Psychiatry (rotation To Come) Flashcards
Which drugs can we use to treat PTSD?
An SSRI e.g. escitalopram, fluoxetine, or venlafaxine
Define psychosis.
Loss of connection with reality.
Hallucinations and delusions
What is the difference between hallucination and illusion?
Illusion = there IS an external stimulus. Hallucination = no external stimulus.
Define delusion
False unshakeable belief even where there is evidence showing the contrary.
Which are the 3 causes of organic psychosis?
Drug-induced
Delirium
Dementia
What is the cause of a patient with dementia who sees little figures walking around them.
Organic psychosis - organic cause is the dementia not neccessarily Psychosis itself.
What is schizophrenia?
Disorder of thinking, perceiving and motivation.
Male = female
Lifetime prevalence = 1%
What causes schizophrenia?
Genetic = increased risk in first degree relatives Neuro-chemical = dopamine 'hypothesis', serotonin 'hypothesis'
General findings: reduced brain mass, increased ventricular size - very non specific findings in psychiatry.
name three positive symptoms in schizophrenia
Delusions
Hallucinations
Sense of being controlled
name three negative symptoms of schizophrenia
Loss of motivation
Paucity of thought (just pause thinking)
Loosening of association i.e. scattered thoughts.
What is the cause of depression?
15% genetic prevalence
Neurochemical: Monoamine ‘hypothesis’ = altered function of NA.
What is Beck’s triad?
Self - the future - experiences
What are the core symptoms of depression?
Low mood
Low energy
Inability to enjoy oneself (anhedonia)
Name some biological symptoms of depression.
Poor sleep (can be too little, too much)
Poor appetite (can be too little, too much).
Poor concentration
Poor motivation
How likely is it that someone treated with depression will experience an episode again?
80%
What are the suicide rates in men vs. women with depression?
Males = 7% Females = 1%
What is bipolar affective disorder?
Must have episodes of mania and depression.
same as manic-depressive disorder
Name some characteristics of mania
Elevated mood Reduced need for sleep Reduced appetite Highly motivated Lots of new interests May have grandiose delusions Increased libido - risky activities
(Often these patients do very well so wouldn’t necessarily seek help immediately).
What is somatisation?
Process of converting psychological into physical symptoms.
What is conversion disorder?
Loss of function as a result of extreme psychological distress.
e.g. can lose sensation, movement in a limb.
In Obsessive compulsive disorder, what is the difference between obsession and compulsion?
Obsession = ruminating, circular throughs. Very intrusive. Recognised as absurd. Compulsion = rituals.
What is Personality disorder?
Becomes a disorder when behaviours impact on everyday life. Marked difficulties with interpersonal relationships.
Define delirium
Acute fluctuating confusional state with clouding of consciousness and psychotic symptoms.
(bear in mind can be hypoactive)
Differentiate between psychosis and schizophrenia.
Schizophrenia is a form of a psychotic disorder.
Name the aspects of the mental state exam.
Appearance and behaviour Speech Mood Thought content Cognition Insight Perception
Which are the three core symptoms of depression?
Low mood
Anhedonia
Reduced energy/ fatigue.
Which are the two hallmark signs of psychosis?
Halluciantions and/or delusions.
What is the ICD-10 criteria for Bipolar affective disorder?
At least two episodes - one of which must be hypomania/ manic or mixed.
What is the difference between bipolar affective disorder 1 and 2?
BAD 1 = one episode of mania +/- depression
BAD 2 = one episode of hypomania +/- depression
Define a manic episode
Elevated mood, or irritable. Sustained for 1 week Some signs: - increased talkativeness - increased activity - increased self esteem - decreased need for sleep - increased sexual energy
What is the difference between hypomania and mania?
Hypomania - 4 days
Mania - 1 week+ consecutive episode
Mania - more severe, longer history.
What is Beck’s triad?
View of self, future and the world
Which person is associated with CBT?
