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Phase 3a conditions list flashcards > Psychiatry - general, legal and Ppsychopharmacology > Flashcards

Psychiatry - general, legal and Ppsychopharmacology Flashcards

1
Q

What are the ‘5 Ps’ that formulate/ summarise a patients difficulties, what might be causing them and make sense of them?

A
  • Predisposing
  • Precipitating
  • Presenting complain
  • Perpetuating
  • Protective
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2
Q

What model helps summarise/ categorise the risk factors and treatment for a mental health condition?

A

Biopsychosocial model

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3
Q

What makes up the biological aspects of the biopsychosocial model (4)?

A
  • Genetics
  • Birth/ pregnancy complications
  • Past medical history
  • Medications/ drugs
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4
Q

What makes up the psychological aspect of the biopsychosocial model (4)?

A
  • Trauma/ abuse
  • Self esteem
  • Mood
  • Personality
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5
Q

What makes up the social aspect of the biopsychosocial model (4)?

A
  • Relationships
  • Finances
  • Stress
  • Culture
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6
Q

What are some extra things to ask about in a psychiatric history (3)?

A
  • Personal timeline - childhood, abuse/ trauma, etc
  • Suicide + self harm
  • Legal involvement
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7
Q

What are the important parts of a mental state examination (7)?

A
  • Appearance + behaviour
  • Speech
  • Emotion (mood + affect)
  • Perception (delusions…)
  • Toughts
  • Insight
  • Cognition
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8
Q

What is psychosis?

A

Loss of touch with reality (often with impaired functioning)

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9
Q

What is a hallucination?

A

Perception in the absence of a stimulus that has the sense of reality

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10
Q

What is a pseudohallucination?

A

A hallucination that the person is able to determine is not real

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11
Q

What is an illusion?

A

Wrong interpretation of a real stimulus e.g. leaves rustling = footsteps

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12
Q

What is a delusion?

A

Fixed false unshakable belief out of keeping with social norms

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13
Q

What is a delusional perception?

A

A false meaning to a true/ correct perception e.g. the traffic light is red, therefore the martians are landing

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14
Q

What are delusional perceptions pathogneomic for?

A

Schizophrenia

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15
Q

What are some types of thought disorders (9)?

A
  • Circumstantiality
  • Tangentiality
  • Neologisms
  • Clang association
  • Word salad
  • Knights move thinking
  • Flight of ideas
  • Perseveration
  • Echolalia
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16
Q

What is circumstantiality?

A

Answering a question with excessive detail and wandering, however RETURNING to the original question and answering it

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17
Q

What is tangentiality?

A

Wandering from a topic WITHOUT returning to it

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18
Q

What are neologisms?

A

New word formations e.g. combining two words to create a new one

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19
Q

What is clang association?

A

Ideas are related only because they sound similar/ rhyme

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20
Q

What is a word salad?

A

Real words strung together in a nonsense sentence

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21
Q

What is knights move thinking?

A

Unexpected and illogical leaps from one idea to another

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22
Q

What is flight of ideas?

A

Leaps from one topic to another with discernible links

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23
Q

What is flight of ideas a feature of?

A

Mania

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24
Q

What is perseveration?

A

Repetition of words despite attempt to change the topic

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25
Q

What is echolila?

A

Repeating words/ phrases that the other has said

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26
Q

What are two types of speech?

A
  • Pressure = rapid (mania)
  • Poverty = lack of (depression, dementia)
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27
Q

What is munchausens?

A

Fabrication of physical or psychological symptoms

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28
Q

What is malingering?

A

Fabrication of symptoms for financial/ personal gain

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29
Q

What is an obsession?

A

Mental preoccupation - pervasive + recurrent

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30
Q

What is a compulsion?

A

An urge and action (physical or mental) to obtain relief

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31
Q

What are some common ways peoples thoughts are affected (4)?

