psychiatry Flashcards
1
Q
hallucination?
A
perception in absence of external stimuli
2
Q
depression auditory hallucination? Schizophrenia?
A
depression = 2nd person, usually persecutory “you are a bad person and deserve to die” schizophrenia = 3rd person
3
Q
anhedonia? anergia? early morning wakening? psychomotor retardation? stupor?
A
anhedonia = loss of enjoyment
anergia = lack of energy
EMW = waking at least 2 hours before normal waking time
PR = slowing of thoughts/movement
Stupor = patient still, quiet, doesn’t respond
4
Q
Depression ICD-10 criteria
Additional symptoms?
A
depressive episode should last at least 2 weeks
NO hypomanic/manic epidodes
General criteria
* depressed mood (to degree that is abnormal for individual) for at least 2 weeks
* anhedonia
* anergia
Additional symptoms
* low self-esteem
* guilt
* pseudodementia
* suicidal thoughts
* sleeping more/less
* eating more/less
5
Q
severity of depression?
A
3 scales
* Hamilton (HAM-D)
* Montgomery-Asperg (MADRS)
* Beck (BDI)
ICD rates severity according to symptoms
* Moderate = 2 core symptoms + 4 additional symptoms (at least 6)
* severe = at least 8
6
Q
depression + mania?
A
first episode of (hypo)mania with depression means it is bipolar
7
Q
hypomania ICD-10
A
mood elevated to degree that is abnormal to individual for 4 days
at least 3 of following signs must be present
* increased activity or restlessness
* increased talkativeness
* decreased need for sleep
* difficulty concentrating
* increased libido
* mild spending sprees or reckless behaviour
8
Q
manic episode ICD-10
A
abnormal mood/activity for at least 1 week (unless severe enough to require hospital admission)
at least 3 of following signs
* increased activity or restlessness
* increased talkativeness
* decreased need for sleep
* flight of ideas (racing thoughts)
* inappropriate behaviour (loss of social inhibition)
* grandiosity
* distractibility or constant change in activity/plans
* reckless behaviour
* marked sexual energy
9
Q
psychotic symptoms bipolar?
A
grandiose delusions
10
Q
onset bipolar?
A
usually late teens
FH results in earlier onset onset
>60 is rare and associated with worse outcomes
11
Q
predictors of poor outcome bipolar?
A
* early-onset or very late onset
* low socioeconomic status
* long duration of illness
* rapid cycling
* psychosis
* comorbidities
* family history
12
Q
bipolar I vs II?
A
bipolar I = mania + depression
bipolar 2 = hypomania + depression
13
Q
substance misuse history
A
TRAPPED
Type
Route - injection/snort
Amount
Pattern - frequency of use and duration
Past abstinence - reason for relapse?
Effect on life
Dependency
14
Q
mood vs affect?
A
mood - how you feel
effect - how patient appears (flattened, emotional labile)
15
Q
thought disorders
A
thought insertion = belief that thoughts inserted into patients mind
thought withdrawal = thoughts removed (i.e. memories)
thought broadcasting = believe others can hear thoughts
16
Q
how to assess cognition?
A
MMSE
MOCA
ACE-III
17
Q
drugs that most effectively cross BB?
A
hydrophobic/lipophillic
18
Q
depression pathophys?
where do they originate?
A
deficiency of monoamines - serotonin and noradrenaline
serotonin from rostral nucleus + caudal raphe
* rostral = mood, sleep, feeding behaviour
* caudal = analgesia
Noradrenaline from locus coeruleus + lateral tegmental area (pons)
19
Q
monoamine oxidase inhibitors?
Side effects?
A
phenelzine (irreversible)
moclobemide (reversible)
S/E
* cheese reaction - hypertensive crisis
* insomnia
* postural hypotension
* peripheral oedema
* increases side effects of other drugs e.g. barbiturates
20
Q
A
D - nausea
21
Q
A
citalopram
22
Q
tricyclic antidepressant examples?
mechanism?
side effects?
