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Y3- TO LEARN > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is somatic syndrome?

A

Depression with more physical symptoms

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2
Q

What is atypical depression?

A

Mood reactivity
Increase appetite and sleep
Leaden paralysis (heavy limbs)

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3
Q

What is psychotic depression?

A

Paranoid or hypochondriae or with nihilistic delusions

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4
Q

What are nihilistic delusions?

A

A nihilistic delusion of the nonexistence or dissolution of a body part; in extreme form, the delusion of being dead or nonexistent

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5
Q

Rate of suicidal thoughts/behaviour in depression?

A

25%

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6
Q

Onset age of bipolar disorder?

A

Late teens/early 20s

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7
Q

Bipolar disorder is a spectrum of..? (2 things)

A

Severity (mania vs hypomania)

Proportion (more depressed/manic)

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8
Q

Symptoms of hypomania + mania?

A 
Elevated mood
Restlessness
Increased talkativeness (pressure of speech)
Decreased need for sleep
Increased sexual energy
Difficulties concentrating
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9
Q

Symptoms of mania?

A

Flight of ideas
Loss of social inhibitions
Grandiosity
Reckless behaviour

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10
Q

Bipolar carries increased risk of … compared to other mental disorders

A

Suicide

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11
Q

Which kind of antidepressants are generally first line?

A

SSRIs

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12
Q

How long should antidepressants be used?

A

At least 6 months after remission

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13
Q

Treatment for bipolar in acute mania?

A

Anti-psychotics + Lithium
Benzodiazepines for symptom control
Hospitalisation if severe

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14
Q

Treatment of bipolar depressive phase?

A

Anti-depressant (SSRI- fluoxetine, lamotrigine)
+ Lithium
ECT if severe

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15
Q

What should be monitored in elderly people taking anti-depressants?

A

Sodium- risk of hyponatraemia

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16
Q

What do monoamine oxidase inhibitors (MAOIs) do?

A

Inhibit enzyme responsible for monoamine metabolism (less serotonin/noradrenaline metabolised)

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17
Q

Examples of MAOIs?

A

Moclobemide (reversible)
Phenelzine (irreversible)

When put fennel in food, it’s irreversible!

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18
Q

Side effects of MAOIs?

A 
Postural hypotension
Drowsiness
Nausea
Insomnia
Constipation
Peripheral Oedema
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19
Q

Depersonalisation?

A

Body not yours or disconnected from you

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20
Q

Derealisation?

A

Disconnected from world or “spaced out”

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21
Q

What are the dietary restrictions associated with MAOIs?

A

Tyramine foods (cheese, red wine, red meats etc)–> cause hypertensive crisis

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22
Q

How do tricyclic antidepressants work?

A

Block the reuptake of monoamines (5-HT and noradrenaline) at the presynaptic terminals

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23
Q

Examples of tricyclics?

A

amitriptyline, imipramine, dosulepin, lofepramine

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24
Q

When should tricyclics be avoided?

A

In suicidal patients

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25
Q

Side effects of triCyCliCs? (3Cs= clue)

A 
Cardiovascular= postural hypotension, tachycardia, arrythmias
Cognitive= impairment in elderly
anti-Cholinergic= blurred vision, dry mouth, constipation, urinary retention

+ Weight gain, sedation

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26
Q

How do SSRIs work?

A

Selectively inhibit reuptake of serotonin

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27
Q

Examples of SSRIs?

A

Fluoxetine, citalopram, escitalopram, sertraline

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28
Q

Side effects of SSRIs?

A

N+V, headache, transient anxiety, agitation, sweating, sexual dysfunction, insomnia, HYPONATRAEMIA in elderly

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29
Q

Examples of dual reuptake inhibitors?

A

Venlafaxine, Duloxetine

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30
Q

Name an atypical anti-depressant and its use?

A

Mirtazapine

Supplement SSRIs to block serotonin side effects e.g. nausea
can cause weight gain, sedation

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31
Q

When is Reboxetine good to use?

A

In patients with reduced energy

won’t get tired with your Reeboks on

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32
Q

How is lithium monitored?

