Psychiatry 3A Flashcards
What is the most dangerous side effect of anti-psychotic medications?
NMS (neuroleptic malignant syndrome)
- Muscle rigidity
- Hyperthermia (raised body temperature)
- Altered consciousness
- Autonomic dysfunction (e.g., fluctuating blood pressure and tachycardia)
=> Raised CK (risk of rhabdomyolysis)
Looks similar to serotonin syndrome but slower onset
Which antipsychotic is used in treatment-resistant psychosis/schizophrenia?
Clozapine
- offered when there have been 2 or more unsuccessful trials of other antipsychotics.
Risk of agranulocytosis so needs regular blood tests
Side effects of anti-psychotic drugs?
- Weight gain
- Diabetes
- Prolonged QT interval
- Raised prolactin
- Extrapyramidal symptoms (due to reduced dopamine)
- Akathisia(psychomotor restlessness, with an inability to stay still)
- Dystonia(abnormal muscle tone, leading to abnormal postures)
- Pseudo-parkinsonism(tremor and rigidity, similar to Parkinson’s disease)
- Tardive dyskinesia(abnormal movements, particularly affecting the face)
Monitoring requirements for anti-psychotics?
- Weight and waist circumference
- Blood pressure and pulse rate
- Bloods ⇒ HbA1c, lipid profile and prolactin
- ECG
Differential diagnoses for psychosis?
- Schizophrenia
- Mania
- Psychotic depression
- Drugs (e.g., hallucinogens and cannabis)
- Stroke
- Brain tumours
- Cushing’s syndrome (e.g., patients taking systemic steroids)
- Hyperthyroidism
- Huntington’s disease
What is Schizophreniform disorder?
When schizophrenia symptoms last less than 6 months
How do you diagnose Schizophrenia? (according to DSM-5)
- Symptoms (including theprodrome phase) must have been present for atleast six months
- With symptoms of theactive phase(delusions, hallucinations, and thought disorder) present forat least one month (or less if treatment is successful).
Positive symptoms of Schizophrenia?
- Delusions
- Hallucinations
- Thought disorder - disorganised thoughts ⇒ abnormal speech and behaviour
Negative symptoms of Schizophrenia?
- Affective flattening(minimal emotional reaction to emotive subjects or events)
- Alogia(“poverty of speech” – reduced speech)
- Anhedonia(lack of interest in activities)
- Avolition(lack of motivation in working towards goals or completing tasks)
What is somatic passivity in Schizophrenia?
Believing that an external entity is controlling their sensations and actions
What is thought broadcasting in Schizophrenia?
Believing that others are overhearing their thoughts
What are persecutory delusions in Schizophrenia?
A false belief that a person or group is going to harm them
What are ideas of reference in Schizophrenia?
A false belief that unconnected events or details in the world directly relate to them
Serious side effect of SSRIs?
SEROTONIN SYNDROME
(more common when multiple antidepressants are used together)
- Altered mental state(anxiety and agitation)
- Autonomic nervous system hyperactivity(e.g., tachycardia, hypertension and hyperthermia)
- Neuromuscular hyperactivity(e.g., hyperreflexia, tremor and rigidity)
