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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Bromocriptine

A

Dopamine agonist

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2
Q

Potential adverse effect of bromocriptine

A

Psychosis

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3
Q

Interaction of NSAIDs and lithium

A

Increased risk of lithium toxicity

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4
Q

Features of lithium toxicity

A 
ataxia
blurred vision
dizziness 
muscle twitching
tinnitus
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5
Q

Physical disease causing depressive illness

A

Hypothyroidism
Cushing’s syndrome
Steroid therapy
Brain tumour

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6
Q

Physical disease causing anxiety disorders

A 
Thyrotoxicosis
Hypoglycaemia (transient)
Complex partial seizure (transient)
Phaechromocytoma
Alcohol withdrawal
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7
Q

Physical disease causing irritability disorders

A

Hypoglycaemia (transient)
Post-concussion
Frontal lobe syndrome

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8
Q

Physical disease causing memory impairment

A

Hypothyroidism
Cushing’s syndrome
Brain tumour

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9
Q

Physical disease causing altered behaviour

A 
Brain tumour
Dementia
Acute delirium
Drugs
Post-ictal state
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10
Q

Examples of anti-convulsants

A

Carbamazepine
Gabapentin
Pregabalin

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11
Q

Effects of Amitriptyline

A

Low dose: analgesia and sedative effects

High dose: anti-depressant effects

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12
Q

Dissociative symptoms

A 
Amnesia
Fugues
Pseudodementia
Psychosis
Dissociative identity disorder
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13
Q

Conversion symptoms

A 
Paralysis
Gait disorders
Tremor
Aphonia
Mutism
Sensory symptoms
Globus hystericus
Hysterical fits
Blindness
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14
Q

Holmes-Rahe Adjustment scale of Life Events in Depression

A 
Death of spouse
Divorce
Separation
Jail
Death of close relative
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15
Q

Beck’s negative cognitive triad

A

Negative thoughts about:
Self
Future
World

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16
Q

Role of serotonin

A

Appetite, mood, energy, sleep

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17
Q

Role of NA

A

Energy

Mood

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18
Q

Role of dopamine

A

Psychomotor activity

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19
Q

What is tryptophan?

A

5HT precursor which is found to be reduced in plasma samples of patients with depression

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20
Q

Pharmacological causes of mania

A

Bromocriptine
Amphetamines
Cocaine

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21
Q

3 core symptoms of depression

A

Low mood
Anergia
Anhedonia
2 week history!

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22
Q

Mild depression

A

1 core symptom + 3 others for 2 weeks

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23
Q

Moderate depression

A

1 core symptom + 4-7 other symptoms for 2 weeks

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24
Q

Severe depression

A

1 core symptom + >7 other symptoms for 2 weeks

+/- psychotic symptoms, hallucinations, delusions

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25
Q

Subtypes of depression (4)

A

SAD
Atypical depression
Agitated depression
Depressive stupor

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26
Q

Bloods done in DDx of depression

A

TFTs
FBC (anaemia)
Glucose/HBA1c

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27
Q

Management of mild depression

A

Psychological treatments

  • CBT
  • Psychodynamic psychotherapy
  • Interpersonal therapy
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28
Q

Common side effects of anti-depressants

A

Hyponatraemia
Sexual dysfunction
Reduced seizure threshold

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29
Q

When to stop antidepressants

A

When depression has resolved plus an extra 6 months to prevent relapse

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30
Q

Antidepressant regimen in recurrent depression

A

Long term Tx e.g. 2 years

Use therapeutic dose as maintenance dose as lower doses are not effective

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31
Q

MOA antidepressants

A

Increase availability of monoamines at synapse (5TH, NA, Dopamine)

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32
Q

SSRI examples

A

Fluoxetine, Sertraline, Citalopram, Escitalopram

33
Q

SEs of SSRIs

A 
Dizzy
Agitation
N&V
Change in appetite and weight
Blurred vision
Anxiety
Insomnia
Tremor
Headache
Sweating
34
Q

Fluoxetine

A

SSRI

35
Q

Citalopram

A

SSRI

36
Q

Sertraline

A

SSRI

37
Q

Escitalopram

A

SSRI

38
Q

MOA of TCAs

A

Reduce repute of NA and 5-HT at presynaptic membrane

39
Q

Examples of TCAs

A

Amitriptyline
Dulosepin
Clomipramine
Imipramine

40
Q

Amitriptyline

A

TCA

41
Q

Dulosepin

A

TCA

42
Q

Clomipramine

A

TCA

43
Q

Imipramine

A

TCA

44
Q

SEs of TCAs

A 
Tachycardia, arrhythmia
Dry mouth, constipation, dizziness, urine retention 
Postural hypotension
Sedation
Nausea
Weight gain
45
Q

