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Medicine - Finals > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

How does SSRI discontinuation syndrome present?

A

GI side effects - diarrhoea, nausea

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2
Q

What adverse effects do antipsychotics increase the risk of in elderly patients?

A

VTE & Stroke

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3
Q

What should be given to patients on SSRI and an NSAID?

A

PPI

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4
Q

How long do symptoms have to persist for an PTSD diagnosis?

A

4 weeks

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5
Q

What to watch out for with Citalopram

A

Citalopram is the most likely SSRI to lead to QT prolongation and Torsades de pointes

Contraindicated in LQTS

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6
Q

Conversion disorder

A

typically involves loss of motor or sensory function. May be caused by stress

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7
Q

How long does a depressive episode have to last to be diagnosed?

A

2 weeks

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8
Q

Questionnaires for depression

A

Patient Health Questionnaire 9 (PHQ-9)

Hospital Anxiety and Depression Scale (HADS)

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9
Q

Diagnosis of Dysthymia

A

2 years of chronic subthreshold depressive symptoms

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10
Q

HPA axis changes in Depression

A

Low hippocamapal volumes due to damage from excess cortisol release.

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11
Q

Risk of SSRIs in adolescents

A

Transient increase in suicidality

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12
Q

When is Mirtazapine for depression particularly useful?

A

Insomnia or low body weight –( as it causes drowsiness and increased appetite)

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13
Q

What is the most potent SNRI?

A

Duloxetine

Venlafaxine is a less potent blocker

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14
Q

Types and examples of MAO inhibitors

A

Irreversible –> Phenelzine

Reversible –> Moclobemide

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15
Q

Risks of MAO inhibitors

A

Cheese reaction - foods high in tyramine may cause hypertensive crisis

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16
Q

Describe ECT treatment

A

Most effective treatment avaiable for severe depression
75% benefit
General Anaesthetic
Electrical pulse through the temporals
Twice weekly for 3-6 weeks
Side effects: post-ictal confusion, headache, memory loss

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17
Q

Management of depression

A

Mild -> CBT

Mod/severe (5+ symptoms) -> SSRI + CBT

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18
Q

Advice on stopping depression medication

A

1 year following remission

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19
Q

Difference between bipolar 1 and 2

A

1 - mania and depression

2 - hypomania and depression

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20
Q

Features of Rapid-cycling bipolar disorder

A

4 or more mood episodes in a 12 month period
resistant to pharmacological treatment
may be worsened by traditional antidepressants

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21
Q

Duration of hypomania and mania episode

A

hypomania - 4 days

mania - 7 days

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22
Q

Questionnaires used for bipolar

A

Mood disorder questionnaire MDQ
Bipolarity Index Depression - Prime MD (useful in GP)
PHQ-9

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23
Q

Gold standard treatment mood stabiliser for bipolar

A

Lithium

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24
Q

Which drug should be avoided with lithium?

