Psychiatry Flashcards
What drug is used to treat benzodiazepine overdose?
Flumazenil
When stopping an SSRI, over what period of time should the dose gradually be reduced?
The dose should gradually be reduced over a 4 week period
What is the mechanism of action of memantine?
It is an NMDA antagonist
What is a key factor in differentiating mania from hypomania?
Mania may present with psychotic symptoms which is not the case with hypomania
What is the mechanism of action of Venlafaxine?
It is a SNRI- serotonin and noradrenaline reuptake inhibitor
What should you do if you have a patient who displays poor compliance to their oral antipsychotic medication?
Switch them to a once monthly IM depot injection
Which atypical antipsychotic has a good side effect profile in terms of prolactin elevation i.e. which antipsychotic might you switch a patient to if they were having issues with hyperprolactinaemia?
Aripirazole
Which antipsychotic is associated with agranulocytosis?
Clozapine
Other than agranulocytosis what are some other issues with clozapine?
Reduces the seizure threshold and can induce seizures in up to 3% of patients. Myocarditis: a baseline ECG should be taken before starting Tx. Dose adjustment of clozapine may be necessary if smoking is started or stopped during treatment
What are 2 characteristic side effects of mirtazapine?
Sedation and increased appetite/ weight gain (although these might be useful in older patients who are suffering from insomnia and poor appetite)
How long can normal grief reaction last?
Can be up to 1 year in duration
Outline the mechanism for alcohol withdrawal
Chronic alcohol consumption enhances GABA mediated inhibition in the CNS, as a response the body upregulates glutamate (the main excitatory neurotransmitter), so when you take the alcohol away this causes the whole neuronal system to go into overdrive due to the excess glutamate receptors
What is the therapeutic range for lithium?
0.4 - 1.0 mmol/L
What are 2 of the core adverse effects of lithium (hint: they require monitoring)?
Nephrotoxicity: nephrogenic diabetes insipidus
Hypothyroidism
Thyroid and renal function should be checked every 6 months
When should lithium blood levels be checked?
After starting lithium or after any dose change, levels should be performed weekly until the concentrations are stable (lithium levels should be taken 12 hours after the last dose). Once stable, lithium blood levels should be ‘normally’ checked every 3 months
What is the hallmark of refeeding syndrome?
Hypophosphataemia
Name the main side effects which come under the umbrella term ‘extrapyramidal side effects’ of antipsychotics
Parkinsonism, acute dystonia, akathisia, tardive dyskinesia
What drug may be used to manage EPSEs associated with e.g. antipsychotics?
Procyclidine
What is acute dystonia? Can you give any specific examples?
Sustained muscle contraction e.g. toricollis (an abnormal spasm of the neck muscles), oculogyric crisis (prolonged, involuntary upward deviation of the eyes)
What is akathisia? (It is an EPSE of antipsychotics)
Severe restlessness- subjective sense of psychomotor restlessness.
What are some specific warnings when using antipsychotics in elderly patients?
Increased risk of stroke and increased risk of VTE
What is the main mechanism of action of antipsychotic medications?
Dopamine D2 receptor antagonists
What is cotard syndrome?
A type of nihilistic delusion in which a patient believes that they or part of them is dead or does not exist. It is most commonly seen in severe depression
What electrolyte abnormality is associated with SSRIs? (Think particularly in the elderly)?
Hyponatraemia
Atypical (new generation) antipsychotics have less EPSEs (extrapyramidal side effects), but they do increase the risk of what…?
Metabolic syndrome
For what conditions is ECT indicated for?
Treatment-resistance depression, catatonic schizophrenia and severe mania
What are the short-term side effects of ECT?
Headache, nausea, memory impairment (retrograde amnesia) and cardiac arrhythmias
What is the preferred antidepressant to prescribe patients following MI?
Sertraline
Describe the thought disorder ‘circumstantiality’
Circumstantiality is the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point
What is ‘knights move thinking’?
A severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.
What factors are associated with a poor prognosis for schizophrenia?
Strong family history, GRADUAL onset, low IQ, premorbid history of social withdrawal, lack of obvious precipitant
How long must symptoms of depression be present for before it can be diagnosed as depression?
2 weeks
What is the mechanism of action of the drug mirtazapine?
