Psychiatry Flashcards
What do antipsychotics in the elderly increase the risk of?
Stroke
VTE
What is conversion diisorder?
Patient is unconsciously feigning symptoms (motor or sensory function loss)
What is somatisation disorder?
Where patients have multiple physical symptoms present for at least 2 years
Patients refuse to accept reassurance/negative results
What is hypochondrial disorder?
Persistent belief in the presence of an underlying serious disease
Patients refuse to accept reassurance/negative results
What is dissociative disorder?
Where the patient separates off certain memories from normal consciousness
Usually involves more psychiatric type symptoms (e.g. amnesia, fugue, stupor)
What is factitious disorder (Munchausen’s)?
The intentional productiion of physical or psychological symptoms
What is malingering?
Fraudulent simulation/exaggeration of symptoms with the intention of gaining (financially or otherwise)
What can SSRI’s cause in the 3rd trimester?
Persistent pulmonary hypertension
What is pseudodementia?
Where severe depression mimics dementia but gives a global pattern of memory loss rather than just short-term memory loss
What is post-concussion syndrome?
A syndrome that can be seen even after minor head trauma. Features include: Headache Fatigue Anxiety/depression Dizziness
Symptoms last >3 months
Features of post-traumatic stress disorder?
Re-experiencing (flashbacks, nightmares)
Avoidance (people, situations)
Hyperarousal (hypervigilence, sleep issues)
Emotional numbing
How do we treat PTSD?
CBT
Eye movement desensitisation and reprocessing
SSRI or venlafaxine
What is adjustment syndrome?
The development of an emotional/behavioural symptom occurring within 3 months of the onset of an identifiable stressor
What is acute stress disorder?
Like PTSD symptom wise except occuring within 1 month of trauma exposure
What is the characteristic side effect of mirtazapine?
Increase in appetite
Also causes sedation
What is the MOA of mirtazapine?
Alpha 2 adrenergic receptor blockage
What do patients often get upon discontinuation of SSRIs?
GI side effects (e.g. diarrhoea)
Side effects of ECT?
Headache
Nausea
Short-term memory loss
Cardiac arrhythmias
What is the SSRI of choice in adolescents?
Fluoxetine
What are the adverse effects of clozapine?
Agranulocytosis Neutropenia Reduced seizure threshold Constipation Myocarditis Hypersalivation
Tardive dyskinesia features?
Extrapyramidal side effects: Lip-smacking Jaw pouting Chewing Repetitive blinking Tongue poking
What causes tardive dyskinesia?
Typical>atypicial antipsychotics
What differentiates mania from hypomania?
Longer length of symptoms (>7 days), severity++, pyschotic symptoms in mania
Sleep paralysis treatment?
If troublesome, can give clonazepam
Section 2
Admission for assessment - 28 days
Section 3
Admission for treatment up to 6 months
Can be renewed
Section 4
72 hour reassessment order
Used in emergencies where section 2 would involve unacceptable delay
Often changed to section 2 upon arrival to hospital
Section 5(2)
A patient who is a voluntary patient in hospital can be legally detained for 72 hours
Section 5(4)
Allows a nurse to detain a patient voluntarily for 6 hours
What is akathisia?
Severe restlessness
Alcohol withdrawal onset of symptoms?
6-12 hours - Tremor, sweating, tachycardia, anxiety
36 hours - seizures
48-72 hours - delirium tremens
MOA of alcohol withdrawal?
Chronic alcohol usage increases inhibitory GABA and inhibits NMDA type glutamate receptors
Alcohol withdrawal leads to the opposite:
Decreased inhibitory GABA and increased NMDA glutamate transmission
How do we treat alcohol withdrawal?
Benzodiazepines - e.g. chlordiazepoxide (lorazepam if hepatic failure)
Carbamazepine
How do we treat anorexia nervosa?
CBT
How do we diagnose anorexia nervosa?
- Restriction of energy intake requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health
- Intense fear of gaining weight/becoming fat, despite being underweight
- Disturbance in the way in which one’s body weight or shape is experienced
How do we manage GAD?