A
  • Broadcasting
  • Insertion
  • Withdrawal
  • Passivity - controlled by external source
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32
Q

What are the common types of delusions (4)?

A
  • Persecutory (mistreated, trying to harm them, spying)
  • Grandiose (one has special powers/ wealth)
  • Guilt + worthlessness
  • Nihilistic (nothing has value/ meaning)
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33
Q

What is capgras delusion?

A

Close relative replaced with imposter

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34
Q

What is cotard delusion?

A

Belief they are rotting/ dying

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35
Q

What is fregoli delusion?

A

Everyone is one person with masks

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36
Q

What is orthello delusion?

A

Believe partner is cheating on them

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37
Q

What is De Clerambault delusion?

A

Beliefe a high status person is in love with them

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38
Q

What is the relationship between the mental capacity and mental health act?

A

Mental health act can “override” capacity act - if patient has capacity they can still be detained

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39
Q

What circumstances can a patient be detained under the mental health act (3)?

A
  • Evidence of mental health illness
  • Risk to society or themselves
  • Will benefit from admission
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40
Q

What are the principles of detention under the mental health act (3)?

A
  • Least restrictive
  • Patient safety protected
  • Effective treatment available + given
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41
Q

What are the different sections of the mental health act that are important to know?

A
  • Section 2
  • Section 3
  • Section 5(2)
  • Section 5(4)
  • Section 135
  • Section 136
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42
Q

What does section 5(2) allow for?

A

Doctors holding power - detention for 72 hours

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43
Q

What does section 5(4) allow for?

A

Nurses holding power - detention for 6 hours

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44
Q

What does section 2 of the MHA allow for?

A

Admission for investigations for 28 days

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45
Q

Can section 2 of MHA be renewed?

A

No

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46
Q

What does section 3 of the MHA allow for?

A

Admission for treatment for 6 months

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47
Q

Can section 3 of MHA be renewed?

A

Yes first of all for another 6 months, then for 1 year each time

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48
Q

Who is required for detention under section 2 and 3 of MHA (3)?

A
  • Approved mental health professional (usually a social worker)
  • A section 12 doctor (usually a psychiatrist)
  • Another doctor (ST4< - usually their GP)
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49
Q

What are the classes of antidepressants (5)?

A
  • Selective serotonin reuptake inhibitors (SSRIS)
  • Serotonin noradrenaline reuptake inhibitors (SNRIs)
  • Monoamine oxidase inhibitors (MAOI)
  • Tricyclic antidepressants (TCAs)
  • Noradrenergic and specific serotonergic antidepressants (NaSSA)
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50
Q

How long do antidepressants typically take to start working?

A

4-6 weeks

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51
Q

When should a follow up be arranged for those starting antidepressants (2)?

A
  • Within 2 weeks (if over 25)
  • Within 1 week (if under 25)
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52
Q

How long should antidepressants be continued for after making a good recovery?

A

At least 6 months

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53
Q

How quickly should antidepressants (SSRIs) be discontinued?

A

Over period of 4 weeks
fluoxetine immediately

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54
Q

What are some signs/ symptoms of discontinuation syndrome (6)?

A
  • Electric shocks
  • Sweating
  • Unsteady
  • Diarrhoea
  • Mood changes
  • Restless
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55
Q

What is a particular risk of starting antidepressants for those under 30?

A

High suicide risk in first few weeks

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56
Q

What is the mechanism of SSRIs?

A

5HT (serotonin) presynaptic reuptake inhibitors

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57
Q

What are some examples of SSRIs?

A
  • Sertraline
  • Fluoxetine
  • Paroxetine
  • Citalopram
58
Q

What are some specific features of each of these SSRIs (4)?

A
  • Sertraline = good for GAD, OCD, PTSD, breastfeeding
  • Fluoxetine = for children (only licensed SSRI
  • Paroxetine = for breastfeeders, high risk of discontinuation syndrome
  • Citalopram = QT prolongation –> torsades de points
59
Q

What are some side effects of SSRIs (8)?

