Psychiatry Flashcards
Safe to eat with MAO B inhibitors:
Eggs.
Which psych drugs causes urinary retention ?
Tricyclic Antidepresants—Amitryptiline.
Which TCA is safest in OD ?
Lofepramide.
How often to check Lithium levels ?
Every 3 months.
Which psych meds causes Hyperprolactinoma ?
Atypical Antipsychotics—Eg: Aripiprazole.
How to differentiate between prolactinoma and ariprazole ass hyperprolactinoma ?
Meds induced prolactin level—2-3k
Prolactinoma induced prolactin levels—5k.
Obsessive Compulsive personality disorder :
Rigid with respect to morals, ethics and values + Reluctant to surrender work to others+ Difficult to collaborate.
Rigid with respect to morals, ethics and values + Reluctant to surrender work to others.
Obsessive compulsive personality disorder :
PP psychosis occurs after how many weeks?
2 weeks.
become dependant on temazepam,:
Switch to equivalent diazepam dose, then slowly withdraw over next 2 months.
Is epilpesy S/e of ECT ?
No
Differentiate Dementia and Severe Depression:
Severe depression—Global memory loss.
Dementia— loss of recent memory.
Aalcohol withdrawal seizures Occurs after how many hours?
36 Hours.
Alcohol withdrawal symptoms occurs after how many hours ?
24 hours.
Alcohol withdrawal—Delerium Tremens occurs after how many hours ?
72 hours.
Long QT interval is caused by which TCA ?
Dosulpin.
Which TCA is dangerous in OD ?
Dosulpin.
Severe depression which mimics dementia key feature ?
Loss of recent and long term memory.
Differentiate Alzheimer’s and Severe Depression:
Alzheimer’s : loss of recent memory, and retains Long term memory.
Severe Depression : Global memory loss
Alcohol withdrawal Rx:
Long term BZD: Chlordiazpoxide.
Stress incontinence Rx and its MOA :
Duloxetine.
MOA: serotonin and noradrenaline reuptake inhibitor
What is raised in Anorexia nervosa?
G and C:
Growth hormone.
Cortisol
Cholesterol
General anxiety disorder first line R:
Several months of anxiety with no clear trigger
SSRI: Duloxetine.
PTSD time duration :
Symptoms onset > 1 month.
Emotional Numbing is a feature of ?
PTSD.
Olanzapine S/E:
Obesity.
Benzodiazepine MOA :
Enhances the effect of GABA
Strongest risk factor for psychotic diseases :
Family history.
Which organ enlarges in Anorexia ?
Parotidomegaly.
impulsivity, feelings of emptiness, fear of abandonment and unstable self image
Borderline personality disorder
Tardive dyskinesia is seen in which psych meds ?
Typical antipsychotics—Chlorpromazine.
Strong risk factor for suicide ?
Addiction.
MOA for atypical antipsychotics:
D2 and serotonin receptors blockade.
Does lithium cause alopecia ?
No.
overly sensitive and can be unforgiving if insulted, question loyalty of those around them and are reluctant to confide in others
Paranoid personality disorder.
fearful of criticism, being unliked, rejection and ridicule
Avoidant personality disorder.
SNRI example:
Duloxetine.
Drug used in PTSD:
Venlafaxine.
Anti psychotics in elderly side effect :
Stroke
Hyponatremia is ass with which meds ?
SSRI
Weight gain is caused by which antipsychotics ?
Atypical antipsychotics
Patient with a fixed, false belief (delusion) that they are infested by ‘bugs’ →
Delusional parasitosis
OCD first line Rx:
cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is first-line
Illness anxiety disorder :
Persistent believe in having ONE particular symptoms + all Ix Normal.
Persistent believe in having ONE particular symptoms + all Ix Normal.
Illness anxiety disorder
often fail to conform to social norms, and show lack of remorse, deception and irresponsibility + Multiple arrests + prone to getting into fights due to aggressiveness
Antisocial personality disorder
excessive reassurance from others, seek out relationships and require others to take responsibility for major life decisions + urgently seek out new relationships when first one fails
Dependant personality disorder
lack empathy, have a sense of entitlement and take advantage of others to achieve their own need
Narcisstic personality disorder.
H/o starting antipsychotics neck pain + neck is involuntarily flexed
Torticolis ass with antipsychotics or acute dystonia.
Person believes he is dead :
Cotard syndrome.
Which visual impairment is ass with Charles Bonnet ?
Peripheral visual impairment
Elderly+ The history of agitation, anhedonia, and sleep disturbance with a relatively high MOCA score:
Depression in elderly
Telling her husband she is afraid of catching avian flu. On exploring this further she is concerned due to the high number of migrating birds she can see in her garden. She reports that the presence of her husbands socks on the washing line in the garden alerted her to this. What is the most likely diagnosis?
avian flue due to migrating birds—Delusion.
Presence of husband’s socks altered her thoughts—Thought disorder.
Dx: Acute schizophrenia.
Stress—Functional neurological disorder( Leg weakness/arm weakness). Dx?
