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Year 4 revision > Psychiatry revision > Flashcards

Psychiatry revision Flashcards

1
Q

combination of symptoms for mild, moderate and severe depression

A 
mild = 2 core + 2 additional
mod = 2 core + 3 additional
severe = 3 core + 4 other
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2
Q

how long does a manic episode last

A

1+ weeks

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3
Q

2 antipsychotics associated with the most weight gain

A

olanzapine

clozapine

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4
Q

3 symptoms of NMS

A

lead pipe rigidity
fever
dysphagia

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5
Q

which antipsychotic treats both the positive and negative symptoms of schizophrenia

A

clozapine

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6
Q

presentation of an oculogyric crisis

A

bilateral elevation of gaze (emergency)

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7
Q

1st line treatment of acute dystonia reaction

A

benzotropines

2nd line = benzodiazepam

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8
Q

screening of which other conditions in an anxiety history

A 
OCD 
panic attacks 
depression
ACS - pain OE, feeling sick, sweating 
hyperthyroidism
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9
Q

how long must symptoms of GAD last for

A

at least 6 months

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10
Q

when can OCD be diagnosed in relation to depression

A

ONLY if ruminations arise and persist in the absence of depressive episode

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11
Q

psychological treatments for OCD

A

CBT

ERP (exposure and response prevention)

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12
Q

drug treatments for OCD

A

SSRIs

TCA (clomipramine)

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13
Q

main treatment of PTSD

A

trauma focused CBT:

  • repeated grade exposure
  • testimony based techniques
  • eye movement desensitisation and reprocessing (EMDR)
  • antidepressants - paroxetine/mirtazepine
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14
Q

problems with TCAs

A
  • high toxicity in overdose
  • anticholinergic side effects
  • sedation
  • arrhythmias
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15
Q

2 major side effects of NaSSAs (e.g. mirtazapine)

A

sedative

weight gain

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16
Q

what to check before starting SNRIs (e.g. venlafaxine)

A

BP
ECG

don’t use is patient has CVS problems

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17
Q

common SSRI side-effects

A
  • agitation
  • nausea/loss of appetite
  • indigestion, diarrhoea, constipation
  • loss of libido
  • dizziness
  • dry mouth
  • blurred vision
  • sweating
  • headaches
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18
Q

electrolyte problems with antidepressants

A

hyponatraemia (worst with SSRIs, best with lofepramine/mirtazapine)

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19
Q

complication of MAOIs

A

tyramine cheese reaction - hypertensive crisis

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20
Q

examples of MAOIs

A

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranylcypromine (Parnate)

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21
Q

combinations of drugs which can cause serotonin syndrome

A

SSRIs + TCA / MAOIs / St John’s Wort / MDMA

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22
Q

which antidepressant might cause priapism

A

trazadone

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23
Q

how long should an antidepressant at least be used for

A

4-6 weeks before switched if not working

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24
Q

what might be added in with antidepressants to augment them

A

lithium

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25
Q

baseline investigations undertaken before commencing lithium

A
  • physical and weight
  • U&Es, renal function, TFTs, Calcium
  • ECG
  • pregnancy test
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26
Q

3 drugs to avoid with lithium

A
  • ACEi
  • NSAIDs
  • diuretics especially thiazides
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27
Q

late side effects of lithium

A
  • diabetes insipidus
  • hypothyroidism
  • arrhythmias
  • ataxia
  • dysarthria
  • weight gain
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28
Q

what should happen before ECT is carried out

A

at least 2 types of treatment trialled

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29
Q

how long does CBT last for

A

16-20 sessions over 3-4 months

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30
Q

who must be present in a MHA assessment

A

2 doctors and 1 AMHP

one doctor must be section 12 approved

AMHP is independent and makes the final decision

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31
Q

what are under the 3 rights to treat of the MHA

A
  1. Cause of mental disorder: organic illness
  2. Mental disorder itself: ECT, psychotropic medications
  3. Direct consequences of mental disorder: Addiction, self-harm, neglect, overdose, feeding in eating disorder
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32
Q

how long does an emergency vs standard DoLs last

A

7 days vs 1 year

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33
Q

organ conditions common in Down’s syndrome

A

A/VSD

oesophageal atresia

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34
Q

6 other conditions associated with Down’s syndrome

A 
cataracts
hypothyroidism
chest infections
transient leukaemia
epilepsy
AD
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35
Q

leading preventable non-genetic cause of learning disability is

A

foetal alcohol syndrome (25-30% have learning disability)