A

NSAIDs

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25
Lithium monitoring
7 days after dose adjustment, 12 hours since last dose Check dose weekly thereafter until dose contant for 4 weeks then 6 weekly then 3 monthly if stable Test U+E and TSH 6 monthly
26
Side effects of lithium
hypothyroidism | nephrogenic diabetes insipidus
27
Signs of lithium toxicity
``` vision loss diarrhoea vomiting hypokalaemia tremor dysarthria coma ```
28
Duration for generalised anxiety disorder diagnosis
6 months
29
Who can apply for an emergency detention under the Mental Health act? Details of detention
FY2 and above 72 hours Allows for assessment and emergency treatment Best to get advice from Mental Health Officer (however not absolutely necessary)
30
Who can apply for a short-term detention under the Mental Health act? Details of detention
Psych ST4 and above with consult from mental health officer Lasts for 28 days Allows for condition treatment May be appealed to Tribunal service
31
Who can apply for a long-term detention under the Mental Health act? Details of detention
Via tribunal using reports from MHO, consultant and GP Lasts 6 months Allows condition treatment May be hospital or community based
32
Criteria for detainment under the mental health act
``` Risk to individual or somebody else Diagnosed mental illness (does not include dependence on drugs or alcohol) SIDMA Available treatment for condition Necessary to detain patient ```
33
Common Law
Acting in the best interest of the public or individual using previous rulings e.g. use of restraint in agitated patients
34
Examples of typical antipsychotics
Chlorpromazine, Haloperidol, Zuplopenthixol, Flupenthixol
35
How do typical antipsychotics work?
block D2 dopamine receptors
36
Which dopaminergic pathway is targeted by antipsychotics?
Mesocorticolimbic - specifically mesolimbic
37
Dopamine pathways and effect of anti-psychotic
Hypothalamospinal pathway blockade -> Akathisia Nigrostriatal pathway blockade -> Parkinsonism, Acute Dystonia, Tardive Dyskinesia Tuberoinfundibular pathway blockade -> hyperprolactinaemia Mesocortical pathway blockade -> reduces negative symptoms Mesolimbic pathway blockade -> reduces positive symptoms
38
Which dopamine receptor does clozapine have the highest affinity for?
D4
39
Which typical antipsychotic lowers seizure threshold?
Chlorpromazine
40
Side effects of Chlorpromazine
Seizures, Sun burn, stiffness, EPSE (dystonic reaction and neuromalignant syndrome)
41
Features of neuromalignant syndrome
ANS instability - swinging BP Malignant pyrexia Increased skeletal muscle tone Test CK Risk of AKI due to rhabdomyolysis
42
Treatment of dystonic reaction and oculogyric crisis
procyclidine
43
How can presentation of acute dystonia and neuromalignant syndrome differ?
Acute dystonia comes on over minutes or hours | Neuromalignant syndrome comes on gradually over days , is associated with a fever
44
Management of Akathisia
Propanolol
45
Which antipsychotic and antisuicidal properties
Clozapine
46
Side effects of Clozapine
``` Seizures - lowers threshold weight gain sedation myocarditis - ecg every 3 months agranulocytosis - weekly for first 6/12, then 2-weekly for next 6/12 and monthly thereafter constipation siallorhoea - hyoscine butylbromide ```
47
How should patients be advised in terms of trying antipsychotics
Try each for at least 6-8 weeks at an adequate dose before moving on if wants stimulating drug then aripiprazole if wants sedation then olanzapine or quetiapine IM Depo is option every 3 months - especially if compliance is bad
48
Difference between hallucinations and pseudohallucination
Pseudohallucination - patients have insight
49
Misidentification Delusion - Capgras
Someone has been replaced by an imposter
50
Misidentification Delusion - Fregoli
multiple people are in fact the same person
51
CAGE - questions for alcohol dependence
Cut down - ever thought about cutting down? Annoyed - ever been annoyed when someone confronts you about your drinking? Guilty - do you feel guilty about drinking Eye-opener - is it the first thing you think about when you wake up
52
Management of alcohol withdrawal syndrome and relapse prevention
BZDs like diazepam - reduce gradually over 7 days Thiamine (b1) - pabrinex Relapse prevention: Remember NDA Naltrexone (first line) - reduces reward Disulfiram - causes the asian flush symptoms Acamprosate - reduces cravings
53
First-line for ADHD
Methylphenidate
54
Triad for normal pressure hydrocephalus
abnormal gait dementia urinary incontinence
55
Management of agitation in FT dementia
Trazadone
56
Max dose of sertraline
200mg
57
IF CBT or EMDR is unsuccessful in PTSD what is next step in management
If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI
58
What should you so if someone misses two clozapine doses in a row?
retitrate and restart again slowly
59
What happens if SSRIS are stopped suddenly?
SSRI discontinuation syndrome Diarrhoea is the main feature as well as abdominal pain and vomiting EXCEPT Fluoxetine
60
What tool can be used to assess alcohol withdrawal severity?
Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale can be used to assess alcohol withdrawal severity
61
What is the risk of giving zopiclone in the elderly?
Increased risk of falls
62
Management of TCA overdose
IV bicarbonate
63
Effect of smoking and alcohol intake of Clozapine levels
Smoking - reduces clozapine levels | Alcohol binges - increases clozapine levels
64
Non-EPSE side effects of anti-psychotics
antimuscarinic: dry mouth, blurred vision, urinary retention, constipation sedation, weight gain raised prolactin - galactorrhoea (inhibition of the dopaminergic tuberoinfundibular pathway) impaired glucose tolerance neuroleptic malignant syndrome: pyrexia, muscle stiffness reduced seizure threshold (clozapine) prolonged QT interval (particularly haloperidol)
65
Risk of antipsychotics in the elderly
increased risk of stroke | increased risk of venous thromboembolism
66
What is the preferred SSRI for use post-MI?
Sertraline
67
What is the SSRI of choice in children and adolescents ?
Fluoxetine
68
SSRI interactions
``` NSAIDs Warfarin/Heparin (use Mirtazapine instead) Aspirin Triptans --> Serotonin Syndrome MAOs --> Serotonin Syndrome St John's Wort --> Serotonin Syndrome Ecstasy --> Serotonin Syndrome Amphetamines --> Serotonin Syndrome ```
69
Risks of SSRIs in Pregnancy
1st Trimester - congenital heart defects (especially Paroxetine) 3rd Trimester - persistent pulmonary hypertension
70
Features of Serotonin Syndrome
Neuromuscular Excitation (e.g. hyperreflexia, myoclonus, rigidity) Autonomic dysfunction (e.g. hyperthermia) Altered mental state
71
Management of Serotonin Syndrome
Supportive with IV fluids Benzodiazepines If severe serotonin antagonists e.g. cyproheptadine and chlorpromazine
72
Differences in the presentation of Serotonin syndrome and Neuroleptic malignant syndrome?
Serotonin Syndrome - SSRIs, MAOs - Fast onset (hours) - Hyperreflexia - Dilated pupils - In severe cases manage with serotonin antagonists (Cyproheptadine or Chlorpromazine) Neuroleptic Malignant Syndrome - antipsychotics - Slow onset (days) - Hyporeflexia - Normal pupils - Manage with Dantrolene

Medicine - Finals (21 decks)

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