A
imapramine, dosulepin, amitryptyline, lofepramine
block reuptake of noradrenaline and 5-HT
Side effects
* anticholinergic - dry mouth, blurred vision, constipation, urinary retention
* sedation
* weight gain
* cardio - postural hypotension, tachycardia, arrhythmias
**** cardiotoxic in overdose!!
23
Q
SSRI examples
mechanism?
side effects
A
fluoxetine, citalopram, sertraline, paroxetine
inhibit reuptake of serotonin
common side effects
* nausea
* headache
* worsened anxiety
* transient increase in self-harm/suicidal ideation <25 years
* sweating/vivid dreams
* HYPONATRAEMIA *(in elderly)
24
Q
SNRI examples
mechnaism?
side effects
A
venlafaxine, duloxetine
block reuptake of serotonin and noradrenaline
side effects = same as SSRI but WITHOUT anticholinergic effects :)
25
atypical antidepressant drugs?
mechanism + side effects?
mirtazapine (blocks alpha receptors causing increased release of 5-HT and noradrenaline)
side effects
\* weight gain!!! - increases appetite
\*sedation
also bupropion which is a dopamine uptake inhibitor
26
ataxia
27
FALSE - renal metabolism
28
B - increase in lithium levels
29
lithium drug?
what is important when prescribing lithium?
lithium carbonate
requires monitoring
\* 12 hours post dose
\* target range is 0.4-1.0 mmol/l
30
Side effects lithium
toxic effects?
side effects
\* dry mouth/strange taste
\* polydipsia + polyuria
\* tremor
\* **hypothyroidism**
\*reduced renal function
\* **nephrogenic diabetes inspidus**
\* weight gain
Toxic effects
vomiting, diarrhoea, ataxia/coarse tremor
drowsiness/unconscious
convulsions, coma
31
E - valproic acid (teratogenic)
32
anticonvulsant mood stabilisers?
side effects?
valproic acid, lamotrigine, carbamazepine
valproate + carbamazepine = **induces liver enzymes**, ataxia, drowsiness, arrhythmia
valproate is teratogenic (neural tube defects)
lamotrigine = small risk of SJS
33
antipsychotics as mood stabilisers
side effects?
quetiapine, apiprazole, olanzapine
side effects
\* weight gain, sedation, metabolic syndrome (others covered in schizophrenia)
34
how long should you trial antidepressant?
is it stopped immediately after remission?
at least 4 weeks (6 weeks in the elderly)
no - continue for at least 6 months after full recovery **without reducing dose**
\*\* if second episode - continue for at least a year after full recovery!!!
35
**acute** mania Tx?
1st line = antipsychotic (olanzapine, quetiapine, risperidone)
36
bipolar Tx?
what about bipolar depression?
1st line = lithium
2nd line = antipsychotics, anticonvulsants
**antidepressants should NOT be prescribed without an antimanic drug**
37
ECT complication?
memory problems - episodic memory
ability to learn new information is **not** affected
38
Anorexia nervosa ICD-10
BMI \<17.5
self-induced weight loss (dieting, vomiting, excessive exercise)
body image isturbance
fear of fatness
amenorrhoea/sexual dysfunction in men
delaye dpuberty
39
physical assessment anorexia?
muscle wasting, hair loss
lanugo hair
cold, blue peripheries
dry skin
hypercarotenaemia (orange palms)
bradycardia, hypotension
bruising
40
high risk anorexia
BMI \<13 or weight loss \>1kg/week
prolonged QT, HR \<40, systolic BP \<80
core temp \<34 C
unable to rise from squat without using arms
cognitive impairment
41
important to avoid when treating anorexia?
refeeding syndrome
patient given too many calories too quickly - fatal
42
Tx anorexia
co-morbidities?
