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Yr 3 ALS > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Section 2

  • How long
  • Who can do it
A
  • Assessment up to 28 days

- 2 doctors and an AMHP

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2
Q

Section 3

  • How long
  • Who can do it
A
  • Up to 6 months
  • After 3 months consent or independent doctor opinion needed
  • 2 doctors and an AMHP
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3
Q

Section 5 (holding power)

  • How long
  • (mental health nurses)
A

Doctor can detain someone in hospital who has changed their mind. Only lasts 72hrs
(Nurses lasts 6 hours|)

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4
Q

Section 136

A

Police take someone from public place to place of safety

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5
Q

Community orders 7+8

A

Power to return patient to hospital if non compliant. As treatment cannot be enforced in the community

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6
Q

M:F

  • GAD
  • Panic disorder
  • NT pathway involved
A
  • GAD = 2:1
  • Panic = F>M
  • 5-HTP
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7
Q

Mixed anxiety and depression definition

A

Both symptoms present but neither predominates, and neither are strong enough to meet diagnostic criteria for each

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8
Q

Depression

  • M:F
  • Screening tool
  • Definition
A
  • 2:1
  • PHQ-9
  • 2+ core symptoms + 2+ additional symptoms from ICD-10 for 2 weeks or more
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9
Q

Depression ICD-10 Symptoms

  • Core
  • Additional
A

Core

  • Sadness
  • Anhedonia
  • Lack energy

Additional

  • Sleep disturbance
  • Appetite symptoms
  • Guilt
  • Poor self esteem
  • Retardation or agitation
  • Diminished concentration
  • Suicidal thoughts
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10
Q

Classify Milkd/Mod/Severe depression

A
  • Mild = 4 symptoms
  • Moderate = 5/6 symptoms
  • Severe = 7-10 symptoms
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11
Q

Which grade of depression should be treated pharmacologically

A

Moderate or severe

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12
Q

Drug ladder for depression

HINT: S(SM)MLE

A
  • SSRI
  • Add another SSRI or Mertazapine
  • MAOI
  • Lithium
  • ECT
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13
Q

Indications for Lithium and ECT in depression

A
  • Lithium = Pychosis

- ECT = Life threatening

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14
Q

Bipolar

  • F:M
  • Definition
A
  • 1:1

- Depression + at least one “manic” episode for at least a week

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15
Q

What constitutes manic in BPD

A
  • Flight of ideas
  • Delusions
  • Thought disorder
  • Elevated mood
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16
Q

Bipolar 1 vs 2

A 
1 = Mania (longer-more severe psychotic or not)
2 = Hypomania (not with psychosis and less severe)
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17
Q

Rapid cycling - definition

-Challenge with treatment

A
  • At least 4 episodes per year

- Doesn’t respond well to Lithium

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18
Q

3 Indications for ECT

A
  • Life threatening depression
  • Catatonia
  • Prolonged mania
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19
Q

Which is more effective ECT (but also has more side effects)

A

Bilateral

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20
Q

2 drug Contraindications ECT

A
  • Lithium

- Anticonvulsants

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21
Q

Hypnogagic vs Hypnopompic hallucinations

A
  • Hypnogagic = before sleep

- Hypnopompic = on waking

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22
Q

Delusions of reference

A

Neutral event has a special meaning

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23
Q

Somatic passivity

A

Sensations being imposed by an outside force

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24
Q

Delusions of perception

A

Linking normal perception to bizarre conclusion

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25
Q

Schizophrenia

  • F:M
  • 3 phases
  • 1/3 principle
A
  • F=M
  • Prodromal - Active - Residual
  • 1/3 recover, 1/3 recur, 1/3 chronically unstable
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26
Q

Avolition

A

Decreased motivation

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27
Q

Alogia

A

Speaking less

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28
Q

How much alcohol is 1 unit

A

10ml pure alcohol

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29
Q

1st rank symptoms of schizophrenia = 7

A
  • Auditory hallucinations
  • Thought insertion
  • Thought broadcasting
  • Thought withdrawal
  • Somatic passivity
  • Primary delusions
  • Delusions of perception
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30
Q

