Psychiatry Flashcards
How long can a normal grief reaction last for?
Up to 6m
What is the antidepressant of choice post-MI?
SSRIs
What are alternatives to prolonged manual restraint?
Rapid tranq or seclusion
What can cause acute dystonic reaction?
Antipsychotics
What is acute dystonic reaction
An oculogyric crisis, with features including neck fixed backwards and laterally, upward deviation of eyes, tongue protrusion and jaw spasm.
How do we treat acute dystonic reaction?
IV procyclidine and withdrawal of the causative medication.
What is Munchausen’s syndrome?
It’s a type of factitious disorder where the person repeatedly and deliberately acts as if he has a physical or mental illness when he is not really sick. People with Munchausen syndrome are willing to undergo painful or risky tests and operations in order to get sympathy and attention associated with being sick.
What is somatization disorder?
Somatisation disorder is characterised by recurrent and multiple somatic complaints for which medical attention has been sought but no physical cause found over many years starting before 30 years of age. These complaints cannot be explained fully by any known general medical condition or any other mental disorder.
Give a common medication that causes hyponatraemia
SSRIs
Which is the most likely SSRI that may lead to QT prolongation and torsades de pointes?
Citalopram
Give side effects of atypical antipsychotics
They act by blocking dopamine D2 receptors in the brain which helps to reduce psychotic symptoms. However, they can also cause hyperprolactinaemia and weight gain which may increase the risk of VTE.
What does OCD differ to OCPD?
It is different to obsessive-compulsive disorder in a number of ways, one being that in OCD, thoughts and behaviours are seen as unwanted/unhealthy, being the product of anxiety-inducing and involuntary thoughts, whereas in OCPD they are egosyntonic (i.e. perceive as being rational and desirable).
How does mania differ from hypomania?
Hypomania is characterised by elevated mood, pressured speech and flight of ideas but without psychotic symptoms. Lasts for < 7 days, typically 3-4 days. Can be high functioning and does not impair functional capacity in social or work setting
What are psychotic symptoms?
delusions, passivity or thought blocking.
What is akathisia?
Severe restlessness
Give five SEs of lithium
L - leucocytosis
I - idiopathic intracranial hypertension
T - tremor, thyroid problems, T wave inversion
H - hyperparathyroidism, hypercalcemia
I - insipidus diabetes
U - urination=polyuria
M - munchies=weight gain
What is the difference between section 135 and 136?
I always think of 135 comes before 136
Because:
The police have to enter your house first (135), before they can take you to a place of safety; hospital/136-suite (136)
135 out of the hive, 136 stop the mix (mixing in public)
What is a section 17a?
CTO
What is a section 4?
72 hour assessment order
used as an emergency, when a section 2 would involve an unacceptable delay
a GP and an AMHP or NR
often changed to a section 2 upon arrival at hospital
Give two useful SEs of mirtazapine
sedation and increased appetite)
Why should triptans be avoided when a pt takes an SSRI
An increased risk of serotonin syndrome is the correct answer. Triptans are synthetic serotonin receptor agonists and so in combination with selective serotonin reuptake inhibitors (SSRIs) can increase the risk of serotonin syndrome, which is potentially life-threatening. NICE guidance for migraines states that triptans should be used with caution in people taking SSRIs. They do not, however, state that triptans are absolutely contra-indicated in combination with SSRIs.
Which things are raised in AN?
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
What PHQ-9 score indicates severe depression?
‘more severe’ depression: encompasses what was previously termed moderate and severe depression
a PHQ-9 score of ≥ 16
What is the difference between restricted, blunted and flat effect?
Restricted affect is where there is a reduction in the range and intensity of emotions shown. Blunted affect is where there is a severe reduction in emotional expression and flat affect is where there are no signs of emotional expression at all.
Give three SEs of clozapine
weight gain
excessive salivation
agranulocytosis
neutropenia
myocarditis
arrhythmias
What is an oculogyric crisis?
An oculogyric crisis, which involves prolonged involuntary upward deviation of the eyes, is a type of acute dystonia. Acute dystonias are extrapyramidal side effects that can occur within hours to days after initiating or increasing the dose of antipsychotic medication like chlorpromazine. They are characterized by sustained, often painful muscle contractions leading to abnormal postures or movements.
What is Hoover’s sign?
Hoover’s sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
What is a conversion disorder?
Functional neurological disorder (conversion disorder) - typically involves loss of motor or sensory function
What is tardive dyskinesia
Tardive dyskinesia is a side effect of long-term use of antipsychotic medications, especially the typical ones like chlorpromazine. It presents with involuntary, repetitive movements that can affect any part of the body but are most commonly seen in the face and tongue. The pouting motion described in this question is likely an example of orofacial dyskinesia, a subtype of tardive dyskinesia.
