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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
Q

Lithium monitoring

A

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

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26
Q

Side effects of lithium

A

hypothyroidism

nephrogenic diabetes insipidus

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27
Q

Signs of lithium toxicity

A 
vision loss
diarrhoea 
vomiting 
hypokalaemia 
tremor 
dysarthria 
coma
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28
Q

Duration for generalised anxiety disorder diagnosis

A

6 months

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29
Q

Who can apply for an emergency detention under the Mental Health act? Details of detention

A

FY2 and above
72 hours
Allows for assessment and emergency treatment
Best to get advice from Mental Health Officer (however not absolutely necessary)

30
Q

Who can apply for a short-term detention under the Mental Health act? Details of detention

A

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
Q

Who can apply for a long-term detention under the Mental Health act? Details of detention

A

Via tribunal using reports from MHO, consultant and GP
Lasts 6 months
Allows condition treatment
May be hospital or community based

32
Q

Criteria for detainment under the mental health act

A 
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
Q

Common Law

A

Acting in the best interest of the public or individual using previous rulings e.g. use of restraint in agitated patients

34
Q

Examples of typical antipsychotics

A

Chlorpromazine, Haloperidol, Zuplopenthixol, Flupenthixol

35
Q

How do typical antipsychotics work?

A

block D2 dopamine receptors

36
Q

Which dopaminergic pathway is targeted by antipsychotics?

A

Mesocorticolimbic - specifically mesolimbic

37
Q

Dopamine pathways and effect of anti-psychotic

A

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
Q

Which dopamine receptor does clozapine have the highest affinity for?

A

D4

39
Q

Which typical antipsychotic lowers seizure threshold?

A

Chlorpromazine

40
Q

Side effects of Chlorpromazine

A

Seizures, Sun burn, stiffness, EPSE (dystonic reaction and neuromalignant syndrome)

41
Q

Features of neuromalignant syndrome

A

ANS instability - swinging BP
Malignant pyrexia
Increased skeletal muscle tone

Test CK
Risk of AKI due to rhabdomyolysis

42
Q

Treatment of dystonic reaction and oculogyric crisis

A

procyclidine

43
Q

How can presentation of acute dystonia and neuromalignant syndrome differ?

A

Acute dystonia comes on over minutes or hours

Neuromalignant syndrome comes on gradually over days , is associated with a fever

44
Q

Management of Akathisia

A

Propanolol

45
Q

Which antipsychotic and antisuicidal properties

A

Clozapine

46
Q

Side effects of Clozapine

A 
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
Q

How should patients be advised in terms of trying antipsychotics

A

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
Q

Difference between hallucinations and pseudohallucination

A

Pseudohallucination - patients have insight

49
Q

Misidentification Delusion - Capgras

A

Someone has been replaced by an imposter

50
Q

Misidentification Delusion - Fregoli

A

multiple people are in fact the same person

51
Q

CAGE - questions for alcohol dependence

A

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
Q

Management of alcohol withdrawal syndrome and relapse prevention

A

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
Q

First-line for ADHD

A

Methylphenidate

54
Q

Triad for normal pressure hydrocephalus

A

abnormal gait
dementia
urinary incontinence

55
Q

Management of agitation in FT dementia

A

Trazadone

56
Q

Max dose of sertraline

A

200mg

57
Q

IF CBT or EMDR is unsuccessful in PTSD what is next step in management

A

If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI

58
Q

What should you so if someone misses two clozapine doses in a row?

A

retitrate and restart again slowly

59
Q

What happens if SSRIS are stopped suddenly?

A

SSRI discontinuation syndrome

Diarrhoea is the main feature as well as abdominal pain and vomiting

EXCEPT Fluoxetine

60
Q

What tool can be used to assess alcohol withdrawal severity?

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale can be used to assess alcohol withdrawal severity

61
Q

What is the risk of giving zopiclone in the elderly?

A

Increased risk of falls

62
Q

Management of TCA overdose

A

IV bicarbonate

63
Q

Effect of smoking and alcohol intake of Clozapine levels

A

Smoking - reduces clozapine levels

Alcohol binges - increases clozapine levels

64
Q

Non-EPSE side effects of anti-psychotics

A

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
Q

Risk of antipsychotics in the elderly

A

increased risk of stroke

increased risk of venous thromboembolism

66
Q

What is the preferred SSRI for use post-MI?

A

Sertraline

67
Q

What is the SSRI of choice in children and adolescents ?

A

Fluoxetine

68
Q

SSRI interactions

A 
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
Q

Risks of SSRIs in Pregnancy

A

1st Trimester - congenital heart defects (especially Paroxetine)
3rd Trimester - persistent pulmonary hypertension

70
Q

Features of Serotonin Syndrome

A

Neuromuscular Excitation (e.g. hyperreflexia, myoclonus, rigidity)

Autonomic dysfunction (e.g. hyperthermia)

Altered mental state

71
Q

Management of Serotonin Syndrome

A

Supportive with IV fluids

Benzodiazepines

If severe serotonin antagonists e.g. cyproheptadine and chlorpromazine

72
Q

Differences in the presentation of Serotonin syndrome and Neuroleptic malignant syndrome?

A

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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