Psychiatry COPY Flashcards
How is depression diagnosed?
ICD-11 criteria
(international classification of diseases)
Depression is;
“…concurrent presence of at least five out of a list of ten symptoms, which must occur most of the day,
nearly every day, for at least 2 weeks.

What questionnaire can be used to aid a diagnosis of depression?
Patient Health Questionnaire (PHQ)-9
9 questions
Max score - 27 (severely depressed)
Min score - 0

Issues and Side effects of SSRI’s
Issues:
Bleeding risk (PPI?)
Interactions (SJW/Tramadol - Serotonin Syndrome)
Hypersensitivity
Side effects:
Minor sedation
Dizziness
Anxiety
Anti-muscurinic (diarrhoea/constipation)
GI
Sexual Dysfunction
Hyponatraemia (elderly - PPI causes hyponatraemia aswell)
Suicidal Ideation
Medication options for Depression
- Consider previously successful drugs
first. *
1st Line – SSRI
2nd Line – Alternative SSRI
3rd Line - Mirtazapine (stimulates appetite) or SNRI or
Trazodone/Tricyclic (both very sedative)
Tricyclic are a worry due to potential for overdose and cardiac arrythmias (cause irreversible cardiac damage and management for trycyclic overdose is purely supportive)

2 common questionaires to assess anxiety:
GAD-7 (General Anxiety Disorder-7)
Hospital Anxiety and Depression Scale (HADS)

Annual Health Check for adults and children aged ___ or above with learning disabilities.
14
When starting an anti-psychotic a Patient’s B.P, pulse rate, HbA1c level, serum cholesterol level and lipid profile should all be checked at ____ weeks, then at ____ and then annually thereafter.
Patient’s weight should be checked weekly for the first ____ weeks, then at ____ weeks, then at one year and then annually thereafter.
Waist circumference should be measured _____.
12
one year
6
12
annually
What is metabolic syndrome? Which class of medications are likely to cause this?
- Essential hypertension
- Truncal Obesity
- Insulin resistance
- Low glucose tolerance
- Dyslipidaemia/Hypercholesterolaemia
*2nd generation antipsychotics*
______ is caused by vitamin B3 (niacin) deficiency and is characterised by _____, _____ and ____.
Pellagra is caused by vitamin B3 (niacin) deficiency and is characterised by Dementia, Dermatitis and Diarrhoea. (3Ds)
Other features include hair loss, sunlight sensitivity and glossitis (“beefy tongue”). If left untreated, this can lead to Death. Alcoholism and Crohn’s disease are both risk factors for Pellagra due to malnutrition/malabsorption.
The first-line pharmacological therapy for moderate to severe Alzheimer’s disease is _____, which can cause ______.
Memantine (NMDA receptor antagonist)

Constipation
If nutritional intake is resumed too rapidly after a period of relatively low caloric intake, the patient is at high risk of _____. Rapidly increasing insulin levels lead to shifts of ____, _____ and from extracellular to intracellular spaces. This is potentially fatal if refeeding is too rapid.
refeeding syndrome
remember PIMP
Potassium Insulin Magnesium and Phosphate
Symptoms of refeeding syndrome may include ____ , ____ and ____. Blood tests initially show hypophosphataemia and it is treated with phosphate supplementation.
oedema
confusion
tachycardia
Because of the resulting malnutrition, those with Anorexia Nervosa are predisposed to cardiac arrhythmias.
An ECG should always be performed in those admitted to hospital with Anorexia Nervosa, in outpatient treatment or in those with symptoms such as dizziness, fainting or light-headedness.
In the body’s attempts to reduce energy expenditure with minimal calorie intake, _____ and _____ are commonly seen, as well as a ______ . This increases the risk of a fatal arrhythmia such as Ventricular Fibrillation.
bradycardia and hypotension
prolonged QT interval
Paranoid schizophrenia, as with any psychotic disorder, is treated first-line with atypical antipsychotics such as _____ .
Risperidone or Olanzapine (dopamine receptor antagonists)
NICE recommends ____ for children and young people whose schizophrenia has not responded to adequate doses of at least two different antipsychotics used sequentially for 6-8 weeks.
Clozapine (shown to be the most efficacious anti-psychotic and so used as last resort)
There are a number of conditions that can mimic schizophrenia:
1. Substance induced psychotic disorder (commonly drugs of abuse, but can be iatrogenic e.g. steroids)
2. Organic psychosis caused by infection, brain injury and CNS diseases such as Wilson’s disease
3. Metabolic disorder such as hyperthyroidism and hyperparathyroidism
4. Dementia and depression can also co-occur with psychosis
Description of dementia, which presents with progressive impairment of ____ , _____ and ____.
IMPairment:
Intellect
Memory
Personality
What is the key distinguishing feature between Anorexia nervosa and bulimia nervosa?
BMI
with most guidelines using a BMI of 17.5 as a diagnostic feature of anorexia nervosa.
Most individuals with bulimia nervosa are in the normal weight range (BMI: 18.5 - 30).
Calluses on the back of the hand as a result of repetitive tooth induction from induced vomiting can be a feature of both bullimia nervosa and anorexia nervosa and is called ____ sign.
Russell’s
Common symptoms of opiate intoxication include:
Drowsiness
Confusion
Decreased respiratory rate
Decreased heart rate
Constricted pupils
Clozapine needs careful blood monitoring with:
Baseline:
FBC
CRP
Troponin-T level
(CRP and Troponin-T to be checked weekly for first six weeks).
Weekly FBC for
- first 18 weeks
- then fortnightly up to one year of treatment
- then four-weekly thereafter.
What is the most notable side effect to be aware of in patients taking anti-psychotics?
Which medication can be used as an alternative if this happens?
Antipsychotic medications commonly also produce ____ symptoms as side effects.
Hyperprolactinaemia
Aripiprazole (also a useful alternative if patient is putting on weight with other antipsychotics)
extrapyramidal
Antipsychotics can cause hyperprolactinaemia. Prolactin production can be stimulated by dopamine receptor antagonists such as Risperidone and many other antipsychotic medications. Hyperprolactinaemia in men can present with gynaecomastia, galactorrhoea, reduced libido and erectile dysfunction. Hyperprolactinaemia in women can present with galactorrhoea and menstrual dysfunction.
Treatment with the responsible antipsychotic should be stopped and alternative medications or adjuncts considered. Aripiprazole is one of the antipsychotics that does not raise prolactin as much as others, so is often a good alternative or adjunct.
The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.
If a patient is voluntarily in hospital and needs to be sectioned under the mental health act a section ____ can be issued by the doctor. This permits detainment for ____ hours for further assessment.
5(2)
72 hours
Sectioning under the Mental Health Act (MHA) is used for those over ____ years of age who will not be admitted voluntarily.
16 years