CBT
dietician
family therapy
inpatient tx for high risk
co-morbs = depression, OCD, **autism**
43
bulimia nervosa ICD-10
persistent preoccupation with eating
irresistable craving for food
binges + attempts to counter effects of binges (starvation, laxatives, purging)
morbid dread of fatness
44
physical assessment bulimia?
Russel's sign
parotid hypertrophy
dental caries
U + Es (hypokalaemia - can lead to seizures)
ketones - dehydration
45
cluster A personality disorders
46
cluster B personality disorders
47
cluster C personality disorders
48
Tx personality disorders?
pharmaoclogical treatment not recommended by NICE!!
For BPD, 1st line = DBT
rest = CBT, some req inpatient care
49
1st v 2nd v 3rd gen antipsychotics
1st = chlorpromazine, haloperidol, prochlorperazine
2nd = clozapine, olaznapine, quetiapine, risperidone
3rd = aripiprazole
50
Tx schizophrenia?
2nd gen antipsychotic 6-8 weeks --\> 1st/2nd gen 6-8 weeks --\> check compliance + correct diagnosis
\* if not compliant = depot haloperidol (3 months)
\* if **NONE** of this has worked, try **clozapine**
**\*\*** or higher dose OR combine 2 antipsychotics
51
antipsychotic mechanism?
dopamine (D2) antagonists
except clozapine - D4
52
side effects antipsychotics? + pathways
extrapyramidal (dystonia, parkinsonism, tardive dyskonesia) = nigrostriatal pathway
neuroleptic maligant syndrome = mesolimbic pathway
hyperprolactinaemia (lactation/gynaecomastia) = tubuloinfundibular pathway
Akathesia/restless legs = hypothalamospinal pathway
other side effects = anticholinergic, weight gain + sedation, postural hypotension, hepatoxicity, prolonged QT, photosensitivity
53
acute dystonia antipsychotics?
Tx?
onset in minutes
increased muscle tone
torticollis
oculogyric crisis
tongu eprotrusion
Tx = procyclidine (anticholingeric)
54
parkinsonism antipsychotic?
Tx?
bradykinesia
cogwheeling rigidity
shuffling gait
hypomimia
Tx = procyclidine
55
tardive dyskinesia antipsychotic?
Tx?
often permanent
involuntary repetative oro-facial movements e.g. pouting, lip-smacking
doesn't reallt respond to procyclidine like acute dystonia or parkinsonism
56
when to suspect neuroleptic malignant syndrome?
Diagnostic test?
Treatment?
gradual onset 1-3 days - EMERGENCY, FATAL
increasing mucle tone, **hyperpyrexia**, changing pulse/BP
**rhabdo \> renal failure \> death**
Ix = raised CK
Tx = STOP ANTIPSYCHOTIC, dentroline (muscle relaxant), dopamine **agonist**, rapid cooling
57
effects of antipsychotic hyperprolactinaemia in women?
Men?
both?
Women = galactorrhoea, decresed libido, amenorrhoea
men = gynaecomastia, erectile dysfunction + **oligospermia**, decreased libido
both = osteoporosis
58
Akathesia symptoms?
Tx?
pacing
unable to sit/stand still
Tx = propanolol 1st line
2nd line = benzo
59
anticholingeric side effects?
5HT2?
anti-adrenergic?
anticholinergic = dry mouth, blurred vision, constipation, urinary retention
5HT2 = weight gain, metabolic syndrome (T2DM)
anti-adrenergic = postural hypotension
all seen in antipsychotic use
60
1st gen vs 2nd gen antipsychotic side effects?
1st gen = extra-pyramidal side effects (dystonia, parkinsonism, TD)
2nd gen = weight gain, sedation, diabetes
61
clozapine side effects
monitoring?
**ANGRANULOCYTOSIS** = neutropenic sepsis
myocarditis
constipation (bowel obstruction)
weight gain
sedation
sialorrhoea
weekly WBC count for first 6 months
62
age of onset depression?
bipolar?
personality disorders?
depression = 50% before 20
bipolar = approx 25
personality disorders = can only be diagnosed after 18
63
seperation anxiety disorder (SAD)?
