Syke Flashcards
Most dangerous SEs of clozapine?
Agranulocytosis, neutropenia (atypical)
SEs of olanzapine?
weight gain, T2DM (atypical)
Carbamazepine SEs?
drowsiness, leucopaenia, diplopia, blurred vision, rash
Sodium valproate SEs?
VALPROATE (A-increased appetite and weight, L- liver failure, P-pancreatitis, R- reversible hair loss which grows back curly, O-oedema, A- ataxia, T- teratogenicity, tremor, thrombocytopaenia; E-encephalopathy, due to hyperammonaemia
MSE components
Appearance and Behaviour Speech Mood and Affect (including suicidality) Thoughts (form and content) Perception Cognition Insight
ASEPTIC (e - emotion for mood and affect)
Depression - min duration, 3 core symptoms
2 weeks min,
low mood, anhedonia, anergia
Bipolar I diagnosis
Criteria for mania.
May have previous hypomania/depression
Bipolar II diagnosis
Hypomaniac episode and current/past depressive episode.
Appetitive/approach system - which substance and roughly where in brain?
DOPAMINE
Centre of the brain
[ascending dopamine systems – mesolimbic/cortical projection; ventral striatum; dorsal striatum (movement); amygdala (conditioning / learning); anterior cingulate (a7ention / conflict / response selection); orbitofrontal cortex (relative reward preference / rule learning)]
Aversive/defensive systems - substance and where in the brain?
SEROTONIN
Peripheries of the brain
[ascending serotonin systems; NA / CRF / peptide transmitters
central nucleus of amygdala; hippocampus; ventroanterior and medial hypothalamus; periaqueductal gray matter]
Examples of MAOI antidepressants?
Phenelzine, Isocarboxazid, Tranylcypromine
Examples of RIMA antidepressants?
Reversible inhibitor of monoamine oxidase A
Moclebemide
Examples of TCAs?
Amitriptyline Clomipramine, Imipramine, Nortriptyline, Dosulepin
Examples of SSRIs?
Fluoxetine, Paroxetine, (Es)Citalopram, Sertraline, Fluvoxamine
Examples of SNRIs?
Venlafaxine, Duloxetine
Example of NARI? (Nor-Adrenaline Reuptake inhibitors)
Reboxetine
SSRIs used for which conditions?
depression, panic disorder, social anxiety disorder, PTSD, OCD, chronic pain, eating disorders, stroke recovery, premature ejaculation
TCAs - tricycling depressant - blocks which receptors?
Histamine, muscarinic ACh, adrenergic
all are post-synapse
SEs of TCAs?
most anticholinergic: Constipation, dry mouth, blurred vision, cardiac function Postural hypotension (cholinergic and adrenergic blockade causing failure of peripheral orthostatic reflexes)
SEs of MAOIs?
Tyramine inactivated in the gut by MAO so gut stuff.
Hypertensive crises with tyramine-containing foods (cheese, yoghurt, yeast, meat, alcohol, broad beans, herring)
Sympathomimetics (OTC cold remedies).
Symptoms: flushing, headache, high BP, rarely CVA. Treat: alpha blockers
Types (3) and examles of mood stabilisers
- anti-convulsants (carbamazepine, valproate, lamotrigine)
- atypical antipsychotics (olanzapine, risperidone, aripiprazole, quetiapine)
- other: lithium carbonate (citrate), nimodipine (Ca channel antagonist)
Anorexia vs bulimia
Anorexia - less than 17.5 BMI or 85% of expected weight (can still vomit then it’s binge-purge subtype)
Anxiety - which brain part is responsible for emotional filter, seeing if a stimulus requires a fear/flee etc?
Which compounds increase in anxiety?
Amygdala
Cathecholamines and cortisol
Panic attacks on PET scans - which region?
anterior pole of temporal lobe – parahippocampal gyrus
PTSD - where in brain?
Limbic brain (amygdala - stores emotionally charged memories, hippocampus - locate memories) and medial prefrontal cortex (emotional and fear responses)
Timeline for acute stress reaction, acute stress disorder and acute or chronic PTSD
acute stress reaction - up to 48 hrs
“ “ disorder - up to 4 weeks
PTSD - up to 3 months if acute. More - chronic
Treatment for OCD
SSRI -> SSRI -> SSRI -> etc
Can add CBT and treat co-morbidities. Consider neurosurgery is still unresponsive
Schneider’s first rank of psychotic symptoms
Auditory hallucinations, delusions of thought interference, delusions of control, (delusional perception)
Rape-pill: name and class
Rohypnol, Benzodiazepine
3 dopaminergic pathways and what they’re controlling
NIGROSTRATAL (extrapyramidal motor system)
MESOLIMBIC/CORTICAL (motivation and reward)
TUBEROINFUNDIBULAR (prolactin release)
personality disorders - cluster A “odd and eccentric”
(2 types)
Paranoid (nie wierzy w wierność, bears grudges; JóCz)
Schizoid (lonely, without close friends; nowa Litw)
Cluster B personality disorder “dramatic and emotional”
3
Antisocial (kłamstwo, łamanie prawa, bójki; ja)
Borderline (raz kogoś uwielbiasz, drugi raz nienawidzisz, boisz się straty, unstable image of self, impulsitivity, suicidal; stara Litw)
Histrionic (teatralny, centre of attention, physical appearance; Matt)
Cluster C personality disorder “anxious and avoidant”
3 types
Avoidant (nie pójdę bo się wstydzę i nikt mnie nie polubi; Karo)
Dependant (inni niech podejmą za mnie decyzje; Zain)
Obsessive-Compulsive (zasady, pieniądze, praca, wysokie standardy; Franco)
Emergency detention
Max 72 hrs
registered medical practitioner
can’t treat
no right to appeal
Short term detention
max 28 days
can treat and can appeal
MHO consent needed
necessary to asses the patient what to give them or give them treatment
Compulsory treatment order
Two medical reports
can appeal and treat
up to 6 months
hospital or community
Learning disability - classification
Mild IQ – 50-69
Moderate 35-49
Severe 20-34 (almost always epilepsy)
Profound <20 (may be bed-bound)
How to calculate units in alcohol?
units = (%*volume)/10
eg 0.4 (40% vodka) * 750 ml / 10 = 30
Parts of brain (3) to do with memory
Amygdala, hippocampus (declarative learning) and striatum (habit learning).
More - neurobiology of cognition (10.21)
neuropatholody of Alzheimer’s dis
Amyloid plaques (breakdown of protein, beta) Neurofibrillary tangles (TAU protein)
Depletion of ACh in nucleus basalis of Meynert - which disease?
Alzheimer’s dementia
Autism - name for normal intelligence but bad socially (A) and for no eye contact, very severe (B)?
Triad of symptoms?
A - Aspergers
B - Kanners
Sympt: socially, language, repetitive behaviour
Side effects of main classes of antidepressants?
TCAs (amitriptylina) - anticholinergic SEs, eg dry mouth
SSRIs (fluoxetine, paroxetine) - hyponatraemia
SNRIs (venlaflaxine) - n&v, dizzy, somnolence
MAOIs (phenelzine) - hypertensive crisis with amines
Secure attachement: strangers?
reaction when parent leaves?
when they’re back?
child explores freely, happy with strangers when mum there
upset when leaving
happy when back
Resistant attachement:
strangers?
when mum leaves?
when mum back?
explores little, wary of stranger always
upset when leaving
ambivalent on return
Avoidant attachement:
strangers?
when mum leaves?
when mum back?
explores freely
may engage with a stranger (not dependent on parent)
little distress when leaving
little reaction when back