Psychiatry Flashcards
Which allele of Apolipoprotein confers risk of Alzheimer’s Disease?
ApoE4
Apo E2 is protective
Duration of symptoms required for Alzheimer’s disease
6 months
5 A’s of dementia
Amnesia Aphasia Agnosia Apraxia Associated symptoms
BPSD
Psychosis Emotionally labile Depression/ anxiety Withdrawal/ apathy Disinhibition Sleep cycle disturbances Altered eating habits Incontinence
Confusion screen
Bloods:
- FBC
- U+E
- LFT
- TFT
- Calcium
- B12
- Folate
- Glucose
CXR
Cultures
Urinalysis and drug screen
Side effects of AChEis
Mild D+V, nausea, headache, fatigue, weird dreams, aggression
Moderate Abdominal pain, loss of appetite, jaundice, dizziness, weight loss, weakness
Parasympathetic effects Bradycardia, Hypotension, Bronchoconstriction, Increased IOP
SLUDGE Syndrome Salivation, Lacrimation, Urination, Defaecation, GI problems, Emesis
Contra-indications of AChEis
Peptic Ulcer Disease
Conduction problems e.g. Sick Sinus Syndrome
Asthma and COPD
Diagnosis of dementia with Lewy Body (DLB)
Presence of dementia-like symptoms, plus 2/3 of:
Fluctuating attention and concentration
- Recurrent, well-formed visual hallucinations
- Spontaneous Parkinsonism (Bradykinesia, Rest/ Intention tremor, Rigidity)
Subtypes of Frontotemporal Dementia
Behavioural Variant
Progressive Non-Fluent
Semantic
Physical features of Hypoactive delirium
More common but also more difficult to detect; Lethargy, reduced mobility and movement, reduced appetite, quiet and withdrawn.
Physical features of hyperactive delirium
Agitation, restlessness, sleep disturbance, hypervigilance, restlessness, wandering
First rank symptoms (FRS) in Schizophrenia
Thought Disorder (echo, insertion, withdrawal, broadcasting)
Delusional Perceptions
Third Person Auditory Hallucinations
Delusions of Control
Additional symptoms in Schizophrenia
Persistent hallucinations in any modality
Breaks in thought
Catatonia (strange, purposeless behaviour)
Negative symptoms
Paranoid Schizophrenia
The most common. Dominated by paranoid hallucinations and delusions, with catatonic behaviour and negative symptoms less common.
Hebephrenic schizophrenia
Affective changes such as inappropriate mood, disorganised thought and speech. Delusions and hallucinations are rarer.
Catatonic schizophrenia
Prominent psychomotor symptoms which may alternate between extremes e.g. hyperkinesis/ stupor, and negativism.
- Constrained attitudes and positives
- Violent excitement
Simple schizophrenia
Conduct and negative symptoms
Undifferentiated schizophrenia
Meets diagnostic criteria but not bound to one disorder
Treatment of Parkinson’s symptoms with Antipsychotics
1st Line: Procyclidine
Treatment of Tardive Dyskinesia with antipsychotics
1st Line: Procyclidine
2nd Line: IV Benzotropine
Treatment of Akathasia with antipsychotics
Procyclidine
Propanolol
Benzodiazepines
Treatment of Tardive Dyskinesia with antipsychotics
Tetrabenazine
its irreversible and can’t be reversed if medications stopped- unless treated
Treatment of Neuroleptic Malignant Syndrome
Dantrolene or Bromocriptine
Othello Syndrome
Morbid jealousy where one believes that the partner is in an affair with someone else, with no evidence or based on minor evidence.
- Associated with alcohol dependence and sexual dysfunction
- Risk of stalking/ violence to partner
De Clerambault’s Syndrome
AKA Erotomania; the belief that a famous person is in love with them
- Communicates via secret signs as can’t declare love
Capgras Syndrome
Delusional misidentification- a spouse/ close friend/ relative is replaced by an identical looking imposter.
- Slightly more common in women
Fregoli’s Syndrome
Patient is being persecuted by a single person
Disguised and changes appearance to look like different people
Cotard’s Syndrome
Nilhilistic Delusions Being dead/ non-existent; or missing body parts
- Associated with depression
Ekbom’s Syndrome
Delusional parasitosis, involving the belief that they are infested with parasites with no physical evidence (formication; can be induced by cocaine). Risk of self-harm trying to get rid of them.