4 elements of alcohol detox

A
  • Vitamin B7 = Biotin
  • Thiamine
  • Chlordiazapoxide
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31
Q

What is in Pabrinex (banana bag)

A

-All the B’s and vitamin C

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32
Q

Disulfuram (Unpleasent)

A

Inhibits aldehdye dehydrogenase so when alcohol is consumed, more acetylaldehdye = unpleasant

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33
Q

Acamprosate

A

Increases GABA and decreases excitatory NT’s therefore redusing cravings

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34
Q

Buspirone

A

5-HT1 agonist can improve outcomes in the anxious

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35
Q

Naltrexone (2 uses)

A
  • Opoid antagonist, proven to be better than placebo at decreasing relapses - prevents relapse.
  • Also used in heroin addiction as longer acting version of naloxone = safety net for relapse
36
Q

Methadone

A

Long acting (24hr half life) opoid, less euphoria. Used for maintanence.

37
Q

Buprenorphine

A

Partial agonist of opoid receptor

38
Q

Bupropion (smoking)

A

NDRI and nicotinic agonist decreases cravings

39
Q

Varenclicline (champix)

A

Full nicotine agoist, more effective than bupropion and reduced cravings

40
Q

Parasomnia vs Dysomnia

A
  • Para = abnorbal behaviour during sleep - terrors/apnea

- Dys = Sleep is normal but timings off - insomnia

41
Q

Mild cognitive impairment

A

Memory loss in absence of cognitive or ADL deficit

42
Q

Most common 3 forms of dementia

A
  • Alz
  • Vascular
  • Lewy body
43
Q

2 Features of Lewy body

A
  • Parkinsonian

- Hallucinations

44
Q

Frontotemporal dementia

-How is memory effected

A

Primary progressive aphasia, repetative behaviour, emotional blunting, personality changes
-Memory preserved at early stages

45
Q

What medications (antipyschotics) usually contraindicated in dementia

A
  • Olanzapine

- Risperidone

46
Q

2 main treatments for dementia

A
  • Ach-esterase inhibitors (Rivastigmine, Donepezil patches, Galantamine)
  • Memantine (mod-sever Ad) Inhibits Ca influx to cells. NMDA antagonist
47
Q
  • Autism triad
  • Presenting age
  • M:F / IQ
  • Associated psychiatry
A

Deficits in

  • Communication (language delayed)
  • Social Interaction
  • Behaviours
  • Often age 2-3 = diagnosis in childhood
  • M>F / often low
  • Anxiety and depression
48
Q
  • Aspergers definition

- M:F / IQ

A
  • Similar to autism but NO language impairement
  • Can have some motor clumsiness
  • 10:1 / Often normal
49
Q

Pervasive development disorder not specified (subthreshold autism)

A

Criteria for autism not met due to age or not all deficite met. Or aspergers like but low IQ or speech deficit

50
Q

Childhood disentergration disorder (Hellers syndrome)

A 
Sudden rapid regression at age 2-10 of 2 or more
-language
-self-care
-bowel/bladder control
-motor
-play
May lose skill completely
51
Q

ADHD

  • M:F
  • Greatest risk factor
  • Diagnostic Index
A
  • 3:1
  • Parental history
  • Barkley Index
52
Q

Diagnostic criteria ADHD

-Exclusion criteria (3)

A

Impaired attention AND Overactivity

  • Early onset (before 6)
  • Impaired at home and school
  • Exclusion of other causes
53
Q

3 Drugs and MOA for ADHD (HINT: M,A,D)

-Use notes

A
  • Methylphenidate: Dopamine+NA reuptake inhibitor
  • Atomexitine: (2nd line) NA reuptake inhibitor
  • ^Can be stopped abruptly
  • Dexamphetamine: NA + Dopamine releasing
  • All need regular monitoring
54
Q

