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)
Side effects of citalopram and escitalopram?
Prolong the QT interval, although this effect is dose-dependent (a higher dose is more likely to cause a prolonged QT). QT prolongation can lead to torsades de pointes. Along with escitalopram, it is considered to be the least safe SSRI in patients with heart disease and arrhythmia (although still a lot safer than TCAs).
Common side effects of SSRIs?
- GI symptoms (nausea and diarrhoea)
- Headaches
- Sexual dysfunction (loss of libido, erectile dysfunction)
- Hyponatraemia (due to SIADH)
- Anxiety or agitation, typically in the first few weeks of use
Increased suicidal thoughts, suicide risk and self-harm (this applies to all antidepressants) - Increased risk of bleeding (e.g., gastrointestinal bleeding, intracranial haemorrhage and postpartum haemorrhage)
Examples of SNRIs?
duloxetine and venlafaxine
Side effects of mirtazepine?
- Sedative
- Weight gain
- Increased appetite
(not good for patient who is oversleeping and overweight)
Mode of action of tricyclic antidepressants?
- Block reuptake of serotonin + NA (like SSRI/SNRI)
- Also block Ach and histamine receptors => anticholinergic side effects of dry mouth, constipation etc
Main symptoms of Wernicke-Korsakoff syndrome?
Ataxia, confusion and ophthalmoplegia.
Features of Korsakoff syndrome?
Korsakoff syndrome involves symptoms of Wernicke encephalopathy plus short-term memory loss and hallucinations
Ataxia, confusion and ophthalmoplegia.
CAGE questions
C – CUT DOWN? Do you ever think you should cut down?
A – ANNOYED? Do you get annoyed at others commenting on your drinking?
G – GUILTY? Do you ever feel guilty about drinking?
E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?
Blood results with alcohol excess?
Raised mean corpuscular volume (MCV)
Raised alanine transaminase (ALT) and aspartate transferase (AST)
AST:ALT ratio above 1.5 particularly suggests alcohol-related liver disease
Raised gamma-glutamyl transferase (gamma-GT) (particularly notable with alcohol-related liver disease)
Delirim tremens?
72-96 hours after alcohol withdrawal
Acute confusion
Severe agitation
Delusions and hallucinations
Tremor
Tachycardia
Hypertension
Hyperthermia
Ataxia
Arrhythmias
What is used to prevent Wernicke-Korsakoff syndrome?
High-dose B vitamins (Pabrinex) are given intramuscularly or intravenously, followed by long-term oral thiamine
PABRINEX = vit C, thiamine (B1), riboflavin (B2), pyridoxine (B6)
Bipolar 1 vs bipolar 2?
- Bipolar I disorderinvolves at least one episode ofmania.
- Bipolar II disorderinvolves at least one episode ofmajor depressionand at least one episode ofhypomania.
What is Cyclothymia?
Mild form of bipolar disorder
Milder symptoms of hypomania and low mood.
The symptoms are not severe enough to significantly impair their function.
Adverse effects of lithium?
- Fine tremor
- Weight gain
- Chronic kidney disease
- Hypothyroidismandgoitre(it inhibits the production of thyroid hormones)
- Hyperparathyroidismandhypercalcaemia
- Nephrogenic diabetes insipidus
Treatment options for bipolar disorder?
- Lithium (1st line)
- Alternatives: sodium valproateorolanzapine
Bipolar: treatment options for anacute manic episode
- Antipsychotic medications(olanzapine, quetiapine, risperidone or haloperidol)
- Other options arelithiumandsodium valproate
- Existing antidepressants are tapered and stopped
Bipolar: treatment options for anacute depressive episode
- Olanzapine, plus fluoxetine
- Antipsychotic medications(olanzapine or quetiapine)
- Lamotrigine
