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TO DO PSYCHIATRY Flashcards

1
Q

MENTAL HEALTH ACT 1983
What is the purpose, duration, location + professionals involved for a Section 2?

A

P – admission for assessment, treatment can be given w/out consent
D – 28d, cannot be renewed, can be converted to S3
L – anywhere in community (airports, jail, A+E, etc)
Prof – 2 Drs (1x S12), 1 AMHP, or nearest relative

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2
Q

MENTAL HEALTH ACT 1983
What is the purpose, duration, location + professionals involved for a Section 3?
Who is involved if a pt is medicated without consent?

A

P – admission for treatment
D – 6m, can be renewed
L – anywhere in community
Prof – 2 Drs (1x S12), 1 AMHP, nearest relative
Second opinion appointed doctor (SOAD) – after 3m SOAD reviews if medication w/out consent is necessary

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3
Q

MENTAL HEALTH ACT 1983
What is the purpose, duration, location + professionals involved, evidence needed for a Section 4?

A

P – emergency order
D – 72h
L – anywhere in community
P – 1 S12 Dr, 1 AMHP, nearest relative
E – same as S2 but only in an urgent necessity when waiting for a second dr (for a S2) would lead to undesirable delay/outcome

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4
Q

MENTAL HEALTH ACT 1983
Where can you apply a S5?
What can the team not do?

A
  • Voluntary pt in hospital that wants to leave (NOT A+E as not admitted)
  • Coercively treat the pt
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5
Q

MENTAL HEALTH ACT 1983
What is the purpose, duration + professionals involved for a Section 5(2)?

A

P – Drs holding power, allows for S2/3 assessment
D – 72h
Prof – 1 Dr (usually in charge of their care or nominated deputy

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6
Q

MENTAL HEALTH ACT 1983
What is the purpose, duration + professionals involved for a Section 5(4)?

A

P – nurses holding power until Dr attends to assess
D – 6h
Prof – 1 registered nurse

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7
Q

MENTAL HEALTH ACT 1983
What are the 2 police sections and their differences? What is the duration and purpose of these?

A
  • S135 – needs magistrates court order to access pts home + remove them
  • S136 –person suspected of having mental disorder in a public place
    D – 24h (extend to 36h if intoxicated but should be seen sooner)
    P – taken to place of safety (local psych unit, police cell) for further assessment
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8
Q

ECT
What are some adverse effects of ECT?

A
  • Short-term retrograde amnesia
  • Headache
  • Confusion + clumsiness
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9
Q

DEPRESSION
What are the 3 diagnostic criteria for depression?

A
  • Sx present most days ≥2 weeks + change from baselines
  • Sx not attributable to other organic or substance causes
  • Sx impair daily function + cause significant distress
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10
Q

DEPRESSION
What are the three core symptoms of depression?

A
  • Low mood
  • Anhedonia
  • Anergia
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11
Q

DEPRESSION
What is Cotard’s syndrome?

A
  • Delusional belief that they are dead, do not exist, are rotting or have lost their blood + internal organs
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12
Q

DEPRESSION
What are some investigations for depression?

A
  • FBC, ESR, B12/folate, U+Es, LFTs, TFTs, glucose, Ca2+
  • ECG, MSE + risk assessment
  • Urine drug screen
  • PHQ-9 + HADS to screen for depression
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13
Q

DEPRESSION
what is the threshold for different levels of treatment?

A

less severe depression = PHQ-9 <16
- 1st line = guided self-help
- 2nd line = group CBT
- 3rd line = individual CBT
- 4th line = SSRI

more severe depression = PHQ-9 >16
- 1st line = individual CBT + SSRI
- 2nd line = individual CBT
- 3rd line = SSRI

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14
Q

DEPRESSION
What is the management for resistant depression?

A
  • Different antidepressants (SNRI, MAOI, mirtazapine) or sometimes two
  • Augmentation with lithium, atypical antipsychotic or tryptophan
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15
Q

DEPRESSION
What is the management of psychotic depression?

A
  • ECT first line + v effective in severe cases followed by antidepressant
  • Antipsychotic initiated before antidepressant if ?primary psychotic disorder then add SSRI
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16
Q

SELF-HARM + SUICIDE
What are some risk factors for suicide?

A

SAD PERSONS –
- Sex (M>F)
- Age (peaks in young + old)
- Depression
- Previous attempt
- Ethanol
- Rational thinking loss (psychotic illness)
- Social support lacking (unemployed, homeless)
- Organised plan (avoid discovery, plan, notes, final acts)
- No spouse
- Sickness (physical illness)
0–4 low, 5–6 mod (?hospital), ≥7 high

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17
Q

SELF-HARM + SUICIDE
What are some protective factors for suicide?

A
  • Married men
  • Active religious beliefs
  • Social support
  • Good employment
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18
Q

BIPOLAR DISORDER
What are the 4 types of bipolar?

A
  • Bipolar 1 = mania + depression in equal proportions, M>F
  • Bipolar 2 = more episodes of depression, mild hypomania (easy to miss), F>M
  • Cyclothymia = chronic mood fluctuations over ≥2y (episodes of depression + hypomania, can be subclinical)
  • Rapid cycling = ≥4 episodes of (hypo)mania or depression in 1 year
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19
Q

BIPOLAR DISORDER
What is the difference between mania and hypomania?

A

MANIA
- abnormally elevated mood or irritability
- >7 days duration
- severe functional impairment
- psychotic symptoms e.g. delusions, hallucinations

HYPOMANIA
- abnormally elevated mood or irritability
- >4 days duration
- no significant functional impairment
- no psychotic features

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20
Q

BIPOLAR DISORDER
What is the acute biological management of bipolar disorder?

A

MANIA
- taper/stop any antidepressants
- ?admission if patient is risk to self/others
- 1st line = haloperidol, olanzapine, quetiapine or risperidone
- 2nd line = try one of others from list above
- 3rd line = lithium/sodium valproate if antipsychotics fail

DEPRESSION
- offer one of the following: antipsychotic (quetiapine or olanzapine), fluoxetine + olanzapine, lamotrigine
- high-intensity CBT

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21
Q

BIPOLAR DISORDER
What type of referral would you do in bipolar?
What is the psychological management of bipolar disorder?

A
  • Hypomania = routine CMHT referral,
  • mania or severe depression = urgent
  • CBT for depression, bipolar support groups + psychoeducation
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22
Q

SCHIZOPHRENIA
What is the neurotransmitter hypothesis in schizophrenia?

A
  • Excess dopamine + overactivity in mesolimbic tract = +ve Sx
  • Lack of dopamine + underactivity in mesocortical tracts = -ve Sx
  • Overactivity of dopamine, serotonin, noradrenaline + underactivity of glutamate + GABA
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23
Q

SCHIZOPHRENIA
What are the first rank symptoms of schizophrenia?
What is the relevance?