Conduct disorder

-Associated pyschiatry

A
  • Precursor dor antisocial personality (adults)

- Associated with ADHD

55
Q

Oppositional defiance

-Marked sign

A

Conduct disorder but not criminal behaviour or marked violence
-VERBAL agression towards authority

56
Q

Fragile X

  • Genetics
  • Frequency
  • Features
A
  • Xq27-28 CCG repeats
  • Most common inheritied genetic learning disability
  • High forehead, large ears, large testicles, low IQ:55
57
Q

What learning disability corrolates most with psychiatric diagnosis

A

Downs syndrome

58
Q

3 Trisomys

A
  • Downs = 21
  • Edwards = 18 (hypothyroid)
  • Pataus = 13 (worst prognosis)
59
Q

Klinefelters and Turners

  • Genetics
  • Features
A

Klinefelters

  • 47 XXY MALES
  • small testicles, normal intelligance, infertility

Turners

  • 45 XO FEMALES
  • Short webbed neck, low thyroid and infertility
60
Q

Type of genetic impairement and features:

  • Prader-Willi
  • Anglemans
  • Williams
A

Deletion mutations

  • 15q paternal = Hungry, mild/mod impairment
  • 15q maternal = Happy, love water, severe impairment
  • 17 = elf-like, heart problems, mild/mod impairment
61
Q
  • Hypnotics = Z drugs (3 types Zop/Zol/Zal)
  • MOA
  • Indications

*4 Prescribing rules

A
  • Zopiclon,Zolpiderm,Zaleplon
  • Selective high affinity GABA(A) subunit agonists
  • Insomnia with severe daytime impairement
  • Short course 2weeks max
  • Do not co-precribe
  • Inform patient that further prescription wont be given
  • Review after 2 weeks
62
Q

SSRI (5 examples) Indication (3 tines and a pram)

A

Anxiety + depression

  • Sertraline
  • Fluxoxetine
  • Paroxetine
  • Citalopram
63
Q

Side effects of SSRI’s

A
  • Sexual dysfunction
  • Hyponatremia - esp elderly
  • Prolonged QT
  • Increased GI bleed risk
  • Skin reactions
64
Q

Serotonin syndrome

-4 features

A
  • Clonus
  • Hypothermia
  • Rhabdomylosis
  • Seizures
65
Q

SNRI

  • Indications
  • 2 Examples
  • SE
A
  • Anxiety and depression
  • Velafaxine and Duloxetine
  • Same as SSRI but Venlafaxine is more toxic
66
Q

MAOI

  • Indications
  • 2 Examples
  • SE Biggest risk
A
  • Anxiety and depression
  • Phenalzine and Moclobemide
  • Similar to SSR, biggest risk of serotonin syndrome
67
Q

Hypertensive crisis

A

Reaction of MAOI to eating tyrosine rich foods (yeast and soy beans)

68
Q

Azapirones

  • Indication
  • Example
  • SE
A
  • Short term anxiety management
  • Buspirone
  • Well tolerated but contraindicated with MAOI + epilepsy
69
Q

Long acting benzos vs short acting active converion product of long acting benzos
-2 actions of GABA subunits

A
  • Long = Diazapam and Chlordiazapoxide - convert Nordazapam
  • Short = Lorazapam and Temazepam
  • GABA(alpha1) = Sedation/amnesia
  • GABA(alpha2) = Anxiolytic
70
Q

NRI

  • Indications
  • 2 examples
  • SE and contraindication
A
  • Atamoxetine = ADHD/Narcolepsy
  • Reboxetine = Depression/panic disorder
  • Antimuscarinic type and contraindicated in bipolar!
71
Q

Biggest risk of SSRI use in elderly and mechanism

-Signs

A
  • Hyponatremia
  • Inappropriate ADH release
  • Drowsiness, convulsions, confusion
72
Q