Normal from age 7 months through preschool
* SAD distinguished by age inappropriate, excessive and disabling anxiety
* SAD and other anxiety disorders tend to lead to school refusal
Note marked increase in social anxiety and perfectionism during adolescence
64
delerium features?
Acute onset
Lasts for hours to weeks
Fluctuates (**worst at night**)
Attention decreased or hyperalert
65
Ax delirium?
I WATCH DEATH
I - infections
W - withdrawal from medications
Acute causes - electrolyte disturbance, **dehydration**
T - toxins, drugs
C - CNS pathology (strokes, tumours)
H - hypoxia
D - deficiencies, thiamine with alcohol abuse, B12
Endocrine - thyroid etc
A - acute vascular shock e.g. hypertensive encephalopathy
T - trauma
H - heavy metals e.g. lead, mercury, manganese poisoning
66
pseudodementia features?
Fluctuating loss of memory
**Good insight into loss of memory**
Prominent slowing of speech
Depressed mood
**Not progressive**
Responds to medication/ECT
67
Tx anxiety?
CBT first!
1st line mediciation = SSRI (sertraline)
benzodiazepines
**avoid propanolol in young people**
68
medication process for depression?
**SSRIs 1st line!!**
## Footnote
Try for 6 weeks, then if no improvement, try **a second SSRI**
if poor response to at least 2 SSRIs, try **antipsychotic** (quetiapine, rispiridone, olanzapine)
69
classic characterisitcs of psychosis?
Ax psychosis?
hallucinations + delusions + disorder of form of thought
Ax
* mania/depressive psychosis
* schizophrenia
* schizoaffective disorder
* organic conditions = delierium, dementia, stroke, brain injury
* substance use = acute intoxication, withdrawal, DT
70
ideas of reference?
examples?
Innocuous events will be ascribed special meaning by the person
* Message in newspaper about them
* Believing that news report is really commenting about their life or talking directly to them
* Seeing that objects or events have been arranged so as to specifically convey a hidden meaning
* Social media posts are about them
71
self-referental experiences?
The sense that external events are related to them in some way
E.g.
* Feeling others are speaking about me/laughing at me
* Belief that TV or radio are transmitting messages aimed at me
* The belief I am the second coming of christ
72
delusion?
types?
A fixed, falsely held belief - impervious to logical argument
Primary delusions - arrive fully formed in consciousness without need for explanation
Secondary delusions - often attempts to explain other psychotic experiences e.g. hallucinations, passivity phenomena, thought insertion
73
thought disorder?
Reflected in speech
* Clanging and punning
* Loosening of associations
* Knight’s move thinking
* Neologisms
* verbigeration/word salad
* circumferentiality/tangentiality
74
thought interference?
Thought insertion - though being put into my head that doesn’t belong to me
Thought withdrawal - thoughts extracted
Thought broadcasting - believe everyone else knows what you’re thinking
Thought blocking - get halfway through a thought and it just stops
75
passivity of volition?
affect?
impulse?
Passivity of…
* Volition - actions
* They made me walk over there, I couldn’t stop them
* Affect - feelings
* They just turn a dial and change me from happy to sad
* Impulse - urges
* They make me want to jump out into the traffic, I have to fight to stop myself
76
3rd person auditory hallucinations?
schizophrenia
77
s/s delirium?
Clouding of consciousness
* Drowsiness or unresponsive
* **Disorientation in time, place and person**
* Lucid intervals
* **Worse at night**
Impaired concentration/memory (esp. new information)
Visual hallucinations (often threatening)
Persecutory delusions
Agitation or psychomotor retardation
Irritability
Insomnia
78
depressive psychosis?
Delusions of worthlessness/guilt/hypochondriasis/poverty/sin/nihilism
Cottard’s syndrome
Hallucinations of accusing/insulting/threatening voices - typically 2nd person
79
mania with psychosis?
