Psychiatry Flashcards
first line medication for anxiety and depression
SSRIs (citalopram, sertraline)
ICD-10 vs DSM-V
DSM-V more up to date for how to classify disorders
main side effect of clozapine and how to test for it
agranulocytosis and neutropenia
test with regular FBC
type 1 vs type 2 bipolar affective disorder
type 1: mania
type 2: hypomania
how do you treat agranulocytosis from clozapine
stop clozapine
send to A&E
medical emergencies in psych
clozapine
NMS
serotonin syndrome
psych emergencies
- acute psychosis
- suicidal patient
- acutely unwell and violent
- eating disorders - more than 1kg weight per week/ regularly making themselves sick/ not eating –> ECG to check postural hypotension + bloods: FBC, U&Es
45yrs
long hx of severe depression with psychotic symptoms
multiple inpatient psychiatric admissions
which type of delusion is most compatible with his diagnosis of severe depression
nihilistic delusions
- self/part of self/body ceasing to exist - eg patient believing they are dead or dying –> indicates extreme depression (hopelessness and guilt)
generalised anxiety disorder
characteristic symptoms of generalised anxiety disorder?
long periods of worry
persistent anxiety
delusion
false unshakeable beliefs that can be present in a range of psychiatric disorders incl severe depression.
in mood disorders delusions are mood congruent
delusions of grandiosity
believe they’re someone else, may also have special abilities/ powers
typically seen in manic episodes
persecutory delusions
belief that you will be persecuted for something even without any evidence
in psychotic disorders
paranoid delusions
feeling that you’re under threat
in psychotic disorders
delusional perception
true perception, to which a patient attributes a false meaning.
e.g. a normal event such as the traffic lights turning red may be interpreted by the patient as meaning that the martians are about to land.
in psychotic disorders e.g. schizophrenia
most common psychiatric cause of intermittent chest pain and breathlessness or recurrent unexplained panic attacks?
panic disorder
compulsive checking behaviours
obsessive compulsive disorder
diagnosis of depression
all three of the below for >2weeks
- persistant low mood
- loss of pleasure
associated symptoms:
- loss of appetite
- loss of concentration
I started on an antipsychotic 2-10 days ago
- fever
- rigidity
- altered mental state
diagnosis + signs and symptoms
neuroleptic malignant syndrome
FALTER: FEVER ARMS LEUKOCYTOSIS TREMORS ELEVATED CPK RIGIDITY - lead pipe
signs : HR: high Temp: high BP: high or low RR: high
serotonin syndrome
usually occurs when SSRIs/ SNRIs are taken in conjunction with other serotonin (another antidepressant, st johns wort)
agitation confusion twitching muscles hypereflexia sweating shivering diarrhoea
seizures
arrhythmia
unconsciousness
neuroleptic malignant syndrome
management
stop antipsychotic
extrapyramidal side effects
what do you get them from and what are they
get with first generation/ typical antipsychotics
e.g. butyrophenones(haloperidol), phenothiazines (prochlorperazine)
- dystonia
- parkinsonian symptoms
- akathisia
- tardive dyskinesia
what is dystonia
- early reaction to 1st gen antipsychotics
- abnormal face and body movements
- eyes rolling back
- arching
what is parkinsonian symptoms
- rigidity
- bradykinesia
- tremor
appears gradually
what is akathisia
- restlessness
- after large initial doses
resemble an exacerbation of the condition being treated
what is tardive dyskinesia
- rhythmic, involuntary movements of tongue, face, and jaw
- e.g. lip smacking
- develops on long-term antipsychotics
treatment for dystonia
anticholinergic drugs
what does risperidone cause to increase as a side effect
prolactin >6mg
side effects of aripiprazole
- decreases prolactin
- decreases weight
atypical/ 2nd generation antipsychotics
- clozapine
- olanzapine
- risperidone
- quetiapine
- aripiprazole
what tests need to be taken when on lithium
bloods - kidney/ thyroid function
NASSA drugs and helpful side effects
mirtazapine:
- increased sedating
- increased appetite
trazodone:
- better sleep
NASSAs good in old age for their side effects
which SSRI increases QTc interval on ECG?
