Pysch Flashcards
Is haliperidol selective or non-selective? What does it block
Non-selective, blocks D2 receptors in the mesolimbic pathway (reward system and motivation)
What metabolic disturbances occur in vomit inducing bullimia?
Metabolic alkalosis, hypokalemia, hypocholaremia
What are the triad of symptoms in Korsakoff syndrome?
Anterograde amnesia, retrograde amnesia and confabulations
What is the underlying vitamin deficiency in Korsakoff syndrome?
Thiamine
How long should you have schizoprenia symptoms for a dx?
1 month or more
What is schizoid personality disorder
Personality disorder where the person tends to lack interest in others. Have few friends, prefer solitary activity
What conditions need to be met to dx bipolar disorder?
One manic episode or mixed (mania and depression) episode and atleast one major depressive episode
What disturbances can a TCA overdose cause?
ECG changes- prolonged QRS and QT interval and metabolic acidosis
What can lithium toxicity cause?
Renal impairment, likely to show raised creatinine, eGFR, raised serum lithium
What is the term in schizophrenia when there is a pause in speech of the patient
Alogia
Common SE of SSRIs
GI disturbance inc gastric ulcers and increased anxiety and agitation
Difference between mania and hypomania?
Mania causes social and occupational functioning impairment and may have psychotic features whereas hypomania does not
How does neuroleptic malignant syndrome occur?
SE of second gen antipsychotic causing increased sweating, rigidity, pyrexia, tachycardia tachypnoea and high blood pressure. Elevated CK found if there is muscle rigidity
Does cholesterol increase or decrease in anorexia?
Increase due to increase in LDL
Describe dementia with Lewy bodies
Fluctuating attention
Recurrent well formed visual hallucinations
Parkinsonism
Describe vascular dementia
Sudden onset cognitive decline and then stepwise deterioration
What is agnosia?
The inability to recognise people, objects or places that were once known to a person.
What can be used to manage acute presentation of mania
Oral risperidone
What medication can exacerbate mood disturbance?
Citalopram
What should SSRIs not be prescribed with?
Anticoagulants especially amongst the elderly due to increased bleeding risk
Investigation for suspected subarachnoid haemorrhage with normal CT
Lumbar puncture 12 hours after symptom onset- CSF would appear yellow than clear
What is normal pressure hydrocephalus?
Abnormal increase in CSF in the ventricles- absent sulci on CT
What is medication can be used for OCD?
- SSRI- sertaline, fluoxetine, citalopram
2.Clomipramine
What is the mesolimbic pathway?
Involved with positive symptoms of schizophrenia.
Motivation, reward and emotions
Projections form the ventral tegmental area to pre-frontal cortex
What is the mesocortical pathway?
Involved with negative symptoms of schizophrenia
Cognition + exec function, emotions and affect
Projections from ventral tegmental area to pre-frontal cortex
What is the nigrostriatal pathway?
Extrapyramidal pathway
Stimulation of purposeful movement
Projections from substantia nigra to striatum (caudate and putamen)
What is the tuberoinfundibular pathway?
Involvement with prolactin release
What anti-depressant can prolong the QT interval?
Citalopram
What are examples of tricyclic antidepressants and how do they work
eg amitriptyline, chloromaprine
Inhibit monoamine uptake on presynaptic membrane
How does tardive dyskinesia arise?
Hypersensitivity of dopamine receptors in the nigrostriatal pathway
Which anti-emetic should not be prescribed in parkisons?
Metaclopramide
Normal IQ
70
What range of IQ is a mild learning difficulty?
50-69
1st and 2nd line treatment of ADHD
Methylphenidate and dexamphetanine
Describe an emergency detention order
72 hours assessment
Does not authorise treatment
FY2 doctor or above with MHO where possible
Likely mental disorder
No right of appeal
Describe a short term detention order
28 days for assessment/treatment
Approved medical practitioner plus MHO
Right of appeal
Can be extended by 3 days if extra time needed to put together an application for CTO or 5 days once CTO submitted
Describe a compulsory treament order?
Initially up to 6 months
2 approved medical practitioner plus MHO
Mental health disorder present
Mandatory tribunal
Treatment authorised
Renewal at 6 months then yearly
Can treatment be given in an emergency detention situation?
Urgent treatment in certain circumstances eg save a patients life, prevent serious deterioration
Must fill in T4 certificate in 7 days following any emergency treatment
How long can medication be given under short term detention/CTO
2 months
Except- ECT, nutrition by artificial means etc
What symptoms does the amygdala produce?
Fear: panic or phobia
What drugs enhance the action of GABA
Benzodiazapines specifically GABA-A receptor
Function of GABA
Main inhibitory neurotransmitter of brain
Reduces activity of neurons in amygdala and cortico-striatal-thalamic-cortical circuit
How do benzodiazepines work?
Bind to separate site to GABA
Increases the chance that GABA will bind/increases effects (agonist)
Increases frequency of opening allowing more chlorine to pass through and hyperpolarise the membrane potential so less likely a neuron will fire an action potential.
Withdrawal symptoms of benzodiazepines?
Abdo cramps, palpitations, sweating, increased anxiety, panic attacks, blurred vision
Mx of PTSD
Mild & < 4 weeks from trauma – watchful waiting
Within 3 months of trauma: Brief psychological intervention: CBT
Hypnotic medication for sleep disturbance
More than 3 months after trauma: Trauma focussed CBT or EMDR (Eye movement desensitization and reprocessing)
-drug treatment: Paroxetine or mirtazepine
Amitriptyline or phenelzine (mental health specialists)
Examples of typical antipsychotics/first generation?
Chlorpromazine and haloperidol
Examples of atypical/2nd gen antipsychotics?
Olanzapine, clozapine, aripiprazole, risperidone
What are the 5 criteria for assessing capacity?
-Understand the info given
-Weigh the risks and benefits of the specific decision
-Communicate the decision
-Retain the decision decided
-Be aware of how this decision may be applied
What are the principles of the AWI act?
-intervention must benefit the adult
-benefit cannot reasonably be obtained without the intervention
-takes into account the adults previously or currently expressed wishes
-Consults with relevant persons
What does section 47 certificate of incapacity allow?
Completed by a doctor to authorise non-emergency treatment in an adult who lacks the capacity to give/refuse consent. Applies to medical and surgical tx
Does not allow for use of force or restraint
What is guardianship?
Can be applied for by family, friends or local authority on behalf of adult who has already lost capacity.
Cannot be used to place an adult in hospital or treatment facility against their will.
Assessment by two medical professionals
What is the tx of choice in depression in children and adolescents?
Fluoxetine- SSRI
What length of time should be left between stopping fluoxetine to another SSRI?
4-7 days
When should lithium levels be checked post dose?
Measured one week after starting treatment, a dose change and weekly until levels are stable.
One stable levels every 3 months 12 hours post dose
What is the effective tx for borderline personality disorder?
Dialectical behaviour therapy
What can SNRIs be associated with and what should be checked before starting?
Hypertension and BP
What class of drug is Mirtazapine?
Noradrengergic and specific serotonergic antidepressants
What drugs can be used to reverse acute dystonic reactions?
Anticholinergics eg procyclidine
Characteristics of opioid withdrawal?
Dilated (open) pupils, abdo pains, N+V
Characteristics of opioid overdose?
Pinpoint pupils, decreased RR, HR
The amygdala is associated with what?
Fear response and aggression
What is the ventral tegmental area associated with?
Experience of pleasure