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36
Q

most common inherited cause of learning disability

A

fragile X syndrome (CGG triplet repeat in FMR-1 gene)

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37
Q

2 domains of diagnostic criteria of autism spectrum disorder

A
  • social interaction and communication

- repetitive behaviours

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38
Q

what should always be looked for in learning disabilities with depression

A

hypothyroidism - especially in Down’s syndrome

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39
Q

which genetic condition is associated with an increased risk of psychosis

A

DiGeorge syndrome (22q11.2 deletion)

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40
Q

mechanism of action of alcohol

A

GABA agonist (inhibitory neurotransmitter) and glutamate receptor antagonist = relaxation and disinhibition

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41
Q

what medication is used to reduce alcohol cravings

A

naltrexone

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42
Q

when might grand-mal seizures occur after last alcoholic drink

A

6-48 hours after

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43
Q

3 things making delirium tremens more likely

A

comorbid infection
liver disease
heavy dependence

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44
Q

symptoms of delirium tremens

A
  • Clouding of consciousness
  • Amnesia
  • Pyscho-motor agitation
  • Lilliputian hallucinations (people/animals-tiny)
  • Marked fluctuations in consciousness- worse in evenings
  • Raised temp
  • Paranoia
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45
Q

what is mydriasis

A

dilation of pupils (side effect of MDMA)

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46
Q

what class are amphetamines

A

B, A if injected

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47
Q

what does a young person presenting to A&E with changes on ECG/chest pain and signs of MI indicate

A

potential cocaine use

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48
Q

what class are benzos

A

class C - binds to GABA and increases effect of GABA (agonist)

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49
Q

what scale is used in opiate withdrawal

A

COWS: clinical opiate withdrawal scale

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50
Q

signs of opiate withdrawal

A
  • Sweating
  • High resting pulse rate (80-120+)
  • Restlessness
  • Increased pupil size
  • Bone and joint aches
  • Runny nose
  • GI upset
  • Tremor
  • Anxiety/irritability
  • Gooseflesh skin
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51
Q

2 main drug treatments in opiate addiction

A 
methadone
buprenorphine (sublingual)

also can use lofexidine or naltrexone (which is used in alcohol withdrawal)

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52
Q

half life of methadone

A

24 hours - can be reduced to 8 in pregnancy

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53
Q

differential diagnoses for dementia in the elderly using DEMENTIA mnemonic

A 
Drugs and delirium 
Emotions/depression
Metabolic disorders
Eye and ear impairment
Nutritional disorders
Tumours, toxins, trauma, thyroid
Infections, 
Arteriosclerosis, alcohol
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54
Q

3 main domains of dementia

A
  • disturbance of multiple higher cortical functions
  • deterioration in judgement and thinking, processing of information, emotional control, social behaviour/motivation
  • NO CLOUDING OF CONSCIOUSNESS
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55
Q

how long must symptoms be present for dementia diagnosis to be made

A

6 months +

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56
Q

organic conditions - differentials for dementia

A
  • low B12, ferritin or folate
  • abnormal endocrine functions (HYPOTHYROIDISM)
  • electrolyte abnormalities - Ca2+
  • chronic alcohol intake
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57
Q

3 acetylcholinesterase inhibitors for AD

A

rivastigmine
galantamine
donepezil

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58
Q

why are antipsychotics inappropriate for use in controlling BPSD of dementia

A

increase risk of stroke, CVD, Parkinsonism side effects, falls and death

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59
Q

which antipsychotic is the only one licensed for use in agitation in dementia

A

risperidone

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60
Q

3 subtypes of pronto-temporal dementia (FTD)