A
  • Impotence
  • Headaches
  • GI Sx (N+V, pain, GI bleeds)
  • Reduced libido
  • Serotonin syndrome
  • Anxiety/ agitation
  • Reduce seizure threshold
  • Increase risk of bleeding
60
Q

What is a key drug interaction of SSRIs?

A

NSAIDs - both increase risk of bleeding
caution when prescribing - use a PPI

61
Q

What is a blood finding of those raking SSRIs?

A

Hyponatraemia (due to SIADH)

62
Q

What are some effects of SSRI use in the first trimester (2)?

A
  • CHD
  • Cleft lip/ pallate
63
Q

What are some effects of SSRI use in the third trimester?

A

Persistent pulmonary hypertension of the newborn

64
Q

Which antidepressant has been most linked to defects during pregnancy?

A

Paroxetine

65
Q

What is the mechanism of SNRIs

A

NAd + 5HT (serotonin) reuptake inhibitor presynaptically

66
Q

What are two examples of SNRIs?

A
  • Venlafaxine
  • Duloxetine
67
Q

What is duloxetine specifically good for treating?

A

When nerve pain is associated

68
Q

What is the mechanism of action of TCA (2)?

A
  • Serotonin, noradrenaline presynaptic reuptake inhibitors
  • Antagonises Ach + histamine
69
Q

What are three examples of TCAs?

A
  • Amitriptyline (sedative)
  • Imipramine (non-sedative)
  • Clomipramine
70
Q

What are some side effects of TCAs (4)?

A
  • Anticholinergic properties (can’t see, pee, shit, spit - dry eyes, urinary retention, constipation, dry mouth)
  • Impotence
  • Sedation
  • Arrhythmias (tachycardia, long QT, L/RBBB)
71
Q

What are the signs/ symptoms of TCA overdose (4)?

A
  • Confused
  • Dry skin, mouth
  • Dilated pupils + blurred vision
  • Drowsiness
72
Q

How is TCA overdose investigated?

A

ECG = wide QRS, long QT,

73
Q

How is TCA overdose treated?

A

IV sodium bicarbonate

74
Q

What is the mechanism of MAOI?

A

Prevents NAd, Ad and serotonin breakdown in CNS

75
Q

What are some complications of MAOI use (2)?

A
  • Hypertensive crisis due to interaction with cheese (tyramine cheese reaction)
  • High risk of serotonin syndrome
76
Q

What is an example of an NaSSA?

A

Mirtazipine

77
Q

What are some side effects of mirtazipine (2)?

A
  • Weight gain
  • Sedation
78
Q

What specific circumstances is mirtazipine often used for?

A
  • Patient has insomnia
  • Patient underweight
  • Patient on LMWH/ warfarin
79
Q

What drugs increases the risk of serotonin syndrome (5)?

A

SSRIs with:
* MAOIs
* Tramadol
* St johns warts
* Ecstasy
* Amphetamines

80
Q

What are the signs/ symptoms of serotonin syndrome (7)?

A
  • Hyperreflexia
  • Clonus
  • Dilated pupils
  • Hyperthermia
  • Tachycardia
  • Sweating
  • Altered mental state
81
Q

How quickly do symptoms of serotonin syndrome develop?

A

Over hours

82
Q

How is serotonin syndrome investigated (2)?

A
  • Toxicology
  • Raised creatinine kinase
83
Q

How is serotonin syndrome managed (2)?

A
  • Supportive
  • Chlorpromazine (typical antipsychotic, serotonin antagonist)
84
Q

What is the mechanism of antipsychotics?

A

D2 receptor antagonist blocking transmission in the mesolimbic pathway
atypical antipsychotics have more mechanisms

85
Q

How should antipsychotics be stopped?

A

Gradual stopping over more than 3 months
prevents relapse

86
Q

What should be monitored for antipsychotics and how frequently should these be monitored (7)?