A

Lithium levels
U+Es
TFTs
ECG

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33
Q

Side effects of lithium?

A

GI upset, Tremor, HYPOTHYROIDISM, Weight gain, renal impairment, polydipsia, polyuria, sedation

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34
Q

Lithium toxicity signs include?

A

Vomiting, diarrhoea, ataxia, tremor, drowsiness, convulsions

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35
Q

What is sodium valproate?

A

Anti-convulsant- sometimes used in mania

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36
Q

Side effects of sodium valproate?

A

sedation, tremor, dizziness, GI upset, weight gain, TERATOGENIC

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37
Q

Features of addiction?

A 
Strong desire
Difficulties in control
Psychological withdrawal
Tolerance
Neglect of alternative pleasures
Persistence despite harm
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38
Q

CAGE questions for alcohol abuse?

A
  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
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39
Q

Why does neglect of other pleasures occur in addiction?

A

Relative lack of dopamine release

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40
Q

Why does tolerance occur in addiction?

A

Less dopamine released than in non-addicts (more needed for pleasure)

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41
Q

What is the role of the prefrontal cortex in addiction (3 roles)?

A

Helps intention guide behaviour + reward pathways + impulse control

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42
Q

Why is prefrontal cortex development relevant to addiction?

A

Last part of brain to develop- in early 20s

Shows lower activity in addicts

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43
Q

Craving in addictions is mediated by which parts of the brain?

A

Hippocampus
Striatum
Amygdala

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44
Q

What is heroin metabolised to?

A

Morphine

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45
Q

Effects of heroin?

A 
Euphoria
Analgesia
Respiratory depression
Constipation
Contricted pupils
Hypotension/bradycardia
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46
Q

Heroin withdrawal symptoms?

A

Dysphoria, agitation, tachycardia/hypertension, piloerection (hairs on end), diarrhoea, N+V, dilated pupils, joint pains

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47
Q

Complications of IV drug use?

A

Infection- cellulitis, abscess, endocarditis, HIV, Hep B/C
DVT
PE
Ischaemic limb

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48
Q

Treatment of heroin addiction?

A

OST- opiate substitution therapy

  • replace short acting for long acting
  • methadone
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49
Q

Why is opiate detoxification risky?

A

10% of completers dead after 4 months

Increased overdose- go back to previous dose

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50
Q

How to calculate number of units?

A

(% x volume)/10

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51
Q

What is high risk drinking?

A

> 35 units/week

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52
Q

Harmful effects of alcohol?

A

N+V, gastritis, mallory-weiss tears, ulcers, malnutrition, vitamin deficiency, hepatitis, arrythmias, dementia, cancer etc

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53
Q

Which LFT indicates liver injury? (in e.g. alcohol)

A

Gamma GT

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54
Q

What causes alcohol withdrawal?

A

Excess glutamate and less GABA activity

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55
Q

Symptoms of delirium tremens?

A

Confusion, agitation, disorientation, hypertension, fever, hallucinations (V+A), paranoia

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56
Q

Treatment of delirium tremens/alcohol withdrawal?

A

Benzodiazepines (e.g. chlordiazepoxide)

Vitamin supplementation

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57
Q

How does Antabuse work?

A

inhibits acetyldehyde dehydrogenase (cause unpleasant effects)

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58
Q

Drug name of antabuse?

A

Disulfiram

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59
Q

What is Acamprosate used for in alcohol relapse prevention?

A

Reduces cravings

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60
Q

First line for alcohol relapse prevention?

A

Naltrexone

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61
Q

Physical symptoms of anxiety?

A

Sweating, tremor, muscle tension, numbness, lightheadedness, dizzy, difficulty breathing, increase HR, nausea, chest pain etc

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62
Q

Behavioural symptoms of anxiety?

A

Avoidance, exaggerated response, sleep disturbance, restlessness, irritability, alcohol/drugs, checking behaviours

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63
Q

Cognitive symptoms of anxiety?

A

Feelings of losing control, on edge/tense, difficulty concentrating, derealisation, depersonalisation. hypervigilance, racing thoughts

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64
Q

2 definitions of anxiety disorder?