A
  • behavioural-variant FTD
  • progressive non-fluent aphasia
  • semantic dementia (loss of long term memory of things which aren’t personal e.g. colours, numbers)
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61
Q

investigation of choice in FTD

A

MRI - FT atrophy can be seen

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62
Q

which medication should NOT be used in FT dementia

A

acetylcholinesterase inhibitors

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63
Q

some managements of FTD

A
  • symptomatic
  • psychosocial
  • SSRIs???
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64
Q

3 core features of LBD

A
  • fluctuating cognition
  • spontaneous motor features of Parkinsonism (70%)
  • 2/3 have visual hallucinations

other features include sleep REM disorder, systematised delusions, depressive episodes, recurrent falls/syncope/LOC

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65
Q

investigations for LBD

A

CT head = generalised atrophy

Spect (DaT scan)

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66
Q

what acetylcholinesterase inhibitor can help with LBD

A

rivastigmine

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67
Q

normal score of the MOCA is

A

above 25

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68
Q

CVS risks in starvation (AN)

A

bradycardia, hypotension, sudden death

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69
Q

CVS risks in binging/purging

A

arrhythmia, cardiac failure, sudden death

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70
Q

renal risks in both AN and BN

A
  • oedema (more severe in BN)
  • electrolyte abnormalities
  • renal calculi
  • renal failure
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71
Q

GI risks of AN

A
  • constipation
  • parotid swelling
  • delayed gastric emptying
  • nutritional hepatitis
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72
Q

thyroid risk in AN

A

hypothyroidism

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73
Q

haematological risks in AN and BN

A
  • AN = anaemia, leucopenia, thrombocytopenia

- BN = leucopenia, lymphocytosis

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74
Q

ECG changes which might be found in AN

A

86% have changes such as:

  • T wave changes due to hypokalaemia
  • bradycardia (<40)
  • QTC prolongation (>450)
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75
Q

4 electrolyte abnormalities in referring syndrome

A

hypophosphataemia
hypomagnesaemia
hypocalcaemia
hypokalaemia

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76
Q

electrolyte abnormalities in laxatives misuse

A

hyperkalaemia
hyponatraemia

vs vomiting which is hypokalaemia

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77
Q

physical risk index used in AN

A

PREDIX - physical risk in eating disorders index

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78
Q

along what guidelines is coordinated care for AN organised

A

MARZIPAN guidelines

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79
Q

1st and 2nd line treatments for BN

A 
1st = CBT
2nd = fluoxetine 60mg
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80
Q

what should be done if an SSRI is ineffective

A
  • dose escalation first
  • then switch to different SSRI or alternative e.g. SNRI
    (venlafaxine or duloxetine)
  • augmentation (lithium)
  • combinations
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81
Q

what might antidepressants be augmented with

A

lithium/quetiapine
risperidone
aripiprazole

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82
Q

2 combinations of antidepressants which can be used

A

venlafaxine and mirtazapine

olanzapine and fluoxetine

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83
Q

antidepressants most likely to cause hyponatraemia and GI bleeds

A

SSRIs

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84
Q

antidepressants most likely to cause hypotension, tachycardia and QTc prolongation

A

SNRIs and NRIs

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85
Q

rare side effect of mirtazapine

A

agranulocytosis

86
Q

what antipsychotic also has an antidepressant effect when given by mouth in small doses

A

flupenthixol

87
Q

D2 antagonism effects

A
  1. Works on Mesolimbic pathway
    - Reduces positive symptoms of schizophrenia
  2. Mesocortical symptom
    - Can worsen negative symptoms of schizophrenia
  3. Nigrostrial pathway
    - EPS, NMS, tardive dyskinesia
  4. Tuberoinfundibular pathway
    - hyperprolactinaemia, sexual dysfunction, weight gain
88
Q

some side effects of antipsychotics due to blockage of M1 receptors

A

blocking cholinergic M1 receptors = constipation, blurred vision, dry mouth, drowsiness