Folie a deux
Induced delusional disorder shared between two people.
When may medications be considered in mild depression
- If depression complicates chronic disease/ physical health
- Past history of moderate-severe depression
- Persists after other interventions
- Subthreshold symptoms present for 2+ years
Pharmacological treatment escalation in depression
- 1st Line: SSRI
- 2nd Line: SSRI
- 3rd Line: SNRI or NaSSA
- 4th Line: MAOI or TCA
- Adjunct Lithium (if recurrent depression)
Serotonin Syndrome
Autonomic Hyperactivity
Altered Mental state
Neuromuscular excitation
Treatment of the serotonin syndrome
Stop the drug
Fluids
Benzodiazepines
Serotonin antagonists (Cyproheptadine, Chlorpromazine)
Which antidepressants should be taken at night-time due to their sedatory effects?
NaSSAs e.g. Mirtazapine
Important patients to use SNRIs with caution in?
Cardiovascular disease
Sedatory effects of Tricyclic antidepressants
More Sedating: Amitriptyline, Clomipramine, Trazodone
Less Sedating: Nortriptyline, Imipramine, Clomipramine
Important SEs of TCAs
Sedation Hypotension Dry mouth Constipation Urinary retention ± overflow incontinence Breast changes Mania Convulsiona
Important interactions with TCAs
MAOIs
Important SE of Monoamine Oxidase Inhibitors e.g. phenelzine, moclobemide
Hypertensive crisis due to reduced breakdown of Tyramine (contained in foods such as cheese, red wine)
Which drug is associated with Ebstein’s anomaly of the heart? (tricuspid/ RV abnormalities)
Lithium
Side effects of Sodium Valproate
GI Upset
Hair loss with regrowth of curly hair
Thrombocytopaenia
Ataxia/ Tremor
Important interactions with Sodium valproate
Its a CYP450 inhibitor
Charles Bonnet Syndrome
Visual hallucinations associated with eye disease
Metabolic changes in Anorexia (decreases)
Anaemia Hypoglycaemia Low TSH (Hypothyroidism) Low Oestrogen Hypokalaemia Hypophosphataemia Reduced renal function
Metabolic changes in Anorexia (increases)
Bicarbonate Amylase Growth Hormone Cortisol Cholesterol Carotinaemia CCK
1st line anorexia treatments in adults
CBT-ED
MANTRA
SSCM
1st line anorexia treatment in children
Family Therapy
Re-feeding Syndrome
Caused by Hypophosphataemia during treatment
- Rhabdomyolysis
- Cardiorespiratory failure
- Hypotension
- Arrhythmias
- Seizures
Increase feeding slowly and supplement Thiamine and Vitamin B1
Wernicke’s Encephalopathy Features
Confusion
Ataxia (wide-based gait)
Ophthalmoplegia (ocular palsies, nystagmus, rectus palsies)
Disulfiram
Antabuse- produces an undesirable effect when alcohol is drank
Acamprosate/ Naltrexone
Start after withdrawal and continue for 6 months. Reduces cravings by enhancing GABA transmission
Features of Opioid dependence
3 of the following present in the last 12 months
- Tolerance
- Withdrawal
- Use increasing/ prolonged duration
- Unsuccessful attempts to reduce usage
- Large amount of time spent using/ recovering
- Takes priority over other life aspects
- Persistent use despite harm
Negative symptoms of schizophrenia
Apathy Reduced motivation (volition) Anhedonia Alogia (poverty of speech) Asociality Blunt affect
Is often a late feature
Catatonia
Strange purposeless behaviour Sudden excitement Posturing Flexibility Negativism Mutism Echopraxia
Drug treatment escalation in GAD
SSRI SSRI/SNRI Pregabalin Benzodiazepines (not in primary care) Beta blockers can be added for palpitations/ tremor
Degrees of learning disability
Mild 70
Moderate 50
Severe 35
Profound 20
20-15-15-20
Guiding principles of the MHA
- Least restrictive options should be used, and maximising independence
- As much as possible, empower service users and involve them
- Respect and Dignity
- Use must have a reason/ purpose and be done effectively
- Efficiency and equity