A

More extreme anxiety than normal

Anxiety is abnormal situations

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65
Q

Treatment of GAD?

A

CBT
SSRI/SNRI
Pregabalin
benzodiazepines (short-term)

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66
Q

Characteristics of panic disorder?

A

Unpredictable, recurrent attacks of severe anxiety with no pattern

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67
Q

What co-exists with panic disorder in 50-65%?

A

Agoraphobia

phobia of having panic attacks in public

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68
Q

Characteristics of phobia?

A

Irrational/Excessive fear
Marked and persistent
Avoidance and anticipatory anxiety

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69
Q

What is social anxiety disorder?

A

Persistent fear of social performance with unfamiliar people/scrutiny of others
Fear of embarrassment/humiliation

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70
Q

Obsessional thoughts associated with OCD?

A

Ideas/images/impulses
Patient’s own thoughts
Unpleasant + resisted thoughts

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71
Q

Compulsive acts associated with OCD?

A

Repeated rituals/stereotyped behaviour

No purpose- view as neutralising

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72
Q

Treatment of OCD?

A

CBT
SSRIs
Clomipramine (TCAD)

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73
Q

Definition of major incident?

A

Situation with multiple casualties due to natural/unnatural causes, that is beyond what normal emergency services can cope with

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74
Q

What is tonic immobility?

A

Involuntary state of profound motor inhibition due to fear

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75
Q

Main events leading to PTSD?

A 
Sexual assault
Burns
Combat veterans
RTAs
Intensive care
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76
Q

Symptoms of PTSD?

A

Intrusive thoughts
Avoidance behaviours (reminders, amnesia, detachment)
Hyperarousal- sleep disturbance, anger, low conc
Dissociation
Survivor guilt

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77
Q

Neurobiological features of PTSD?

A

Hippocampal atrophy
Increase amygdala activity
Low cortisol

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78
Q

Treatment of PTSD?

A

Trauma focused CBT
EMDR
Exposure therapy
Meds: paroxetine, mirtazapine

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79
Q

Reasons for deliberate self harm?

A

Die
Escape situation/anguish
Display desperation
Influence others

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80
Q

What do brain scans show in recent self-harmers?

A

Decreased frontal lobe activity

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81
Q

What are the most common methods of suicide in UK?

A

Hanging/poisoning

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82
Q

What pathology causes Alzheimer’s disease?

A

Amyloid plaques and neuro-fibrillary tangles

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83
Q

At what age is Alzheimer’s disease considered early onset?

A

<60 years

84
Q

How do benzodiazepines work?

A

Enhancing action of GABA- open Cl channels- less APs produced

85
Q

Examples of benzodiazepines?

A

Lorazepam, diazepam, chlordiazepoxide

86
Q

What do benzodiazepines do?

A

Reduce anxiety, aggression
Sedation
Muscle relaxation
Anti-convulsant

87
Q

What can benzodiazepines cause with alcohol?

A

Respiratory depression

88
Q

Symptoms of benzodiazepine withdrawal?

A

Confusion, tachycardia, psychosis, sweating, hypertension, tremor, agitation, abdo cramps

89
Q

What is a functional disorder?

A

Cannot easily associate symptoms with classically identifiable organic disease

(like a ‘software’ problem- no obvious cause)

90
Q

Common functional symptoms?

A

Pain, altered sensation, dizziness, movement disorder, weakness, seizures (non-epileptic attacks), cognitive symptoms

91
Q

Important history for functional symptoms?

A 
Timeline of symptoms
Disability
PMH
ICE
Psychiatric/mood history
92
Q

Should you exam functional symptoms?

A

ALWAYS EXAMINE

inconsistent findings common

93
Q

Management of functional disorders?

A

Reassure
CBT
Tricyclic antidepressants

94
Q

Classic symptoms of psychosis?

A

Hallucinations, delusions, disorder of form of thoughts
Impaired communication/relating to others
Unable to recognise reality

95
Q

What are neologisms?

A

Assuming you understand strange words they’re using

96
Q

Differential of psychosis?

