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3rd year medicine > psychiatry > Flashcards

psychiatry Flashcards

1
Q

hallucination?

A

perception in absence of external stimuli

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2
Q

depression auditory hallucination? Schizophrenia?

A

depression = 2nd person, usually persecutory “you are a bad person and deserve to die” schizophrenia = 3rd person

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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

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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

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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

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6
Q

depression + mania?

A

first episode of (hypo)mania with depression means it is bipolar

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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

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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

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9
Q

psychotic symptoms bipolar?

A

grandiose delusions

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10
Q

onset bipolar?

A

usually late teens

FH results in earlier onset onset

>60 is rare and associated with worse outcomes

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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

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12
Q

bipolar I vs II?

A

bipolar I = mania + depression

bipolar 2 = hypomania + depression

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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

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14
Q

mood vs affect?

A

mood - how you feel

effect - how patient appears (flattened, emotional labile)

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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

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16
Q

how to assess cognition?

A

MMSE

MOCA

ACE-III

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17
Q

drugs that most effectively cross BB?

A

hydrophobic/lipophillic

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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)

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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

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20
Q
A

D - nausea

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21
Q
A

citalopram

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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!!

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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)

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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 :)

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25
Q

atypical antidepressant drugs?

mechanism + side effects?

A

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

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26
Q
A

ataxia

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27
Q
A

FALSE - renal metabolism

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28
Q
A

B - increase in lithium levels

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29
Q

lithium drug?

what is important when prescribing lithium?

A

lithium carbonate

requires monitoring

* 12 hours post dose

* target range is 0.4-1.0 mmol/l

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30
Q

Side effects lithium

toxic effects?

A

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

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31
Q
A

E - valproic acid (teratogenic)

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32
Q

anticonvulsant mood stabilisers?

side effects?

A

valproic acid, lamotrigine, carbamazepine

valproate + carbamazepine = induces liver enzymes, ataxia, drowsiness, arrhythmia

valproate is teratogenic (neural tube defects)

lamotrigine = small risk of SJS

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33
Q

antipsychotics as mood stabilisers

side effects?

A

quetiapine, apiprazole, olanzapine

side effects

* weight gain, sedation, metabolic syndrome (others covered in schizophrenia)

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34
Q

how long should you trial antidepressant?

is it stopped immediately after remission?

A

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!!!

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35
Q

acute mania Tx?

A

1st line = antipsychotic (olanzapine, quetiapine, risperidone)

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36
Q

bipolar Tx?

what about bipolar depression?

A

1st line = lithium

2nd line = antipsychotics, anticonvulsants

antidepressants should NOT be prescribed without an antimanic drug

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37
Q

ECT complication?

A

memory problems - episodic memory

ability to learn new information is not affected

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38
Q

Anorexia nervosa ICD-10

A

BMI <17.5

self-induced weight loss (dieting, vomiting, excessive exercise)

body image isturbance

fear of fatness

amenorrhoea/sexual dysfunction in men

delaye dpuberty

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39
Q

physical assessment anorexia?

A

muscle wasting, hair loss

lanugo hair

cold, blue peripheries

dry skin

hypercarotenaemia (orange palms)

bradycardia, hypotension

bruising

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40
Q

high risk anorexia

A

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

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41
Q

important to avoid when treating anorexia?

A

refeeding syndrome

patient given too many calories too quickly - fatal

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42
Q

Tx anorexia

co-morbidities?

A

CBT

dietician

family therapy

inpatient tx for high risk

co-morbs = depression, OCD, autism

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43
Q

bulimia nervosa ICD-10

A

persistent preoccupation with eating

irresistable craving for food

binges + attempts to counter effects of binges (starvation, laxatives, purging)

morbid dread of fatness

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44
Q

physical assessment bulimia?

A

Russel’s sign

parotid hypertrophy

dental caries

U + Es (hypokalaemia - can lead to seizures)

ketones - dehydration

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45
Q

cluster A personality disorders

A
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46
Q

cluster B personality disorders

A
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47
Q

cluster C personality disorders

A
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48
Q

Tx personality disorders?