Conversion Disorder.
Alcohol withdrawal symptoms Rx:
Chlordiazepoxide + High dose IM Vitamin B replacement.
Haloperidol acts on which receptor ?
Haloperidol is a typical antipsychotic. It acts on D2 receptors.
De Clerambault’s syndrome
Delusional disorder, whereby the patient has a fixed belief that another individual, usually someone famous or of high social standing, is in love with them.
Delusional disorder, whereby the patient has a fixed belief that another individual, usually someone famous or of high social standing, is in love with them.
De Clerambault’s syndrome.
patient presents with nausea, headaches and palpitations. He has had multiple previous admissions with such symptoms over the past 2 years, each time no organic cause was found. What kind of disorder is this likely to represent?
Somatisation disorder.
Somatisation= So many symptoms
He has previously been investigated for abdominal pain and no cause has been found. He states that unless he is given morphine for the pain he will kill himself. This is an example of
Malingering,
Getting morphine is the gain here.
akathisia (severe restlessness) Is an example of ;
Antipsychotics meds.
sprinter who is currently preparing for a national athletics meeting asks to see the team doctor due to an unusual sensation in his legs. He describes a numb sensation below his knee.Dx?
Conversion disorder.
inappropriate sexual seductiveness, suggestibility and intense relationships
Histrionic personality disorder.
Histrionic personality disorder.
inappropriate sexual seductiveness, suggestibility and intense relationships
Differentiate Mania and Hypomania :
Mania: Lasts for more than 7 days.
Presence of psychotic symptoms—delusion symptoms/Psychotic symptoms.
Hypomania- lasts less than 7 days.
No psychotic symptoms.
Oculogyric crisis Rx:
Procyclidine.
Bullima 2nd line Rx:
First line—CBT
Second line—High dose Fluoxetine
Features of PTSD :
Hyperarousal
Emotional Numbing
Intrusive memories—Nightmares.
Avoidance
Baby blues time frame and Rx:
Time = Less than one week
Rx= Explanation and Reassurance
Imipramine class ?
Atypical antipsychotics
Atypical antipsychotic S/e :
Anticholinergic side effects: blurred vision , dry mouth.
Argument—Now unable to speak—all Ix are normal. Dx?
Psychogenic aphonia
Acute onset— good or bad prognosis in schizophrenia ?
Good prognosis
Early symptoms of depression:
Early morning waking up
pathological jealousy where a person is convinced their partner is cheating on them without any real proof.
Othello syndrome
The risk of developing schizophrenia if one monozygotic twin is affected is approximately:
50 %
A 32-year-old woman is brought to the Emergency department by the police. She was found preaching outside the local supermarket, telling people that she is god’s disciple and has been sent to prevent them from wasting money. It transpires that she has also spent up to her limit on her bank card. She began treatment with fluoxetine some 3 weeks ago for reactive depression after splitting from her husband. A limited physical examination due to poor compliance is unremarkable, as is a routine blood screen.
Mania.
Preaching outside as god’s disciple—Delusion of Grandeur—Psychosis.
She has spent most of her money>disinhibition,elevated mood
(Mania is often associated with spending money )
antidepressants like fluoxetine can sometimes trigger manic episodes in individuals with bipolar disorder.
Schizophrenia is also unlikely given the absence of features such as auditory hallucinations or delusions of reference
psychotic depression typically presents with depressive symptoms accompanied by psychosis. In this case, the patient does not exhibit depressive symptoms but rather shows signs of excessive energy and elevated mood typical of mania.
Patients with a history of complex withdrawals from alcohol (i.e. delirium tremens, seizures, blackouts
should be admitted to hospital for monitoring until withdrawals stabilised—Inpatient detoxification and community follow up
SSRIs with higher incidence of discontinuation symptoms?
Paroxetine.
Apart from Chlordiazepoxide, what is used in treatment for Delerium tremens /
lorazepam or diazepam are used in the treatment of delirium tremens/alcohol withdrawal.
H/O age-related macular degeneration, followed by glaucoma and cataract + Disturbing Visual Hallucinations :
Charles Bonnet syndrome.
Charles bonnet syndrome Rx:
Reassurance.
Experiencing Depression every winters :
Seasonal Affective disorder.
Strong risk factor for Suicide ?
Deliberate self harm.
a mental health condition where an individual obsesses over perceived flaws or defects in their appearance that are either minor or not observable by others
Dysmorphobia.
Which one of the following interventions is most likely to be beneficial in a patient with schizophrenia?
CBT.
Which symptom is seen in SSRI discontinuation syndrome ?
Diarrhoea.
SSRI + NSAID—which side effect ?
GI bleed.
Diarrhoea is caused by which psych med ?
SSRI—Citalopram.
Avoid which meds with SSRI ?
Triptans.
Triptans is avoided in which meds ?
SSRI
Antidepressants should be continued for at least____ after remission of symptoms to decrease risk of relapse
6 Months
When stopping a SSRI the dose should be gradually reduced over__
4 weeks.
