Psychiatry Flashcards
What antidepressant to use in post natal depression?
Paroxetine
Post concussion syndrome
Headache
Fatigue
Anxiety/depression
Dizziness
PTSD symptoms
ICD-10
Symptoms for at least one month
Persistent intrusive thinking or re-experiencing Avoidance Persistent anxiety (hyperarousal) Numbness
Management of PTSD
Single session interventions NOT recommended
Mild (less than 4 weeks) - watchful waiting
Severe - CBT or EMDR
drugs not first line but if needed use Paroxetine or mirtazapine
Side effects of atypical antipsychotics
Weight gain
Agranulocytosis
Extra-pyramidal symptoms: parkinsonisms, acute dystonia, akathisia, tardive dyskinesia
Elderly patients - increased risk of VTE/stroke
What scoring tool can be used for post natal depression?
Edinburgh postnatal depression scale
Score of more than 13 indicates a depressive illness of carrying severity.
Definition of anorexia
Morbid fear of fatness Deliberate weight Lord Distorted body image Amenirrhoea BMI
Complications of anorexia
Bradycardia Hypotension Anaemia Osteoporosis Bruising Lanugo
Raised Gs and Cs
Diffenreitals of anorexia
Organic - DM, addisons
Psychotic - schizophrenia
Differentials of bulimia
Kleine-luvin
Kuller-bucy
BMI for obesity
> 30
Definition of PICA
Persistent eating of non-nutritive substances
Underlying nutritional deficiency
Psychiatric illness?
Differentials for acute confusion
Intracranial:
- trauma, vascular, epilepsy, infection, tumour
Extracranial: infection, toxic, endocrine, metabolic, hypoxia
Schizophrenia management
Antipsychotics ECT Psychotherapy Rehabilitation Community care
Schneiders first rank symptoms
Auditory hallucinations
Thought disorders
Passivity
Delusional perceptions
Antipsychotic monitoring
FBC U&Es lipids Weight Fasting glucose ECG BP monitoring Prolactin concentration
Exclusions to sections
Under 16
Under the influence of drugs or alcohol
Depression definition
Mild 2-3 features
Moderates: more than 4
Severe: feelings of worthlessness, guilty, suicidal
For longer than2 weeks
Duration of antidepressants
For atleast 6 months after symptom free
Not addictive
Withdraw over 4 weeks
Lithium counselling
Mood stabiliser Regular reviews gradually less frequent Potentially toxic Lots of side effects Checks before starting - bloods, preg test, ECG Monitoring - kidneys, thyroid, 5 days after first dose, weekly until stable for 4, then 3 months Female? Pregnancy implications Stress compliance
Conversion disorder
Loss of motor or sensory function
Not consciously feigning symptoms
ECT indications
Severe depression not responsive to medications
Psychotic symptoms
ECT side effects
Short term: headache, nausea, short term memory impairment, loss of memory from before ECT, cardiac arrhythmia,
Long term: impaired memory
Contra-indication: raised ICP
Benzodiazepine withdrawal
Tolerance/dependence
Withdraw in steps of 1/8 of the family dose every fortnight.
Change to diazepam
Low mood differentials
Psychiatric - depression/bipolar/schizoaffective Metabolic - hypothyroid Pregnancy Recreational drugs Biopsychosocial - reactive depression
