Pyschiatry Flashcards
Which SSRIs are used in which situation?
Post MI = sertraline
Adolescents = Fluoxetine (inFants)
Paroxetine associated with congenital defects 1st trimester and pulmonary HTN newborn 3rd trimester
Citalopram prolongs QT
Which antidepressants more dangerous if overdosed? What are side effects?
TCA
Cause CVS compromise
Hypotension, Ventricular Arythmia, Neuro deterioration
Which meds are TCAs?
Amitryptilline
-pramines
How do you treat seasonal affective disorder?
Same way you treat mild depression (CBT first, then SSRI)
What are suicide risk factors vs protective?
Risk factors:
alcohol/drugs involved
note left
attempt to conceal
final arrangements made
social isolation
unmarried/widowed
history of mental illness
Protective:
children at home
religious belief
regret
What is a community treatment order?
CTO (Section 17a)
Patient discharged into community but on terms of adhering to treatment. If does not comply and this is proven to significantly impact their mental health, can be recalled to hospital. Order valid for 6 months. Recall to hospital permitted for up to 72hrs - after which either need to sectioned or discharged back into community
What are:
Section 2
Section 3
Section 4
Section 5(2)
Section 5(4)
Section 135
Section 136
section 2 - admit for assessment, 28 days
section 3 - admit for treatment, 6 months
section 4 - if section 2 can’t be done in time, can be done by GP
section 5(2) - doctor, voluntary attendance to hospital, for 72 hrs
section 5(4) - nurse, voluntary attendance to hospital, 6hrs
section 135 - from private place
section 136 - police, from public, 24hrs
How should SSRis be discontinued?
Any exceptions?
Side effects if not done ?
Gradually reduced over 4 weeks
Fluoxetine doesn’t need to be because it has a long half life
Side effects are GI symptoms, restlessness, mood swings, NEURO STUFF SUCH AS PARASTHESIA
Indication for using mirtazapine as antidepressant?
What do you need to remember about the dose..
It improves appetite and acts as sedative, so useful if poor appetite and poor sleep
Minimum effective dose 30mg ON
Side effect of sedation paradoxically improves with higher dose
Duration of mood symptoms for depression diagnosis?
2 weeks
When should clozapine be used?
Side effect of clozapine?
if 2 antipsychotics already tried for 6-8 weeks each and not worked
Side effect = agranulocytosis
needs weekly FBC monitoring to start with
What are the typical antipsychotics?
SEs?
Haloperidol
Chlorpromazine
DAPT - dystonia (acute), akithesia, Parkinsonism, tardive dyskinesia (long term) (pouting, chewing)
All antipsychotics cause degree of high prolactin
What are the atypical antipsychotics?
SEs?
Olanzapine
Quietiapine
Aripiprazole
Risperidone
Clozapine
weight gain
gluccose intolerance
in elderly - arterial and venous thrombus
All antipyschotics cause degree of high prolactin
Which antipsychotic best to minimise side effect of high prolactin?
Aripiprazole
Difference between mania and hypomania?
Mania =
7 days
hallucinations (voices) and delusions (grandeur)
affects functioning
What is the management of panic disorder?
SSRIs such as sertraline
What is the medical management of GAD?
Specifically Sertraline 1st line
What are the general side effects with atypical antipsychotics?
Weight gain
dyslipidaemia
increased prolactin
increased stroke/VTE?
What is the medical management of PTSD (i.e. if trauma focussed CBT and EMDR therapy haven’t worked)?
SSRIs or venlafaxine (SNRI)
What are the symptoms of PTSD?
At least 4 weeks duration of:
HEAR
Hyperarousal, emotional numbing, avoidance, recurrence - nightmares
What are the different conditions under ‘Unexplained symptoms’?
Malingering - faking symptoms for gain (either financial, medicines etc)
Somatisation - symptoms for at least 2 years, with no organic cause
Conversion - neuro symptoms that are ‘real’ and the patient isn’t faking - usually motor or sensory. Can be brought on by upcoming stressful event
Hypochondriac - persistent worrying about sinister diagnoses such as cancer despite reassurance.
Do you have to refer all patient deaths to the CORONER which occurred whilst they were under a mental health act?
YES
How do wean someone off a benzodiazepine?
Cut their dose by 1/8th every fortnight
If they were on a short acting benzo such as temazepam, switch to a long acting one such as Diazepam and wean.
What are the different types of personality disorders?
Borderline (EUPD) - emotionally labile, intense relationships, abandonment, insecure
Schizoid - no interest and no engagement in social stuff
Avoidance - has interest in social stuff but avoids because they feel inferior
Paranoid
Obsessive Compulsive personality disorder
Give two types of atypical grief reactions?
onset of grief delayed for 2 weeks
grief duration exceeds 12 months
Difference between adjustment disorder and depression?
In adjustment disorder, there is a significant stressor which occurred in the last 3 months which has caused the symptoms.
What are the side effects of TCAs?
They are anticholinergic, meaning they oppose the parasympathetic system.
This causes dry eyes, dry mouth, constipation, urinary retention (followed by overflow incontinence)
What are the side effects of clozapine?
Agranulocytosis
Myocarditis
(weight gain, excessive salivation, arrhythmias)
What are positive and negative symptoms of schizophrenia?
Positive - delusions, hallucinations, thought disorder (insertion, withdrawal, broadcasting)
Negative - neglect, flat mood, anhedonia, social withdrawal
What are the benefits of atypical antipsychotics over the typical?
Lower chance of EPSEs
Better for treating negative symptoms of schizophrenia
3 stages of alcohol withdrawal and their timeline?
up to 12hrs - hangover (tachy, sweaty, nauseous, headache)
36hrs - seizure
72hrs - Delirium tremens (confusion, coarse tremor, hallucinations)
NICE guidance on management of depression?
PHQ <16 - mild
Psychological interventions such as CBT
PHQ 16 or more - moderate and severe
CBT + medical management (SSRIs)
What are interaction considerations with SSRIs?
Shouldn’t prescribe with warfarin
If prescribing with NSAIDs/aspirin - also give PPI
Shouldn’t prescribe with triptans, as this increases risk of serotonin syndrome (triptans are serotonin agonists)
Which drugs cause low sodium?
SSRIs
Carbamazepine
Loop diuretics