Beck
Name two cognitive distortions
Shoulds and Musts
Mental filter
Give 3 biological symptoms of depression.
Loss of libido
Loss of appetite
Early morning awakening
How do most antidepressants work?
Aim to increase monoamine neurotransmitters i.e. serotonin, noradrenaline, adrenaline.
Which percentage of patients with depression recover with placebo?
30%
What is the last consideration of treatment with depression?
Considering the addition of ECT.
How many weeks should you wait to see if an SSRI is effective?
2 weeks - increase dose if no improvement by week 4.
Consider switch after 6 weeks.
Name two mood stabilisers.
Lithium and lamotrigine.
Name x3 SSRIs
Citalopram, sertraline, fluoxetine.
Which drug class is mirtazapine?
NASSA - Noradrenergic and specific serotonergic antidepressants.
Name x2 TCAs
Amitriptyline, Clomipramine.
Name one SNRI. What is this?
Duloxetine - Serotonin and noradrenaline reuptake inhibitors.
Serotonin is also known as which chemical?
5 hydroxytryptamine.
Synthesis of serotonin starts with which chemical?
Tryptophan.
Which enzyme stops serotonin action?
Monoamine oxidase (MAO).
Which form of Monoamine oxidase A has the strongest affinity for serotonin?
MAO-A.
Citalopram is which kind of drug?
SSRI.
Which are the two main SSRIs?
Citalopram, fluoxetine.
Why may we see nausea and vomiting with SSRIs?
There are many serotonin receptors in the gut.
Which ECG change can be seen with citalopram?
QTc prolongation (escitalopram has less cardiac interactions).
Duloxetine is what type of drug class?
SNRI - serotonin and noradrenaline reuptake inhibitor.
What is a key benefit of SNRIs?
Dopamine has a similar chemical affinity to noradrenaline so the noradrenaline reuptake transporter can take it up too.
What type of drug class is Mirtazapine?
NASSA
An alpha 2 receptor antagonist
How do TCAs work?
Block the reuptake of noradrenaline via NET inhibition. (noradrenaline reuptake transporter).
Give an example of a TCA
amitriptyline.
MAO-B is mainly used for which condition?
Parkinson’s disease; raises dopamine = raises levodopa
What is the cheese reaction?
Tyramine interaction from the diet.
If you are on MAOI = raises too much tyramine = risk of hypertensive crisis. (because tyramine increases the release of noradrenaline).
Which antidepressant is most likely to cause withdrawal symptoms?
Paroxetine.
What is St John’s wort?
Plant - hypericum perforatum
herbal remedy that is actually effective!
Binds to serotonin and noradrenline reuptake transporters.
Disadvantage: MANY side effects e.g. increase risk of bleeding, potent hepatic enzyme inducer (affects metabolism heavily).
Generally how long do antidepressants take to work?
2-6 weeks
Antidepressants are addictive. True or false.
No; they change dopamine levels in the mesolimbic reward pathway.
What is the first line medication in someone with bipolar disorder?
Mood stabilisers NOT antidepressants - as can push into mania.
What is the difference between section 2 and section 5(2)?
What is the difference between section 2 and 3?
Which are the three signs of ADHD?
Inattention
Impulsivity
Hyperactivity
The SNAP Questionnaire assesses which mental health condition?
ADHD.
What is psychosis?
Disorders of perception, belief and functioning. Hallucinations and delusions.
Define hallucination.
Perception in the absence of an external sensory stimulus.
Define delusion
Fixed, unshakeable beliefs out of keeping with socio-cultural context.
Name 3 types of schizophrenia
- Paranoid schizophrenia
- Catatonic schizophrenia - hyperkinetic psychomotor disturbance
- Residual schizophrenia - Chronic negative symptoms with poor self care and social performance.
Name two positive and two negative symptoms of schizophrenia.
