disorder”
Episode of psychosis
Less than a month
NOT substance related/ induced
