Psychiatry Flashcards
Section 2
- How long
- Who can do it
- Assessment up to 28 days
- 2 doctors and an AMHP
Section 3
- How long
- Who can do it
- Up to 6 months
- After 3 months consent or independent doctor opinion needed
- 2 doctors and an AMHP
Section 5 (holding power)
- How long
- (mental health nurses)
Doctor can detain someone in hospital who has changed their mind. Only lasts 72hrs
(Nurses lasts 6 hours|)
Section 136
Police take someone from public place to place of safety
Community orders 7+8
Power to return patient to hospital if non compliant. As treatment cannot be enforced in the community
M:F
- GAD
- Panic disorder
- NT pathway involved
- GAD = 2:1
- Panic = F>M
- 5-HTP
Mixed anxiety and depression definition
Both symptoms present but neither predominates, and neither are strong enough to meet diagnostic criteria for each
Depression
- M:F
- Screening tool
- Definition
- 2:1
- PHQ-9
- 2+ core symptoms + 2+ additional symptoms from ICD-10 for 2 weeks or more
Depression ICD-10 Symptoms
- Core
- Additional
Core
- Sadness
- Anhedonia
- Lack energy
Additional
- Sleep disturbance
- Appetite symptoms
- Guilt
- Poor self esteem
- Retardation or agitation
- Diminished concentration
- Suicidal thoughts
Classify Milkd/Mod/Severe depression
- Mild = 4 symptoms
- Moderate = 5/6 symptoms
- Severe = 7-10 symptoms
Which grade of depression should be treated pharmacologically
Moderate or severe
Drug ladder for depression
HINT: S(SM)MLE
- SSRI
- Add another SSRI or Mertazapine
- MAOI
- Lithium
- ECT
Indications for Lithium and ECT in depression
- Lithium = Pychosis
- ECT = Life threatening
Bipolar
- F:M
- Definition
- 1:1
- Depression + at least one “manic” episode for at least a week
What constitutes manic in BPD
- Flight of ideas
- Delusions
- Thought disorder
- Elevated mood
Bipolar 1 vs 2
1 = Mania (longer-more severe psychotic or not) 2 = Hypomania (not with psychosis and less severe)
Rapid cycling - definition
-Challenge with treatment
- At least 4 episodes per year
- Doesn’t respond well to Lithium
3 Indications for ECT
- Life threatening depression
- Catatonia
- Prolonged mania
Which is more effective ECT (but also has more side effects)
Bilateral
2 drug Contraindications ECT
- Lithium
- Anticonvulsants
Hypnogagic vs Hypnopompic hallucinations
- Hypnogagic = before sleep
- Hypnopompic = on waking
Delusions of reference
Neutral event has a special meaning
Somatic passivity
Sensations being imposed by an outside force
Delusions of perception
Linking normal perception to bizarre conclusion
Schizophrenia
- F:M
- 3 phases
- 1/3 principle
- F=M
- Prodromal - Active - Residual
- 1/3 recover, 1/3 recur, 1/3 chronically unstable
Avolition
Decreased motivation
Alogia
Speaking less
How much alcohol is 1 unit
10ml pure alcohol
1st rank symptoms of schizophrenia = 7
- Auditory hallucinations
- Thought insertion
- Thought broadcasting
- Thought withdrawal
- Somatic passivity
- Primary delusions
- Delusions of perception
4 elements of alcohol detox
- Vitamin B7 = Biotin
- Thiamine
- Chlordiazapoxide
What is in Pabrinex (banana bag)
-All the B’s and vitamin C
Disulfuram (Unpleasent)
Inhibits aldehdye dehydrogenase so when alcohol is consumed, more acetylaldehdye = unpleasant
Acamprosate
Increases GABA and decreases excitatory NT’s therefore redusing cravings
Buspirone
5-HT1 agonist can improve outcomes in the anxious
Naltrexone (2 uses)
- 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
Methadone
Long acting (24hr half life) opoid, less euphoria. Used for maintanence.
Buprenorphine
Partial agonist of opoid receptor
Bupropion (smoking)
NDRI and nicotinic agonist decreases cravings
Varenclicline (champix)
Full nicotine agoist, more effective than bupropion and reduced cravings
Parasomnia vs Dysomnia
- Para = abnorbal behaviour during sleep - terrors/apnea
- Dys = Sleep is normal but timings off - insomnia
Mild cognitive impairment
Memory loss in absence of cognitive or ADL deficit
Most common 3 forms of dementia
- Alz
- Vascular
- Lewy body
2 Features of Lewy body
- Parkinsonian
- Hallucinations
Frontotemporal dementia
-How is memory effected
Primary progressive aphasia, repetative behaviour, emotional blunting, personality changes
-Memory preserved at early stages
What medications (antipyschotics) usually contraindicated in dementia
- Olanzapine
- Risperidone
2 main treatments for dementia
- Ach-esterase inhibitors (Rivastigmine, Donepezil patches, Galantamine)
- Memantine (mod-sever Ad) Inhibits Ca influx to cells. NMDA antagonist
- Autism triad
- Presenting age
- M:F / IQ
- Associated psychiatry
Deficits in
- Communication (language delayed)
- Social Interaction
- Behaviours
- Often age 2-3 = diagnosis in childhood
- M>F / often low
- Anxiety and depression
- Aspergers definition
- M:F / IQ
- Similar to autism but NO language impairement
- Can have some motor clumsiness
- 10:1 / Often normal
Pervasive development disorder not specified (subthreshold autism)
Criteria for autism not met due to age or not all deficite met. Or aspergers like but low IQ or speech deficit
Childhood disentergration disorder (Hellers syndrome)
Sudden rapid regression at age 2-10 of 2 or more -language -self-care -bowel/bladder control -motor -play May lose skill completely
