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Phase 2 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Paranoid Personality Disorder - characteristics?

A

Suspicious, mistrustful
Holds grudges
Entitled to more rights

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2
Q

Schizoid personality disorder

A

Detached, aloof, no interest in friends or sex

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3
Q

Schizotypal

A

Eccentric, odd beliefs

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4
Q

BPD/EUPD

A

Impulsive, feelings of ‘emptiness’, unstable, fear of abandonment

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5
Q

Narcissistic

A

Grandiose…

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6
Q

Antisocial

A

Antisocial, disregard for feelings of others, lack sense of responsibility

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7
Q

Histrionic

A

Theatrical, dramatic, seductive, self-harm

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8
Q

Anankastic

A

Obsessive compulsive, rigid, stubborn, perfectionist

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9
Q

Dependent

A

Dependent on others to make decision, need constant reassurance

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10
Q

Anxious avoidant

A

Persistent anxiety, sensitive to rejection, avoid relationships unless acceptance is guaranteed

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11
Q

SSRIs

A

SSRIs - sertraline (safest in cardiac disease), citalopram (prolongs QT), fluoxetine (adolescents)
First line for depression

Side-effects: Nausea and Vomiting, GI Bleeding, Initial worsening of anxiety/suicidal ideation - because they work on your motivation before they work on your mood, hence more likely to act out suicide

Contra-indications - Warfarin/heparin; NSAIDs (give with PPi)

Coming off SSRI - discontinuation syndrome (NV, Diarh, Insomnia - Paroxetine because short half life). Hence take off slowly over 4 weeks.

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12
Q

Serotonin Syndrome

A

Serotonin syndrome is a potentially life-threatening syndrome that is precipitated by the use of serotonergic drugs and overactivation of both the peripheral and central postsynaptic 5HT-1A and, most notably, 5HT-2A receptors. This syndrome consists of a combination of mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity.

More likely with Fluoxetine because long half life

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13
Q

SNRIs

A

Serotonin-Adrenaline reuptake inhibitor

Venlafaxine
Duloxetine

SEs - Loss of appetite/weight
Fatigue
NV
Reduced libido

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14
Q

TCA antidepressants

A

Amitriptyline (Neuropathic pain)
Clomipramine (OCD)
Donepezil (palliative for Alzheimers)

SEs

Can’t see, can’t pee, can’t spit, can’t shit and drowsiness

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15
Q

NaSSAs - Noradrenergic and Specific Serotonergic antidepressants

Block a2 adrenoceptors and specific serotonergic receptor

A

Mirtazapine

Weight gain
Sleepiness
Constipation
Dry mouth

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16
Q

MAOIs

A

Monamine oxidase inhibitor
prevents breakdown of monoamine neurotransmitters (last line - consultant choice)

Serotonin, melatonin, adrenaline, noad

Hydrazine
Isocarboxazid
Nialamide

Tyramine cheese reaction - pt needs to avoid things with Tyramine such as animal livers, cheese, fortified wine

Increased tyramine. Increased Norad. a1 receptor, vasoconstriction = hypertensive crisis

17
Q

Treatment for hypertensive crisis

A

hydralazine/sodium nitroprusside

18
Q

Depression core symptoms

A

Symptoms:

1) Low mood
2) Anhedonia
3) Low energy

  • Cognitive (Reduced concentration, negativity, guilt, suicidal ideation)

Beck’s Triad: -ive thoughts about self, world, future

  • Biological (mood variation - diurnal, worse in the morning; EMW; loss of libido)

+/- Psychotic symptoms:

  • 2nd person auditory hallucinations
  • Hypochondriacal, guilt, nihilistic, persecutory delusions
19
Q

Differentials for depression

A 
Anaemia
Thyroid
Hypercalcaemia ("Painful stones, abdominal groans and psychic moans")
LFTs
U&Es

Precipitating factors

Steroids and Long term conditions

20
Q

Diagnosis of depression vs diagnosis of mania duration

A

> 2 wks depression

>1 wks mania

21
Q

Treatment of Mania

A

Acute mania: Olanzapine, Risperidone, Quietiapine

Mood stabilisers:
Sodium Valproate
Lithium
Lamotrigine

Carmazapine (linked to benzos)

Note: Quetiapine is first line because of risks with Lithium

22
Q

Lithium SEs

Lithium Toxicity

A 
Lethargy/leucocytosis
Intentional tremor
Teratogenicity
Hypothyroidism
Insipidus
Urine excess/renal failure
Metalic taste

Toxicity – can be fatal
• Confusion, coarse tremor, nausea and vomiting, ataxia and seizures

  • Treated with supportive measures – dialysis if necessary
  • Potential for toxicity increases with dehydration – advise to drink lots of water in hot climates
23
Q

About to start pt on Lithium, what tests

A

Baseline U&Es, LFTs, TFTs, Pregnancy, ECG

Not metabolised, just excreted by kidneys - hence need to make sure kidneys are accurately excreting to maintain therapeutic dose