A 
Schizophrenia
Substance abuse (drug induced)
Mania with psychosis
Depressive psychosis
Dementia
Delirium
97
Q

Positive symptoms of schizophrenia?

A

Hallucinations (often 3rd person auditory)
Delusions
Passivity of thought
Thought interference
Passivity (outside control of affect, impulses etc.)

98
Q

Negative symptoms of schizophrenia?

A 
Reduced speech
BLUNTED affect
Reduced motivation
Reduced interest
Reduced social interaction
99
Q

Causes of schizophrenia?

A

Multifactorial GENETIC (often seen in same families)

100
Q

Risk factors for schizophrenia?

A 
Obstetric problems (pre-eclampsia, fetal hypoxia, prolonged labour)
Childhood viral CNS infection
Drug use (esp. cannabis)
Urban dwelling
Social adversity/deprivation
101
Q

Neurological findings in schizophrenia?

A

Reduced frontal lobes volume + grey matter
Enlarged ventricles

Altered dopamine signalling (overactivity)

102
Q

Prognosis of schizophrenia?

A

Some have relapsing/remitting, some have progressively worse
10-15% commit suicide

103
Q

Which anti-psychotics are first line?

A

Atypicals (2nd generation- newer)

104
Q

Which type of anti-psychotic can be used if compliance is an issue?

A

Depot

105
Q

Name some mood stabilisers?

A

Lithium
Sodium Valproate
Carbamazepine
Lamotrigine

106
Q

How do typical anti-psychotics work?

A

Block D2 receptors

107
Q

Examples of typical anti-psychotics?

A 
Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol
Zuclopentixol
108
Q

Side effects of typical anti-psychotics?

A

Acute dystonic reaction (muscle spasms)
Parkinsonism
Tardive dyskinesia (repetitive involuntary purposeless movements + inner restlessness)
Hyperprolactinaemia (due to lack of prolactin inhibition by dopamine)

109
Q

Treatment of acute dystonic reactions?

A

Anti-cholinergics

110
Q

What is akathisia?

A

Inner restlessness

111
Q

Symptoms of hyperprolactinaemia in antipsychotics?

A

Sexual dysfunction, galactorrhoea, gynaecomastia, amennorhea, infertility

112
Q

How do atypical anti-psychotics work?

A

Transient block D2 receptors, and block 5HT2 receptors too

113
Q

Examples of atypical anti-psychotics?

A

Olanzapine
Risperidone
Quetiapine
Clozapine

114
Q

Side effects of atypical anti-psychotics?

A 
MUSCARINIC BLOCKADE (blurred vision, dry eyes, dry mouth, constipation, urinary retention)
Metabolic syndrome (high CV risk)
Sedation
Increased appetite
Postural hypotension
115
Q

Major side effects of clozapine?

A

Agranulocytosis (fever, sore throat)

Myocarditis

116
Q

Monitoring for clozapine?

A

FBC

ECG + BP

117
Q

Psychiatric illness is 3 times as common in people with LD. How can it be managed?

A 
Improve skills + relaxation
CBT
Antidepressants
Physical e.g. headgear, guards
Aid communication
118
Q

Define violence?

A

Intentional use of physical force or power, threatened or actual against self or others
Results in injury, psychological harm or deprivation

119
Q

Predictors of violent behaviour?

A

Severe mental illness
Substance abuse
History of violence

120
Q

Define aggression?

A

Intentionally hurting or gaining advantage over another

121
Q

What can be used as rapid tranquillisation in aggression?

A

oral Lorazepam or Haloperidol

Then IM injection

122
Q

What are personality disorders and when are they diagnosed?

A

Enduring pattern of inner experience + behaviour that deviates markedly from the expectations of an individuals culture
Diagnosed >18 years

123
Q

Manifestations of personality disorders? (4)

A
  1. Cognition (perceptions)
  2. Affectivity (range/ intensity of emotion)
  3. Interpersonal functioning
  4. Impulse control
124
Q

Which personality disorder is most inheritable?

A

Obsessive compulsive personality

125
Q

How many people are affected by personality disorders?

