Psychiatry Flashcards by Gill Mill

Which SSRI should you give if you have cardiac problems?

Sertraline

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Which SSRI should you give if you have epilepsy?

Citalopram

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Core symptoms of depression?

MIE
Mood
Interest/pleasure
Energy

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Other features to ask about in depression

ACG - appetite, concentration, guilt
S- self confidence
S - sleep
S - self harm
S - suicidal thoughts

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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

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Which anti-depressants should you avoid in older people?

TCAs - avoid in old people and people likely to OD

cardiac toxicity in overdoes

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Medication good for bipolar depression

Lamotrigine

-generally avoid antidepressants in bipolar as can cause switch to hypomania/mania

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Medication good for hypomania

Sodium valproate

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Mirtazepine mechanism of action

NaSSA

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May be used if patient has insomnia +/- poor appetite

Mirtazepine (sedative and weight gain)

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Need to be careful about this with mirtazepine

Causes GI upset when taken with alcohol

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Name 2 SNRIs

Venlafaxine, duloxetine

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What is california rocket fuel

Mirtazepine and venlafaxine

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How do you treat hypertensive crisis?

Phentolamine infusion

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Name 3 irreversible MAOIs

Phenelzine
Tranylcypromine
Isocarboxazid

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Name a reversible MAO

Moclobemide

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What type of drug is trazadone?

SARI

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What medications interact with lithium? DAAN

Diuretics
ACEi
ARBs
NSAIDs

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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)

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Treatment of lithium toxicity

Stop lithium
IV fluids
Monitor renal function

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Treatment of acute mania

Olanzapine

Sodium valproate

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Lithium monitoring

Weekly until stable for 4 weeks
Then monthly for 6 months
Then 3-monthly

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Clozapine monitoring

Weekly for first 18 weeks
Then fortnightly to make up to 1 year
Then monthly

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First rank symptoms of schizophrenia

DTAP

Delusions
Thought disorder (insertion/withdrawal/broadcasting)
Auditory hallucinations
Passivity

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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