Hallucinations and delusions
Anhedonia, Alogia (without speech), FTD - formal thought disorder
Name some ‘first rank symptoms’ of schizophrenia.
- Auditory hallucinations (third person commentaries i.e. hearing voices)
- Thought withdrawal - thoughts being taken out of head.
- Delusional perception - I saw a red car and I knew I had 2 souls.
Name some negative symptoms in schizophrenia.
Social withdrawal, anhedonia, attention control, apathy
What do we mean when we say ‘affective’ psychosis?
Congruent affect i.e. depressed/elated with emotions - appropriate for that situation.
Name the investigations for psychosis
History and mental state examination. Physical examination. Urine drug screen, blood tests, EEG.
Which neural pathways are associated with schizophrenia?
Mesocortical and mesolimbic pathways - dopamine
What is the likely response in giving schizophrenic patients dopamine?
Hallucinations and psychotic symptoms.
How do we first treat schizophrenia?
1st generation antipsychotic: chlorpromazine, haloperidol.
2nd generation include olanzapine.
Loss of touch with reality associated with delusions and hallucinations. Definition?
Psychosis
Give 3 negative symptoms of psychosis
Clue: 3As.
Alogia, apathy, avolition
Chlorpromazine is what type of drug?
Anti-psychotic
What is the dopamine theory of psychosis?
Lowered dopamine = helps with psychosis.
Dopamine increase in the mesolimbic pathway can cause the positive psychotic symptoms.
Positive psychotic symptoms are associated with which pathway?
Mesolimbic pathway
Negative psychotic symptoms are associated with which pathway?
Mesocortical pathway
What is the nigrostriatal pathway?
Projects from dopaminergic cell bodies in substantia nigra (midbrain) to axons in the basal ganglia.
Which main neurotransmitter do anti-psychotics work to block?
Dopamine
Name two examples of first generation antipsychotics.
Chlorpromazine and Haloperidol.
Aripiprazole and risperidone are examples of which kind of drugs?
2nd generation anti-psychotic medications.
Which percentage of dopamine receptors usually need to be blocked to see antipsychotic effect without major side effects?
60-80%
Which drugs are most commonly used as rapid tranquilisation?
Haloperidol and Olanzapine.
What is the impact on prolactin of antipsychotics?
Hyperprolactinaemia; dopamine antagonists.
Why does Aripiprazole not cause QT prolongation?
Does not bind to sodium channels in the heart.
Which areas are involved in the extra-pyramidal pathway?
Outside of corticospinal tracts in the medulla pyramids.
Refers to basal ganglia, cerebellum and motor cortex.
Which extra-pyramidal effects can we see as an affect of anti-psychotics?
Dystonia
Akathisia
Parkinsonism
Define dystonia
Involuntary muscle spasm/ contraction.
Eyes rolling upward into head. Medical term?
Oculogyric crisis
What is Akathisia?
Internal restlessness.
Those with schizophrenia tend to die how many years prior than the general population?
15-20 years earlier.
What are some aspects of the metabolic syndrome associated with antipsychotic use?
Weight gain, dyslipidaemia, insulin sensitivity.
Which medications act on the h1 receptor?
‘pines’ - clozapine, quetiapine, olanzapine.
Which is considered the gold standard for psychosis?
Clozapine
Binds to 30+ receptors - actually not the highest affinity for dopamine despite binding.
How long is a section 2?
28 days (1 month).
How long is a section 3?
6 months
Who is required in the room to section a patient?
Approved mental health professional (AMHP)
2 doctors
What is a benefit of aripiprazole?
Less metabolic side effects i.e. less weight gain.
What is the medical term for restlessness?
Akathisia
Which drug class is Chlorpromazine?
antipsychotic
Which drug class is olanzapine?
anti-psychotic medication
What is a main common side effect of antipsychotic medication?
Hyperprolactinaemia.
Name x3 side effects of hyperprolactinaemia.