A

pharmaoclogical treatment not recommended by NICE!!

For BPD, 1st line = DBT

rest = CBT, some req inpatient care

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49
Q

1st v 2nd v 3rd gen antipsychotics

A

1st = chlorpromazine, haloperidol, prochlorperazine

2nd = clozapine, olaznapine, quetiapine, risperidone

3rd = aripiprazole

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50
Q

Tx schizophrenia?

A

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

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51
Q

antipsychotic mechanism?

A

dopamine (D2) antagonists

except clozapine - D4

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52
Q

side effects antipsychotics? + pathways

A

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

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53
Q

acute dystonia antipsychotics?

Tx?

A

onset in minutes

increased muscle tone

torticollis

oculogyric crisis

tongu eprotrusion

Tx = procyclidine (anticholingeric)

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54
Q

parkinsonism antipsychotic?

Tx?

A

bradykinesia

cogwheeling rigidity

shuffling gait

hypomimia

Tx = procyclidine

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55
Q

tardive dyskinesia antipsychotic?

Tx?

A

often permanent

involuntary repetative oro-facial movements e.g. pouting, lip-smacking

doesn’t reallt respond to procyclidine like acute dystonia or parkinsonism

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56
Q

when to suspect neuroleptic malignant syndrome?

Diagnostic test?

Treatment?

A

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

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57
Q

effects of antipsychotic hyperprolactinaemia in women?

Men?

both?

A

Women = galactorrhoea, decresed libido, amenorrhoea

men = gynaecomastia, erectile dysfunction + oligospermia, decreased libido

both = osteoporosis

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58
Q

Akathesia symptoms?

Tx?

A

pacing

unable to sit/stand still

Tx = propanolol 1st line

2nd line = benzo

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59
Q

anticholingeric side effects?

5HT2?

anti-adrenergic?

A

anticholinergic = dry mouth, blurred vision, constipation, urinary retention

5HT2 = weight gain, metabolic syndrome (T2DM)

anti-adrenergic = postural hypotension

all seen in antipsychotic use

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60
Q

1st gen vs 2nd gen antipsychotic side effects?

A

1st gen = extra-pyramidal side effects (dystonia, parkinsonism, TD)

2nd gen = weight gain, sedation, diabetes

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61
Q

clozapine side effects

monitoring?

A

ANGRANULOCYTOSIS = neutropenic sepsis

myocarditis

constipation (bowel obstruction)

weight gain

sedation

sialorrhoea

weekly WBC count for first 6 months

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62
Q

age of onset depression?

bipolar?

personality disorders?

A

depression = 50% before 20

bipolar = approx 25

personality disorders = can only be diagnosed after 18

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63
Q

seperation anxiety disorder (SAD)?

A

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

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64
Q

delerium features?

A

Acute onset

Lasts for hours to weeks

Fluctuates (worst at night)

Attention decreased or hyperalert

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65
Q

Ax delirium?

A

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

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66
Q

pseudodementia features?

A

Fluctuating loss of memory

Good insight into loss of memory

Prominent slowing of speech

Depressed mood

Not progressive

Responds to medication/ECT

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67
Q

Tx anxiety?

A

CBT first!

1st line mediciation = SSRI (sertraline)

benzodiazepines

avoid propanolol in young people

68
Q

medication process for depression?

A

SSRIs 1st line!!

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
Q

classic characterisitcs of psychosis?

Ax psychosis?

A

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
Q

ideas of reference?

examples?

A

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
Q

self-referental experiences?

A

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
Q

delusion?

types?

A

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
Q

thought disorder?

A

Reflected in speech

  • Clanging and punning
  • Loosening of associations
  • Knight’s move thinking
  • Neologisms
  • verbigeration/word salad
  • circumferentiality/tangentiality
74
Q

thought interference?

A

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
Q

passivity of volition?

affect?

impulse?

A

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
Q

3rd person auditory hallucinations?

A

schizophrenia

77
Q

s/s delirium?

A

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
Q

depressive psychosis?