ADHD
- M:F
- Greatest risk factor
- Diagnostic Index
- 3:1
- Parental history
- Barkley Index
Diagnostic criteria ADHD
-Exclusion criteria (3)
Impaired attention AND Overactivity
- Early onset (before 6)
- Impaired at home and school
- Exclusion of other causes
3 Drugs and MOA for ADHD (HINT: M,A,D)
-Use notes
- Methylphenidate: Dopamine+NA reuptake inhibitor
- Atomexitine: (2nd line) NA reuptake inhibitor
- ^Can be stopped abruptly
- Dexamphetamine: NA + Dopamine releasing
- All need regular monitoring
Conduct disorder
-Associated pyschiatry
- Precursor dor antisocial personality (adults)
- Associated with ADHD
Oppositional defiance
-Marked sign
Conduct disorder but not criminal behaviour or marked violence
-VERBAL agression towards authority
Fragile X
- Genetics
- Frequency
- Features
- Xq27-28 CCG repeats
- Most common inheritied genetic learning disability
- High forehead, large ears, large testicles, low IQ:55
What learning disability corrolates most with psychiatric diagnosis
Downs syndrome
3 Trisomys
- Downs = 21
- Edwards = 18 (hypothyroid)
- Pataus = 13 (worst prognosis)
Klinefelters and Turners
- Genetics
- Features
Klinefelters
- 47 XXY MALES
- small testicles, normal intelligance, infertility
Turners
- 45 XO FEMALES
- Short webbed neck, low thyroid and infertility
Type of genetic impairement and features:
- Prader-Willi
- Anglemans
- Williams
Deletion mutations
- 15q paternal = Hungry, mild/mod impairment
- 15q maternal = Happy, love water, severe impairment
- 17 = elf-like, heart problems, mild/mod impairment
- Hypnotics = Z drugs (3 types Zop/Zol/Zal)
- MOA
- Indications
*4 Prescribing rules
- 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
SSRI (5 examples) Indication (3 tines and a pram)
Anxiety + depression
- Sertraline
- Fluxoxetine
- Paroxetine
- Citalopram
Side effects of SSRI’s
- Sexual dysfunction
- Hyponatremia - esp elderly
- Prolonged QT
- Increased GI bleed risk
- Skin reactions
Serotonin syndrome
-4 features
- Clonus
- Hypothermia
- Rhabdomylosis
- Seizures
SNRI
- Indications
- 2 Examples
- SE
- Anxiety and depression
- Velafaxine and Duloxetine
- Same as SSRI but Venlafaxine is more toxic
MAOI
- Indications
- 2 Examples
- SE Biggest risk
- Anxiety and depression
- Phenalzine and Moclobemide
- Similar to SSR, biggest risk of serotonin syndrome
Hypertensive crisis
Reaction of MAOI to eating tyrosine rich foods (yeast and soy beans)
Azapirones
- Indication
- Example
- SE
- Short term anxiety management
- Buspirone
- Well tolerated but contraindicated with MAOI + epilepsy
Long acting benzos vs short acting active converion product of long acting benzos
-2 actions of GABA subunits
- Long = Diazapam and Chlordiazapoxide - convert Nordazapam
- Short = Lorazapam and Temazepam
- GABA(alpha1) = Sedation/amnesia
- GABA(alpha2) = Anxiolytic
NRI
- Indications
- 2 examples
- SE and contraindication
- Atamoxetine = ADHD/Narcolepsy
- Reboxetine = Depression/panic disorder
- Antimuscarinic type and contraindicated in bipolar!
Biggest risk of SSRI use in elderly and mechanism
-Signs
- Hyponatremia
- Inappropriate ADH release
- Drowsiness, convulsions, confusion
NaSSA
- Indication and use
- Affected NT’s
- SE
- Benefits
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
Tricylcics
- 3 examples
- MOA
- SE
- Amitryptiline, Imipramine, Lofepramine
- Block serotonin and Na reuptake, also Na/Ca channel blocker
- Cardiotoxic, antimuscarinic, MAOI interaction
Anticonvulsants MOA 3 examples -Indication -SE
Sodium channel blockers - 2nd line Bipolar
- Carbamazepine: Trigeminal neuralgia, epilepsy. AGRANULOCYTOCIS
- Sodium valproate: growth disorder, danger pregnancy
- Lamotrogine: Adverse skin reactions
Lithium (carbonate)
- Indications and contraindication
- Proposed MOA
- Key info about use
- SE and alternative
- Treatment resistant depression and bipolar
- AVOID in Rapid Cycling
- Decreased Na releae and increased serotonin synthesis
- Narrow therapeutic index
- Teratogenic - lamotrogine preffered
Lithium clearance and interactions
- Decreasers of lithium conc
- Increasers of Lithium conc
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
Lithium overdose
- Features
- Test
- Tremor, Nystagmus, extrapyramidal , vomitting, ataxia, diarrhoea
- Fingerstick glucose and serum Li conc
Typical antipyschotics
- MOA
- 4 examples (HCFS)
- main SE
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
Atypical antipyschotics
- MOA and indication
- 4 examples (ROCA)
- main SE
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
Neuroepileptic malignant syndrome
Life threatening muscle rigidity and high temperature
What Antipsychotics are most associated with weight gain
- Olanzapine
- Chlorpromazine
What is the main risk of using Clozapine
Agranulocytosis - do FBC regularly
What Antipyschotics are available as a DEPOT injection
- Haloperidol
- Aripiprazole
- Risperidone
- Palloperidone
- Olanzapine
What is the absorption of benzodiazapenes
Rapidly absorbed and pentrate the brain, onset = 1hr
Classical conditioning (pavlov)
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
Operant conditioning (skinner)
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