Delusions of grandeur/special ability/persecution/religiosity
Hallucinations - tend to be 2nd person and auditory (e.g. hearing God’s voice telling you that you are great)
Flight of ideas
80
schizophrenia ICD-10?
at least one **1st rank symptom**:
* thought echo/insertion/withdrawal/broadcasting
* passivity
* 3rd person auditory hallucinations
* delusions
plus at least 2 of the following:
* neologisms, other speech disorder
* catatonic behaviour e.g. waxy flexibility
* "negative" symptoms: apathy, paucity of speech
81
positive vs negative symptoms schizophrenia
82
hebephrenic schizophrenia?
the type you think of when you picture schizophrenia
83
acute and transient psychotic disorder?
Schizophrenia-like symptoms lasting \<1 month
84
just learn this in case asked to feedback mental state exam
85
chance of passing schizophrenia to child?
If one parent has schizophrenia, chance is approx 10%
86
risk factors schizophrenia?
**genetics**
2nd trimester viral illness
obstretric problems - pre-eclampsia, foetal hypoxia, emergency c-section
substance misuse = **THC**, cocaine, amphetamines
87
schizophrenia effect on brain
88
Section 47 AWIA (adults with incapacity act)?
used to authorise treatment of **PHYSICAL** disorder in somone without capacity to consent
89
powers of welfare guardian?
make welfare/financial decisions for patient
## Footnote
**Cannot place the adult in hospital for treatment of mental disorder against their will**
90
Mental Health Act?
subcategories?
Allows for treatment of **MENTAL** disorder in someone without capacity to consent to treatment
* Emergency detention certificate
* Short term detention certificate
* Compulsory treatment order
91
criteria for emergency detention?
92
criteria for short term detention?
93
children and consent?
16 years - presumed to have capacity to make most decisions about treatment and care
94
incapacity in young people?
what about Mental Health Act?
incapacity in young people = **the Children Act**
* if young person lacks capacity, ask one parent for consent
* if parents diagree = legal advice
95
....
96
SIDMA?
not the same as incapacity - caused by mental disorder alone
incapcity is decreased congition
97
features of emergency detention order?
lasts for 72 hours
**does not authorise treatment!!!**
its used to assess patient
98
features of short term detention order?
unlike emergency detention, this **does** authorise treatment
99
compulsory treatment order?
100
in what circumstances **can** treatment be given under emergency detention order?
must completet T4 certificate afterwards
101
what treatments **cannot** be given under short term detention or compulsory treatment order?
electroconvulsive therapy
artificial nutrition
vagus nerve stimulation
transcranial magnetic stimulation
any medicine given to reduce sex drive
neurosurgery
102
advance statement?
103
advocacy and named person?
104
ADHD triad?
Inattention
Hyperactivity
Impulsivity
105
genetics ADHD?
60% increased risk for ADHD for offspring of adults with ADHD
106
Ax ADHD?
genetics
perinatal factors
* tobacco + alcohol during pregnancy
* prematurity
* perinatal hypoxia
* prolonged labour, foetal distress, forceps delivery, pre-eclampsia
psychosocial adversity e.g. marital discord, low social class, maltreatment
107
neurobiology ADHD?
Underactive function in frontal lobe
Frontal lobe mainly responsible for
* Reasoning
* Planning
* Impulse control
* Judgement
* Initiation of actions
* social/sexual behaviour
* Long term memory
108
diagnostic criteria ADHD
109
Tx ADHD?
parent training, social skills training
pharmacological (only for moderate + severe)
* 1st line = stimulants (methylphenidate, dexamfetamine)
* 2nd line = SNRIs (atomoxetine)
* 3rd line = alpha agonists (clonidine, guanficine)
* 4th line = antidepressants + antipsychotics (risperidone)
110
mechanism methylphenidate?
Increase dopamine by blocking its transporter
111
ASD disorders?