A

Delusions of worthlessness/guilt/hypochondriasis/poverty/sin/nihilism

Cottard’s syndrome

Hallucinations of accusing/insulting/threatening voices - typically 2nd person

79
Q

mania with psychosis?

A

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
Q

schizophrenia ICD-10?

A

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
Q

positive vs negative symptoms schizophrenia

82
Q

hebephrenic schizophrenia?

A

the type you think of when you picture schizophrenia

83
Q

acute and transient psychotic disorder?

A

Schizophrenia-like symptoms lasting <1 month

84
Q

just learn this in case asked to feedback mental state exam

85
Q

chance of passing schizophrenia to child?

A

If one parent has schizophrenia, chance is approx 10%

86
Q

risk factors schizophrenia?

A

genetics

2nd trimester viral illness

obstretric problems - pre-eclampsia, foetal hypoxia, emergency c-section

substance misuse = THC, cocaine, amphetamines

87
Q

schizophrenia effect on brain

88
Q

Section 47 AWIA (adults with incapacity act)?

A

used to authorise treatment of PHYSICAL disorder in somone without capacity to consent

89
Q

powers of welfare guardian?

A

make welfare/financial decisions for patient

Cannot place the adult in hospital for treatment of mental disorder against their will

90
Q

Mental Health Act?

subcategories?

A

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
Q

criteria for emergency detention?

92
Q

criteria for short term detention?

93
Q

children and consent?

A

16 years - presumed to have capacity to make most decisions about treatment and care

94
Q

incapacity in young people?

what about Mental Health Act?

A

incapacity in young people = the Children Act

  • if young person lacks capacity, ask one parent for consent
  • if parents diagree = legal advice
96
Q

SIDMA?

A

not the same as incapacity - caused by mental disorder alone

incapcity is decreased congition

97
Q

features of emergency detention order?

A

lasts for 72 hours

does not authorise treatment!!!

its used to assess patient

98
Q

features of short term detention order?

A

unlike emergency detention, this does authorise treatment

99
Q

compulsory treatment order?

100
Q

in what circumstances can treatment be given under emergency detention order?

A

must completet T4 certificate afterwards

101
Q

what treatments cannot be given under short term detention or compulsory treatment order?

A

electroconvulsive therapy

artificial nutrition

vagus nerve stimulation

transcranial magnetic stimulation

any medicine given to reduce sex drive

neurosurgery

102
Q

advance statement?

103
Q

advocacy and named person?

104
Q

ADHD triad?

A

Inattention

Hyperactivity

Impulsivity

105
Q

genetics ADHD?

A

60% increased risk for ADHD for offspring of adults with ADHD

106
Q

Ax ADHD?

A

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
Q

neurobiology ADHD?

A

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
Q

diagnostic criteria ADHD

109
Q

Tx ADHD?

A

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
Q

mechanism methylphenidate?

A

Increase dopamine by blocking its transporter

111
Q

ASD disorders?

A

ASD refers to 5 different disorders

  • Asperger’s syndrome
  • Rett’s syndrome
  • Childhood autism
  • Pervasive developmental disorder
  • Pervasive developmental disorder NOS
112
Q

triad of impairments ASD?

plus one?

A

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
Q

Ax ASD?

A

genetics

umbolical cord complications

foetal distress

birth injury

congenital malformations

maternal haemorrhage

low birth weight/SGA

114
Q

diagnostic tools ASD?

A

3di, DISCO, Autism Diagnostic Observation Schedule (ADOS)

115
Q

Tx ASD?

A

Self and family psychoeducation

Behaviour analysis, speech and language therapy, social skills training

Family and school supports

116
Q

intellectual disability?

A

Deficits in intellectual functioning

Occurs <18 years

117
Q

Dx intellectual disability?

A

WAIS scale

118
Q

is dementia an intellectual disability?

A

NO occurs <18 y/o

things like: dyslexia, acquired brain injury, dementia are not intellectual disabilities

119
Q

severity intellectual disability?

