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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Indications for ECT

A

Severe depression resistant to treatment
Severe depression causing harm to patient e.g. not eating or drinking
Catatonia

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2
Q

Side effects of ECT

A

Memory loss
Headache
Confusion

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3
Q

Investigations for suspected dementia

A 
Neurological examination
Urinalysis
ECG
Bloods
- FBC
- U&Es
- LFTs
- Bone profile, Mg2+
- HbA1c
- TFTs
- B12
- Folate
- Thiamine
CXR
CT head
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4
Q

AP causing seizures

A

Clozapine (reduces seizure threshold)

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5
Q

Clozapine SEs

A
  • Agranulocytosis
  • Neutropenia
  • Reduced seizure threshold
  • Myocarditis
  • Metabolic SEs - weight gain
  • Hyperprolactinaemia
  • Hypersalivation
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6
Q

Olanzapine SEs

A
  • Metabolic syndrome - dyslipidaemia, weight gain
  • Sedation
  • Hyperprolactinaemia
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7
Q

Quetiapine SEs

A
  • Metabolic syndrome
  • Hyperprolactinaemia
  • Postural hypotension
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8
Q

Risperidone SEs

A
  • EPSEs?
  • Sexual dysfunction
  • Postural hypotension
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9
Q

Sodium Valproate SEs

A 
VALPROATE
Appetite - weight gain
Liver failure (hepatitis)
Pancreatitis
Reversible hair loss (alopecia)
Oedema
Ataxia
Teratogenic; tremor; thrombocytopenia
Enzyme inhibitor (p450), encephalopathy (high ammonia)
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10
Q

SSRI + what other drugs increase the risk of serotonin syndrome?

A

Tryptans

MAOIs

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11
Q

Atypical APs (2nd gen) SEs - general

A
  • Metabolic syndrome - weight gain, dyslipidaemia, diabetes, CVS risk
  • Increased risk of stroke and VTE in elderly
  • Neuroleptic malignant syndrome
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12
Q

Examples of atypical APs

A

Olanzapine
Risperidone
Quetiapine
Clozapine

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13
Q

Examples of typical APs

A

Haloperidol

Chlorpromazine

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14
Q

SEs of typical APs (1st gen)

A

EPSEs

  • Dystonia (susained muscle contraction)
  • Parkinsonism
  • Akathisia
  • Tardive dyskinesia

Hyperprolactinaemia

Antimuscarinic - dry mouth, blurred vision, urinary retention, constipation

Sedation, weight gain

Increased risk of stoke/ VTE in elderly

Neuroleptic malignant syndrome

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15
Q

SSRIs and pregnancy

A
  • weight up benefit and risk
  • small increased risk heart defects if used in 1st trimester
    use in 3rd trimester - risk of persistent pulmonary HTN of newborn

Paroxetine - increased risk of congenital malformations

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16
Q

Mirtazapine SEs

A

SSRI - Swap to another SSRI if 1st line isn’t working

SEs
Increased appetite and weight gain (sig)
Drowsiness (sig)

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17
Q

How long can miss doses before having to restart Clozapine and titrate up again?

A

48 hrs (more than 2 consecutive days)

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18
Q

Monitoring for APs

A
  • BMI, weight
  • BP
  • ECG
  • Bloods - FBC, U&Es, LFTs, HbA1c, fasting glucose, lipids
  • Prolactin
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19
Q

If a 1st line SSRI for GAD has not worked, next step…

A

Try another SSRI/ SNRI

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20
Q

How many hours after lithium dose, should lithium levels be checked?

A

12 hours

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21
Q

Initial Rx of PTSD

A

Psychotherapy - CBT (trauma focused), Eye movement desensitisation and reprocessing therapy (EMDR)

Drug Tx = not 1st line (if needed - SSRI or SNRI)

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22
Q

Mirtazapine drug class and indication

A

Noradrenergic and specific serotonergic antidepressant - increases release of neurotransmitters by blocking alpha2 adrenoreceptors

Antidepressant

More useful in older - less SEs and interactions
- SEs - sedation, increased appetite

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23
Q

Alcohol withdrawal - symptoms, most risk of seizures and delirium at what hrs after stopping alcohol?

A

Symptoms 6-12hrs

Seizures 36hrs

Delirium tremens 72hrs

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24
Q

Duloxetine drug class

A

SNRI

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25
Q

SNRI examples

A

Venlafaxine

Duloxetine (‘Duo’ - NAd and 5HT)

26
Q

Chlorpromazine class and mechanism of action

A

Typical antipsychotic

D2 receptor antagonist - blocks dopaminergic transmission in mesolimbic pathways

Others in same class: Haloperidol

27
Q

Torticollis

A

Unilateral pain and devaition of the neck
Pain on palpation
Restricted range of movement

Due to sustained muscle contracation - type of acute dystonia

Associated with antipsychotics

28
Q

Acute dystonias - name 2 types…

A

Oculogyric crisis

Torticollis

29
Q

If good initial response to antidepressants, how long should continue the medication for?