MAOIs MOA

A

Reduce metabolism of monoamines, thus increasing availability in the synapse

46
Q

Examples of MAOIs

A

Phenelzine

Tranylcypromine

47
Q

Tranylcypromine

A

MAOI

48
Q

Phenelzine

A

MAOI

49
Q

SEs of MAOIs

A 
Drowsiness
N&V
Constipation
Blurred vision
Insomnia
Postural hypotension
CHEESE EFFECT (Tyramine foods)
50
Q

Duloxetine

Venlafaxine

A

Serotonin and NA reuptake inhibitors

SNARI

51
Q

Mirtazapine

A

NA and specific serotonin reuptake inhibitor

52
Q

Reboxetine

A

NARI

53
Q

Moclobemide

A

Reversible inhibitor if MAO

54
Q

Cause of serotonin syndrome

A

2 antidepressants at once or not allowing a washout period between different drugs

55
Q

Symptoms of serotonin syndrome

A 
Restlessness
Sweating
Myoclonus
Confusion
Fits
56
Q

Refractory depression

A

Failure to respond to 2 classes of antidepresants at adequate doses for 6-8 weeks
Check compliance!

57
Q

Augmentation strategies in refractory depression

A

Lithium
T3/T4
Busprinone

58
Q

Busprinone

A

An anxiolytic with action at 5-TH 1c receptor that has a synergistic effect with SSRIs in treatment of refractory depression

59
Q

Non drug treatment of depression

A

ECT

Light therapy

60
Q

Diagnosis of mania

A

1 week

symptoms prevent work or normal social activity

61
Q

Definition of hypomania

A

Less severe than mania with less effect on life

62
Q

Core symptoms of mania

A

Increased energy, High mood, Enjoyment

63
Q

Cognitive symptoms of mania

A 
High self esteem and self-confidence
Belive self is gifted/special/powerful
Reduced concentration
Flights of ideas
Pressure of speech
64
Q

Biological symptoms of mania

A 
Reduced sleep
Increased desire for food and sex
Reckless, disinhibited, inappropriate behaviour
Speeding, spending, gambling
Experiment with drugs and alcohol
65
Q

Psychotic symptoms in mania

A

Delusions (grandeur or persecutory)

Hallucinations

66
Q

Definition of BPAD

A

Mania + 1 other affective episode (depression, mania, hypomania, mixed)

67
Q

Definition of BPAD Type I

A

Mania interspersed with depressive episodes

68
Q

Definition of BPAD Type II

A

Depressive episodes more prominent with less mania and hypomania

69
Q

Definition of BPAD Type III

A

4 or more affective episodes per year
More common in females
More responsive to valproate

70
Q

Definition of cyclothymia

A

Mood instability where episodes are too short for depressive or manic episodes to be diagnosed

71
Q

List 3 mood stabilisers used in mania

A

Lithium
Valproate
Carbamazepine (typical antipsychotic)

72
Q

Use of lithium in mainia

A

Mood stabiliser
Narrow therapeutic index
Monitor 1 week after starting/changing dose
Monitor weekly until stable therapeutic level thereafter 3 monthly (TFTs and U&Es)

73
Q

Use of valproate in mania

A

Mood stabiliser
Anticonvulsant
Used for acute mania, prophylactic too
Many side effects (teratogenic)

74
Q

Use of carbamazepine in mania

A

Mood stabiliser and typical antipsychotic
Anti-convulsant
Toxic at high dose
Liver enzyme inducer
2nd line after lithium for BPAD prophylaxis

75
Q

Antipsychotics used in BPAD

A

Carbamazepine
Olanzapine
Risperidone (Dopamine antagonist)
Quitiapine

76
Q

Anti-convulsants used in BPAD

A

Carbamazepine

Lamotrigine

77
Q

Acute management of mania

A

Mood stabiliser or Anti-psyctotic (both if severe)
Benzodiazepine if necessary for sedation
ECT if unresponsive or risk of extreme fatigue and overactivity

78
Q

Long term treatment of mania

A

Required after 1 episode
Mood stabilisers (lithium, valproate, carbamazepine)
If have symptoms, add benzo or anti-psychotics

79
Q

Psychological treatments in BPAD

A

CBT
Psychodynamic therapy
Social intervention

Medicine (15 decks)

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