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53 Cards in this Set
- Front
- Back
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Tell me the DSM IV criteria for schizophrenia. (A-E)
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A. Two or more of the following symptoms present for 1 month or more
- delusions - hallucinations - disorganised speech - grossly disorganised or catatonic behaviour -negative symptoms B.Social/Occupational dysfunction C. continual signs of the disorder persist for at least 6 months D. schizoaffective and mood disorders ruled out E. Drug abuse and other medical conditions ruled out |
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How long does it take to see a reduction in positive symptoms of schizophrenia when treated with antipsychotics?
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4-6 weeks (immediate calming effect, neg symptoms 6-12months)
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How do typical antipsychotics work?
(chlorpromazine, haloperidol and fluphenazine) |
They block D2 receptors. (Treat positive symptoms only)
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How do atypical antipsychotics work?
(olanzapine, clozapine, quetiapine, risperidone, aripiprazole) |
They block D2 and or D1 receptors and 5HT2 receptors.
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what is akathisia?
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State of agitation, distress and restlessness. Occasional side effect of antipsychotics and antidepressants.
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When does one use clozapine ?
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treatment resistant schizophrenia
severe neurological side effects from other antipsychotics |
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What are the side effects of clozapine?
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agranulocytosis (1-2% - must monitor)
EPSE NMS weight gain hypersalivation myocarditis/cardiomyopathy |
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What are the main side effects of typical antipsychotics?
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Movement disorders (tardive dyskinesia, EPS)
Anticholinergic effects (Dry mucous membranes, Blurred vision, Constipation, Urinary retention, Sweating, Delayed/retrograde ejaculation) Endocrine effects (gynaecomastia D2, weight gain 5HT2, menstrual irregularities) |
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What are the risk factors for neuroleptic malignant syndrome?
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dehydration
sudden increase of dose increased temperature low serum iron male |
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what are the symptoms of neuroleptic malignant syndrome?
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Fever
ANS changes (sweating, incr HR, labile BP) Rigidity Mental state changes (confusion) |
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What lab findings are present in neuroleptic malignant syndrome?
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raised CPK
leucocytosis myoglobinuria |
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How long, on average, does it take for antidepressants to have an effect?
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2-6 weeks
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What is enuresis?
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Involuntary urination (often by children at night)
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Name four common TCAs.
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amitripyline
imipramine nortriptyline desipramine |
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Name three common SSRIs
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Fluoxetine
citalopram sertraline |
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Name an SNRI
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venlafaxine
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Name an SDRI
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buproprion
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What is prozac?
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Fluoextine (SSRI)
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What is the mechanism of action of TCAs?
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They inhibit 5HT and NA reuptake
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What is a sympathomimetic?
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A drug that stimulates the sympathetic nervous system.
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Before starting lithium therapy what must you screen for?
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pregnancy
thyroid disease renal disease CVD seizure disorder |
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What are the clinical signs of lithium toxicity?
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GI: N+V, diarrhoea
Cerebellar: ataxia, slurred speech, incoordination Cerebral: coma, delirium, myoclonus, choreiform or Parkinsonian movements, UMN signs, seizures. |
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What is the mechanism of action of benzodiazapines?
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They potentiate the binding of GABA to receptors thereby enhancing the effects of GABA
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What are azapirones?
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They are an anxiolytic, eg buspirone, They are partial 5HT1A receptor agonists.
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what are some side effects of lithium?
(mechanism of action is unknown!) |
polyuria, polydipsia, tremor, lethargy, headache, weight gain, hypothyroidism, hair thinning, muscle weakness, N+V, diarrhoea, renal failure.
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What is methylphenidate prescribed for?
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ADHD (Ritalin)
Lasts 3-4hrs, 2-4 doses per day. Long acting (Concerta) available, 8-12 hour action. |
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What are the three main paradigms of psychotherapies?
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Psychodynamic
Behavioural/cognitive Experiential/humanistic |
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What are the seven DSM IV classifications of anxiety disorders?