ASD refers to 5 different disorders
* Asperger's syndrome
* Rett’s syndrome
* Childhood autism
* Pervasive developmental disorder
* Pervasive developmental disorder NOS
112
triad of impairments ASD?
plus one?
Social communication
* Generally good language skills but find it hard to grasp underlying meaning of conversation
* Difficulties in understanding jokes, idioms, metaphors and sarcasm
* Voices often sound monotonous
* Often have narrow interests which dominates their conversations
Social interaction
* Difficulties picking up non-verbal cues (body language)
Social imagination
* Difficulties thinking in abstract ways
* Inability to understand others points of view, take things literally
repatitive behaviours
* motor movements, speech, adherance to routines
* hyper or hypo reactivity to sensory input
113
Ax ASD?
genetics
umbolical cord complications
foetal distress
birth injury
congenital malformations
maternal haemorrhage
low birth weight/SGA
114
diagnostic tools ASD?
3di, DISCO, Autism Diagnostic Observation Schedule (ADOS)
115
Tx ASD?
Self and family psychoeducation
Behaviour analysis, speech and language therapy, social skills training
Family and school supports
116
intellectual disability?
Deficits in intellectual functioning
## Footnote
**Occurs \<18 years**
117
Dx intellectual disability?
WAIS scale
118
is dementia an intellectual disability?
NO occurs \<18 y/o
things like: dyslexia, acquired brain injury, dementia are **not** intellectual disabilities
119
severity intellectual disability?
Borderline ID - IQ 70+
Mild ID - IQ 50-69
Moderate ID - IQ 35-49
Severe ID - IQ 20-34
Profound ID - IQ \<20
120
Ax intellectual disability?
Chromosomal mutations e.g. Downs, prader-Willi, cri du chat, Angelman)
antenatal - maternal infections, poor diet, substance abuse
birth - extreme prematurity, birth injury, cerebral hypoxia
infancy - infections, NAI, toxins
Sex chromosomes - Turners, trisomy X, klinefelter, fragile X
Genetic conditions - TS, Lesch Nyhan, PKU
121
intellectual disability co-morbidities?
more likely to have mental illness + dementia
(schizophrenia + depression 3 times more common)
122
GAD?
Tx?
Anxiety that is generalised and persistent
Not specific to certain situations
Tx = CBT + SSRIs
123
panic disorder?
S/s?
Tx?
Recurrent attacks of severe anxiety - happens repeatedly but unpredictably
S/s = sudden onset palpitations, chest pain, choking sensations, dizziness, feelings of unreality
Tx = CBT + SSRI
124
types of phobia?
Tx?
3 types
* Agoraphobia (fear of leaving home, entering public spaces)
* Specific phobia
* Tx = exposure therapy
* Social phobia - more than being shy
* Tx = CBT + SSRIs
125
OCD?
Obsessive thoughts
* Ideas, images or impulses
* **Recognised as patient’s own thoughts**
* Unpleasant, resisted and ego-dystonic
Compulsive acts
* Repeated rituals
* Not enjoyable
* Recognised as pointless
126
Dx OCD?
Obsessive symptoms or compulsive acts must be present for at least 2 weeks
* Obsessions must be individual’s own thoughts
* Resistance must be present
* Rituals are not pleasant
* thoughts/images/impulses must be repetitive
127
Tx OCD?
CBT
**SSRIs**/clomipramine
128
neurobiology findings trauma
129
PTSD ICD-10?
* Traumatic event
* Intrusive symptoms (nightmares, flashbacks)
* Avoidance symptoms
* Negative alterations in cognition and mood
* Increased arousal and reactivity (hypervigilance, sleep disturbance)
130
complex PTSD?
core PTSD symptoms PLUS:
* negative self concept (low self-esteem, self-blame)
* emotional dysregulation (violent/emotional outbursts, self-destructive behaviour, dissociation)
* self-harm, substance abuse
* issues with trust, maintaining relationships
131
comorbidity PTSD?
\>80% have depression, drug + alcohol abuse, or anxiety
132
Tx PTSD?