A

10%

126
Q

Which personality disorders are until Cluster A: odd and eccentric?

A

Paranoid
Schizoid
Schizotypical

127
Q

Which personality disorders are until Cluster B: dramatic, emotional, erratic?

A

Antisocial
Borderline
Histrionic
Narcissistic

128
Q

Which personality disorders are until Cluster C: anxious and fearful?

A

Avoidant
Dependent
Obsessive-Compulsive

129
Q

Features of paranoid PD?

A

Distrust and suspicion of others that motives are malevolent
Doubts of loyalty and partner fidelity
Bears grudges
No confiding in others

130
Q

Features of schizoid PD?

A 
Detachment from social relationships and restricted range of emotion
No close relationships
Solitary
Detachment/emotional coldness
Aloof/fantasy world
131
Q

Features of antisocial PD?

A 
Disregard for rights of others
Deceitful
No conform to laws
Impulsivity, aggression
Disregard for safety
Irresponsible
Lack of REMORSE
132
Q

Features of borderline PD?

A 
Instability of interpersonal relationships, self-image, affect + impulsivity (money, sex, driving etc.)
Avoid abandonment
Unstable/intense relationships
Extreme moods
Suicidal/DSH
133
Q

Features of histrionic PD?

A 
Excessive emotionality + attention seeking
Centre of attention
Provocative behaviour
Self-dramatisation
Suggestible
134
Q

Features of avoidant PD?

A

Social inhibition, feeling inadequate, hypersensitive to negative evaluation
Avoid activities leading to criticism
Reluctant for new activities- embarrassment

135
Q

Features of dependent PD?

A 
Excessive need to be taken care of
Submissive/clingy behaviour
Fear of separation
Seeking advice/reassurance
Uncomfortable alone
Seeks new relationships when others end
136
Q

Features of obsessive-compulsive PD?

A 
Preoccupation with orderliness, perfectionism at expense of flexibility and efficiency
Details, rules, lists, order, schedules
Devoted to work
Overconscientious
Rigid
137
Q

Treatments of PD?

A

Antidepressant (borderline)
DBT- dialectical behavioural therapy
Mindfulness
Topiramate for aggression

138
Q

What causes Karsakoff’s amnesia?

A 
Severe thiamine (vit B1) deficiency
In chronic alcoholism
139
Q

How long do dementia symptoms last for a diagnosis?

A

At least 6 months

140
Q

What must be considered when interpreting cognition score?

A

Pre-morbid cognition (e.g. doctor, lawyer etc. may have higher scores)

141
Q

Symptoms of Alzheimer’s disease?

A

Memory loss (esp. short term)
Dysphasia
Dyspraxia
Agnosia (cannot recognise objects)

142
Q

Neuropathology of Alzheimer’s disease?

A

Amyloid plaques and neurofibrillary tangles

Temporal lobe atrophy

143
Q

Posterior Frontal Atrophy is a type of Alzheimer’s disease. What are its special features?

A

Visual/ visuo-spatial symptoms

144
Q

Symptoms of vascular dementia?

A 
Dysphasia
Dyscalculia (number difficulties)
Frontal lobe symptoms
Apathy
Decreased processing speed
Focal neurology
145
Q

Progression of vascular dementia?

A

Step-wise decline

146
Q

What does a CT/MRI show in vascular dementia?

A

Small vessel disease or multiple lacunar infarcts

147
Q

Symptoms of frontotemporal dementia?

A 
Behaviour changes
Executive functioning
Disinhibition +Impulsivity
Decreased social skills
PRIMARY PROGRESSIVE APHASIA- lack of words, impaired understanding of words
148
Q

What does a CT/MRI show in frontotemporal dementia?

A

Frontotemporal atrophy

149
Q

Features of Lewy-Body Dementia?

A

Cognitive impairment + parkinsonism
Triad of FALLS, VISUAL HALLUCINATIONS + FLUCTUATING COGNITIVE IMPAIRMENT
REM sleep disorders

150
Q

Features of dementia with Parkinson’s?

A

Parkinsonism for >1 year BEFORE dementia onset

151
Q

How is all Alzheimer’s, Lewy Body and Parkinson’s Dementia treated?

