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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
Subtypes of depression (4)
SAD Atypical depression Agitated depression Depressive stupor
26
Bloods done in DDx of depression
TFTs FBC (anaemia) Glucose/HBA1c
27
Management of mild depression
Psychological treatments - CBT - Psychodynamic psychotherapy - Interpersonal therapy
28
Common side effects of anti-depressants
Hyponatraemia Sexual dysfunction Reduced seizure threshold
29
When to stop antidepressants
When depression has resolved plus an extra 6 months to prevent relapse
30
Antidepressant regimen in recurrent depression
Long term Tx e.g. 2 years | Use therapeutic dose as maintenance dose as lower doses are not effective
31
MOA antidepressants
Increase availability of monoamines at synapse (5TH, NA, Dopamine)
32
SSRI examples
Fluoxetine, Sertraline, Citalopram, Escitalopram
33
SEs of SSRIs
``` Dizzy Agitation N&V Change in appetite and weight Blurred vision Anxiety Insomnia Tremor Headache Sweating ```
34
Fluoxetine
SSRI
35
Citalopram
SSRI
36
Sertraline
SSRI
37
Escitalopram
SSRI
38
MOA of TCAs
Reduce repute of NA and 5-HT at presynaptic membrane
39
Examples of TCAs
Amitriptyline Dulosepin Clomipramine Imipramine
40
Amitriptyline
TCA
41
Dulosepin
TCA
42
Clomipramine
TCA
43
Imipramine
TCA
44
SEs of TCAs
``` Tachycardia, arrhythmia Dry mouth, constipation, dizziness, urine retention Postural hypotension Sedation Nausea Weight gain ```
45
MAOIs MOA
Reduce metabolism of monoamines, thus increasing availability in the synapse
46
Examples of MAOIs
Phenelzine | Tranylcypromine
47
Tranylcypromine
MAOI
48
Phenelzine
MAOI
49
SEs of MAOIs
``` Drowsiness N&V Constipation Blurred vision Insomnia Postural hypotension CHEESE EFFECT (Tyramine foods) ```
50
Duloxetine | Venlafaxine
Serotonin and NA reuptake inhibitors | SNARI
51
Mirtazapine
NA and specific serotonin reuptake inhibitor
52
Reboxetine
NARI
53
Moclobemide
Reversible inhibitor if MAO
54
Cause of serotonin syndrome
2 antidepressants at once or not allowing a washout period between different drugs
55
Symptoms of serotonin syndrome
``` Restlessness Sweating Myoclonus Confusion Fits ```
56
Refractory depression
Failure to respond to 2 classes of antidepresants at adequate doses for 6-8 weeks Check compliance!
57
Augmentation strategies in refractory depression
Lithium T3/T4 Busprinone
58
Busprinone
An anxiolytic with action at 5-TH 1c receptor that has a synergistic effect with SSRIs in treatment of refractory depression
59
Non drug treatment of depression
ECT | Light therapy
60
Diagnosis of mania
1 week | symptoms prevent work or normal social activity
61
Definition of hypomania
Less severe than mania with less effect on life
62
Core symptoms of mania
Increased energy, High mood, Enjoyment
63
Cognitive symptoms of mania
``` High self esteem and self-confidence Belive self is gifted/special/powerful Reduced concentration Flights of ideas Pressure of speech ```
64
Biological symptoms of mania
``` Reduced sleep Increased desire for food and sex Reckless, disinhibited, inappropriate behaviour Speeding, spending, gambling Experiment with drugs and alcohol ```
65
Psychotic symptoms in mania
Delusions (grandeur or persecutory) | Hallucinations
66
Definition of BPAD
Mania + 1 other affective episode (depression, mania, hypomania, mixed)
67
Definition of BPAD Type I
Mania interspersed with depressive episodes
68
Definition of BPAD Type II
Depressive episodes more prominent with less mania and hypomania
69
Definition of BPAD Type III
4 or more affective episodes per year More common in females More responsive to valproate
70
Definition of cyclothymia
Mood instability where episodes are too short for depressive or manic episodes to be diagnosed
71
List 3 mood stabilisers used in mania
Lithium Valproate Carbamazepine (typical antipsychotic)
72
Use of lithium in mainia
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
Use of valproate in mania
Mood stabiliser Anticonvulsant Used for acute mania, prophylactic too Many side effects (teratogenic)
74
Use of carbamazepine in mania
Mood stabiliser and typical antipsychotic Anti-convulsant Toxic at high dose Liver enzyme inducer 2nd line after lithium for BPAD prophylaxis
75
Antipsychotics used in BPAD
Carbamazepine Olanzapine Risperidone (Dopamine antagonist) Quitiapine
76
Anti-convulsants used in BPAD
Carbamazepine | Lamotrigine
77
Acute management of mania
Mood stabiliser or Anti-psyctotic (both if severe) Benzodiazepine if necessary for sedation ECT if unresponsive or risk of extreme fatigue and overactivity
78
Long term treatment of mania
Required after 1 episode Mood stabilisers (lithium, valproate, carbamazepine) If have symptoms, add benzo or anti-psychotics
79
Psychological treatments in BPAD
CBT Psychodynamic therapy Social intervention

Medicine (15 decks)

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