Psychiatry 2 Flashcards
List some common side effects of lithium:
Tremor Thyroid enlargement - hypothyroidism Weight gain Leucocytosis Hyperparathyroidism Nephrogenic Diabetic Insipidus
Once stable U&Es and TFTs should be checked every 6 months
What are the symptoms of post concussion syndrome?
Headache
Fatigue
Anxiety/ depression
Dizziness
What is a treatment option for personality disorders?
Dialectal Behavioural Therapy (DBT)
and mood stabilisers such as Lamotrigine
What is the ECG abnormalities that can be seen in anorexia nervosa?
Long QT syndrome
Bradycardia
*thought to be due to hypomagnesium and hypocalcaemia
What are some of the common side effects associated with anti-psychotics?
Common:
- weight gain
- hyperprolactomaia
- reduced seizure threshold
- glucose impairment
More serious:
Parkinsonian
Acute dystonia
- Torticollis
- oculogyric crisis
Tardive dyskinesia
- late onset chorea like movements
What are some of the specific risks to elderly people using anti-psychotics?
VTE
Stroke
Define catatonia:
Increased muscle tone at rest but abolished by voluntary muscle activity
What are the similarities and differences between neuroleptic malignant syndrome and Serotonin syndrome?
Similar:
- Fever
- Tachycardia
- Hypertension
NMS:
- Rigidity
- Raised CK and WBC
- slower onset (days)
SS:
- Hyperreflexia
- Clonus
- Diarrhea
- rapid onset
What is the treatment for Neuroleptic malignant syndrome?
Stop Anti-psychotic
IV fluids (reduce AKI due to raised CK levels)
Dantrolene
- muscle relaxant
Dopamine agonists
- bromocriptine
What is the management of serotonin syndrome?
IV fluid
Benzodiazepines
Anti SSRIs
- chlorpromazine
Highlight the key features of autism:
Difficulties with social communication and interaction
- poor non-verbal communication
- difficulty reciprocating behaviour
- Poor joint communication/ attention
Restricted/ repetitive behaviours
- rituals
- hand flapping
- fixed routines
- specific knowledge in one subject
Core symptoms:
- Global impairment of language
- Impaired social relationships
- Repetitive/ restricted behaviours
*symptoms must start before the age of the 3
What are some signs of autism:
Delayed speech
Delayed response to name
Poor eye contact
Hand flapping
Dislike to additional stimuli
Delayed playing with others
Name a screening tool used for autism:
Gilliam Autism Rating Scale (GARS)
List the management for people with autism:
Speech and language therapist
Psychosocial intervention
- techniques to try and help child interact
Behavioural intervention
- look at areas to help calm the child down, including reorganising the environment to be less noisy
Sleep management
- often those with autism have poor sleep due to excessive stimulus
How long can an emergency detention be used for?
72 hours
*cannot be appealed
Name the other types of detention orders that can be used other than an emergency detention:
Short Term Detention Certificate :
- Approved medical practitioner (psychiatrist)
+
- Mental health officer
- Assessment and treatment
- Can last up to 28days
- can be appealed
Compulsory Treatment Order:
- 2 medical recommendations
+
- mental health officer
*last up to 6 months
What are some red flags regarding anorexia?
BMI <13
Weight loss of >1kg per week
Purpura
ECG abnormalities
- long QT
Unable to get up without using arms
Name a very common side effect of antipsychotic medication, especially second generation:
Weight gain
What is the name of the disorder in which people believe a famous person is in love with them?
Erotmania
List some important risk factors towards suicide:
Male sex
Isolation
Low social econmic status
Unemployment
History/ family history of mental disorders
Drug and alcohol abuse
History of abuse
*previous suicide attempt
What signs in a mental state examination may point to wards suicidal intention?
Appearance:
- self harm
- bizarre behaviour
Mood:
- low
Thoughts:
- hopelessness
- guilt
- nihilistic delusions
Perception
- hallucinations
What things should be considered in a risk assessment of someone who attempted to commit suicide?
How serious was the intent
Was there careful preparation or impulsive
Likely hood of a rescue
Sense of relief or regret
Hopelessness
Recent escalation in self harming
Give some organic differentials to schizophrenia:
Drug induced
- amphetamines
- cannabis
- Steroids
Temporal lobe epilepsy
Delirium
Diffuse brain disease
- neurosyphilis
- tumours
Name two questionnaires that can be used to screen for alcohol abuse:
Alcohol use disorders identification test - AUDIT
CAGE questions
What is the most important risk to consider in assessing someone with suicidal thoughts or attempted suicide?
Ongoing suicidal idealisation
What conditions are most associated with suicidal idealisation?
