TO REVISE PSYCH Flashcards
MANIA
what are the cardinal symptoms of mania?
DIG FAST
Distractibility
Indiscretion
Grandiosity
Flight of ideas
Activity increased
Sleep deficit
Talkative (pressure of speech)
GAD
What are some organic differentials for GAD?
- Endo = hyperthyroidism, pheochromocytoma, hypoglycaemia
- CVS = arrhythmias, cardiac failure, anti-hypertensives, MI
- Resp = asthma (excessive salbutamol), COPD, PE
ANOREXIA NERVOSA
What screening tool can be used in anorexia?
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?
ANOREXIA NERVOSA
What is the pathophysiology of refeeding syndrome?
- 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
ANOREXIA NERVOSA
What is the clinical presentation of refeeding syndrome?
- Fatigue, weakness, confusion, dyspnoea (risk of fluid overload)
- Abdo pain, vomiting, constipation, infections
BULIMIA NERVOSA
What is the diagnostic criteria for bulimia?
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
PERSONALITY DISORDERS
What are some investigations for personality disorders?
- Assessed (Hx + MSE) more than once
- Minnesota Multiphasic Personality Inventory (MMPI)
- Eysenck Personality Inventory + Personality Diagnostic Questionnaire
LITHIUM TOXICITY
What is the clinical presentation of lithium toxicity?
- Ataxia, dysarthria, confusion (drunk)
- COARSE tremor, blurred vision, hyperreflexia
- N+V, diarrhoea
- Myoclonus, seizures + coma if severe
NMS
What is the clinical presentation?
Bodybuilder–
- Pyrexia >38 + diaphoresis
- Muscle rigidity (diffuse “lead-pipe” rigidity)
- Confusion, agitation, altered consciousness
- Tachycardia, high/low BP
- Hyporeflexia
NMS
What is the management of NMS?
- ABCDE approach
- Stop antipsychotic (wait >2w before restarting, consider atypical)
- Give L-dopa if dopamine withdrawal in Parkinson’s
- IV dantrolene or lorazepam to reduce rigidity 1st line (amantadine second)
- Bromocriptine prophylaxis
SEROTONIN SYNDROME
What is the clinical presentation of serotonin syndrome?
Sx onset + recovery fast–
- Neuro = confusion, agitation
- Neuromuscular = myoclonus, tremors (incl. shivering), hyperreflexia, ataxia
- Autonomic = hyperthermia, diarrhoea, tachycardia, mydriasis
SEROTONIN SYNDROME
What is the management of serotonin syndrome?
- ABCDE
- Stop offending agent
- IV access to correct volume + reduce risk of rhabdomyolysis as in NMS
- BDZs like slow IV lorazepam for agitation, seizures + myoclonus
- Serotonin receptor antagonists like PO cyproheptadine or chlorpromazine if severe
AUTISM SPECTRUM
What are some risk factors for autism?
- M>F
- Obstetric complications
- Perinatal infection (rubella)
- Genetic disorders (Fragile X, Down’s)
ADHD
What are some risk factors for ADHD?
- Epilepsy, low socioeconomic status, learning difficulties
- Premature or LBW
- Brain damage (in vitro or after severe head injury later)
GENDER DYSPHORIA
What are some risks of the hormone therapy?
- Oestrogen = clots, gallstones, high triglycerides
- Testosterone = polycythaemia, acne, dyslipidaemia
- Both = elevated LFTs, infertility, weight gain
ANTI-PSYCHOTICS
What regular investigations are done for people on anti-psychotics?
- 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
ANTI-DEPRESSANTS
What are the side effects of SSRIs?
- GI Sx most common (N+V, hyponatraemia, abdo pain, bowel issues, increased bleed risk)
- Sedation + sexual impotence
- Citalopram + QTc prolongation (dose-dependent)
ANTI-DEPRESSANTS
What is the mechanism of action of monoamine oxidase inhibitors (MAOI)?
- Inhibits monoamine oxidase enzyme which reduces breakdown of adrenaline, noradrenaline + serotonin so increases level
ANTI-DEPRESSANTS
What are some side effects from MAOIs?
- Sexual dysfunction, weight gain + postural hypotension
MOOD STABILISERS
What are the side effects of lithium?
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
HYPNOTICS
What is the mechanism of action of hypnotics?
- GABA agonists on alpha2-subunit of GABA(A)-BDZ receptor/Cl- channel complex
ANTI-PSYCHOTICS
How is akathisia managed?
Reduce dose, introduce beta-blocker (propranolol)
MOOD STABILISERS
What is the mechanism of action of mood stabilisers?
Lithium inhibits cAMP production which inhibits monoamines
HYPNOTICS
What are the adverse effects?
Same as BDZs
- Amnesia, ataxia (esp elderly = falls risk), confusion, drowsiness, dizziness next day (hangover effect), tolerance
- Monitor for resp depression (caution in resp disease)
BDZs
What is the mechanism of action of anxiolytics/benzodiazepines (BDZs)?
- Enhance effect of inhibitory GABA by increasing frequency of Cl- channels + flow of Cl- ions causing hyperpolarisation of membrane + so prevention of further excitation
BDZs
How would you manage an overdose?
What is the risk of using this?
IV flumazenil (danger of inducing status epilepticus or death though)
SUBSTANCE ABUSE
List 8 features of dependence
- Withdrawal
- Cravings
- Continued use despite harm
- Tolerance
- Primacy/salience
- Loss of control
- Narrowed repertoire
- Rapid reinstatement
ALCOHOL DEPENDENCE
How does alcohol affect the activity of neurotransmitters in the brain?
- Ethanol > ADH > acetaldehyde > ALDH > acetate > CO2 + H2O
- Ethanol binds to GABA + makes inhibitor/depressant effect stronger
- Glutamate antagonism which decreases excitatory neurotransmission
- Activates opioid receptors to release endorphins
- Release dopamine + serotonin
ALCOHOL DEPENDENCE
What are the CAGE questions?
- 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?
ALCOHOL DEPENDENCE
What are the AUDIT questions?
- 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?
ALCOHOL DEPENDENCE
What is the mechanism of action of naltrexone?
- Opioid receptor antagonist
- Blocks euphoric effects of alcohol
- Helps people stick to detox programme + avoid relapse
ALCOHOL DEPENDENCE
What is the mechanism of action of acamprosate?
- NMDA antagonist acts on GABA to reduce cravings + risk of relapse
BDZs
What drugs can BDZs interact with?
- Anti-hypertensives as enhanced hypotensive effect
SUBSTANCE ABUSE
What is an addiction?
- Compulsive substance taking behaviour with physiological withdrawal state
OPIATES/OPIOIDS
With opioids, what are the symptoms of withdrawal
“Goose flesh” (piloerection),
raised HR/BP,
fever,
pupil dilatation,
abdo cramps,
insomnia,
agitation
(everything runs > D+V, lacrimation, rhinorrhoea, diaphoresis)
PHENOMENOLOGY
what is Fregoli syndrome?
Fregoli = idea various people are the same person
