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1MSRA - Learning Points > Pyschiatry > Flashcards

Pyschiatry Flashcards

1
Q

Which SSRIs are used in which situation?

A

Post MI = sertraline
Adolescents = Fluoxetine (inFants)

Paroxetine associated with congenital defects 1st trimester and pulmonary HTN newborn 3rd trimester

Citalopram prolongs QT

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2
Q

Which antidepressants more dangerous if overdosed? What are side effects?

A

TCA

Cause CVS compromise
Hypotension, Ventricular Arythmia, Neuro deterioration

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3
Q

Which meds are TCAs?

A

Amitryptilline

-pramines

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4
Q

How do you treat seasonal affective disorder?

A

Same way you treat mild depression (CBT first, then SSRI)

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5
Q

What are suicide risk factors vs protective?

A

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

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6
Q

What is a community treatment order?

A

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

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7
Q

What are:
Section 2
Section 3
Section 4
Section 5(2)
Section 5(4)
Section 135
Section 136

A

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

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8
Q

How should SSRis be discontinued?
Any exceptions?

Side effects if not done ?

A

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

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9
Q

Indication for using mirtazapine as antidepressant?

What do you need to remember about the dose..

A

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

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10
Q

Duration of mood symptoms for depression diagnosis?

A

2 weeks

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11
Q

When should clozapine be used?

Side effect of clozapine?

A

if 2 antipsychotics already tried for 6-8 weeks each and not worked

Side effect = agranulocytosis
needs weekly FBC monitoring to start with

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12
Q

What are the typical antipsychotics?
SEs?

A

Haloperidol
Chlorpromazine

DAPT - dystonia (acute), akithesia, Parkinsonism, tardive dyskinesia (long term) (pouting, chewing)

All antipsychotics cause degree of high prolactin

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13
Q

What are the atypical antipsychotics?
SEs?

A

Olanzapine
Quietiapine
Aripiprazole
Risperidone
Clozapine

weight gain
gluccose intolerance
in elderly - arterial and venous thrombus

All antipyschotics cause degree of high prolactin

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14
Q

Which antipsychotic best to minimise side effect of high prolactin?

A

Aripiprazole

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15
Q

Difference between mania and hypomania?

A

Mania =
7 days
hallucinations (voices) and delusions (grandeur)
affects functioning

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16
Q

What is the management of panic disorder?

A

SSRIs such as sertraline

17
Q

What is the medical management of GAD?

A

Specifically Sertraline 1st line

18
Q

What are the general side effects with atypical antipsychotics?

A

Weight gain
dyslipidaemia
increased prolactin
increased stroke/VTE?

19
Q

What is the medical management of PTSD (i.e. if trauma focussed CBT and EMDR therapy haven’t worked)?

A

SSRIs or venlafaxine (SNRI)

20
Q

What are the symptoms of PTSD?

A

At least 4 weeks duration of:

HEAR

Hyperarousal, emotional numbing, avoidance, recurrence - nightmares

21
Q

What are the different conditions under ‘Unexplained symptoms’?

A

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.

22
Q

Do you have to refer all patient deaths to the CORONER which occurred whilst they were under a mental health act?

A

YES

23
Q

How do wean someone off a benzodiazepine?

A

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.

24
Q

What are the different types of personality disorders?

A

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

25
Q

Give two types of atypical grief reactions?

A

onset of grief delayed for 2 weeks

grief duration exceeds 12 months

26
Q

Difference between adjustment disorder and depression?

A

In adjustment disorder, there is a significant stressor which occurred in the last 3 months which has caused the symptoms.

27
Q

What are the side effects of TCAs?

A

They are anticholinergic, meaning they oppose the parasympathetic system.

This causes dry eyes, dry mouth, constipation, urinary retention (followed by overflow incontinence)

28
Q

What are the side effects of clozapine?

A

Agranulocytosis

Myocarditis

(weight gain, excessive salivation, arrhythmias)

29
Q

What are positive and negative symptoms of schizophrenia?

A

Positive - delusions, hallucinations, thought disorder (insertion, withdrawal, broadcasting)

Negative - neglect, flat mood, anhedonia, social withdrawal

30
Q

What are the benefits of atypical antipsychotics over the typical?

A

Lower chance of EPSEs

Better for treating negative symptoms of schizophrenia

31
Q

3 stages of alcohol withdrawal and their timeline?

A

up to 12hrs - hangover (tachy, sweaty, nauseous, headache)

36hrs - seizure

72hrs - Delirium tremens (confusion, coarse tremor, hallucinations)

32
Q

NICE guidance on management of depression?

A

PHQ <16 - mild
Psychological interventions such as CBT

PHQ 16 or more - moderate and severe
CBT + medical management (SSRIs)

33
Q

What are interaction considerations with SSRIs?

A

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)

34
Q

Which drugs cause low sodium?

A

SSRIs
Carbamazepine
Loop diuretics

1MSRA - Learning Points (20 decks)

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