Breast tenderness
Breast enlargement
Lactation
Which antipsychotic medication is associated with agranulocytosis?
Clozapine.
How is Lithium used in psychiatry?
As a mood-stabiliser in bipolar disorder.
When checking lithium levels, when should samples be measured?
12 hours post dose.
What is the first line treatment in a patient with PTSD?
CBT.
Give two examples of atypical antipsychotics.
What is the advantage of atypical antipsychotics?
Olanzapine, Clozapine, Risperidone.
Atypical agents avoid extrapyramidal affects.
How many SSRIs should you try and what would offer if neither of these are effective?
SNRI - eg. duloxetine.
What is malingering?
An act, not a psychological condition.
Give x3 atypical antipsychotics.
Olanzapine
Risperidone
Clozapine.
What can cause a rise in clozapine levels within the blood?
Smoking cessation.
Give x3 indications of ECT.
Catatonic episodes
Prolonged or severe, manic episode.
Severe, life threatening depression.
Define Agoraphobia.
A type of anxiety disorder in which you fear or avoid situations which may cause panic.
What are the key presentations of autism?
Repetitive behaviours e.g. repeating phrases, actions
Does not understand social cues
Avoiding eye contact
Which disorder will CBT not be effective in?
Personality disorders - DBT - Dialectical behaviour therapy.
What is DBT?
Dialectical behavioural therapy.
Based on CBT but focuses more on accepting who you are at the same time as changing behaviours.
More group work.
What is adjustment disorder?
Any event - doesn’t have to be as stressful as in acute stressful. Disorder gets better as stressful event recedes e.g. relationship ending. Typical time period; 1 month.
Name the three core diagnostic symptoms of PTSD.
- Reliving of event e.g. nightmares.
- Hyperarousal, vigilence
- Avoidance due to re-exposure.
Which is the first line medication for PTSD?
SSRIs,
CBT.
What is EMDR?
Eye movement desensitisation reprocessing.
keeping a traumatic memory in mind and following doctor’s fingers. Working memory is working so hard on trying to focus on event and fingers - the thoughts have less hold and power.
Why do we not treat PTSD right away with therapy?
Must be a delay to differentiate away from an acute stress reaction.
Are panic attacks part of the diagnostic criteria for PTSD?
No. It is a separate diagnosis.
There is a low weight requirement for anorexia nervosa. True or false?
False; no longer a weight loss requirement - more rapid weight loss over short period of time.
Which medications used to treat hypertension can cause depression?
Beta blockers
Name 3 SSRIs
Escitalopram, sertraline, fluoxetine.
Which drug class if moclobemide?
MAO I/ RIMA (reversible inhibitors of monoamine oxidase).
What is tardive dyskinesia?
Abnormal involuntary movements e.g. licking lips.
What is the term for restlessness, abnormal involuntary movements?
Akathisia.
What is the difference between antisocial and avoidant behaviour?
Antisocial behaviour is more associated with aggressive and impulsive behaviour.
Define schizoid.
Emotional aloofness and social isolation. Few interests.
What is serotonin syndrome and what can it be caused by?
High heart rate, hyperreflexia, sweating.
Caused by triptans (taken for headaches) + escitalopram.
Which medication is most commonly associated with agranulocytosis?
Clozapine
What should you remember to refer if you see a patient on clozapine?
Full blood count; Clozapine can cause agranulocytosis/ neutropenia.
Which drug class is Venlafaxine?
SNRI - serotonin and noradrenaline reuptake inhibitor.
Which type of hallucination is seen as a first rank synotin in Schizophrenia?
Auditory hallucinations (not visual).
A manic episode must always be more than 7 days in duration. True or false?
False.
What is the FTD we can typically see in manic patients?
Flight of ideas
Which is the gold standard mood stabiliser?
Lithium
What is a large disadvantage of lithium?
Has a very narrow therapeutic range.
Name the common side effects of lithium.
