Psychiatry

Question 1

How to differentiate serotonin syndrome from others?

Answer 1

Serotonin (SSRIs in combination with TCA and MAOI, tramadol, fluconazole):
Mydriasis
Increased muscle tone
Increased reflexes
Onset

Question 2

Antipsychotics:
Typical
Atypical

Answer 2

Typical: Stronger affinity for D2 receptor
Haloperidol
Chlorpromazine
AE: Greater AE of extrapyramidal SE

Atypical: less affinity
Clozapine
Olanzapine
Risperidone

AE:
EPD - dystonias, drug induced Parkinsonian, tardive dyskinesia, akasthisia (Motor restlessness), NMS
Weight gain
hyperglycaemia
dyslipidaemia
Insulin resistance
Sexual AE
Reduced libido

Question 3

Antidepressants:
SSRI
SNRI

Answer 3

SSRI:
Citalopram
Sertraline
Fluoxetine

AE: serotonin overactivity. diaphoresis, hyperthermia, tremor, myoclonus, ataxia, hyperreflexia, diarhoea, aggitation, delerium
Tx: Benos

SNRI:
Desvenlafaxine
Dduloxetine
Mirtazapine - sedation and weight gain
Venlafaxine - HT, widening QRS

AE: as above

Question 4

TCAs:
Names
MOA
AE

Answer 4

DINA
Doxepin
Imipramine
Nortriptyline
Amitryptiline

Anticholinergic:
urinary retention
constipation
preicipitation of narrow angle glaucoma
Delerium

Cardiac toxicty:
sinus tachy
delays in AV conduction incl AV block, prolonged QRS, T wave changes, SVT, VT

Alpha adrenergic blockade- postural hypotension
Others:
Sedation, mild intention tremor, sexual dysfunction

Question 5

Lithium:
Ecretion
Toxicty SE
Tx
Long term complications
CI

Answer 5

Close monitoring, 0.6-0.8 levels
Excretion: Renal

AE:
polyuria, polydipsia, tremor, dysarthria, poor concentration, delerium.

Tx:
Saline diuresis
Dialysis

Long term complications:
hypothyroidism
Nephrogenic Diabetes insipidus
Progressive decline in GFR

CI:
1st trimester due to cardiac abnormalities e.g. Ebstein’s anomaly. US at 18-20 weeks.

Question 6

Conversion disorder:

What

Answer 6

Loss of function e.g. movement of limb, loss of sensation mimicking neuro disorder triggered by psychological stress

Question 7

Somatisation vs. secondary somatisation

Answer 7

Somatisation:
Expression of a person’s emotional distress in the form of physical or so called somatic symptom.
Onset in adolescent years.
Requires supporting concurrent psychological trigger, prior Hx of medical presenations

Secondary:
secondary to underlying psych illness e.g.
depression - fatigue, malaise, weight loss
Anxiety- GI symptoms