Psychiatry Flashcards
Which SSRI should you give if you have cardiac problems?
Sertraline
Which SSRI should you give if you have epilepsy?
Citalopram
Core symptoms of depression?
MIE
Mood
Interest/pleasure
Energy
Other features to ask about in depression
ACG - appetite, concentration, guilt S- self confidence S - sleep S - self harm S - suicidal thoughts
How long should you continue depression medications for?
Continue for 6-12 months after resolution of symptoms for 1st episode
If they have recurrent episodes - continue for 12-24 months after
Which anti-depressants should you avoid in older people?
TCAs - avoid in old people and people likely to OD
cardiac toxicity in overdoes
Medication good for bipolar depression
Lamotrigine
-generally avoid antidepressants in bipolar as can cause switch to hypomania/mania
Medication good for hypomania
Sodium valproate
Mirtazepine mechanism of action
NaSSA
May be used if patient has insomnia +/- poor appetite
Mirtazepine (sedative and weight gain)
Need to be careful about this with mirtazepine
Causes GI upset when taken with alcohol
Name 2 SNRIs
Venlafaxine, duloxetine
What is california rocket fuel
Mirtazepine and venlafaxine
How do you treat hypertensive crisis?
Phentolamine infusion
Name 3 irreversible MAOIs
Phenelzine
Tranylcypromine
Isocarboxazid
Name a reversible MAO
Moclobemide
What type of drug is trazadone?
SARI
What medications interact with lithium? DAAN
Diuretics
ACEi
ARBs
NSAIDs
Safe lithium levels
0.6-1.0
(when above 1.5 can get toxicity - coarse tremor, GI upset, blurred vision, coarse tremor, ataxia, drowsiness, confusion, LOC, seizures, coma, death)
Treatment of lithium toxicity
Stop lithium
IV fluids
Monitor renal function
Treatment of acute mania
Olanzapine
Sodium valproate
Lithium monitoring
Weekly until stable for 4 weeks
Then monthly for 6 months
Then 3-monthly
Clozapine monitoring
Weekly for first 18 weeks
Then fortnightly to make up to 1 year
Then monthly
First rank symptoms of schizophrenia
DTAP
Delusions
Thought disorder (insertion/withdrawal/broadcasting)
Auditory hallucinations
Passivity
What is Cotard syndrome?
When someone believes they are already dead
associated with severe depression
What is conversion disorder?
Typically involves loss of sensation or motor function
What is munchausen’s/factitious disorder?
When people deliberately fake their symptoms - charlotte black
What is malingering?
Faking symptoms for financial or other gain
Treatment of sleep paralysis
First line treatment - improve sleep hygiene!!!
clonazepam may be offered as very last resort
How long do your symptoms need to be present for to diagnose panic disorder?
1 month
If you have delusions/hallucinations AND mood symptoms, what should you consider?
Schizoaffective disorder
Side effect of anaesthetic drugs?
Malignant hyperthermia
When does tardive dyskinesia present?
Presents a long time after being on anti-psychotics
What is tardive dyskinesia?
Involuntary movements - chewing and pouting of jaw are most common, also things like lip-smacking
How does neuroleptic malignant syndrome present
Fever and muscle stiffness
Short term side effect of ECT
Arrhythmias
One of the most common side effects of clozapine
Constipation
Lip smacking
Difficulty swallowing
Excessive blinking
Tardive dyskinesia
Slight difference between atypicals and typical antipsychotics
Atypicals - very likely to cause weight gain
Typicals - extra-pyramidal side effects
Side effect of benzodiazepines
Can cause anterograde amnesia - can’t remember new memories
What happens if you miss clozapine for more than 48 hours
Need to re-titrate dose up again
What happens if you combine sertraline with NSAID/aspirin?
Increased bleeding risk!! –> must give PPI
Atypical with the fewest side effects
Aripiprazole
Peak incidence of SYMPTOMS following alcohol withdrawal
6-12 hours
Peak incidence of seizures following alcohol withdrawal
36 hours
Peak incidence of delirium tremens
72 hours
First line for alcohol withdrawal
Chlordiazepoxide
How does lansoprazole work?
Inhibits the H+/K+ ATPase in gastric cells or something
Delirium criteria
ACDC Attention Cognition Develops over hours usually + fluctuating No other cause
4AT
Alert
Acute
Name, DOB, current year, where are you
Attention -ask to list months bacwards
Management of schizophrenia
Oral atypical psychotics are first line
CBT should also be offered
Treatment for PTSD
Trauma-based CBT
Eye-movement desensitisation and reprocessing (EMDR)
Drugs not usually offered but paroxetine or mirtazepine can be used
Five stages of grief? DABDA
Denial Anger Bargaining Depression Acceptance
What is regression
An ego defence where we revert to immature behaviour in setting of stress
e.g. manager loses deal so stamps on table
Conductive disorder
Basically antisocial disorder in someone younger than 18
What is oppositional defiant disorder
Like conductive/antisocial but far less extreme - no violation of the rights of others
What is fixation?
Lack of progression through development - someone stays in child-like state of maturity (i think this was example when someone played videogames for ages)
How do you work out units in a drink?
% x mls (divided by 1000)
Low risk drinking
Less than 14 units per week
Moderate risk drinking
14-35 units per week
High risk drinking
> 35 units per week
First line agent for alcohol relapse prevention
Naltrexone
ADHD triad
Inattention
Hyperactivity
Impulsiveness
Difference between mania and hypomania
Hypomania - no psychotic symptoms, features not significant enough to interfere with social or occupational hospitalisation
(hypomania - refer to community mental health)
What does Sundowner syndrome refer to?
Features of dementia are often worse at night time
Treatment of dementia
Donepezil, tacrine, rivastigmine, galantamine
acetylcholinersterase inhibitors
Risk factors for Alzheimer’s disease?
Down syndrome
Previous head injury
Hypothyroidism
Tayside rapid tranquilisation protocol
Lorazepam 1-2mg and/or haloperidol 5mg
When can you apply to have compulsory treatment order removed?
Can apply to have it removed after 3 months
Which section of adults with incapacity should you use to treat someone who doesn’t have capacity?
Section 47
What does having capacity mean?
1) To be able to understand and retain information
2) to use that information to make a decision
3) To be able to communicate that decision
What is memantine?
A partial NMDA agonist