89
Q

side effects of antipsychotics due to blockage of H1 receptors

A

sedation and weight gain

90
Q

when to assess if antipsychotics have worked after starting them

A

over 2-3 weeks - if some effect then continue for 4 weeks

91
Q

which antipsychotics can change seizure threshold and cause QTc prolongation

A

all

92
Q

pharmacological interactions between clozapine and carbamazepine

A

clozapine concentrations are REDUCED by carbamazepine

93
Q

3 medications which can react with antipsychotics to increase QTc

A

ketoconazole
clarithromycin
erythromycin

94
Q

3 main drugs which interact with lithium

A

NSAIDS
thiazide diuretics
ACEis

increases risk toxicity

95
Q

valproate’s main use

A

mania (not as effective as lithium for BPAD)

96
Q

safe plasma levels of valproate

A

50-100mg/L

97
Q

treatment of catatonia

A

high dose benzos

then ECT

98
Q

3 main uses of carbamazepine (enzyme inducer = lots of interactions)

A

anticonvulsant
trigeminal neuralgia
BPAD if unresponsive to lithium

99
Q

safe plasma level of carbamazepine

A

4-12 mg/L

100
Q

drugs which are not compatible with carbamazepine

A 
clozapine (reduced conc) 
valproate
paroxetine
lorazepam
furosemide
lithium
101
Q

what can furosemide cause with carbamazepine

A

hyponatraemia

102
Q

contraindication to benzos

A

severe hepatic impairment

103
Q

signs of lithium toxicity

A 
D+V
confusion, drowsiness
blurred vision 
COARSE tremor
seizures
hypotension
104
Q

4 situations which can lead to lithium toxicity

A

dehydration
excessive alcohol
NSAIDs
diuretics

105
Q

medical treatment of psychosis related aggression

A

haloperidol (otherwise usually lorazepam)

106
Q

what is accuphase

A

zuclopenthixol - v sedating so use on a patient who is constantly v aggressive

107
Q

what can be used to counteract the EPSEs of antipsychotics

A

procyclizine (anticholinergic)

but DON’T use in TD - makes it worse

108
Q

what can be used to treat akathisia (procyclizine doesn’t work)

A

benzos

109
Q

symptoms of NMS (FEVER)

A 
Fever 
Encephalopathy 
Vitals and BP unstable
Enzymes elevated
Rigidity of muscles
110
Q

what is seen on bloods in NMS

A

elevated CK

111
Q

how might NMS be treated

A

benzos
stopping meds
rapid cooling

bromocryptine (rarely)

112
Q

how is serotonin syndrome treated

A

discontinue and supportive

cyproheptadine

113
Q

4 side effects of clozapine

A

paralytic ileus and constipation
hypersalivation
agranulocytosis
myocarditis

114
Q

what stops if patient stops taking clozapine

A

if >48 hours must be re-titrated from baseline

115
Q

another name for anankastic personality disorder

A

OCD-like personality disorder

116
Q

main antipsychotic which has acceptable use in the elderly

A

risperidone - up to 6 week course for aggressive/psychotic behaviour

117
Q

what is folie a deux

A

shared psychotic disorder -

often dominant has primary delusion and dependent develops it

dominant needs formal treatment, dependent needs to be away from dominant for it to disappear

118
Q

which antidepressant is contraindicated in AN

A

bupropion - lowers seizure threshold

119
Q

how long is half life of lithium

A

24 hours

120
Q

if SSRIs/SNRIs aren’t tolerated, what can be used got anxiety

A

pregabalin

121
Q

what can be used to manage moderate-severe tardive dyskinesia

A

tetrabenazine

122
Q

what can happen if using benzos in liver failure

A

hepatic encephalopathy

123
Q

how must flumazenil (antidote for benzos) be administered

A

IM - as IV can irritate the veins

124
Q

what can slate-grey cyanosis be a sign of

A

benzos OD

125
Q

specific side effect of zopiclone

A

taste disturbance

126
Q

specific side effect of zolpidem

A

GI upset

127
Q

cautions and contraindications in AChesterase inhibitors

A

caution = COPD, asthma, PUD

contraindications = heart block and sick sinus syndrome

CORE DRUGS QUIZLET

128
Q

side effects of AChesterase inhibitors

A
  • Nausea, diarrhoea and vomiting: due to increased cholinergic activity in PNS
  • Asthma, COPD- exacerbations
  • Peptic ulcers, bleeding
  • Bradycardia
  • Central cholinergic effects: hallucinations, aggressive behaviour