CBT/EMDR
antidepressants (SSRI)
antipsychotics for severe hyperarousal
prazosin
mood stabilisers e.g. carbamazepine
133
neurobiology of fear
Amygdala - integrates sensory and cognitive info
Affect of fear
* Anterior cingulate cortex/orbitofrontal cortex
Avoidance
* Periaqueductal gray (fight/flight)
Endocrine
* Hypothalamus (increase in cortisol)
Autonomic output
* Locus coeruleus (increase in BP/HR)
Re-experiencing
* Hippocampus (traumatic memories)
134
mechanism benzodiazepines?
enhance GABA action
135
benzodiazepine withdrawal s/s?
Abdominal cramps
Increased anxiety, panic attacks
* chest pain, palpitations, sweating, shaking
Blurred vision
Depression
Insomnia, nightmares
Dizziness
Headaches
Nausea + vom
136
how to Tx benzodiazepine dependency?
Transfer patient to daily dose of **diazepam/chlordiazepoxide** taken at night
Reduce dose every 2-3 weeks in steps of approx 2mg
* If withdrawal symptoms occur maintain this dose (i.e. don't reduce) until symptoms improve
Continue until complete withdrawal (can take 4 weeks to a year)
137
PTSD \<4 weeks trauma?
don't treat - watchful waiting
138
hazardous drinking?
harmful drinking?
hazardous = anyone drinking \>14 units a week but **without** alcohol-related problems
harmful = consuming \>35 units per week
139
alcohol and cancer?
Increases risk for 7 types of cancer
**Breast**, bowel, liver, oesophagus, larynx, mouth, throat
140
tools for alcohol screening?
FAST
AUDIT (alcohol use disorders identification test)
CAGE - screening for dependence
141
alcohol/drug dependance syndrome ICD-10?
3 or more of following:
* Strong desire or sense of compulsion to take drug
* Difficulty in controlling use of substance
* Physiological withdrawal state
* Evidence of tolerance
* neglect of other pleasures/interests
* Persistence with use despite harm
142
alcohol withdrawl s/s
resolves?
complication?
Occur within hours and peak 24-48 hours
* Restlessness
* Tremor
* Sweating
* Anxiety
* Nausea + vom
* Insomnia
* Generalised seizures in first 24 hours
Symptoms usually resolve in 5-7 days
Can progress to medical emergency **delirium tremens**
143
delerium tremens occurs when?
s/s?
Peak onset within **2 days** of abstinence
s/s
* Confusion (espcially at **night**)
* Disorientation
* Agitation
* Hypertension
* Fever
* Visual and auditory hallucinations
* Paranoid ideation
144
Tx alcohol withdrawal?
Benzos!!
* Use long-acting agents - **diazepam or chlordiazepoxide**
Vitamin supplementation - **thiamine** as prevention of Wernicke’s encephalopathy
hydration, anti-emetics etc
145
addictive drugs activate?
dopamine receptors in **mesolimbic pathway**
146
areas of brain invlved in addiction
147
...
148
Tx alzheimers?
1st line = cholinesterase inhibitors e.g. donezapil, galantamine, rivastigmine
2nd line = NMDA receptor antagonists e.g. memantine
149
A - lithium carbonate
B - olanzapine
C - risperidone
D - venlafaxine
E - Quetiapine
E - quetiapine
150
opoid dependence Tx?
Best option?
methadone or buprenorphine
Choosing between methadone and buprenorphine:
* ECG/QTc (methadone can prolong QT interval)
* Sedation (methadone)
* Combining with other drugs (methadone metabolised by liver)
151
opoid overdose?
naloxone
152
mild intellectual disability (50-69)
153
often patients have no awareness
154
methylphenidate because of age and severity
155
is EMDR 1st line for PTSD?
no 2nd line after CBT
156
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166
types of memory loss?
Semantic
Episodic
Dates, deadlines, meals (short term memory)
167
Visuospatial impairment?