Fine tremor
Mild GI upset
How do we treat acute mania?
- First line antipsychotic
- Stop antidepressant first, then offer antipsychotic
- Benzodiazepine e.g. clonazepam
Longer term = lithium, sodium valproate.
What is the difference in timeframe between baby blues and postnatal depression?
Baby blues: upto 10 days
Post natal depression: peak 3 months
How do we treat post natal depression?
Reassurance and CBT
SSRIs - sertraline, paroxetine - can continue to breastfeed.
What are the first rank symptoms in schizophrenia?
Auditory hallucinations, thought disorder (thought insertion, thought withdrawal, thought broadcasting), delusional perceptions (the traffic light is green therefore I am King).
How would we assess if THOUGHT (from asetpci) is disordered?
?Thought insertion
?Thought withdrawal
?Thought broadcasting
What is a delusional perception?
Two stage process where second intense delusion has no meaning relative to the first.
Is schizophrenia characterised by auditory of visual hallucinations as a first rank symptom?
Auditory
What is the difference between mania and hypomania?
Mania = lasts at least 7 days and impairs functional capacity at work. Hypomania = lasts typically up to 4 days and does not impair functional capacity at work.
How would thought present in mania?
Flight of ideas.
Which symptoms are mainly diagnostic of depression?
Low mood, anhedonia and fatigue.
How do we treat GAD?
- Educate patient and active monitoring.
- Low intensity psychological interventions.
- CBT, drugs first line Sertraline as SSRI.
Which is the first line drug treatment for GAD?
Sertraline.
How do we define borderline personality disorder?
Unstable self image, recurrent suicidal behaviour, efforts to avoid real or imagined abandonment.
What does histrionic mean?
Acting in an inappropriately seductive way to get attention from others. Need to be centre of attention.
Give three features of narcissistic behaviour
Grandiose ideas of self.
Lack of empathy
Sense of entitlement
Define schizoid behaviour.
Few interests, preference to solitary activities, lack of desire for companionship, loss of libido.
What is the difference between affect and mood?
Affect = Patient's immediate expression of emotion Mood = Sustained emotion
What is schizotypal behaviour?
Few interests, odd and eccentric behaviour, inappropriate affect.
What is a neologism?
New made up word which can be made up of a combination of more than one word.
What is a clang association?
Ideas which are associated only because they rhyme/ sound similar to one another.
Anorexia nervosa is diagnosed by BMI. True or false.
False.
What do we diagnose anorexia by?
- Restrictive eating
- Intense fear of gaining weight/ becoming fat
- Body dysmorphia.
What is the main difference between typical and atypical antipsychotics?
Typical = Dopamine D2 receptor antagonists. Mainly extrapyramidal side effects e.g. parkinsonism, dystonia, akathisia. Atypical = weight gain, agranulocytosis (clozapine), hyperprolactinaemia. LESS EXTRAPYRAMIDAL.
What is the main difference between typical and atypical antipsychotics?
Typical = more associated with extrapyramidal
Name one typical and atypical antipsychotic.
Typical = haloperidol Atypical = clozapine, olanzapine, risperidone, aripiprazole.
Name one key side effect that is more seen in atypical antipsychotics than typical?
Atypical = hyperprolactinaemia, agranulocytosis (clozapine).
Which are the most preferred SSRIs?
Escitalopram and Fluoxetine.
Sertraline too especially post MI.
Which two treatments have interactions which can cause serotonin syndrome?
SSRIs and triptans
Name the most common side effect of ECT.
Retrograde amnesia.
When is lithium most commonly used? What type of drug is it? Give 2 specific considerations for Lithium.
Most commonly used for bipolar disorder. A mood stabilising drug.
- Very narrow therapeutic range
- Weekly bloods to check lithium levels and once normal check every 3 months.
Define personality disorder
Cannot be explained by social or cultural factors
Causes distress to personal, family, social, educational and other important areas of functioning.