citalopram
which SNRI increases blood pressure
venlafaxine
somatisation disorder
multiple physical SYMPTOMS present for at least 2 yrs
patient refuses to accept reassurance or negative test results
illness anxiety disorder (hypochondriasis)
persistent belief in presence of underlying serious DISEASE
refuses to accept reassurance or negative test results
conversion disorder
loss of motor or sensory function
patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients indifferent to disorder (la belle indifference)
dissociative disorder
‘separating off’ certain memories from normal consciousness
involves psychiatric symptoms e,g amnesia, fugur, stupor
factitious disorder
also known as Munchausens syndrome
intentional production of physical or psychological symptoms
malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
generalised anxiety disorder first line mx
SSRI = sertraline
if ineffective then alternative SSRI or SNRI
panic disorder mx
CBT or SSRI
side effects of tricyclic antidepressants
e.g. amitriptyline, clomipramine drowsiness dry mouth blurred vision constipation urinary retention lengthening of QT interval
mx for personality disorders
dialectical behavioural therapy
side effects of lithium
for prophylaxis of bipolar disorder
side effects: fine tremor nephrotoxicity: polyuria, can cause nephrogenic diabetes insipidus thyroid enlargement, hypothyroidism weight gain intracranial HTN leucocytosis hyperparathyroidism and resultant hypercalcaemia
monitoring of lithium therapy
check lithium levels 12hrs post dose
lithium levels checked weekly until concentrations stable
then checked every 3 months
after change in dose, levels checked a week later and weekly until levels stable
TFTs and U&Es - every 6 months
other side effects of antipsychotics except extra pyramidal
increased risk of STROKE AND VTE in elderly
dry mouth, blurred vision, urinary retention, constipation
sedation
raised prolactin - galactorrhoea
neuroleptic malignant syndrome: pyrexia, muscle stiffness
reduced seizure threshold
prolonged QT interval (haloperiodol)
how long can benzodiazepines be prescribed for
2-4 weeks due to tolerance and dependence
slow withdrawal
benzodiazepines vs barbiturates for chloride channels
benzos increase freq of Cl channels
barbiturates increase duration of Cl channels
FREQuently BENd - DUR BARBeque
side effect of benzodiazepines
respiratory depression
visual impairment + visual or auditory hallucinations
no other psychiatric symptoms
charles - Bonnet syndrome
repetition of someone else’s speech including the questions being asked
echolalia
feature of schizophrenia
the inability to answer a question without giving excessive, unnecessary detail
circumstantiality
wondering from a topic without returning to it
tangentiality
when ideas are related to each other only by the fact they sound similar or rhyme
clang associations
loosening of associations, where there are unexpected and illogical leaps from one idea to another.
knights move thinking
schizophrenia
leaps from one topic to another but with discernible (apparent) links between them.
flight of ideas
Mania
repetition of ideas or words despite an attempt to change the topic.
preservation
antidepressant which causes sedation and increased appetite - can help in elderly
mirtazapine
on MMSE depression vs dementia
depression: dont know (dont try with answers)
dementia: try but get it wrong
how long do symptoms need to be present for for a diagnosis of PTSD
at least 1 month
what drugs should be avoided on SSRIs
NSAIDs: take PPI at same time
warfarin/heparin: take mirtazapine instead
triptans and MAOIs - risk of serotonin syndrome
anorexia features
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
WBC high on lithium mx
safety net if symptoms develop, repeat bloods as per usual under notmal monitoring schedule
can cause leucocytosis
adverse effects of clozapine
agranulocytosis, neuropaenia reduced seizure threshold constipation myocarditis: baseline ECG hypersalivation
dose adjustment might be needed if smoking is started and stopped during treatment
most likely SSRI leading to long QT and torsades de pointes
citalopram
mx for alcohol withdrawal
benzodiazepines e.g. chlordiazepoxide
lorazepam in hepatic failure
indications for ECT
treatment resistant severe depression (catatonia)
manic episodes
episode of moderate depression known to respond to ECT in past
life threatening catatonia
short term side effects of ECT
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmias
what is a poor prognostic indicator of schizophrenia
gradual onset strong family hx low IQ prodromal phase of social withdrawal lack of obvious precipitant
schizophrenia mx
first line: oral atypical antipsychotics
CBT to all patients
what psychotic more likely to be used in drug resistant schizophrenia
clozapine
should only be tried after at least 2 other antipsychotics for 6-8 wks
clozapine + infection
worry about neutropaenia - check FBC
scoring system for alcohol withdrawal severity
CIWA (clinical institute withdrawal assessment)
mania vs hypomania
mania: psychotic symptoms (delusions of grandeur, auditory hallucinations)
hypomania = no psychotic symptoms
tardive dyskinesia
chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary movements on typical antipsychotics
neuroleptic malignant syndrome
started on antipsychotic tetrad: - hyperthermia - muscle rigidity - autonomic instability - altered mental status
citalopram side effect
long QT syndrome
man believes they can/have transformed into an animal
clinical lycanthropy
thinking theyre rotting away
Cotard delusion