(& how long to reduce dose)

A

6 months

Taper dose over 4 weeks

30
Q

1st line medication for delirium tremens

A

Chlordiazepoxide (BDZ)

31
Q

Poor prognostic indicators for schizophrenia

A 
Gradual onset
FHx
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant/ trigger
32
Q

Strongest risk factor for psychotic disorders

A

FHx - parent with Schizophrenia

33
Q

Schizotypal Personality Disorder - features

A
  • 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
34
Q

Schizoid Personality Disorder - features

A
  • 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
35
Q

Physiological abnormalities of Anorexia Nervosa

A

Reduced BMI
Bradycardia
Hypotension
Enlarged salivary glands

Hypo-K+
Low FSH, LH, oestrogen and testosterone
Impaired glucose tolerance
Low T3

Gs and Cs raised - GH, Glucose, salivary Glands, Cortisol, Cholesterol, Carotenemia

36
Q

Which antidepressants can be given to breastfeeding mothers?

A
  • SSRIs - Sertraline and Paroxetine = most appropriate
37
Q

Contraindications for SSRIs

A
  • Mania

- Caution in children and adolescents

38
Q

Contraindications for TCAs

A
  • Ischaemic heart disease
  • Can exacerbate Schizophrenia
  • Long QT syndrome
  • Caution in pregnancy/ breastfeeding
  • Liver damage
39
Q

How adjust SSRI dose prior to ECT?

A

Reduce the dose of SSRI but don’t stop it

40
Q

Knight’s move thinking vs flight of ideas

A

Knight’s move thinking - illogical steps from one idea to another/ unexpected leaps from one idea to the next without logical associations

Flight of ideas - discernible links between ideas

41
Q

Acute presentation of Bullimia - ABG and ECG findings?

A

ABG - Metabolic alkalosis, low K, low Cl- (loss via vomiting)

ECG - Flattened T waves, tall P waves, heart block (all signs of hypokalaemia)

42
Q

Clomipramine drug class

A

TCA

43
Q

Drugs interacting with SSRIs

A

Risk of SS

  • Triptans
  • MAOIs
  • Lithium
  • Methadone
  • Ondansetron
  • SNRIs

Phenytoin - risk of toxicity
fNSAIDs - risk of GI bleeding
Antiplatelets/ coagulants!!!! - risk of GI bleeding
Amitriptyline - risk of hyponatraemia

44
Q

Rx of heroin withdrawal

A

Supportive - fluids, analgesia etc

do not give opiates

45
Q

How assess risk of suicide?

A 
SAD PERSONS Scale
S - Sex
A - Age
D - Depression
P -  Previous suicide attempt
E - Ethanol
R - Rational thinking loss
S - Social support lacking
O - Organised suicide plan
N - No spouse
S - Sickness
46
Q

When do you use the SAD PERSONS Scale?

A

Assessing suicide risk

Sex
Age
Depression
Previous suicide attempt
Ethanol misuse
Rational thinking loss
Social support lacking
Organised suicide plan
No spouse
Sickness
47
Q

Strongest predictor of future violence?

A

Past Hx of violence

48
Q

Advanced paternal age is a RF for which mental health condition?

A

Schizophrenia

>40yrs or <20yr

49
Q

If have Schizophrenia, risk of identical twin developing the condition?

A

50%

50
Q

Absolute CI for ECT

A

Raised ICP with mass effect

Phaechromocytoma

51
Q

Hypomanic - urgent or routine referral to CMHT?

A

Routine

Urgent if manic -affecting functionning

52
Q

SSRI recommended for postnatal depression?

A

Paroxetine - as low milk/plasma ratio so can use if breastfeeding

(Alternative = Sertraline)

53
Q

Section 4 - what and how long?

A

Emergency admission for assessment

  • 72hrs
  • Only needs a section 12 doctor and AMHP
54
Q

1st line psychotherapy Rx of anorexia in child/ adolescent

A

Family therapy

2nd line = ED-CBT (individual)

Adults - 1st line = Maudsley anorexia N Tx or specialist supportive clinical management

55
Q

Methadone SEs

A 
Nausea, vomiting
Sweating
Constipation
Drowsiness
Respiratory depression
HypOtension
Allergic reaction
56
Q

Acomprosate - class, indication

A

GABA analogue - reduces alcohol cravings

57
Q

Drugs used to support alcohol abstinence (3)

A

Disulfiram - aldehyde dehydrogenase inhibitor (unpleasant reaction if drink alcohol)

Acamprosate - GABA analogue (reduces alcohol cravings)

Naltrexone - partial opiate antagonist (reduces alcohol cravings)

58
Q

Medical management of mild-moderate Alzheimer’s

A

Anticholinergics - Galantamine, donepazil, rivastigmine

59
Q

Medical management of severe Alzheimer’s

A

Memantine (NDMA receptor antagonist)

60
Q

Inheritance pattern of Huntington’s

A

AD with incomplete penetrance
(CAG repeats)

larger number of repeats = associated with earlier onset (anticipation)

Medicine (6 decks)

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