Depression
Schizophrenia
Bipolar affective disorder
Substance abuse
What symptoms may you see as side effects of anti-psychotic medication?
Tremor
Rigidity
Bradykinesia
Weight gain
What is the prognosis of schizophrenia?
1/3 recover
1/3 relapse
1/3 have ongoing issues
What are some organic causes to schizophrenia?
Substance abuse
- alcohol
- drugs
Encephalitis
Tumours
Brain injury
Electrolyte imbalances
Hyper/ hypothyroidism
What is the differential for OCD?
Anankastic/ obsessive compulsive personally disorder
- they are not okay with the way they are (egosyntonic)
Cluster C
Generalised anxiety disorder
In scotland what act can be used to treat a patient who is unconscious?
Adult with Incapacity Act 2000
Give some differentials for a reduced GCS in someone presenting after falling over due to alcohol abuse?
Still intoxicated
Head injury
Delirium tremens
Seizures
Hypoglycaemic
Additional substance abuse
How long can a nurse detain someone for?
2 hours with an additional 1 hour to allow drs to examine the patient.
What are the symptoms of a panic disorder:
Intense fear/ impeding doom
Chest palpitations
Sweating/ flushing
Dizziness/ fainting
Dyspnea
Tingling around the lips and hands
- calcium binding to albumin as H+ is released
What drug types can be used to treat depression?
SSRIs
SNRIS
Noradenraline Specific serotonergic receptor agonists
- Mirtazapine
TCAs
Which two autoimmune conditions are associated with developing OCD?
Sydenham’s chorea
- rheumatic fever
PANDA - Group A step infection
What are the treatments for OCD?
Mild:
- Low intensity CBT
- Exposure therapy
Moderate:
- Intensive CBT
- SSRI
Severe: - psychological therapy - different SSRI or - clomipramine
List some genetic disorders that predispose individuals to ADHD:
Tuboscloerosis
Fragile X
NF-1
Turner’s syndrome
What is the diagnostic criteria for ADHD?
Symptoms of inattention, hyperactivity and impulsivity which is persistent.
For those < 16 years old there needs to be >6 features
For those > 17 years old there needs to be >5 features
Features must be present in more than >2 environments and have begun early in life.
List some differentials into ADHD:
Sleep disorder
- apnoea from adenoid enlargement
Anxiety
Depression
Learning difficulties
- dyslexia
Drug abuse
- either taken or seeking behaviour
Hearing/ visual disorders
Conduct disorder
Which questionnaire is useful for assessing symptoms of ADHD across different environments?
Conner’s questionnaire
Upon starting medication for ADHD, what examinations and investigations first need to undertaken?
Base line weight and height
- redone every 6 months
Base line ECG
- drugs can be cardiotoxic
What are the medications used in ADHD?
1st line:
- methylphenidate
- dexamphetamine
- dopamine/ noradrenaline reuptake inhibitor
- can be given as long acting or short acting
2nd line:
- Atomoxetine
- noradrenaline reuptake inhibitor
- takes up to 6 weeks to work
Bupropion can also be used.
it is a Noradreanline - serotonin reuptake inhibitor
*reduces seizure threshold.
Can you treat someone’s physical conditions under the mental health act?
No. if someone is refusing treatment for their physical conditions and has been detained, you can only legally treat their mental disorder under the mental health act.
in order to treat their physical illness you need an Adults with incapacity
- which they may have due to their mental health issue
What criteria must the mental health act justify?
- likely mental health disorder
- Impaired decision making
- there is a risk if left
- there is treatment (even if just under observation this maybe enough to off put killing themselves)
- Least restrictive option
What investigation can be done to help identify the aetiology of dementia, specifically used for Lewy body dementia?
Dat- SPECT scan
radioisotope which binds to dopamine transporters found on the dopamine producing cells.
What are the core symptoms of lewy body dementia? What drug can be used in its management?
Visual hallucinations and other vivid hallucinations
Memory disturbance
REM sleep abnormalities
Variability in presentation
Motor signs of Parkinson’s may begin later on
Drug:
- Rivastigmine
What are the core presenting symptoms of fronto-temporal dementia?
Language defect (attenuate, perseveration, mutism) - usually first to go
Exudative function dysfunction
Impulse control dysfunction
Lack of inhibition
- memory is usually relatively well preserved.
- associated with early onset
- associated with MND
In addition to FBC and U&Es and urine dip etc what additional blood tests should be conducted into a confused patient?
B12 Folate TFTs Bone profile Glucose
What is a contraindication to donepezil and what is a major side effect of it?
Bradycardia
Fronto-temporal dementia
Vascular dementia
Side effects:
- effect on sleep
What drugs are contraindicated in individuals with fronto-temporal dementia?
Acetylcholinesterase inhibitors
