Psychiatry Flashcards
Alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:
increased risk of stroke
increased risk of venous thromboembolism
Gastrointestinal side-effects such as diarrhoea are seen in SSRI discontinuation syndrome
Cyanopsia, or blue-tinted vision, is a recognised side effect of some drugs, including sildenafil.
Paroxetine has a higher incidence of discontinuation symptoms.
olanzapine: higher risk of dyslipidemia and obesity
** may be diagnosed in patients who are overly sensitive and can be unforgiving if insulted, question loyalty of those around them and are reluctant to confide in others
Paranoid personality disorder
Patients with avoidant personality disorder are fearful of criticism, being unliked, rejection and ridicule
Antidepressants and interactions
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome
NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
Anorexia features
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
***** as this disorder tends to manifest as (often persecutory) audiovisual hallucinations in older patients.
Paraphrenia
The National Institute for Health and Care Excellence (NICE) guidelines recommend high-dose fluoxetine (60 mg daily) as the first-line pharmacological treatment for adults with *****
bulimia nervosa.
Elderly patients with depression are less likely to complain of low mood and instead may present with health anxiety, agitation and sleep disturbance
SSRIs are first line (adverse side-effect profile of TCAs more of an issue in the elderly)
Antidepressants should be continued for at least 6 months after remission of symptoms to decrease risk of relapse
****, also known as erotomania, is a form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.
De Clerambault’s syndrome
Patient with a fixed, false belief (delusion) that they are infested by ‘bugs’ → delusional parasitosis
Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
*****,, is 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.
Dysmorphophobia, also known as body dysmorphic disorder (BDD)
***** , a selective serotonin reuptake inhibitor (SSRI), has the highest incidence of discontinuation symptoms amongst all SSRIs. This is primarily due to its short half-life which leads to rapid plasma clearance. As a result, abrupt cessation or missed doses can lead to withdrawal symptoms such as dizziness, sleep disturbances, mood swings and irritability.
Paroxetine
Post partum psychosis
Whilst there is not a full complement of psychotic features there are a number of pointers towards significant mental health problems:
poor interaction with the baby: this is very unusual, including in women with postnatal depression
‘talking in an incoherent fashion about the future’
stating that the baby ‘has been brought into a very bad world’ is odd and somewhat worrying
PTSD DRUG RX
drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used
Edinburgh Postnatal Depression Scale
The Edinburgh Postnatal Depression Scale may be used to screen for depression:
10-item questionnaire, with a maximum score of 30
indicates how the mother has felt over the previous week
score > 13 indicates a ‘depressive illness of varying severity’
sensitivity and specificity > 90%
includes a question about self-harm
SSRI VS NSAIDS
It is thought SSRI potential deplete platelet serotonin, resulting in a reduction in clot formation, therefore, increasing the risk of bleeding. As this patient is already established on an NSAID the addition of an SSRI will increase her risk of GI bleeding further and therefore a protein pump inhibitor (PPI) should also be prescribed.
Hypericum perforatum
Hypericum perforatum, commonly known as St John’s Wort is a plant frequently used in alternative medicine, particularly for the management of depression. Although its use remains controversial multiple studies have indicated it may have superiority over placebo on treating mild to moderate depression, with the active ingredients thought to be hypericin and hyperforin. St John’s wort can interfere with other medications, and its use with other antidepressants is associated with an increased risk of serotonin syndrome
olanzapine mainly acts on serotonin receptors, particularly the 5-HT2A subtype. This is a key mechanism of action for atypical antipsychotics like olanzapine, which distinguishes them from typical antipsychotics.
The combined antagonism of D2 and 5-HT2A receptors is thought to contribute to the improved efficacy and reduced extrapyramidal side effects compared to typical antipsychotics.
