Pysch Flashcards
extrapyramidal side effects of antipsychotics
1) Parkinsonism
2) Acute dystonia: sustained muscle contraction (e.g. torticollis, oculogyric crisis)
3) Akathisia (severe restlessness)
4) Tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
Specific warnings when antipsychotics are used in elderly patients
1) increased risk of stroke
2) increased risk of venous thromboembolism
Other side-effects of anti-pyschotics
1) antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
2) sedation, weight gain
3) raised prolactin
may result in galactorrhoea
due to inhibition of the dopaminergic tuberoinfundibular pathway
4) impaired glucose tolerance
5) neuroleptic malignant syndrome: pyrexia, muscle stiffness
6) reduced seizure threshold (greater with atypicals)
7 ) prolonged QT interval (particularly haloperidol)
antimuscarinic
dry mouth, blurred vision, urinary retention, constipation
Benzodiazepines
enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels.
GABAA drugs effect on chloride channel
Benzodiazipines
Barbiturates
benzodiazipines increase the frequency of chloride channels
barbiturates increase the duration of chloride channel opening
Anton’s syndrome
rare symptom of brain damage occurring in the occipital lobe characterised by cortical blindness, but will not accept they are blind despite being told that they are.
Cotard syndrome
believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.
Dead or non existent part of body
Cotard syndrome
Othello syndrome
Patients partner is committing infidelity despite no evidence of this. It can often result in violence and controlling behaviour.
Patient believes their partner is cheating on them. They may be threatening or stalk their partner. This seems to affect males more than females.
Othello syndrome
De Clerambault syndrome
patient believes that a person of a higher social or professional standing is in love with them.
Celeb is in love with me
De Clerambault syndrome
Ekbom syndrome
Delusional parasitosis and is the belief that they are infected with parasites or have ‘bugs’ under their skin. This can vary from the classic psychosis symptoms in narcotic use where the user can ‘see’ bugs crawling under their skin or can be a patient who believes that they are infested with snakes.
Capgras delusion
friends or family members have been replaced by an identical looking imposter.
Person believing their friend or relative had been replaced by an exact double.
Capgras delusion
Couvade syndrome
‘sympathetic pregnancy’. It affects fathers, particularly during the first and third trimesters of pregnancy, who suffer the somatic features of pregnancy.
Expectant Fathers: suffer the somatic features of pregnancy.
Couvade syndrome
Bouffée délirante
Acute psychotic disorder in which hallucinations, delusions or perceptual disturbances are obvious but markedly variable, changing from day to day or even from hour to hour.
Fregoli delusion
Mistaken belief that some person currently present in the deluded person’s environment (typically a stranger) is a familiar person in disguise.
Severe Depression in Elderly
Dementia
Global memory loss
Dementia characteristically causes recent memory loss
ECT ( Electroconvulsive therapy)
Absolute contradincation
Short- term side effects
Long-term side effects
The only absolute contraindications is raised intracranial pressure.
Short-term side-effects headache nausea short term memory impairment memory loss of events prior to ECT cardiac arrhythmia
Long-term side-effects
some patients report impaired memory
5-HT1A partial agonist
Buspirone can be used in GAD ( Generalised anxiety disorder)
Generalised anxiety disorder mangement
SSRIs are the first-line pharmacological therapy.
If contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered
Features of atypical grief reactions include:
Delayed grief
Prolonged grief
Delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins
Prolonged grief: difficult to define. Normal grief reactions may take up to and beyond 12 months
Korsakoff’s syndrome
Features
1) anterograde amnesia: inability to acquire new memories
2) retrograde amnesia: unable to recall past memories
3) confabulation: making up new memories
Wernicke’s encephalopathy
1) ataxia,
2) ophthalmoplegia
3) confusion
4) Nystagamus
Lithium
It has a very narrow therapeutic range (0.4-1.0 mmol/L)
A long plasma half-life being excreted primarily by the kidneys.
Lithium Adverse Effects
1) nausea/vomiting, diarrhoea
2) fine tremor
3) nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
4 ) thyroid enlargement, may lead to hypothyroidism
5) ECG: T wave flattening/inversion
6) weight gain
7) idiopathic intracranial hypertension
8) leucocytosis
9) hyperparathyroidism and resultant hypercalcaemia
Post-Traumatic Stress Disorder (PTSD)
Mangement
Eye Movement Desensitization and Reprocessing Therapy (EMDR)
Trauma-focussed CBT
If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used
OCD mangement
Exposure-response prevention (ERP) therapy
Schizophrenia: features 1st rank symptoms :4
Auditory hallucinations
Thought disorders
Passivity phenomena
Delusional perceptions
Schizophrenia: prognostic indicators 5
1) strong family history
2) gradual onset
3) low IQ
4) premorbid history of social withdrawal
5 )lack of obvious precipitant
SSRI in MI
sertraline is useful post myocardial infarction
SSRIs should be used with caution in children and adolescents Drug of choice
Fluoxetine is the drug of choice when an antidepressant is indicated
Citalopram and the QT interval
associated with dose-dependent QT interval prolongation and should not be used in those with: congenital long QT syndrome
maximum daily dose is now
40 mg for adults;
20 mg for patients older than 65 years
20 mg for those with hepatic impairment
SSRIs and pregnancy
- Use during the first trimester gives a small increased risk of congenital heart defects
- Use during the third trimester can result in persistent pulmonary hypertension of the newborn
- Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
discontinuation symptoms seen more in which SSRI
When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.
Serotonin and noradrenaline reuptake inhibitors ( venlafaxine and duloxetine) uses
- major depressive disorders
- generalised anxiety disorder
- social anxiety disorder
- panic disorder
- menopausal symptoms
Sleep Paralysis
REM sleep
Transient paralysis of skeletal muscles which occurs when awakening from sleep or less often while falling asleep.
Safest TCA in overdosage
TCA avoid as dangerous in overdose
Lofepramine - the safest TCA in overdosage
Dosulepin and amitriptyline - avoid as dangerous in overdose
- multiple physical SYMPTOMS present for at least 2 years
- patient refuses to accept reassurance or negative test results
Somatisation disorder
Hypochondrial disorder
- persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
- patient again refuses to accept reassurance or negative test results
Factitious disorder/ Munchausen’s syndrome
the intentional production of physical or psychological symptoms