A
  • Delusional perceptions
  • Auditory hallucinations (3 types)
  • Thought alienation (insertion, withdrawal + broadcasting)
  • Passivity phenomenon, incl. somatic
  • ≥1 for at least 1m is strongly suggestive Dx
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24
Q

SCHIZOPHRENIA
What are the three types of auditory hallucinations that count as a first rank symptom?

A
  • 3rd person = talking about the patient (he/she)
  • Running commentary = often on person’s actions or thoughts
  • Thought echo = thoughts spoken aloud
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25
Q

SCHIZOPHRENIA
What is the management of schizophrenia?

A

1ST LINE
- atypical antipsychotic
- psychological interventions e.g. CBT, art therapy + family interventions

2ND LINE
- alternative antipsychotic

3RD LINE
- clozapine

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26
Q

DELUSIONAL DISORDER
What is erotomania or De Clerambault’s syndrome?

A
  • Delusion in which patient (usually single woman) believes another person (typically higher social status) is in love with them
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27
Q

DELUSIONAL DISORDER
What is Othello syndrome?

A
  • Delusional jealousy
  • Patients (typically men) possess fixed belief that their partner has been unfaithful + often try to collect evidence
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28
Q

GAD
What are 3 cardinal features of GAD?

A
  • Symptoms of muscle + psychic tension
  • Causes significant distress + functional impairment
  • No particular stimulus
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29
Q

GAD
What is the ICD criteria of GAD?
What are the groups of symptoms present in GAD?

A
  • Difficulty controlling worry, present for more days than not for ≥6m
  • ≥4 symptoms with ≥1 from autonomic arousal section
  • Autonomic arousal, physical, mental, general, tension, other
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30
Q

GAD
What symptoms in GAD come under the following categories…

i) autonomic arousal?
ii) physical?
iii) mental?
iv) general?
v) tension?
vi) other?

A

i) Palpitations, tachycardia, sweating, tremor
ii) Breathing issues, choking, CP, nausea, abdo distress
iii) Dizzy, derealisation + depersonalisation, fear of losing control, impending death
iv) Numbness + tingling, hot flushes + chills, sleep issues (initial insomnia, fatigue on waking)
v) Muscle aches + pains, restless, lump in throat
vi) Exaggerated responses to minor surprises/startled

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31
Q

GAD
What are the investigations for GAD?

A
  • History, MSE + risk assessment
  • GAD-7 + Hospital Anxiety + Depression Scale (HADS) questionnaire
  • Exclude organic (FBC, U+Es, LFTs, TFTs, fasting glucose, PTH)
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32
Q

GAD
What is the stepwise management for GAD?

A

STEP 1
- education about GAD
- active monitoring

STEP 2
- self-help, individual guided self-help

STEP 3
- CBT or SSRI (sertraline)

STEP 4
- refer for specialist treatment

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33
Q

GAD
What is the biological management used in GAD?

A
  • Sertraline first line, if ineffective offer alternative SSRI or SNRI
  • If SSRI/SNRI not tolerated then pregabalin
  • Beta-blockers like propranolol for physical Sx sometimes
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34
Q

PANIC DISORDER
What is the stepwise management of panic disorder?

A
  • Recognition + diagnosis with treatment in primary care
  • CBT or drug therapy (SSRIs 1st line, if C/I or no response after 12w then imipramine or clomipramine)
  • Psychodynamic psychotherapy + specialist MH services if severe
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35
Q

AGORAPHOBIA
What is the biological management of agoraphobia?

A
  • SSRIs as for panic disorder
  • BDZs for short-term use only (clonazepam)
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36
Q

OCD
What are the two types of compulsions?
What is the natural cycle in OCD?

A
  • Overt = can be observed (checking the door)
  • Covert = can’t be observed (repeating a phrase in their mind)
  • Obsession > anxiety > compulsion > relief
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37
Q

OCD
What is the biological management of OCD?

A
  • 1st line SSRIs = sertraline
  • 2nd line = clomipramine (TCA) with specific anti-obsessional action
  • ?Psychosurgery (stereotactic cingulotomy if intractable > 2 antidepressants, 3 combination Tx, ECT + behavioural therapy
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38
Q

PTSD
What are the 4 core symptoms of PTSD?
How long do they need to be present for to diagnose?

A

HEAR (≥1m) –
- Hyperarousal
- Emotional numbing
- Avoidance + rumination
- Re-experiencing (involuntary)

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39
Q

PTSD
What is the medical management of PTSD?

A
  • Venlafaxine or SSRI like sertraline
  • Risperidone for severe cases where resistant to treatment or psychotic
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40
Q

ANOREXIA NERVOSA
What is the diagnostic criteria for anorexia?

A

FEED ≥3m with absence of binge eating –
- Fear of fatness
- Endocrine disturbance
- Extreme weight loss
- Deliberate weight loss

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41
Q

ANOREXIA NERVOSA
What are some complications of anorexia?

A
  • Osteoporosis, thyroid issues, cardiac atrophy
  • Electrolyte disturbances (hypokalaemia > arrhythmias)
  • Decrease in WBC > increased infections
  • Death due to health complications or suicide
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42
Q

ANOREXIA NERVOSA
What screening tool can be used in anorexia?

A

SCOFF –
- Do you ever make yourself SICK as too full?
- Do you ever feel you’ve lost CONTROL over eating?
- Have you recently lost more than ONE stone in 3m?
- Do you believe you’re FAT when others say you’re thin?
- Does FOOD dominate your life?

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43
Q

ANOREXIA NERVOSA
What are some investigations for anorexia?

A
  • Sit up squat stand (SUSS) test /3
  • BP (low), temp (low)
  • ECG (brady, T-wave changes, QTc prolongation)
  • FBC (anaemia, dehydrated), LFTs, urinalysis, serum proteins
  • U+Es, Ca2+, Mg2+, phosphate > vomiting, laxatives, diuretics, water loading
  • DEXA scan after 1y of underweight (osteopenia)
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44
Q

ANOREXIA NERVOSA
In anorexia, most things are low apart from what?

A

Gs + Cs –
- GH, Glucose, salivary Glands
- Cortisol, Cholesterol, Carotinaemia

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45
Q

ANOREXIA NERVOSA
What risk assessment tool can be used for assessing if a patient with anorexia needs inpatient psychiatric admission?

A

Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN)

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46
Q

ANOREXIA NERVOSA
What are the MARSIPAN indicators of admission?

A
  • BMI <13, severe malnutrition or dehydration
  • HR <40, ECG changes
  • BP <90 systolic, <70 diastolic esp with postural drop
  • Temp <35
  • Severe electrolyte disturbances (K+, Na+, Mg2+, phosphate = low)
  • SUSS test of 0 or 1
  • Significant suicide or serious self-harm risk
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47
Q

ANOREXIA NERVOSA
What are the biological treatments for anorexia nervosa?