Small risk of NMS/EPS

129
Q

3 interactions of AChesterase inhibitors

A
  1. NSAIDs/steroids: increased risk of peptic ulcer
  2. Antipsychotics: increased risk of NMS
  3. B-blockers: can cause bradycardia/heart-block
130
Q

caution to memantine

A

epilepsy - can lower seizure threshold

131
Q

side effects of memantine

A
  • loss of balance
  • Constipation
  • Dizziness
  • Drowsiness, headache
  • Dyspnoea
  • Hypertension
132
Q

what is concrete thinking

A

inability to understand abstract ideas/concepts - subjects focused on the here and now

133
Q

what are ideas of reference

A

A delusional belief that innocuous events or coincidences are directly linked and have personal significance to the subject. Common clinical examples are subjects believing that the television or radio is talking about them / to them.

134
Q

what is splitting

A

a primitive ego defense mechanism that places people in good/bad categories

For instance a person who is abused by some-one they love may split that person into a loving and an abusive person

135
Q

5 pathological changes to the brain in Alzheimer’s disease

A
  1. Neurofibrillary tangles
  2. Amyloid deposits
  3. Neuronal loss/cortical atrophy
  4. Senile plaques
  5. Reduction in Acetylcholine synthesis
136
Q

2 genetic risk factors for AD

A
  • presence of 1 or more APOE-e4 alleles

- Down’s syndrome

137
Q

other tests to carry out for AD

A
  • B12/folate (SADC)
  • CA2+ hypercalcaemia
  • Chronic alcoholism
  • Endocrine: HYPOTHYRODISM [TFT’s]
  • MRI: space occupying lesion
138
Q

what is subcortical dementia

A

Dementia caused by disease of small vessels deep in the brain- thought to be most common vascular dementia

Slowness of processing, depression, forgetfulness, impaired cognition, apathy

139
Q

3 main pathophysiologies of vascular dementia

A
  1. Infarction: Ischaemic stroke
    - Embolism, thrombosis, lacunar infarction….
  2. Leukoaraiosis: disease of white matter
  3. Haemorrhagic stroke
140
Q

1st symptoms in VD

A

NOT usually memory loss, instead:

  • Problems planning & organising/making decisions
  • Difficulty doing things with number of steps: making cup of tea
  • Slower speed of thought
  • Problems concentrating
  • Short periods of confusion
141
Q

how is VD managed

A

Main goal is to prevent further strokes:

  • Antiplatelets
  • Carotidectomy in carotic stenosis

Improvement of cognitive symptoms:
- Cholinesterase inhibitors/mematine

Life-style changes:
- Lifestyle modification: regular exercise, weight and glycaemic control, smoking cessation

142
Q

pathophysiology of DLB

A

Alpha-synuclein aggregates form Lewy-bodies which damage neurons in the brain

Lewy bodies contain the neurofilament ubiquitin

143
Q

how is DLB diagnosed

A

Clinical diagnosis:
The diagnosis is Lewy body dementia when:
· Dementia symptoms consistent with Lewy body dementia develop first.
· When both dementia symptoms and movement symptoms are present at the time of diagnosis.
· When dementia symptoms appear within one year after movement symptoms.

144
Q

side effects of giving antipsychotics in DLB

A

postural hypotension

NMD

145
Q

3 side effects of AChesterase inhibitors

A
  • N+V
  • hyper salivation
  • orthostatic hypotension
146
Q

what is posterior cortical atrophy

A

Damage to the areas at back of the brain which help with sight and spatial awareness

  • Problems reading and identifying obkects
  • Struggle to judge distances
  • Uncoordinated
147
Q

what is logopenic aphasia

A

damage to left side of brain = problems with speech

148
Q

what is HIV associated dementia

A

Condition which 30% of HIV patients developed:

  • Movement disorders: tremor, myoclonus
  • Depression, apathy
  • Focal cognitive deficits: amnesia