A
  • FBC
  • U&E
  • LFTs
  • BMI
  • Prolactin
  • HBA1C
  • BP + ECG
    baseline measurements should be taken, then monitored more frequently during first year, then annually
87
Q

What are the two classes of antipsychotics?

A
  • Atypical
  • Typical
88
Q

What are some examples of typical antipsychotics (2)?

A
  • Haloperidol
  • Chlorpromazine
89
Q

What is the name for the side effects that commonly occur with typical antipsychotics?

A

Extrapyramidal side effects (EPSEs)

90
Q

What is the cause of the extrapyramidal side effects with antipsychotic use?

A

Decreased dopaminergic activity in the nigrostriatal pathway

91
Q

What are some examples of EPSEs (4)?

A
  • Acute dystonia
  • Parkinsonism
  • Akathisia
  • Tardive dyskinesia
92
Q

What is the presentation of acute dystonia from antipsychotic use?

A

Rapid onset sustained muscle contractions e.g. torticollis

93
Q

What is the treatment of dystonia?

A

Procyclidine

94
Q

You know what Parkinsonism is so I am not going to ask you what that is!!

A

HAHA you fucking idiot you had to look it up

95
Q

What is the treatment for Parkinsonism?

A

Procyclidine

96
Q

What is the presentation of akathisia from antipsychotic use?

A

Rapid onset severe motor restlessness

97
Q

How is akathisia treated?

A

Propranolol

98
Q

What is the presentation of tardive dyskinesia from antipsychotic use?

A

Irregular disco-ordinated involuntary movements (like chorea) years after antipsychotic use
usually affects jaw

99
Q

What is the treatment of tardive dyskinesia?

A

Tetrabenazine

100
Q

What are some other side effects of typical antipsychotics (5)?

A
  • Anticholinergic (can’t see, pee, shit or spit)
  • Weight gain
  • Sedation
  • Impaired glucose tolerance
  • Reduced seizure threshold
101
Q

What causes raised prolactin levels with antipsychotic use?

A

Dopamine blockage in the tuberoinfundibular pathway, dopamine surprises prolactin, therefore less dopamine = more prolactin

102
Q

What are the symptoms of high prolactin (3)?

A
  • Lactation
  • Reduced libido
  • Infertility
103
Q

What are some examples of atypical antipsychotics (5)?

A
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Aripiprazole
  • Clozapine
104
Q

What are atypical antipsychotics associated with?

A

Metabolic syndrome

105
Q

When is clozapine prescribed?

A

For treatment resistant schizophrenia (after 2 different antipsychotics have been tried)

106
Q

What are some complications of clozapine (4)?

A
  • Agranulocytosis
  • Hypersalivation
  • Weight gain
  • Constipation
107
Q

How is clozapine monitored (3)?

A
  • Weekly for first 18 weeks
  • Next 16 weeks = biweekly
  • Then monthly
    FBC, BP, BMI…
108
Q

When should the dose of those taking clozapine be retitrated (2)?

A
  • Not taken for > 48 hours
  • Smoking status changed
109
Q

What is a major complication of antipsychotic use?

A

Neuroleptic malignant syndrome

110
Q

What are the signs/ symptoms of neuroleptic malignant syndrome (3)?

A
  • HYPOreflexia
  • Rigidity
  • Normal pupils
111
Q

How quickly do symptoms of neuroleptic malignant syndrome come on?

112
Q

What are blood test finding in neuroleptic malignant syndrome (2)?

A
  • Raised creatinine kinase
  • Raised WCC
113
Q

How is neruoleptic malignant syndrome managed?

A

Bromocriptine (dopamine agonist)

114
Q

What are some complications of neuroleptic malignant syndrome (2)?

A
  • Rhabdomyolisis
  • AKI
115
Q

What are some risks associated with antipsychotic use in the elderly (2)?