A
  • Fluoxetine, chlorpromazine + TCAs may be used for weight gain
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48
Q

ANOREXIA NERVOSA
What are the psychological therapies for anorexia?

A
  • Individual therapy (eating disorder focussed CBT, CBT-ED)
  • Maudsley anorexia nervosa treatment for adults (MANTRA)
  • Specialist supportive clinical management (SSCM)
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49
Q

ANOREXIA NERVOSA
What is the pathophysiology of refeeding syndrome?

A
  • Reduced carb consumption leads to reduced insulin secretion so the body switches from carb > fat + protein metabolism
  • Electrolyte stores depleted as needed to convert glucose>energy
  • Reintroducing food causes abrupt shift from fat>carb metabolism + insulin secretion surges, driving electrolytes from serum>cells to help convert glucose>energy causing further serum concentration decrease
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50
Q

ANOREXIA NERVOSA
What is the clinical presentation of refeeding syndrome?

A
  • Fatigue, weakness, confusion, dyspnoea (risk of fluid overload)
  • Abdo pain, vomiting, constipation, infections
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51
Q

ANOREXIA NERVOSA
What are the biochemical features of refeeding syndrome?

A
  • Hypophosphataemia main disturbance due to role of converting glucose>energy
  • Hypokalaemia, hypomagnesaemia + thiamine deficiency too
  • Abnormal fluid balance
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52
Q

ANOREXIA NERVOSA
What is the management of refeeding syndrome?

A
  • Start up to 10cal/kg/day + increase to full needs SLOWLY over 4–7d
  • Start PO thiamine, B vitamins + supplements before + during feeding
  • K+, phosphate + magnesium replacement
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53
Q

BULIMIA NERVOSA
What is the diagnostic criteria for bulimia?

A

BPFO ≥2 a week for ≥3m –
- Behaviours to prevent weight gain
- Preoccupation with eating (compulsion to eat but regret after)
- Fear of fatness
- Overeating ≥2/week

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54
Q

BULIMIA NERVOSA
What are some physical symptoms of bulimia?

A

SYMPTOMS
- recurrent episodes of binge eating
- feelings of loss of control during binges
- compensatory behaviours (induced vomiting, laxative use or diuretic abuse, excessive exercise)
- preoccupation with body weight and shape
- thinking about food a lot

SIGNS
- erosion of tooth enamel
- enlarged salivary glands
- Russell’s sign (calluses/scars on knuckles from induced vomiting)
- weight fluctuations
- warning signs (eating very rapidly, goes to bathroom very soon after eating)

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55
Q

PERSONALITY DISORDERS
What are cluster A personality disorders?

A
  • Characterised by odd, eccentric thinking or behaviour
  • MAD
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56
Q

PERSONALITY DISORDERS
What is paranoid personality disorder?

A
  • pattern of suspiciousness about others
  • tendency to perceive attacks on their character + questions loyalty of friends
  • hypersensitivity + unforgiving when insulted
  • preoccupation with conspiracy beliefs + hidden meaning
  • reluctance to confide in others
  • are less resistant to change their beliefs when challenged compared to a patient with delusions
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57
Q

PERSONALITY DISORDERS
In terms of paranoid personality disorder…

i) think the world is?
ii) think people are?
iii) acts as if?
iv) common behaviour?
v) least likely to be?
vi) emotional hotspot?

A

i) Conspiracy
ii) Devious, trying to cause harm
iii) Always on guard + suspicious of others, emotionally cold/distant
iv) Watchfulness
v) Trusting (fear others will use information against you)
vi) Being discriminated against

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58
Q

PERSONALITY DISORDERS
What is schizoid personality disorder?

A
  • emotional coldness
  • lack of desire for companionship
  • preference for solitary activities
  • few friends or confidants
  • lack of interest in sexual interactions
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59
Q

PERSONALITY DISORDERS
In terms of schizoid personality disorder…

i) think the world is?
ii) think people are?
iii) thinks they are?
iv) common behaviour?
v) least likely to be?
vi) emotional hotspot?
vii) other?

A

i) Uncaring
ii) Pointless, replaceable
iii) Only person they can depend on
iv) Withdrawal, prefer to be alone
v) Emotionally available + close
vi) Being over-cared for or smothered by others
vii) Inability to take pleasure from activities, little interest in sex

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60
Q

PERSONALITY DISORDERS
What is schizotypal personality disorder?

A
  • odd, eccentric behaviour or ‘magical thinking’
  • inappropriate behaviour
  • ideas of reference (applying meaning to coincidences or innocuous events)
  • peculiar speech, mannerisms or dress code
  • are not psychotic
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61
Q

PERSONALITY DISORDERS
What are some features of schizotypal personality disorder?

A
  • Ideas of reference (not delusions as insight)
  • Excessive social anxiety with lack of close friends + social withdrawal
  • “Magical thinking” believing you can influence people/events with thoughts
  • Unusual perceptions (illusions, overvalued ideas)
  • Odd/eccentric behaviour, beliefs, speech or appearance
  • Inappropriate affect with paranoid or suspicious ideas
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62
Q

PERSONALITY DISORDERS
What are cluster B personality disorders?

A
  • Characterised by dramatic, overly emotional or unpredictable thinking or behaviour (BAD)
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63
Q

PERSONALITY DISORDERS
What is dissocial/antisocial personality disorder?

A
  • Childhood conduct disorder before 15 + pattern of irresponsible + antisocial behaviour after age 15
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64
Q

PERSONALITY DISORDERS
What is a psychopath?
What is a sociopath?

A
  • When they get in trouble with the law
  • Same traits but without law involvement
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65
Q

PERSONALITY DISORDERS
In terms of antisocial personality disorder…

i) think the world is?
ii) think people are?
iii) thinks they are?
iv) common behaviour?
v) least likely to be?
vi) emotional hotspot?
vii) other?

A

i) Predatory
ii) Weak
iii) Autonomous + alone
iv) Aggressive/violent
v) Gentle + sensitive, conform to social norms
vi) Perceiving exploitation
vii) Disregard for others’ needs, feelings, safety, impulsive + lacks remorse

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66
Q

PERSONALITY DISORDERS
What is borderline/emotionally unstable personality disorder?
What is a big risk factor?

A
  • intense and unstable interpersonal relationships
  • unstable affect regulation (variable, intense moods)
  • repeated self-injury and suicidality
  • Often Hx of childhood sexual abuse
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67
Q

PERSONALITY DISORDERS
In terms of EUPD…

i) think the world is?
ii) think people are?
iii) common behaviour?
iv) least likely to be?
v) emotional hotspot?
vi) other?

A

i) Contradictory
ii) Untrustworthy
iii) Self-harm/suicide (impulsive + unpredictable)
iv) Able to show self-compassion
v) Abandonment (extreme reactions)
vi) Paranoid when stressed, labile mood, unstable + intense relationships

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68
Q

PERSONALITY DISORDERS
In terms of EUPD, what is the difference between…

i) impulsive type?
ii) borderline type?