SUBCORTICAL DEMENTIA

149
Q

triad of symptoms of normal pressure hydrocephalus

A

Clinical symptoms due to build up of CSF:

  1. Abnormal gait
  2. Urinary incontinence
  3. Dementia
150
Q

1st line medical management of delirium

A

haloperidol 0.5mg

151
Q

2 drugs which can induce mania

A
  • SSRIs

- prednisolone (steroids)

152
Q

what is cyclothymia

A

The patient has at least two years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes

153
Q

screening tools for BAD

A
  • PHQ-9 for depression screening
  • Mood disorder Questionairre (MDQ) for mania screening
  • Bipolarity index (score of over 60)
  • Young mania rating scale
154
Q

how long should a mood stabiliser be taken for BAD

A

after 1st episode - at least 2 years

at least 5 years if frequent episodes, psychotic episodes, substance misuse

155
Q

treatments for GAD, panic disorder, social anxiety/phobia, agoraphobia

A

all CBT/SSRI

156
Q

SSRI used in PTSD

A

paroxetine

157
Q

5 criteria (of which 3 must be present) to diagnose anxiety

A
  1. Restlessness/anxiety
  2. Poor concentration
  3. Irritability
  4. Muscle tension
  5. Sleep disturbance
158
Q

which medications can cause anxiety

A
  • Asthma meds: Salbutamol, theophylline
  • Corticosteroids
  • BB’s
  • Antidepressants
  • some herbal medications
159
Q

how long must obsessions or compulsions be present for OCD to be diagnosed

A

most days for period of at least 2 weeks

160
Q

management of OCD

A

Psychological:

  • CBT
  • Exposure and repsponse therapy

Drug treatment:

  • SSRI: sertraline, fluoxetine
  • Clomipramine (TCA) 2nd line
161
Q

negative symptoms of schizophrenia

A
  • alogia (poverty of speech)
  • avolition (lack of motivation)
  • blunted affect
  • anhedonia
  • asociality
162
Q

5 drugs which can induce psychosis

A
  • Steroids
  • L-DOPA
  • Disulfiram
  • Digitalis
  • Anticholinergics
163
Q

how is NMS treated

A
  • stop the offending drug
  • supportive care - IV fluids, balance the electrolytes, treat the rhabdomylosis, cooling blankets
  • bromocriptine
  • dantrolene
164
Q

FEVER acronym for NMS

A

Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigid muscles

165
Q

what is schizotypal disorder

A

Personality disorder which is like a lighter version of schizophrenia
-They don’t experience true hallucinations/delusions, and are open to idea that their perceptions and ideas are distorted

166
Q

2 subtypes of schizoaffective disorder

A
  • bipolar type (younger patients)

- depressive type (older patients)

167
Q

which symptoms are not included in delusional disorder and would instead point to schizophrenia

A
  • Persistent, clear auditory hallucinations
  • Delusions of control
  • Marked blunting of affect
  • Deterioration of personality

delusions must be present for 3+ months

168
Q

what is De Clerambault’s syndrome

A

Also known as Erotomania- delusional belief that a famous person/higher social status is in love with them
- Convinced they communicate love by secret signs

169
Q

what is Capgras syndrome

A

Belief that a spouse/friend/family member has been switched with indentical imposter/double

170
Q

what is Fregoli’s syndrome

A

Belief that multiple people are actually the same person but in disguise
- Patient often believes they are being persecuted by that person

171
Q

what is Cotard’s syndrome

A

Delusion of being dead/dying/rotting, or having lost parts of the body or organs

172
Q

what is Ekbom’s syndrome

A

Delusional parasitosis:

  • Patients claim they are infested with parasites with no evidence (only freckles/spots)
  • Risk of self-harm trying to get rid of them
173
Q

2 contraindications of SSRIs

A
  • epilepsy

- PUD

174
Q

SSRI with highest risk of suicide

A

paroxetine

175
Q

side effect of citalopram

A

QTc prolongation (don’t give with antipsychotics)

176
Q

what is often prescribed with SSRIs and an NSAID

A

PPI

177
Q

3 contraindications for SNRIs (e.g. duloxetine, venlafaxine)