A
  • Increased VTE risk
  • Increased stroke risk
116
Q

What are some examples of mood stabilisers (4)?

A
  • Lithium
  • Carbamazepine
  • Sodium valproate
  • Olanzapine
117
Q

What is a theory for the mechanism of lithium?

A

Interferes/ inhibits with cAMP

118
Q

What are two features of lithium in terms of pharmacokinetics (3)?

A
  • Long half life
  • Excreted by the kidneys
  • Narrow therapeutic range - 0.4-1 mmol/l
119
Q

What are some important drug interactions to know about for lithium (3)?

A
  • NSAIDs –> AKI
  • Diuretics –> dehydration
  • ACE-i –> AKI + dehydration
120
Q

What are some adverse effects of lithium (7)?

A
  • Leukocytosis
  • Fine tremor
  • Dehydration + increased thirst (diabetes insipidus)
  • Weight gain
  • Nephrotoxicity + oedema
  • Hyperparathyroid + hypercalcaemia
  • Hypothyroid
121
Q

What is the effect of taking lithium during pregnancy?

A

Ebsteins anomaly

122
Q

What is a rare complication of lithium years after stopping taking it (3)?

A

SILENT (syndrome of irreversible lithium effectuated neurotoxicity)
Neurological Sx:
* Cerebellar symptoms
* EPSEs
* Dementia

123
Q

What are some symptoms of lithium toxicity (3)?

A
  • N+V
  • Course tremor
  • Fatigue
124
Q

When should lithium concentrations be monitored (2)?

A
  • 12 hours after dose
  • Weekly until stable then every 3 months
125
Q

What should be monitored when taking lithium (4)?

A
  • FBC, U&E, TFTs
  • eGFR
  • BMI
  • ECG
126
Q

How do benzodiazepines work?

A

GABA agonists

127
Q

What are benzodiazepines used for (3)?

A
  • Sedation
  • Anxiolytics
  • Anticonvulsants
128
Q

What are 3 examples of benzodiazepines and what is their duration?

A
  • Diazepam = longer acting
  • Chlordiazepoxide = longer acting
  • Lorazepam = shorter acting
129
Q

What are some side effects of benzodiazepines (3)?

A
  • Resp depression
  • Sedation
  • Amnesia (anterograde)
130
Q

How can an overdose of benzodiazepines be treated?

A

Supportive, resp support
IV flumenazil can be used

131
Q

What is another type of anxiolytic other than benzodiazepines?

A

Pregabalin

132
Q

What drug is similar to benzodiazepines and helps with sleep?

A

Zopiclone
and other “Z” drugs

133
Q

What is the mechanism of zopiclone?

A

GABA agonist

134
Q

What is a side effect of zopiclone in the elderly?

A

Increased risk of falls

135
Q

What is ECT?

A

Electroconvulsive therapy - electric currents passed through brain under general anaesthetic, inducing muscle jerks/ seizures

136
Q

What are some side effects of ECT (4)?

A
  • Amnesia
  • Nausea
  • Headaches
  • Arrhythmias
137
Q

What are some contraindication for ECT (4)?

A
  • Raised intracranial pressure = absolute
  • Recent MI
  • Severe hypertension
  • <12 years
138
Q

What are some examples of talking therapies (4)?

A
  • CBT
  • DBT (dialectical behaviour therapy)
  • IPT (interpersonal psychotherapy)
  • Couple therapy
139
Q

What is the approach to CBT (5)?

A
  • Situation
  • Toughts
  • Emotions
  • Actions
  • Pphysical feelings
140
Q

What is dialectical behaviour therapy?

A

Changing negative thinking + promoting acceptance

141
Q

What is IPT?

A

Resolving relationship problems

142
Q

What is couples therapy (3 principles)?

A
  • Improve communication
  • Reduce emotional avoidance
  • Modify dysfunctional behaviour

Phase 3a conditions list flashcards (31 decks)

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