Important to see there is disruption in OVERALL functioning rather than in a specific area.
Which are the three clusters of personality disorders?
Cluster A - odd and eccentric
B - dramatic, emotional
C - Anxious, obsessive
Define schizoid personality disorder
Perceived as emotionally cold
Preference to be by themselves
Limited capacity to express feelings and experience pleasure.
Which condition is commonly seen in patients whereby they may think they have bipolar
Borderline personality disorder - mood changes will happen more frequently in a day (not so quick in bipolar)
Intense and unstable personal relationships.
Absolute glorification/ demonisation of people in personal relationships.
Difficulty managing emotions and behaviour.
Very much black and white behaviour.
Name one typical antipsychotic - which are the main side effects of typical antipsychotics?
Haloperidol.
Extra-pyramidal side effects e.g. parkinsonism, muscle contraction, akathisia (severe restlessness).
Is akathisia associated with typical or atypical antipsychotics?
Typical e.g. haloperidol; extra-pyramidal effects.
Name one atypical antipsychotic - which are the main side effects of atypical antipsychotics?
Olanzapine, clozapine, risperidone. Hyperprolactinaemia
Clozapine - agranulocytosis.
Weight gain.
Which drugs do SSRIs interact with?
NSAIDs - must give SSRIs with a proton pump inhibitor if patient is on NSAIDs.
Triptans - risk of serotonin syndrome.
Name 3 discontinuation symptoms of SSRIs.
Increased mood change, restlessness, sweating, unsteadiness, GI symptoms e.g. pain.
What is the most common side effect of ECT?
Retrograde amnesia.
Which cardiac medication can cause depression?
Beta blockers
Which are the two medications of choice in treating bipolar disorder?
Lithium and sodium valproate.
but sodium valproate not to be used in women of child bearing age so first line: lithium.
Which remedy do we use for benzodiazepine overdose?
Flumazenil
Which remedy do we use for zopiclone overdose?
Flumazenil
When may we use naloxone?
Opiate overdose
Which remedy do we use for paracetamol overdose?
N-acetylcysteine.
Which side effect may be seen with lithium?
Ebstein’s anomaly = tricuspid valve is displaced in the neonate.
Lithium toxicity occurs above which level?
Above 1.5mmol/L.
Which are the three main symptoms of Wernicke’s encephalopathy?
Confusion, ataxia and nystagmus.
What is the name of the condition which can present 72 hours within withdrawal of alcohol if a patient is experiencing hallucinations?
Delirium Tremens
Which diagnosis can follow Wernicke’s encephalopathy where there can be amnesia, apathy and loss of insight?
Korsakoff’s psychosis.
AUDIT PC and FAST are questionnaire tools for screening for which condition?
Assessing alcohol use
What treatment do we give for alcohol withdrawal?
Treat cause e.g. thiamine if Wernicke’s encephalopathy.
Often use benzodiazepines e.g. diazepam or chlordiazepoxide = reduce symptoms.
Toby has had to drink more alcohol recently in order to ‘relax’ describes what behavior?
Tolerance
Define one unit of alcohol in terms of mg and ml?
One unit of alcohol is defined as “amount of alcohol that an adult can metabolise in 1 hour which is equivalent to about 10 ml of pure ethanol or 8g of pure ethanol.”
Which two of the following neurotransmitters are believed to play a role in CNS effects of alcohol?
GABA and NMDA
Alcohol Withdrawal Syndrome occurs 24 hours after the last drink. True or false?
Within 4-12 hours
Which medication is the first line prescription for alcohol withdrawal?
Benzodiazepines.
What is methadone used for?
Treatment for opiate dependence.
It is a long acting synthetic opiate.
What is the treatment for opiate overdose?
Naloxone
Name two signs of opiate overdose
Pin point pupils and respiratory depression.
Flumazenil is used to treat what?
Benzodiazepine overdose.
What is disulfiram used for?