A
  • conditions with high risk cardiac arrhythmia
  • uncontrolled HTN
  • hepatic impairment, severe renal impairment
178
Q

cardiac side effects of SNRIs

A
  • SVT

- torsade de pointes (QTc prolongation)

179
Q

what do antifungals interact with

A

SNRIs

180
Q

which TCA is used for OCD

A

clomipramine

181
Q

receptors affected by TCAs (as well as blocking reuptake of serotonin and norepinephrine)

A

H2
D2
alpha 1 and 2

182
Q

how is TCA overdose managed

A

IV sodium bicarbonate and supportive treatment

183
Q

can you ever give MAOIs and TCAs together

A

no - increase level of 5HT and noradrenaline = serotonin syndrome

184
Q

can MAOIs be used in pregnancy

A

no - increased risk of foetal malformations

185
Q

which brain pathway do antipsychotics work on to target positive symptoms of schizophrenia

A

mesolimbic pathway

186
Q

3 drugs you can never give to Parkinson’s patients

A

haloperidol
metoclopramide
chlorpromazine

187
Q

which pathway do antipsychotics work on to cause EPSEs

A

nigrostriatial pathway

188
Q

main group of drugs which antipsychotics interact with

A

drugs which prolong the QTc interval:

  • macrolides
  • amiodarone
  • citalopram
189
Q

antipsychotic with the strongest link with sexual dysfunction

A

risperidone

190
Q

3 serious side effects of clozapine

A
  • agranulocytosis
  • neutropenia - leading to MYOCARDITIS
  • paralytic ileus (constipation?!)
191
Q

how are antipsychotics monitored

A
  • lipids
  • HbA1c
  • FBC
  • U&Es and LFTs
  • weight and waist circumference
  • ECG - for QTc prolongation
192
Q

what happens if clozapine is stopped

A

if >48 hours - must re-titrate from the beginning

193
Q

what can be used to treat the hypersalivation (from clozapine)

A

procyclizine (anticholinergic)

194
Q

what do 1/3 of people on lithium develop

A

CKD

195
Q

what is section 62 of the MHA

A

A treatment such as ECT can be given WITHOUT consent or 2nd opinion if:

  • It is necessary to save a patient’s life
  • Reversible, to save a patient’s condition
  • Reversible and not hazardous to an to stop patient being a harm to self or others
196
Q

what is congruent affect

A

appropriate mood for the situation

197
Q

only contraindication for ECT

A

raised ICP

198
Q

how can NMS be distinguished from serotonin syndrome

A

SS tends to have clonus of lower limbs

NMS has parkinsonism

199
Q

treatments for NMS

A

1st line = dantrolene
2nd line = bromocryptine
3rd line = ECT

stop drug
rehydration and rapid cooling

200
Q

2 antipsychotics which double the risk of stroke in older people

A

risperidone

olanzapine

201
Q

what should be done if QTc is over 500m/s

A

stop meds immediately - call cardiology

202
Q

triad of 3 most important things to consider when assessing suicide risk

A
  • likelihood - have they made a plan
  • immediacy - when
  • impact - intent to be lethal or self harm
203
Q

what syndrome can present as mania/psychosis

A

22q11 deletion syndrome - DiGeorge syndrome

204
Q

pathophysiology of bipolare

A

deficiency of 5-HT in midbrain

in locus serilius there is more dopamine and noradrenaline - contributes to mania

205
Q

which type of antidepressants shouldn’t be used in BAD (NB: never use antidepressants without a mood stabiliser in BAD)

A

SNRIs - increase noradrenaline as well = more mania

206
Q

some medications used in hypomania

A

benzos - clonazepam, lorazepam

207
Q

what is alexthymia

A

inability to verbally express emotions

208
Q

what are pareidolia illusions

A

seeing shapes in objects e.g. seeing faces in the clouds

209
Q

what are affect illusions

A

illusions based on current affect (feeling)

210
Q

what are hypnogogic and hypnopompic hallucinations

A
  • hypnogogic = occurring as body goes from being awake to asleep
  • hypnopompic = occurring upon awakening

Year 4 revision (5 decks)

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