A

i) Difficulties with impulsive + risky behaviours (unsafe sex, gambling) + anger
ii) Difficulties with relationships, self-harm + feelings of emptiness

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69
Q

PERSONALITY DISORDERS
What is histrionic personality disorder?

A
  • exaggerated dramatic behaviour designed to attract attention
  • attention seeking
  • flirtatious, seductive, charming and lively
  • manipulative and impulsive
  • uncomfortable when they are not the centre of attention
  • may embarrass friends/family with public displays of emotion
  • consider their relationships to be closer than they actually are
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70
Q

PERSONALITY DISORDERS
In terms of histrionic personality disorder…

i) think the world is?
ii) think people are?
iii) common behaviour?
iv) least likely to be?
v) emotional hotspot?
vi) think they are?
vii) think relationships with others are?

A

i) Their audience (crave attention)
ii) In competition for attention
iii) Exhibitionism (provocative for attention)
iv) Able to listen to others
v) Actively or passively side-lined
vi) Vivacious, easily influenced by others, excessive concern with physical appearance
vii) Closer than what they really are

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71
Q

PERSONALITY DISORDERS
What is narcissistic personality disorder?

A
  • grandiose sense of self-importance (e.g. exaggeration of achievements)
  • sense of entitlement + expectation of favourable treatment
  • arrogant, haughty behaviour
  • believes they are special + can only be understood by other special people
  • lacks empathy + often exhibits envy
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72
Q

PERSONALITY DISORDERS
In terms of narcisssitic personality disorder…

i) think the world is?
ii) think people are?
iii) thinks they are?
iv) common behaviour?
v) least likely to be?
vi) emotional hotspot?
vii) other?

A

i) Competition
ii) Inferior
iii) Special + more important than others
iv) Competitiveness
v) Humble
vi) Loss of social rank/status or being embarrassed
vii) Failure to recognise other’s needs or feelings, arrogance, envy (both ways)

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73
Q

PERSONALITY DISORDERS
What are cluster C personality disorders?

A
  • Characterised by anxious, fearful thinking or behaviour (SAD)
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74
Q

PERSONALITY DISORDERS
What is anxious/avoidant personality disorder?

A
  • avoidance of feared stimuli
  • major fears include fear of criticism and rejection
  • views self as inept and inferior
  • extreme social anxiety
  • strong desire for intimacy
  • strongly linked to childhood issues (neglect + abuse)
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75
Q

PERSONALITY DISORDERS
In terms of anxious/avoidant personality disorder…

i) think the world is?
ii) think people are?
iii) thinks they are?
iv) common behaviour?
v) least likely to be?
vi) emotional hotspot?
vii) other?

A

i) Evaluative
ii) Judgemental
iii) Inept
iv) Inhibition (social, avoids this)
v) Assertive
vi) Exposed, ridicule, criticism or rejection
vii) Feeling inadequate or inferior, extreme shyness, fear of disapproval

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76
Q

PERSONALITY DISORDERS
What is dependent personality disorder?

A
  • difficulty in decision making without excessive reassurance
  • lack of initiative or extreme passivity
  • will make effort to encourage others to make decisions regarding their own life
  • often seen in those with overprotective or authoritarian parents
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77
Q

PERSONALITY DISORDERS
In terms of dependent personality disorder…

i) think the world is?
ii) think people are?
iii) they are?
iv) common behaviour?
v) least likely to be?
vi) emotional hotspot?
vii) other?

A

i) Overwhelming
ii) Stronger + more competent than themselves
iii) Needy
iv) Clinging
v) Self-sufficient
vi) Making a decision, abandonment
vii) Requires excessive advice/reassurance, tolerant of abusive treatment, relationship hops, difficult disagreeing with others

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78
Q

PERSONALITY DISORDERS
What is anankastic/obsessive-compulsive personality disorder?
What may it be seen in?

A
  • Pervasive pattern of perfectionism + inflexibility lacking insight
  • Hx of family pressure + wanting approval
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79
Q

PERSONALITY DISORDERS
In terms of anankastic/OC personality disorder…

i) think the world is?
ii) think people are?
iii) think they are?
iv) common behaviour?
v) least likely to be?
vi) emotional hotspot?
vii) other?

A

i) Sloppy
ii) Irresponsible
iii) Responsible
iv) Controlling
v) Flexible
vi) Making a mistake
vii) Preoccupied with order, extreme perfectionism, neglect friends due to excessive project commitment, rigid + stubborn

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80
Q

PERSONALITY DISORDERS
What are some investigations for personality disorders?

A
  • Assessed (Hx + MSE) more than once
  • Minnesota Multiphasic Personality Inventory (MMPI)
  • Eysenck Personality Inventory + Personality Diagnostic Questionnaire
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81
Q

PERSONALITY DISORDERS
What are the psychological therapies for personality disorders?

A
  • Dialectical behavioural therapy for EUPD
  • CBT (change unhelpful ways of thinking)
  • Cognitive analytical therapy (recognise + change unhelpful patterns in relationships + behaviours)
  • Psychodynamic therapy (looks at how past experiences affect present behaviour)
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82
Q

DELIRIUM TREMENS
How does delirium tremens present?

A
  • Clouding of consciousness, disorientation + amnesia of recent events
  • Autonomic = diaphoresis, fever, tachycardia (risk of CV collapse)
  • Psychomotor agitation, delusions + coarse tremor
  • Visual, auditory + tactile hallucinations
83
Q

WERNICKE’S
What is Wernicke’s encephalopathy?

A
  • Atrophy of mammillary bodies due to thiamine deficiency, often alcohol abuse
84
Q

WERNICKE’S
How does Wernicke’s present?

A

Triad –
- Ataxia
- Confusion
- Ophthalmoplegia + nystagmus

85
Q

KORSAKOFF’S
What are some causes of Korsakoff’s?

A
  • Heavy alcohol drinkers
  • Head injury, post-anaesthesia
  • Basal or temporal lobe encephalitis
  • CO poisoning
  • Other causes of thiamine deficiency (anorexia, starvation, hyperemesis)
86
Q

LITHIUM TOXICITY
What is the clinical presentation of lithium toxicity?

A
  • Ataxia, dysarthria, confusion (drunk)
  • COARSE tremor, blurred vision, hyperreflexia
  • N+V, diarrhoea
  • Myoclonus, seizures + coma if severe
87
Q

LITHIUM TOXICITY
What are some complications of lithium toxicity?

A
  • Arrhythmias (VT)
  • Acute renal failure
  • Syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) after cessation of lithium >2m = truncal ataxia, ataxic gait, scanning speech, incoordination
88
Q

LITHIUM TOXICITY
When would you do haemodialysis in lithium toxicity?