A

Cholinesterase Inhibitors

152
Q

Examples of Cholinesterase Inhibitors?

A

Donepezil, Rivastigmine, Galantamine

153
Q

How do Cholinesterase Inhibitors work?

A

Increase cholinergic transmission

SLOWS PROGRESSION

154
Q

Side effects of Cholinesterase Inhibitors?

A

N+V, diarrhoea, headache, muscle cramps, bradycardia, worsen COPD/asthma

155
Q

Contraindications of Cholinesterase Inhibitors?

A

Active peptic ulcer
Asthma
COPD

156
Q

Apart from Cholinesterase Inhibitors, what else is commonly prescribed in Alzheimer’s, and how does it work?

A

Memantine

Blocks NMDA-type glutamate receptors

157
Q

What is Memantine used for?

A

Slows progression + prevent “challenging behaviour” (hallucinations/delusions, insomnia, anxiety/depression, aggression, disinhibition)

158
Q

Side effects of Memantine?

A

Hypertension, dizziness, sedation, headache, constipation, insomnia

159
Q

What are all people diagnosed with dementia and their families offered?

A

Post-diagnosis support (information, advance planning, advice, counselling)

160
Q

Who else needs to know about a diagnosis of dementia?

A

DVLA

161
Q

What is more common in ASD?

A

Gender dysphoria

162
Q

Core features of ASD?

A

Difficulties in Social Communication, Social Interaction and Social Imagination
+ Repetitive behaviours
+ sensory problems

163
Q

Causes of ASD?

A 
Rubella is pregnant mother
Tuberous sclerosis
Fragile X
Encephalitis
Untreated PKU
Birth injury/foetal distress
164
Q

Neuropathological changes in ASD?

A

Large amygdala + cerebellum pathology

165
Q

Diagnostic tools for ASD?

A

ADOS- autism diagnostic observation schedule

166
Q

Common co-morbidities in ASD?

A 
Anxiety/depression
Eating disorders
Learning disability
OCD
Tourette's
Self harm etc
167
Q

What can be used to manage aggression and self-injury in ASD?

A

Risperidone

168
Q

Triad of ADHD?

A

Inattention
Hyperactivity
Impulsivity

169
Q

What is the typical feature of adult ADHD?

A

Inattention or “inner restlessness”

170
Q

Impact of ADHD on children?

A 
Parenting difficulties
Home stress
Reckless behaviour
Emotional dysregulation
Barrier to learning
Impaired decision making
171
Q

Impact of ADHD on adults?

A

Increased psychiatric problems
Criminality
Antisocial behaviour
Substance misuse

172
Q

Causes of ADHD?

A

Genetics (increases through generations)
Alcohol + smoking in pregnancy
Prematurity
Psychosocial adversity (economic class, crime, parent martial status, trauma)

173
Q

Neuropathological changes in ADHD?

A

Frontal lobe underactivity

Decreased noradrenaline, serotonin and dopamine

174
Q

Prognosis of ADHD?

A

Some will ‘grow out of it’

Some have symptoms persistent into adulthood

175
Q

First line medication in ADHD?

A

Methylphenidate (block dopamine transport)
or
Dexamphetamine

176
Q

Other second line treatments of ADHD?

A

Atomoxetine (SNRI)

Clonidine (alpha agonist)

177
Q

What is one of the biggest predictors for serious antisocial behaviour, criminality and substance misuse?

A 
Oppositional Defiant Disorder (<12s)
Conduct Disorder (>12s)
178
Q

How is separation anxiety recognised?

A

Age appropriate, excessive and disabling anxiety

179
Q

6 features of anorexia?

A
  1. BMI <17.5
  2. Self-induced weight loss
  3. Fear of fatness
  4. Body image disturbance
  5. Delayed puberty/amonorrhea
  6. Sexual dysfunction (men)
180
Q

Physical symptoms of anorexia?

A 
Muscle wasting
Hair loss
Lanugo hair
Dry skin
Hypotension
Cold, blue peripheries
Bradycardia
Bruising
Hypercarotenaemia (orange skin)
181
Q

High risk anorexia?