SSRIs Buspirone Beta blockers Benzodiazepines Cognitive behaviour therapy
What is bipolar disorder?
A chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of depression
What characterises type I and type II bipolar disorders?
Type I (most common): Mania and depression
Type II:
Hypomania and depression
How do we treat bipolar disorder?
Psychological interventions
Lithium is the mood stabiliser of choice
Valproate is 2nd line
Mania:
Consider stopping antidepressant
Antipsychotics: olanzapine/haloperidol
Depression:
Fluoxetine
What does bipolar increase the risk of?
Diabetes
CVD
COPD
How can we assess depression?
PHQ-9 questionnaire
How do we treat mild/subthreshold depression?
CBT
If a monozygotic twin has schizophrenia, how likely is the other twin to get it?
50%
FHx is a strong risk factor
What are the symptoms of GAD?
Persistent anxiety with associated features
Symptoms of panic disorder
Random panic attacks on a background of no anxiety
Treatment for panic disorder?
CBT
SSRI
Tricyclic antidepressant
Pregabalin
What is a pseudohallucination?
Where a patient has insight to the fact the hallucination is not real
Common in grieving patients
What is antisocial personality disorder?
Failure to conform to social norms with respect to lawful behaviours - repeatedly performing acts that warrant arrest
Deception for personal gain/pleasure
Impulsiveness
Irresponsibility
Lack of remorse
Reckless disregard for safety of self or others
Avoidant personality disorder
Avoidance of occupational activities which involve significant interpersonal contact for fears of criticism/rejection
Unwillingness to be involved unless certainty of being liked
Reluctance to take personal risks for fear of embarrassment
Views self as inept/inferior to others
Social isolation accompanied by craving for social interaction
Borderline personality disorder
Efforts to avoid real/imagined abandonment
Unstable self image
Impulsivity with regards to self damaging behaviour
Recurrent suicidal behaviour
Unstable interpersonal relationships which alternate between idealization and devaluation
Dependent personality disorder
Difficulty making everyday decisions without excessive reassurance from others
Need for others to take responsibility for major areas of their life
Difficulty expressing disagreement for fear of losing support
Lack of initiative
Unrealistic fear of being left to care for themselves
Histrionic personality disorder
Inappropriate sexual seductiveness
Need to be centre of attention
Suggestibility
Self dramatization
Relationships considered more intimate than they are
Physical appearance used for attention seeking purposes
Obsessive-compulsive personality disorder
Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities
Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness
Paranoid personality disorder
Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others
Preoccupation with conspirational beliefs and hidden meaning
Unwarranted tendency to perceive attacks on their character
Schizoid personality disorder
Indifference to praise and criticism Preference for solitary activities Lack of interest in sexual interactions Lack of desire for companionship Emotional coldness Few interests Few friends or confidants other than family
Schizotypal personality disorder
Ideas of reference (differ from delusions in that some insight is retained) Odd beliefs and magical thinking Unusual perceptual disturbances Paranoid ideation and suspiciousness Odd, eccentric behaviour Lack of close friends other than family members Inappropriate affect Odd speech without being incoherent
How do we treat schizophrenia?
Oral atypical antipsychotics are first line (olanzapine, quetiapine, risperidone)
CBT for all patients
High rates of cardiovascular disease in psychotic patients (due to meds/high smoking rates) - so keep an eye on this
When might we use ECT?
Treatment resistant severe depression
Manic episodes
Life threatening catatonia
Features of anorexia
Reduced BMI
Bradycardia
Hypotension
Enlarged salivary glands
Most things are low, but G's and C's raised: Growth hormone Glucose Salivary glands Cortisol Cholesterol Carotinaemia
What are torticollis and oculogyric crisis signs of?
Acute dystonia (extra-pyramidal side effects of antipsychotics)
Torticollis - wry neck, an abnormal asymmetrical neck position
Oculogyric crisis - upward deviation eyes
What is akathisia?
Severe restlessness
What medication can cause psychosis?
Steroids
Name 2 examples of SNRIs
Venlafaxine
Duloxetine
How long for symptoms of depression to be classified as a depressive episode?