A
  • Serum [Li] >5mmol/L
    OR >4 + renal dysfunction
    OR severe toxicity (seizures, coma, life-threatening arrhythmias)
89
Q

ACUTE DYSTONIA
What is the clinical presentation of acute dystonic reaction?

A
  • Rapid onset after dose given or changed
  • Spasm of muscles of tongue, face, neck + back
  • Oculogyric crisis (prolonged involuntary upward deviation of eyes)
  • Torticollis (twisted neck)
  • Tongue protrusion
90
Q

ACUTE DYSTONIA
What is the management of acute dystonia?

A
  • ABCDE approach as emergency
  • Anticholinergic – IM procyclidine
  • Stop antipsychotic (switch to atypical as less EPSEs)
91
Q

NMS
What is the clinical presentation?

A

develops over days to weeks

SYMPTOMS
- altered mental state
- muscle discomfort
- confusion
- agitation
- sweating

SIGNS
- fever >38 degrees
- reduced GCS
- generalised muscle rigidity (lead-pipe rigidity)
- tachycardia
- hyporeflexia

92
Q

NMS
What are the complications of NMS?

A
  • Resp failure, CV collapse
  • Rhabdomyolysis
  • DIC
93
Q

NMS
What is the management of NMS?

A
  • ABCDE approach

1ST LINE
- Stop antipsychotic (wait >2w before restarting, consider atypical)
- Give L-dopa if dopamine withdrawal in Parkinson’s
- supportive care (IV rehydration)

2ND LINE
- IV dantrolene or lorazepam to reduce rigidity 1st line (amantadine second)
- Bromocriptine prophylaxis

94
Q

SEROTONIN SYNDROME
What is the clinical presentation of serotonin syndrome?

A

develops within 24hrs

SYMPTOMS
- shivering
- headache
- diarrhoea
- agitation
- pressured speech
- hypervigilance

SIGNS
- hypertension
- tachycardia
- mydriasis
- myoclonus
- hyperreflexia
- hyperthermia
- muscle rigidity

95
Q

SEROTONIN SYNDROME
What is the management of serotonin syndrome?

A
  • ABCDE

1ST LINE
- discontinuation of serotonergic agent
- supportive care (IV fluids + treatment of hyperthermia)
- benzodiazepines (DIAZEPAM)

2ND LINE
- cyproheptadine (if symptoms persist)

96
Q

LEARNING DISABILITIES
What is the triad in learning disabilities?

A
  • Low intellectual performance (IQ < 70)
  • Onset during birth or early childhood
  • Wide range of functional impairment
97
Q

LEARNING DISABILITIES
What are some causes of learning disabilities?

A
  • Genetic = Down’s, Fragile X, Prader-Willi, neurofibromatosis
  • Antenatal = TORCH
  • Perinatal = asphyxia, intraventricular haemorrhage
  • Postnatal = meningitis, kernicterus
  • Environmental = malnutrition, smoking or alcohol in pregnancy
98
Q

LEARNING DISABILITIES
How is mild learning disability characterised by…

i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?

A

i) 50–69
ii) 9–12
iii) Mobile
iv) Mostly adequate
v) Difficulties reading + writing
vi) Most independent

99
Q

LEARNING DISABILITIES
How is moderate learning disability characterised by…

i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?

A

i) 35–49
ii) 6–9
iii) Mobile
iv) Simple-no speech, may sign, reasonable comprehension
v) Limited, some learn to read, write + count
vi) Lifelong supervision, may need prompting + support

100
Q

LEARNING DISABILITIES
How is severe learning disability characterised by…

i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?

A

i) 20–34
ii) 3–6
iii) Marked impairment
iv) Simple-no speech, may sign, reasonable comprehension
v) Limited, some learn to read, write + count
vi) Lifelong supervision, may need prompting + support

101
Q

LEARNING DISABILITIES
How is profound learning disability characterised by…

i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?

A

i) <20
ii) <3
iii) Severe impairment
iv) Basic non-verbal comms, understands basic commands
v) None
vi) Complete dependency

102
Q

AUTISM SPECTRUM
What are some risk factors for autism?

A
  • M>F
  • Obstetric complications
  • Perinatal infection (rubella)
  • Genetic disorders (Fragile X, Down’s)
103
Q

AUTISM SPECTRUM
What are the 3 areas of impaired functioning that need to be present in autism?

A
  • Social interaction
  • Communication (speech + language)
  • Behaviour (imposition of routine with ritualistic or repetitive behaviour)
104
Q

AUTISM SPECTRUM
Give some examples of impaired social interaction

A
  • Failure to notice + respond to social cues + others’ emotional states
  • Difficulty establishing friendships
  • Lack of eye contact
  • Delay in smiling
105
Q

AUTISM SPECTRUM
Give some examples of impaired communication

A
  • Expressive speech + comprehension usually delayed or minimal
  • Concrete thinking (lack imagination)
  • Absence of gestures
  • Later speech consists of monologues, endless questions, echolalia
106
Q

AUTISM SPECTRUM
Give some examples of impaired behaviours

A
  • Inability to adapt to new environments (distress)
  • Tendency to have rigid routine with resistance to change
  • Greater interest in objects, numbers + patterns than people
  • Stereotypical repetitive movements which may be self-stimulating movements to comfort themselves (rocking, hand-flapping)
107
Q

ADHD
What are some risk factors for ADHD?

A
  • boys and men
  • history of neurodevelopmental disorder (autism + other learning difficulties)
  • family history of ADHD or other mental health disorder
  • premature birth
  • epilepsy
108
Q

ADHD
What is the triad of symptoms in ADHD?

A
  • Inattention
  • Impulsivity
  • Hyperactivity
109
Q

ADHD
What is the management of ADHD?

A

Conservative initially (watch + wait) –
- Family education on ADHD + parenting advice
- Establish normal balanced diet, exercise can improve Sx
- Food diary to identify any triggers + eliminate with dietician
- 1st line = Methylphenidate (“Ritalin“)
-2nd line = Lisdexamfetamine
- 3rd line = Atomoxetine

110
Q

SOMATISATION DISORDER
What is the clinical presentation of somatisation disorder?

A
  • Non-specific + atypical Sx (usually derm, GI)
  • Discrepancy between subjective + objective findings (S = Sx)
  • Sx often in one system, may move to another once Dx possibilities exhausted
  • Often results in multiple needless investigations + operations (pt refuses to accept -ve results)
111
Q

GENDER DYSPHORIA
Define…

i) transsexual
ii) trans woman
iii) trans man

A

i) Person who emotionally + psychologically feels that they belong to opposite sex
ii) Assigned male sex 46XY at birth who later identifies as a woman
iii) Assigned female sex 46XX who later identifies as a man

112
Q

GENDER DYSPHORIA
What is the management of gender dysphoria in…

i) <18?
ii) >18?