NaSSA- noradrenergic and specific serotonergic antidepressant
Outline schizoid vs schizotypal personality disorder
Schizoid- emotionally ‘cold’ lacks interest in others, rich fantasy world, excessive introspection (some cross over with ASD)
Schizotypal- characterised by odd behaviour, may represent a partial expression of schizophrenia, higher incidence in family members of people with schizophrenia
What are 3 cardinal features of PTSD?
Flashbacks, avoidance and hyperarousal
What is somatisation disorder?
At least a 2 year history of multiple complaints (physical symptoms). Symptoms not explained by any detectable physical disorders. Will not accept medical reassurance or negative test results. 6 or more symptoms occurring in at least 2 separate groups (GI, CVS..)
What is conversion disorder?
Characterised by loss or alteration in physical functioning suggestive of a physical disorder- it typically involves loss of motor or sensory function. The patient is NOT intentionally producing symptoms. Onset is related to stressful life event
What is lanugo hair and in what condition might you see it?
Fine downy hair growth in response to the loss of body fat- may support the diagnosis of anorexia nervosa
What food item should patients taking monoamine oxidase inhibitor antidepressant medications avoid and why?
Cheese- when tyramine containing foods are taken alongside an MAOI drug a hypertensive crisis can occur
What should you do if a patient presents to primary care with symptoms of mania?
Urgent referral to the community mental health team (CMHT)
What is the treatment for mania?
Stop antidepressants if the patient is taking any, if not on any meds for bipolar start atypical antipsychotic e.g. olanzapine. If already on an antipsychotic add a mood stabiliser e.g. lithium.
What is the risk of developing schizophrenia if one monozygotic twin is affected?
50%
Outline (very simply) the management of schizophrenia
Oral atypical antipsychotics are first-line
CBT should be offered to all patients
How is ‘knights move thinking’ different to ‘flight of ideas’?
Knights move thinking- there are illogical leaps from one idea to another, flight of ideas- there are discernible links between ideas
What is first-line therapy for children and young people with anorexia nervosa?
Family based therapy
What drug should be used first-line to treat alcohol withdrawal?
Chlordiazepoxide (a benzodiazepine)
For how long should patients continue to take their antidepressant medication after they are feeling better?
For at least 6 months after remission as this reduces the risk of relapse
Procyclidine may be used to help manage EPSEs of antipsychotics, what other drug might be used in the treatment of tardive dyskinesia?
Tetrabenazine
What is the medical name for delusional jealousy?
Othello syndrome
What is the SSRI of choice for patients aged under 18?
Fluoxetine
What is the typical presentation of borderline personality disorder?
Associated with a history of recurrent self-harm and intense interpersonal relationships
When switching to another SSRI from fluoxetine, what do you need to remember?
Fluoxetine has a long half-life so needs to be withdrawn and a gap of 4-7 days left before starting a low dose of the alternative SSRI (this is different to other SSRIs where the gap does not need to be as long)
A medication type used for migraine should be avoided in patients taking an SSRI, what medication type is this and why is this the case?
Triptans- due to increased risk of serotonin syndrome
Outline section 2 of the MHA
Admission for assessment for up to 28 days (treatment can be given against the patient’s wishes)
Outline section 3 of the MHA
Admission for treatment for up to 6 months
When is the peak incidence of 1) withdrawal seizures and 2) Delirium tremens following alcohol withdrawal?
Peak incidence of withdrawal seizures following alcohol withdrawal = 36 hours
Peak incidence of delirium tremens following alcohol withdrawal = 72 hours
What is the mechanism of action of duloxetine?
Serotonin and noradrenaline reuptake inhibitor (SNRI)
What is the strongest risk factor for developing a psychotic disorder (including schizophrenia)?
Family history
What type of medication can be an organic cause of someone presenting with psychosis?
Steroids (steroid-induced psychosis is a recognised side effect of corticosteroid use)
What should you do if you’re going to prescribe an SSRI to a patient who is taking an NSAID?
Prescribe a PPI too as SSRIs increase the risk of GI bleeding even further
What is the main treatment for personality disorders?
DBT- dialectical behavioural therapy
What signs/ symptoms do you tend to see in Wernicke’s encephalopathy?
Ophthalmoplegia, nystagmus, ataxia and confusion
What is important to remember about opiate withdrawal compared to alcohol withdrawal?
Opiate withdrawal tends to be non-fatal (unlike alcohol withdrawal)
What is important to remember about Korsakoff syndrome?
It causes anterograde amnesia, confabulation, hallucinations and is considered irreversible (whereas Wernickes is considered reversible)
What is the most common genetic cause of learning disability?
Down syndrome
