Psychiatry Flashcards
What are the 1st line, 2nd line and 3rd line treatments for moderate/severe depression
- SSRI’s- escalitopram
2. increase dose, and switch to another SSRI. Or switch to other class of drug eg SNRI, MOAIs, TCA
Which types of depressive patients do you use ECT in?
- severe depression if not responding to pharam treatment, if they got psychomotor retardation, suicide or homocide, or if theyve got severe weight loss or biological features
- 1st line in psychotic depression
Pharmacological treatment of psychotic depression
Antidepressant with antipyschotic- eg fluoxetine with olnazapine
What is treatment resistant depression, and how do you treat it?
- failure to respond to two anti-depressants or 1 antidepressant and ECT
Tx- add lithium or T2 tryptophan
What is the first line treatment for acute manic episodes?
- you either stop anti-depressants or add:
Antipsychotics- haloperidol, olnazapine, risperiodone, quietapine
describe 2nd and 3rd line treatments for acute manic episode?
2nd line- add lithium to APA
3rd line- add valporate
- can also Benzodiazapenes if patient already taking anti-psychotics because has sedation effects
Management for acute depressive episode in BPD that is moderate/severe
1. Fluoxetine and Olnazapine or Quiteapine- taken as monotherapy 2. LAMTROGINE monotherapy if taking lithium- then check serum lithium levels just add the above onto lithium
How long should a normal grief reaction last for?
5 stages of grief, which include denial, acceptance, anger, depression etc
normal grief reaction can last up to 12 months, if beyond this then atypical grief reaction
What is the most important blood test to do in a patient on Clozapine?
FBC- due to agranulocytosis
What are the four first rank symptoms of Shizophrenia
1) . 3rd person auditory hallucination
2) . Passivity phenomena
3) . Delusional perceptions
4) . Thought alienation- eg thought echo, thought broadcast, thought withdrawal
What are the short term side effects of ECT
Nausea Vomiting Headaches Short term anterograde amnesia Cardiac arrythmias
Why do you review patients, under the age of 30 who are taking SSRI’s and SNRI’s?
Increased risk of suicide. You do this for the first month
If a patient is having a good response to SSRI’s, how long should they continue this treatment for?
Continue treatment for at least 6 months to prevent relapse
What is the time period in which symptoms, seizures and delerium tremens develop following alcohol withdrawal?
Symptoms- 6-12 hours
Seizures- 36 hours
Delerium tremens- 72 hours
Describe the type of symptoms in post-concussive syndrome and how long they last for?
non specific, and occur 3 months following the initial injury
What treatment is 1st line in young patients presenting with anorexia nervosa?
Family based therapy
What are two symptoms of acute dystonia, which occur as side effects of anti-psychotics?
torticollis, oculargyrate crisis
Which psychiatric condition can mimic AD in the elderly?
Depression with lack of concentration can mimic memory loss. Depression and AD are common in elderly patients
As rule of thumb which symptoms do those with hypochondrial disorder and somatisation disorder present with?
Hypochondrial disorder- Cancer
Somatisation- Symptoms
According to NICE, what are the three indications for ECT?
ECT is used to achieve rapid and short term improvement:
- Catatonia
- prolonged or severe mania in BPD
- Severe depression which is life threatning
What are the six syndromes which result in unexplained symptoms:
- Somatization disoder
2) . Hypochrondrial disoder - Dissociative disorder
- Conversion disorder
- Malingering
- Factitious
Which two medical conditions are most important to exclude before diaganosing GAD? what investigations do you do to exclude these?
- hyperthyroidism: TFT’s
- phaecromocytoma: diagnose using urinary creatinine, catecholamines which are raised and urinary VMA