Disulfiram is used as an adjunct in management of alcohol dependence, it gives extremely unpleasant systemic reaction due to accumulation of acetaldhehyde. Interferes with metabolism of acetaldehyde.
Which is the psychoactive ingredient in ‘mushrooms’?
Psilocybin
Which plant is heroin extracted from?
The opium poppy = Papaver Somniferum
Give 3 symptoms/ signs of alcohol withdrawal?
Dilated pupils, raised blood pressure, yawning, cool, clammy skin.
Which medication can cause cogwheel rigidity as a side effect?
Haloperidol; typical antipsychotic.
Which medication can cause loss of outer eyebrow as a side effect?
Lithium.
Hypertensive crisis can be a side effect of which medication?
Moclobamide
Anxiety can be a side effect of which medication?
Escitalopram - can cause patients to get worse for first few weeks before feeling better.
Akathisia can be a side effect of which medication?
Risperidone.
Give examples of tardive dyskinesia.
Lip smacking, grimacing
What is delusional parasitosis?
Delusional disorder where convinced they have infestation of parasites, worms and flees.
- More common in older women
What is formication?
Experience where people are itching and they feel like they have insects on their skin - specifically related to drug use and drug withdrawal.
Do we want bipolar patients to stop lithium treatment during pregnancy?
no; risk of relapse during pregnancy if discontinued is worse than risk of birth defects.
Is mania associated more with elevated mood or irritability?
Irritability!
Which medication cause hyponatraemia as a side effect?
SSRIs e.g. Escitalopram
Which are the main side effects of mirtazepine?
Sedation and increased appetite.
Fine tremor is a key side effect of which medication?
Lithium.
What are two common effects of acute stress reaction?
Depersonalisation and derealisation
What is somatisation disorder?
Excessivelt worried about symptom
- hypochrondriasis is worried about diagnosis
Which drug do we use to manage short term alcohol abuse vs. long term alcohol abuse?
Short term alcohol withdrawal = Short-acting benzodiazepines. e.g. lorazepam
Long term alcohol withdrawal = Long-acting benzodiazepines e.g. chlordiazepoxide, diazepam
What is the difference between Type 1 and Type 2 bipolar affective disorder?
Type 1 bipolar affective disorder =x1 episode of major depression and x1 episode of mania
Type 2 bipolar affective disorder = x1 episode of major depression and x1 episode of hypomania.
How do we treat GAD - generalised anxiety disorder?
SSRIs and CBT
Acetylcysteine is used in the treatment of what?
Paracetamol overdose
Which medication do we use to treat delirium or alcohol withdrawal?
Chlordiazepoxide.
Which enzyme is raised in alcoholics?
GGT - gamme glutamyl transferase
What is the first treatment for OCD?
Exposure and response prevention
How do we differentiate between hypomania and mania?
Auditory hallucinations
What are the most common side effects of TCAs?
Dry mouth and blurred vision
Which is the antidepressant which increases appetite the most?
Mirtazapine
What is Korsakoff’s syndrome?
Often a complication of Wernicke’s - confusion, ataxia and opthalmoplegia.
Dizziness, electric shock sensations and anxiety are symptoms of discontinuing which drug?
SSRIs e.g. fluoxetine, paroxetine
- mainly think SSRI discontinuation with ‘electric shock’.
Which medication is associated with hyponatraemia?
SSRIs. e.g. sertraline
What is the risk of using SSRIs during pregnancy?
Pulmonary hypertension
Which antidepressant increases appetite?
Mirtazapine
What type of therapy is used for borderline personality disorder. Disorders where people experience emotions very intensely?
DBT - Dialectical behaviour therapy
A young woman complains of feeling lonely. She has stopped seeing her old friends as she is worried about not being liked or criticised. What is the diagnosis?
Avoidant personality disorder - not agoraphobia; s a disorder characterised by anxiety surrounding places or situations that might not be ‘safe’