2 weeks
Features of a mild depressive episode?
2/3 of the main symptoms
At least 2 other symptoms present
Minimum duration 2 weeks
Able to continue functioning, despite being distressed by symptoms
Features of a moderate depressive episode?
2/3 of the main symptoms.
At least 3 additional symptoms
Individuals have difficulty continuing with normal work/social functioning
Features of a severe depressive episode?
All three typical symptoms present Four additional symptoms Minimum duration 2 weeks May experience psychotic symptoms Individuals show severe distress/agitation
What are the 3 main symptoms of depression?
Depressed mood
Anhedonia
Anergia (low energy levels)
What are Schneider’s first rank symptoms?
Features of schizophrenia:
Auditory hallucinations
Thought disorder
Passivity phenomena
Delusional perceptions
In Schneider’s first rank symptoms, what are the types of auditory hallucinations?
Two plus voices discussing the patient in the third person
Thought echo
Voices commenting on patient’s behaviour
In Schneider’s first rank symptoms, what are the types of thought disorder?
Thought insertion
Thought withdrawal
Thought broadcasting
What is passivity phenomena?
Bodily sensations being controlled by an external influence
Actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
What are the stages of delusional perceptions in Schneider’s first rank symptoms?
1 - A normal object is perceived
2. A sudden intense delusional insight into the object’s meaning for the patient
What are the negative symptoms of schizophrenia?
Incongruity/blunting of affect, anhedonia (inability to derive pleasure), alogia (poverty of speech), avolition (poor motivation)
Treatment of opioid overdose
Naloxone
Treatment of benzodiazepine overdose
Flumazenil
We usually manage benzo overdose supportively though because flumezanil has a high risk of seizures
Management of ethylene glycol overdose
Fomepizole (inhibitor of alcohol dehydrogenase)
Alcohol second line
Haemodialysis
Cyanide poisoning
Hydroxocobalamin
Management of paracetamol overdose
Activated charcoal if <1 hour
N-acetylcysteine
Salicylate overdose treatment
IV sodium bicarbonate
Haemodialysis
Management of tri-cyclic antidepressant overdose
IV bicarbonate (reduces seizure/arrhythmia risk)
Lithium overdose management
Saline resuscitation
Haemodialysis
Sodium bicarbonate is sometimes used
Salicylate overdose presentation
Aspirin overdose:
Mixed respiratory alkalosis and metabolic acidosis
Hyperventilation Tinnitus Lethargy Sweating/pyrexia Nuasea/vomiting Coma
Tricyclic antidepressant overdose presentation
Amitriptyline and dosulepin:
Anticholinergic properties: dry mouth, dilated pupils, agitation, blurred vision, sinus tachycardia
Arrhythmias
Seizures
Metabolic acidosis
Coma
Opiate overdose features
Rhinorrhoea Needle track marks Pinpoint pupils Drowsiness Watery eyes Yawning
Complications of opioid misuse
Viral infections (HIV, hep B/C)
VTE
Respiratory depression, death
Management of alcohol misuse
Acute withdrawal - benzodiazepines
Disulfram promotes abstinence
Acamprosate (reduces craving)
Neuroleptic malignant syndrome
A rare condition that can be caused by taking antipsychotic medication (dopaminergic drugs)
Essentially you get a massive release of glutamate and subsequent neurotoxicity + muscle damage
Neuroleptic malignant syndrome features
Usually hours to days after starting the drug
Pyrexia
Muscle rigidity
Autonomic lability (HTN, tachyc/tachyp)
Delirium
What might you see raised in neuroleptic malignant syndrome
Creatinine kinase
You may also see an AKI
Leukocytosis occasionally
Management of neuroleptic malignant syndrome
Stop offending drug
IV fluids to prevent AKI
Dantrolene
Bromocriptine (dopamine agonist)
Serotonin syndrome features
Neuromuscular excitation (e.g. hyperreflexia, myoclonus, rigidity)
Autonomic nervous system excitation (hyperthermia)
Altered mental state
Management of serotonin syndrome
Supportive
IV fluids
Benzos
Chlorpromazine