A

BMI <13, >1kg loss/week, HR <40, Prolonged QT, sBP<80, temp <34
Unable to rise from squat without help
Confusion

182
Q

Specific investigations of anorexia?

A

LFTs- show liver damage (catabolism of liver for calories)
FBC- anaemia
ECG
DEXA- osteopenia/porosis

183
Q

What causes re-feeding syndrome?

A

Due to depletion of already inadequate nutrient stores (quickly used up when body starts repairing)

184
Q

How to prevent re-feeding syndrome?

A

Slow pace initial feeding

Frequent bloods

185
Q

5 features of bulimia?

A
  1. Preoccupation with food
  2. Irresistible craving for food
  3. Bingers
  4. Counter effects of binges (starvation, vomiting, laxatives)
  5. Morbid dread of fatness
186
Q

Physical symptoms of bulimia?

A

Calluses of knuckles (Russell’s sign)
Parotid hypertrophy
Dental caries
Abnormal U+Es

187
Q

Complications of bulimia?

A

Oesophageal reflux/tears/rupture
Hypokalaemia
Subconjunctival haemorrhage

188
Q

What MMSE scores could suggest dementia?

A 
21-26 = mild
10-20= moderate
<10= severe dementia
189
Q

Features of puerperal psychosis and when does it occur?

A

Sudden psychotic/manic symptoms, disinhibition, confusion

2-4 weeks post-birth

190
Q

Risk factors for puerperal psychosis?

A 
Mental illness
Thyroid disorder
FH
First pregnancy
C-section
Perinatal death
191
Q

Risk factors of post-natal depression and when does it occur?

A 
Hx of depression/anxiety
Complicated pregnancy
Traumatic birth
Domestic violence
Trauma/abuse
Financial difficulties

2-6 week post-birth

192
Q

When is urgent referral needed in perinatal mental health? (3)

A

Significant change in mental state/new symptoms
Thoughts/acts of violent self-harm
Incompetency as mother/estrangement from baby

193
Q

Risk factors for perinatal mental health problems?

A 
Young
Single
Domestic issues
Lack of support
Substance abuse
Unplanned pregnancy
Pre-existing MH condition
194
Q

How many people with bipolar will relapse during pregnancy?

A

50%

195
Q

Management of puerperal psychosis?

A 
EMERGENCY admission to mother + baby unit
Antidepressants
Antipsychotics
Mood stabilisers
ECT
196
Q

What is the recurrence rate of puerperal psychosis?

A

80% in 10 years

25% will develop bipolar

197
Q

3 general prescribing principles in pregnancy mental health?

A
  1. Low risk medication + low dose monotherapy
  2. Beware altered pharmacokinetics e.g. lithium
  3. Encourage breastfeeding- relatively less that exposure in-utero
198
Q

Which 2 anti-depressives to avoid in pregnancy?

A

Paroxetine (heart defects)

Citalopram

199
Q

Can benzodiazepines be used in pregnancy?

A

NO

Increase malformations + floppy baby syndrome

200
Q

Which anti-psychotics are safe to use in pregnancy?

A

Typicals better

AVOID clozapine (agranulocytosis) + olanzapine (diabetes, weight gain)

201
Q

Can lithium be used during pregnancy?

A

Yes

Monitor serum levels closely (toxicity can mimic pre-eclampsia)

202
Q

Can lithium be used during breastfeeding?

A

NO

concentrated to baby

203
Q

Is sodium valproate safe in breastfeeding?

A

Yes

204
Q

Is tetracycline safe in breastfeeding?

A

No

absorbed by breastmilk- can discolour infant teeth permanently

205
Q

Is carbamazepine safe in pregnancy?

A

No

Neural tube + facial defects

206
Q

Is lamotrigine safe in pregnancy?

A

No

Oral cleft + stevens-johnson syndrome

207
Q

Management of illicit drug misuse in pregnancy?

A 
Methadone
Child protection/social work
Early IV access
Vitamins
Contraception!

Y3- TO LEARN (13 decks)

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