NaSSA

  • Indication and use
  • Affected NT’s
  • SE
  • Benefits
A

Noradrenergic and specific serotonergic antidepressant

  • Mirtazapine
  • Depression/Pain/PTSD/Anxiety
  • NA, 5-HT3, H1 receptor = sleepy
  • Weight gain and sedation but less tremor
  • Can be combined with SSRI/SNRI
73
Q

Tricylcics

  • 3 examples
  • MOA
  • SE
A
  • Amitryptiline, Imipramine, Lofepramine
  • Block serotonin and Na reuptake, also Na/Ca channel blocker
  • Cardiotoxic, antimuscarinic, MAOI interaction
74
Q 
Anticonvulsants 
MOA
3 examples
-Indication
-SE
A

Sodium channel blockers - 2nd line Bipolar

  • Carbamazepine: Trigeminal neuralgia, epilepsy. AGRANULOCYTOCIS
  • Sodium valproate: growth disorder, danger pregnancy
  • Lamotrogine: Adverse skin reactions
75
Q

Lithium (carbonate)

  • Indications and contraindication
  • Proposed MOA
  • Key info about use
  • SE and alternative
A
  • Treatment resistant depression and bipolar
  • AVOID in Rapid Cycling
  • Decreased Na releae and increased serotonin synthesis
  • Narrow therapeutic index
  • Teratogenic - lamotrogine preffered
76
Q

Lithium clearance and interactions

  • Decreasers of lithium conc
  • Increasers of Lithium conc
A

Lithium cleared renally through filtration so is affected by water and electrolytes

  • Caffeine,Na and theophylline reduce
  • NSAID’s, ACEi, ARB and diuretics increase

*Lithium inhibits ADH

77
Q

Lithium overdose

  • Features
  • Test
A
  • Tremor, Nystagmus, extrapyramidal , vomitting, ataxia, diarrhoea
  • Fingerstick glucose and serum Li conc
78
Q

Typical antipyschotics

  • MOA
  • 4 examples (HCFS)
  • main SE
A

D2 Receptor antagonists
-Reduce dopamine release also act on histamine, serotonergic, muscarinic and nicotinic receptors

  • Haloperidol = HIGH potency
  • Chlopromazine = LOW potency
  • Flupentixol
  • Sulpiride

-Extrapyramidal SE

79
Q

Atypical antipyschotics

  • MOA and indication
  • 4 examples (ROCA)
  • main SE
A

D2/5-HT/Alpha-adrenoreceptor blockers

  • Dopamine main action, less effective than typical but less SE, good for -ive symptoms
  • Risperidone
  • Olanzapine
  • Clozapine
  • Aripiprazole
  • Extrapyramidal (parkinsonian)
  • Tardive Dyskinesia (involuntary movements)
  • Neuroepileptic malignant syndrome
80
Q

Neuroepileptic malignant syndrome

A

Life threatening muscle rigidity and high temperature

81
Q

What Antipsychotics are most associated with weight gain

A
  • Olanzapine

- Chlorpromazine

82
Q

What is the main risk of using Clozapine

A

Agranulocytosis - do FBC regularly

83
Q

What Antipyschotics are available as a DEPOT injection

A
  • Haloperidol
  • Aripiprazole
  • Risperidone
  • Palloperidone
  • Olanzapine
84
Q

What is the absorption of benzodiazapenes

A

Rapidly absorbed and pentrate the brain, onset = 1hr

85
Q

Classical conditioning (pavlov)

A

Pavlovs dogs
Biologically potent stimulus is paired with a previously neutral stimuluas. As a result the responce to potent stimulus becomes paired with the neutral stimulus

86
Q

Operant conditioning (skinner)

A

Encompassess all types of behaviour modification vie reward or punishment:
REINFORCEMENT = ↑behaviour
-Positive reinforcement = reward
-Negative reinforcement = remove adverse stimulus
PUNISH = ↓behaviour
-Positive punishment = adding adverse consequance
-Negative punishment = remove good stimulus

Yr 3 ALS (10 decks)

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