A

i) Referral to gender identity development service (GIDS) with MDT (CAMHS, clinical psychologist, social worker, family therapist)
ii) Referral to gender dysphoria clinic (GP or self-referral)

113
Q

GENDER DYSPHORIA
What are some risks of the hormone therapy?

A
  • Oestrogen = clots, gallstones, high triglycerides
  • Testosterone = polycythaemia, acne, dyslipidaemia
  • Both = elevated LFTs, infertility, weight gain
114
Q

SCHIZOAFFECTIVE
What are the two types of schizoaffective disorder?

A

Manic type or depressive type

115
Q

SCHIZOAFFECTIVE
How does it differ to schizophrenia?

A

Psychotic Sx tend to wax + wane, unlike in schizophrenia

116
Q

SCHIZOPHRENIA
What area of the brain is most affected?

A

Temporal lobe

117
Q

TIC DISORDERS
How does Tourette’s syndrome present?

A
  • Multiple motor tics + at least 1 phonic tic (coprolalia)
118
Q

PHENOMENOLOGY
Define illusion

A

The false perception of a real external stimulus

119
Q

PHENOMENOLOGY
Define hallucination

A

An internal perception occurring without a corresponding external stimulus. The person experiences it as they would a real perception.

120
Q

PHENOMENOLOGY
Define delusion

A

A fixed, false, unshakable belief which is out of keeping with the patient’s educational, cultural + social norms. It’s held with extraordinary conviction + certainty (even despite contradictory evidence)

121
Q

PHENOMENOLOGY

What are the 3 delusional misidentification syndromes?

A
  • Capgras = idea someone has been replaced by an imposter.
  • Fregoli = idea various people are the same person
  • Intermetamorphosis = one significant relative is replaced by another (father is son).
122
Q

PHENOMENOLOGY
Define delusional perception and give an example

A

A primary delusion of two components – where a normal perception is subject to delusional interpretation
E.g. – traffic light changed red so that means I am the son of God

123
Q

PHENOMENOLOGY
In terms of thought disorders, what is flight of ideas?

A

Abrupt leaps between topics as a result of thoughts presenting more rapidly than can be articulated. Each thought = more associations. ?Discernible links between successive ideas. Presents as pressure of speech.

124
Q

PHENOMENOLOGY
Define passivity phenomena + somatic passivity

A
  • Delusion that one is a passive recipient of actions from an external agency against their will
  • The same but sensations are controlled by an external agency
125
Q

PHENOMENOLOGY
Define belle indifference

A

A surprising lack of concern for, or denial of, apparently severe functional disability (not specific to psych)

126
Q

PHENOMENOLOGY
Define conversion

A

Development of features suggestive of physical illness but which are attributed to psych illness or emotional disturbance rather than organic pathology

127
Q

PHENOMENOLOGY
Define sterotypy

A

Repetitive + bizarre act which is not goal-directed. Action may have delusional significance to the pt

128
Q

PHENOMENOLOGY
Define mannerism

A

Abnormal + occasionally bizarre performance of voluntary, goal-directed activity

129
Q

PHENOMENOLOGY
What are extracampine hallucinations?

A

hallucinations which are experienced outside the normal sensory field (seeing something behind them)

130
Q

PHENOMENOLOGY
In terms of thought disorders, what is circumstantiality?

A

irrelevant wandering in conversation (going around the point).

131
Q

PHENOMENOLOGY
Define loosening of associations

A

This is thought disorder denoting a lack of connection between ideas.

Links between ideas may be illogical or the speech may wander between trains of thought.

It is also known as knight’s move thinking

132
Q

PHENOMENOLOGY
define perseveration

A

When someone gets stuck on a topic or an idea
There may be repetition of words or phrases

133
Q

ANTI-PSYCHOTICS
What is the mechanism of action of typical (1st generation) anti-psychotics?

A
  • D2 receptor antagonist
  • Reduced release of dopamine from dopaminergic neurones + so reduced electrical activity in dopaminergic pathways
134
Q

ANTI-PSYCHOTICS
What pathway do typical (1st generation) anti-psychotics work on to have anti-psychotic effect?

A

Mesolimbic pathway (reduces +ve Sx)

135
Q

ANTI-PSYCHOTICS
What is the mechanism of action of atypical (2nd generation) anti-psychotics?

A
  • Antagonists at dopamine D2 receptors but more selective in dopamine blockade + so block serotonin 5-HT2a
136
Q

ANTI-PSYCHOTICS
What are the 5 broad categories of SEs caused by anti-psychotics?

A
  • Extra-pyramidal side effects (EPSEs)
  • Hyperprolactinaemia
  • Metabolic
  • Anticholinergic
  • Neurological
137
Q

ANTI-PSYCHOTICS
What are the extra-pyramidal side effects (EPSEs) of anti-psychotics?

A
  • Acute dystonic reaction
  • Parkinsonism
  • Akathisia
  • Tardive dyskinesia
138
Q

ANTI-PSYCHOTICS
What are the metabolic SEs?

A
  • Weight gain (esp. olanzapine)
  • Hyperlipidaemia, risk of stroke + VTE in elderly
  • T2DM risk + metabolic syndrome
139
Q

ANTI-PSYCHOTICS
What are the anticholinergic SEs?

A

Can’t see, pee, spit, shit –
- Blurred vision
- Urinary retention
- Dry mouth
- Constipation
+ tachycardia

140
Q

ANTI-PSYCHOTICS
What regular investigations are done for people on anti-psychotics?

A
  • Lipids + BMI at 3m
  • Fasting glucose + prolactin at 6m
  • Frequent BP during dose titration
  • FBC, U+Es, LFTs, lipids, BMI, fasting glucose, prolactin + CV risk yearly
141
Q

ANTI-DEPRESSANTS
What is the mechanism of action of SSRIs?
Give some examples

A
  • Prevents reuptake + subsequent degradation of serotonin from synaptic cleft by inhibiting its reuptake transporter on the post-synaptic membrane
  • Prolonged serotonin in synaptic cleft = prolonged neuronal activity
  • Citalopram, sertraline, fluoxetine
142
Q

ANTI-DEPRESSANTS
What are the side effects of SSRIs?

A
  • GI Sx most common (N+V, hyponatraemia, abdo pain, bowel issues, increased bleed risk)
  • Sedation + sexual impotence
  • Citalopram + QTc prolongation (dose-dependent)
143
Q

ANTI-DEPRESSANTS
What is the mechanism of action of SNRIs?

A
  • Prevents reuptake + subsequent degradation of serotonin AND noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic membrane
144
Q

ANTI-DEPRESSANTS
What are some side effects of SNRIs?

A
  • GI (N+V, constipation),
    central/peripheral effects (SIADH, rhabdomyolysis)
145
Q

ANTI-DEPRESSANTS
What is the mechanism of action of monoamine oxidase inhibitors (MAOI)?