Monitor 12 hour after first dose
Weekly for 4 weeks until therapeutic dose achieved
3 monthly

Every 6 months monitor U&Es
Every year TFTs

24
Q

Causes of psychosis

A

Non organic: Schizophrenia, Schizotypal disorder, Schizoaffective disorder, Acute psychotic episode, Delusional disorder

Organic: Dementia, Delirium, Huntington’s disease, Endocrine or hypocalcaemia, Syphilis, Drug-induced (Cannibis)

25
Q

Classification of depression

A

Mild 2 core + 2 others
Moderate 2 core + 3-4 others
Severe 3 core + others

RISK takes you straight to severe

26
Q

Antipsychotics

A

Typical: Haloperidol, Chlorpromazine

Atypical: Olanzapine, Risperidone, Quetiapine, Aripiprazole, CLOZAPINE

Block D2 receptor

Also have other effects:

Serotonergic - help affective symptoms
Antihistaminergic - sedative
Antiadrenergic - postural hypotension, tachycardia
Anticholinergic - Can’t see,pee,spit,shit

27
Q

Antipsychotics

A

Typical: Haloperidol, Chlorpromazine

Atypical: Olanzapine, Risperidone, Quetiapine, Aripiprazole, CLOZAPINE

Block D2 receptor

28
Q

Extra-pyramidal side effects

A

Parkinsonism - tremor, rigidity, bradykinesia
Akathisia
Dystonia (+ Oculogyric crisis)
Tardive dyskinesia

29
Q

Dopaminergic pathways and side effect profile of antipsychotic

A

Mesolimbic pathway - positive symptoms of schizo

Mesocortical - negative “”

Nigrostriatal pathway (EPS and TD)

Tuberoinfundibular - hyperprolactinaemia

30
Q

What can be given to reduce extra-pyramidal side effects of antipsychotics?

A

Procyclidine

Anti-cholinergic

31
Q

Metoclopramide

Odansatron

Cyclizine

A

Dopamine antagonist

Serotonin antagonist

?

32
Q

SEs of antipsychotics except clozapine

A

Weight gain - metabolic syndrome - increased bp, incr lipids and glucose, increased abdominal circumference

Hyperprolactinaemia - Dec. libido, amenorrhoea, gynaecomastia, dec. bone density

33
Q

Clozapine SEs

A

Should be used in schizophrenia after two other antipsychotics have not worked
• Significant potential for agranulocytosis (severe leukopenia): therefore close monitoring of FBC: weekly for first 18 weeks then fortnightly then monthly.
• Significant potential for gastrointestinal hypomobility: constipation, potentially fatal bowel obstruction.
• Other side-effects include hypersalivation and urinary incontinence.
• Dose titrated slowly upward over two weeks and vital signs monitored due to potential for autonomic dysregulation

34
Q

Neuroleptic Malignant Syndrome

A

• Rare, life-threatening reaction to antipsychotics
• Fever, confusion, muscle rigidity, sweating, autonomic instability
• Death usually due to:
• Rhabdomyolysis, renal failure, seizures
• Risk factors include:
• High potency dopamine antagonists (typical antipsychotics) in antipsychotic
naive, high doses, young men • Treatment:
• Emergency referral to A&E; stop antipsychotics; fluid resuscitation; reduce temperature

35
Q

Benzos

A

Most typically used are diazepam (long half-life) and lorazepam (shorter half-life)
• Bind to GABA receptors to potentiate the effect of GABA and therefore reduce the excitability of neurones.
• Therefore they are positive allosteric modulators of GABA receptor
• Significant potential for tolerance and dependence
• Significant potential for misuse
• Use very cautiously and for no more than six weeks
• Occasionally cause paradoxical disinhibition

36
Q

Pregabalin

A

Binds to voltage gated calcium channels in neurones
• Increases extra-cellular amounts of the enzyme responsible for synthesis of GABA and therefore increases GABA concentrations in the brain
• Reduces neuronal activity (i.e. is a CNS depressant)
• Used in anxiety, neuropathic pain and epilepsy
• Less potential for misuse and dependence (and tolerance) than benzodiazepines – but still misused – nickname “Budweisers”
• BNF says short term use – often used indefinitely
• Causes sedation and can cause weight gain

37
Q

Benzo alternative

OD treatment

A

Positive allosteric modulator of GABA
Zopiclone, Zolpidem

OD of benzo: Flumazenil

38
Q

Lamotrigine

A

Has a potential to cause Steven Johnson’s Syndrome

39
Q

Aspirin give to children - bad…

A

Reye’s (Reye) syndrome is a rare but serious condition that causes swelling in the liver and brain. Reye’s syndrome most often affects children and teenagers recovering from a viral infection, most commonly the flu or chickenpox.

Phase 2 (6 decks)

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