A

Borderline ID - IQ 70+

Mild ID - IQ 50-69

Moderate ID - IQ 35-49

Severe ID - IQ 20-34

Profound ID - IQ <20

120
Q

Ax intellectual disability?

A

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
Q

intellectual disability co-morbidities?

A

more likely to have mental illness + dementia

(schizophrenia + depression 3 times more common)

122
Q

GAD?

Tx?

A

Anxiety that is generalised and persistent

Not specific to certain situations

Tx = CBT + SSRIs

123
Q

panic disorder?

S/s?

Tx?

A

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
Q

types of phobia?

Tx?

A

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
Q

OCD?

A

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
Q

Dx OCD?

A

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
Q

Tx OCD?

A

CBT

SSRIs/clomipramine

128
Q

neurobiology findings trauma

129
Q

PTSD ICD-10?

A
  • Traumatic event
  • Intrusive symptoms (nightmares, flashbacks)
  • Avoidance symptoms
  • Negative alterations in cognition and mood
  • Increased arousal and reactivity (hypervigilance, sleep disturbance)
130
Q

complex PTSD?

A

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
Q

comorbidity PTSD?

A

>80% have depression, drug + alcohol abuse, or anxiety

132
Q

Tx PTSD?

A

CBT/EMDR

antidepressants (SSRI)

antipsychotics for severe hyperarousal

prazosin

mood stabilisers e.g. carbamazepine

133
Q

neurobiology of fear

A

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
Q

mechanism benzodiazepines?

A

enhance GABA action

135
Q

benzodiazepine withdrawal s/s?

A

Abdominal cramps

Increased anxiety, panic attacks

  • chest pain, palpitations, sweating, shaking

Blurred vision

Depression

Insomnia, nightmares

Dizziness

Headaches

Nausea + vom

136
Q

how to Tx benzodiazepine dependency?

A

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
Q

PTSD <4 weeks trauma?

A

don’t treat - watchful waiting

138
Q

hazardous drinking?

harmful drinking?

A

hazardous = anyone drinking >14 units a week but without alcohol-related problems

harmful = consuming >35 units per week

139
Q

alcohol and cancer?

A

Increases risk for 7 types of cancer

Breast, bowel, liver, oesophagus, larynx, mouth, throat

140
Q

tools for alcohol screening?

A

FAST

AUDIT (alcohol use disorders identification test)

CAGE - screening for dependence

141
Q

alcohol/drug dependance syndrome ICD-10?

A

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
Q

alcohol withdrawl s/s

resolves?

complication?

A

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
Q

delerium tremens occurs when?

s/s?

A

Peak onset within 2 days of abstinence

s/s

  • Confusion (espcially at night)
  • Disorientation
  • Agitation
  • Hypertension
  • Fever
  • Visual and auditory hallucinations
  • Paranoid ideation
144
Q

Tx alcohol withdrawal?

A

Benzos!!

  • Use long-acting agents - diazepam or chlordiazepoxide

Vitamin supplementation - thiamine as prevention of Wernicke’s encephalopathy

hydration, anti-emetics etc

145
Q

addictive drugs activate?

A

dopamine receptors in mesolimbic pathway

146
Q

areas of brain invlved in addiction

148
Q

Tx alzheimers?

A

1st line = cholinesterase inhibitors e.g. donezapil, galantamine, rivastigmine

2nd line = NMDA receptor antagonists e.g. memantine

149
Q

A - lithium carbonate

B - olanzapine

C - risperidone

D - venlafaxine

E - Quetiapine

A

E - quetiapine

150
Q

opoid dependence Tx?

Best option?

A

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
Q

opoid overdose?

152
Q
A

mild intellectual disability (50-69)

153
Q
A

often patients have no awareness

154
Q
A

methylphenidate because of age and severity

155
Q

is EMDR 1st line for PTSD?

A

no 2nd line after CBT

165
Q
166
Q

types of memory loss?

A

Semantic

Episodic

Dates, deadlines, meals (short term memory)

167
Q

Visuospatial impairment?

3rd year medicine (13 decks)

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