A
  • Inhibits monoamine oxidase enzyme which reduces breakdown of adrenaline, noradrenaline + serotonin so increases level
146
Q

ANTI-DEPRESSANTS
What are some side effects from MAOIs?

A
  • Sexual dysfunction, weight gain + postural hypotension
147
Q

ANTI-DEPRESSANTS
What are some cautions with MAOIs?

A
  • Increased risk of serotonin syndrome if used with other serotonergic drugs
  • Hypertensive crisis with ingestion of foods containing tyramine (aged cheeses, smoked/cured meats, pickled herring, Bovril, Marmite)
148
Q

ANTI-DEPRESSANTS
What is the mechanism of action of tricyclic antidepressants (TCAs)?

A
  • Prevents reuptake + subsequent degradation of serotonin + noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic neuronal membrane
149
Q

ANTI-DEPRESSANTS
What are the side effects of TCAs?

A
  • Anticholinergic (can’t see, pee, spit, shit)
150
Q

ANTI-DEPRESSANTS
What is the mechanism of action of mirtazapine?

A
  • Blocks alpha-2 adrenergic receptors > increased release of neurotransmitters
151
Q

MOOD STABILISERS
What are the side effects of lithium?

A

LITHIUM –
- Leukocytosis
- Insipidus (diabetes, nephrogenic)
- Tremors (fine if SE, coarse if toxicity)
- Hydration (easily dehydrates, renally cleared)
- Increased GI motility (N+V, diarrhoea)
- Underactive thyroid
- Mums beware (Ebstein’s anomaly)

Can cause weight gain + derm (acne, psoriasis) long-term too

152
Q

MOOD STABILISERS
What drugs does lithium interact with?

A
  • NSAIDs, ACEi, ARBs + diuretics may increase lithium levels
  • Diuretics = dehydration,
    NSAIDs = renal damage
153
Q

MOOD STABILISERS
What regular monitoring is done for lithium?

A
  • Weekly serum lithium after initiation + dose changes until stable then every 3m for a year, then every 6m (sample taken 12h after dose)
  • 6m = TFTs, U+Es, eGFR
  • Annual = BMI
154
Q

HYPNOTICS
What is the mechanism of action of hypnotics?

A
  • GABA agonists on alpha2-subunit of GABA(A)-BDZ receptor/Cl- channel complex
155
Q

ANTI-PSYCHOTICS
What pathway do typical anti-psychotics work on to cause side effects?

A

Nigrostriatal (Parkinsonism),
tuberoinfundibular (prolactin)

156
Q

ANTI-PSYCHOTICS
What is the benefit of atypical anti-psychotics?

A

More useful in treating -ve Sx of schizophrenia + less likely to cause EPSEs

157
Q

ANTI-PSYCHOTICS
What anti-psychotic has a reduced SE profile and why?

A

Aripiprazole as it is a partial dopamine agonist

158
Q

ANTI-PSYCHOTICS
What is the most common adverse effect of clozapine?
What other adverse effects may it have?

A
  • Constipation (big issue in elderly)
  • Reduced seizure threshold, hypersalivation (Rx hyoscine hydrobromide)
159
Q

ANTI-PSYCHOTICS
How is tardive dyskinesia managed?

A

Prevention crucial,
switch to atypical anti-psychotic,
tetrabenazine used if mod–severe but unlikely to completely resolve

160
Q

ANTI-DEPRESSANTS
What are some interactions of SNRIs?

A
  • NSAIDs
    warfarin (increased risk of bleeding),
    lower seizure threshold
161
Q

ANTI-PSYCHOTICS
Give an example of a typical (1st generation) anti-psychotic.

A

haloperidol,
flupentixol
zuclopenthixol (decanoate = depot)
chlorpromazine

162
Q

ANTI-PSYCHOTICS
Give examples of atypical (2nd generation) psychotics.

A

olanzapine,
risperidone (depot),
clozapine,
aripiprazole (depot),
quetiapine

163
Q

ANTI-DEPRESSANTS
Give some examples of SNRIs?

A

Venlafaxine, duloxetine

164
Q

ANTI-DEPRESSANTS
Give some examples of monoamine oxidase inhibitors (MAOI)?
Give some examples.

A
  • Selegiline is selective MAO-B inhibitor which also increases dopamine
  • Isocarboxazid, phenelzine
165
Q

ANTI-DEPRESSANTS
In terms of TCA overdose what are the ECG signs?

A

Sinus tachy,
wide QRS,
prolonged QT interval

166
Q

ANTI-DEPRESSANTS
What is the management of a TCA overdose?

A

Sodium bicarbonate

167
Q

ANTI-DEPRESSANTS
What are some side effects of mirtazapine?

A

Increased appetite + weight gain + sedation are big ones, also increased triglyceride levels

168
Q

MOOD STABILISERS
What is the mechanism of action of mood stabilisers?

A

Lithium inhibits cAMP production which inhibits monoamines

169
Q

HYPNOTICS
Give some examples

A

Zopiclone, zolpidem, BDZs used for hypnotic effect (lorazepam, temazepam)

170
Q

BDZs
What is the mechanism of action of anxiolytics/benzodiazepines (BDZs)?

A
  • Enhance effect of inhibitory GABA by increasing frequency of Cl- channels + flow of Cl- ions causing hyperpolarisation of membrane + so prevention of further excitation
171
Q

BDZs
How would you manage an overdose?
What is the risk of using this?

A

IV flumazenil (danger of inducing status epilepticus or death though)

172
Q

SUBSTANCE ABUSE
List 8 features of dependence

A
  • Withdrawal
  • Cravings
  • Continued use despite harm
  • Tolerance
  • Primacy/salience
  • Loss of control
  • Narrowed repertoire
  • Rapid reinstatement
173
Q

SUBSTANCE ABUSE
What are some primary care interventions for drug users?

A
  • Health checks + BBV screening
  • Contraception, smear + sexual health advice
  • General immunisation status + hep A/B
  • Information on local drug services (needle exchange)
174
Q

ALCOHOL DEPENDENCE
What areas of the brain can alcohol affect?

A
  • Amygdala + nucleus accumbens
  • Cerebral cortex
  • Pre-frontal cortex
  • Cerebellum
  • Hypothalamus + pituitary
  • Medulla
175
Q

ALCOHOL DEPENDENCE
How does alcohol affect…

i) amygdala + nucleus accumbens?
ii) cerebral cortex?
iii) pre-frontal cortex?
iv) cerebellum?
v) hypothalamus + pituitary?
vi) medulla?

A

i) Euphoria, pleasure + reward centre
ii) Slows thinking + speech
iii) Slow behavioural inhibition centres (confident + relaxed)
iv) Slows movement + impairs coordination
v) Alters mood + hormones (libido increases)
vi) Decreases breathing, consciousness + body temp

176
Q

ALCOHOL DEPENDENCE
What are the 3 stages of alcohol withdrawal?