What is Cotard syndrome?
Cotard syndrome is characterised by a person believing they are dead or non-existent
What is Capgras delusion?
Capgras syndrome is a neuropsychiatric phenomenon in which patients believe that a partner/family member/friend has been replaced by an imposter.
What is Charles-Bonnet syndrome?
Charles Bonnet syndrome is a phenomenon in which patients with severe visual impairment report vivid hallucinations. Charles Bonnet syndrome is a complex neuropsychiatric/ophthalmological phenomenon and is commonly misdiagnosed as a primary psychosis.
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 Othello syndrome?
Othello syndrome is incorrect. 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.
Describe the pathophysiology in alcohol withdrawal
Alcohol withdrawal results from decreased inhibitory GABA and increased NMDA glutamate transmission
GABA is an inhibitory neurotransmitter which means it decreases brain activity and produces calming effects when levels are elevated. This is increased during alcohol consumption and causes the classic symptoms of drunkenness.
Glutamate is an excitatory neurotransmitter, meaning it increases brain activity and acts as a sort of natural stimulant. This is decreased during alcohol consumption, causing the body to slow down on a physiological level.
How does SSRI discontinuation syndrome present?
Dizziness, electric shock sensations and anxiety are symptoms of SSRI discontinuation syndrome
What is paroxetine?
SSRI
After 4 weeks of mirtazapine 15mg she is reviewed and has not achieved a satisfactory therapeutic response. She describes a side effect of sedation.
What is the most appropriate management?
Mirtazapine is generally more sedating at lower BNF doses (e.g. 15mg) than higher doses (e.g. 45mg)
How do we manage acute dystonia secondary to antipsychotics?
Procyclidine
How does procyclidine help with acute dystonia?
Procyclidine will help to reverse the event. It belongs to a class of medication called anticholinergics that work by blocking acetylcholine. This helps decrease muscle stiffness, sweating, and the production of saliva, and helps improve walking ability in people with Parkinson’s disease.
What is the peak incidence of seizures in alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
If CBT or EMDR therapy are ineffective in PTSD, what are the first-line drug tx?
If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI
Patients ≤ 25 years who have been started on an SSRI should be reviewed after…
1 week
How long can a section 136 last for?
24 hours
Where can the police take a pt on a section 136?
A safe place includes a hospital, the person’s home or a friend’s home or, if there is no other option, a police station.
How do we manage benzo addiction?
switch to the equivalent diazepam dose then slowly withdraw over the next 2 months. This approach is recommended because diazepam has a longer half-life than temazepam, which allows for a smoother and more gradual withdrawal process. Additionally, UK guidelines support using diazepam as the preferred benzodiazepine for withdrawal due to its long half-life and availability in lower doses, which facilitates gradual tapering.
After how much time can we diagnose a depressive disorder?
2 weeks
How do benzos work?
Enhances the effect of gamma-aminobutyric acid. Temazepam belongs to a class of drugs known as benzodiazepines. Its mechanism of action involves enhancing the effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain. This enhancement is achieved by increasing the frequency of chloride channel opening within the GABA-A receptor complex, leading to hyperpolarisation of neurons and ultimately decreased neuronal excitability.
What is Parkinsonism?
characterised by the presence of a resting tremor, bradykinesia (slowness of movement), rigidity and postural instability
Do we use paroxetine in pregnancy?
Paroxetine use in pregnancy - can lead to increased risk of congenital malformations
What is imipramine?
It is a tertiary amine tricyclic antidepressant.
What are the antimuscarinic SEs that may be seen with imipramine use?
Can’t See - blurred vision
Can’t Pee - Urinary retention
Can’t Spit - dry mouth
Can’t Sh*t - constipation
TCA
Give the common sx in SSRI discontinuation syndrome
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
What is venlafaxine?
SNRI
Can we give SSRIs with warfarin?
NICE guidelines recommend avoiding SSRIs and considering mirtazapine
How might lorazepam affect memory?
One of the side effects of this drug is that this can cause anterograde amnesia. Where memory recall and the creation of new memories is significantly impaired.
What is delusional disorder?
Delusional disorder is correct because the patient presents with a fixed, false belief (being spied on by his neighbours) that persists despite a lack of evidence. The belief is non-bizarre, meaning it could happen in reality, but there is no substantial evidence, and the patient’s overall functioning is relatively intact, which is characteristic of delusional disorder.
What is adjustment disorder?
Adjustment disorder is correct because the patient’s symptoms of low mood and stress began in response to a clear external stressor (job loss). The symptoms are relatively mild and short-term, and there is no history of more severe mood disturbances or chronic depression, making adjustment disorder the most likely diagnosis.
Which overrides which - the MHA or the MCA
The MHA
After 3 months on a section 3 a second opinion is needed