A
  • 6–12h = tremors, sweating, tachycardia, anxiety, irritability + aggression
  • 36h = seizures
  • 48–72h = delirium tremens
177
Q

ALCOHOL DEPENDENCE
What are the CAGE questions?

A
  • Have you ever felt you need to CUT down on your drinking?
  • Have people ANNOYED you by criticising your drink?
  • Have you ever felt GUILTY about your drinking?
  • EYE-opener – ever felt you need drink first thing in morning to steady your nerves?
178
Q

ALCOHOL DEPENDENCE
What are the AUDIT questions?

A
  • How often do you have a drink containing alcohol?
  • How many units of alcohol do you drink on a typical day?
  • How often did you have >6 units on a single occasion in the past year?
179
Q

ALCOHOL DEPENDENCE
What are public health measurements to help prevent alcohol abuse?

A
  • Increasing tax on alcohol + restricting advertisement on alcohol
  • Drinkaware + know your limits campaign
  • Keeping alcohol out of site (behind counter + having to ask for it)
  • School alcohol education to reduce long-term alcohol use + binge drinking
180
Q

ALCOHOL DEPENDENCE
What is the regime for acute detoxification?

A
  • Chlordiazepoxide 1st line (2nd = diazepam, lorazepam is preferred for pts with liver cirrhosis) for withdrawal Sx + preventing seizures
  • Thiamine (PO or IV)
  • Rehydrate with fluids (often IV), correct electrolyte disturbance
  • Reducing regime (slowly reduce doses over days)
181
Q

ALCOHOL DEPENDENCE
What are the 3 biological treatments used in alcohol dependence?

A
  • Naltrexone
  • Acamprosate
  • Disulfiram
182
Q

ALCOHOL DEPENDENCE
What is the mechanism of action of naltrexone?

A
  • Opioid receptor antagonist
  • Blocks euphoric effects of alcohol
  • Helps people stick to detox programme + avoid relapse
183
Q

ALCOHOL DEPENDENCE
What is the mechanism of action of acamprosate?

A
  • NMDA antagonist acts on GABA to reduce cravings + risk of relapse
184
Q

ALCOHOL DEPENDENCE
What is the mechanism of action of disulfiram?
What affects does it have?

A
  • Inhibits acetaldehyde dehydrogenase > build-up of acetaldehyde
  • Produces hangover-like Sx when alcohol is drunk = deterrent (flushing, headaches, anxiety, nausea, reduced BP)
185
Q

OPIATES/OPIOIDS
How do opioids work?

A
  • Bind to m-receptor > endogenous endorphins causing cortical inhibitor effects (analgesia) almost immediately
  • Addictive as high reward for minimal effort
186
Q

OPIATES/OPIOIDS
What drug can be used to prevent relapses?

A
  • Naltrexone
  • Opiate antagonist which prevents lapse > relapse
187
Q

SEDATIVES
What are some types of sedatives?
What is a ‘date-rape’ drug?
What routes can it be taken?

A
  • BDZs, barbiturates (increased duration of Cl- channels) often taken for their anxiolytic effects
  • Rohypnol > intoxicant, aphrodisiac + anterograde amnesia
  • PO + IV
188
Q

SEDATIVES
What are the withdrawal effects of sedatives?

A

Sweating,
myalgia,
tremors,
risk of seizures

189
Q

STIMULANTS
What are some examples?

A

Cocaine,
ecstasy (MDMA),
amphetamines (speed)

190
Q

STIMULANTS
What are the withdrawal effects of stimulants?

A

Psychomotor agitation,
dysphoric mood,
insomnia
bizarre/unpleasant dreams

191
Q

STIMULANTS
What are some other adverse effects of cocaine?

A
  • Arrhythmias, MI + damage to nasal septum if used chronically
192
Q

CANNABINOIDS
What are the…

i) psych
ii) physical

effects of cannabinoids?

A

i) Euphoria + disinhibition, hallucinations, paranoid, agitation, time passes slowly
ii) Increased appetite, dry mouth, tachycardia

193
Q

HALLUCINOGENS
What are some psych + physical effects of hallucinogens?

A
  • Hallucinations, illusions, depersonalisation + derealisation, paranoia, impulsivity, anxiety, magic mushrooms > euphoria as serotonin release
  • Tachycardia, palpitations, sweating, blurred vision
194
Q

ALCOHOL DEPENDENCE
How do you calculate number of units in a drink?

A
  • % ABV x volume (L)
195
Q

OPIATES/OPIOIDS
With opioids, what are the symptoms of withdrawal

A

“Goose flesh” (piloerection),
raised HR/BP,
fever,
pupil dilatation,
abdo cramps,
insomnia,
agitation
(everything runs > D+V, lacrimation, rhinorrhoea, diaphoresis)

196
Q

SEDATIVES
What are the…

i) psych
ii) physical

effects of sedatives?

A

i) Euphoria + disinhibition, hallucinations, paranoid, agitation, time passes slowly
ii) Unsteady gait, dysarthria, hypotension, nystagmus
iii) Sweating, myalgia, tremors, risk of seizures

197
Q

ANTIPSYCHOTICS
what is the effect of smoking on clozapine?

A
  • when smoking a higher level of clozapine may be required to get therapeutic dose
  • if stopping smoking a lower dose of clozapine may be required
198
Q

STIMULANTS
What is the action of stimulants?

A
  • Potentiate mood enhancing neurotransmission (dopamine, serotonin, noradrenaline) by blocking their uptake + increase cortical excitability
199
Q

STIMULANTS
What are the…

i) psych
ii) physical

effects of stimulants?

A

i) Euphoria, increased alertness + endurance, grandiosity, hallucinations, aggression, impulsivity
ii) Tachycardia, HTN, N+V, pupil dilation, CP + convulsions

200
Q

HALLUCINOGENS
Give some examples of hallucinogens

A
  • LSD, magic mushrooms (PO)
201
Q

VOLATILE SOLVENTS
Are the effects of solvents dangerous?

A

Very –laryngospasm due to cold temp, brain damage, hypoxia

202
Q

PERSONALITY DISORDERS
what are the clinical features of EUPD?

A

UNSTABLE SELF IMAGE
- low self esteem
- recurrent suicidal/self-harming behaviour

IMPULSIVITY
- self-sabotaging or risk-taking behaviour
- difficulty controlling temper

POOR INTERPERSONAL RELATIONSHIPS
- short romantic relationships
- feelings of abandonment
- idealisation + devaluation of others

PARANOIA
- quasi-psychotic thoughts in response to stress (transient psychosis that is not prolonged and does not require medication)

203
Q

STIMULANTS
what is the management of cocaine toxicity?

A
  • 1st line = benzodiazepines
  • chest pain = benzodiazepines + GTN
  • MI = PCI
  • HTN = benzodiazepines + sodium nitroprusside

MY REVISION - ALL TO DO (21 decks)

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