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1. Panic disorders (with or without agoraphobia)
2. Agoraphobia without PD 3. Generalised anxiety disorder (GAD) 4. Social anxiety disorder (SAD) 5. Specifc phobias 6. OCD 7. PTSD |
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What drugs can be used in OCD?
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Only serotonergic
- SSRIs - clomipramine (a TCA) |
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What drugs can be used to treat GAD?
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SSRIs
buspirone (= azapirone, 5HT1A partial agonist) TCAs |
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What drugs can be used to treat panic disorder?
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SSRIs
Imipramine (TCA) MAOIs |
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What drugs can be used to treat SAD?
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SSRIs
MAOIs |
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Name the 4 clinical categories you should ask about in depression.
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1. emotional: anhedonia, hopelessness, guilt
2. physical: sleep, food, sex. 3. suicide/self harm 4. psychotic symptoms |
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What is the DSV IV criteria for a major depressive episode?
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Need 5+ for 2+ weeks
1. decreased mood all day everyday 2. anhedonia 3. 5% weight loss or gain 4. sleep more or less 5. increased or decreased psychomotor 6. fatigue 7. feeling worthless or guilty 8. decreased concentration 9. recurrent thoughts of death |
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What are some ways to describe thought form?
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normal
blocked tangential circumstantial flight of ideas |
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what are the three components of insight?
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1. recognising the phenomena as abnormal
2. attributing the abnormal phenomena to illness process 3. seeking and accepting treatment for illness |
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what are the DDx for delirum?
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Delirium, Dementia, Depression
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What are the DSM IV criteria for the diagnosis of delirum?
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1. altered consciouness
2. acute onset and fluctuating course 3. altered cognition 4. underlying medical condition |
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What are the ICD criteria for evidence of dependence?
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1. craving
2. loss of control over use 3. substance takes higher priority over other aspects of life 4. withdrawal syndrome if not taken 5. tolerance 6. continued use depsite evidence of harms |
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Match the monoamine to each part of the brainstem:
1. Loceus Coereleus 2. Ventral Tegmental area 3. Rostral Raphe Nuclei |
1. NA
2. DA 3. 5HT |
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Define the axis I and axis II types of psych problems.
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Axis I = clinical disorders (things that happen to you) mood disorders, substance abuse disorders
Axis II = Personality disorders and itellectual disablities (trait based, who you are) |
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Name the personality disorders in each cluster.
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A. schizoid, schizotypal, paranoid
B. histrionic, narcissistic, antisocial, boderline C. Avoidant, dependent, obsessive |
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state the four attachment patterns
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secure
avoidant ambivilant/resistant disorganised |
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what are the three 'first line' atypical antipsychotics?
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risperidone
olanzapine quetiapine |
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What are the symptoms of serotonin syndrome?
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Firstly: restlessness, confusion, lethargy
Can progress to: myoclonus, hytperthermia, rigor, hypertonicity |
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define alogia
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poverty of speech
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Assessing for metabolic syndrome includes what?
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BMI
BSL lipids blood pressure |
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What are the routine screening tests to be done for a patient with a suspected mood disorder?
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FBC
TFT EUC urinalysis urine drug screen |
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What are the DSM IV criteria for a manic episode?
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A. 1 week or more of abnormally or persistently elevated, expansive or irritable mood.
B. during this period, 3+ of: - inflated self esteem or grandiosity - decreased sleep - pressured speech - flight of ideas, thoughts racing - distractibility - increased goal directed activity - excessive involvement in pleasurable activities that may have painful consequences (spending, sex, foolish business deals) C. not a mixed episode D. causes life impairment (work, relationships..) E. not caused by something (drugs, medical condition) |
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What is the prevalence of Major depressive disorders for
a) males b) females |
a) 2-4%
b) 5-9% |
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What is a conversion disorder?
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Somataform disorder (DSM) or dissociative disorder (ICD)
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Naltrexone is used in the management of alcohol dependence. What receptors does it antagonise and it what type of drinker is it helpful?
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opioid recepters. Used in people who drink to feel good. It reduces cravings and if you do drink you don't feel as good.
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Acamprosate is used in the management of alcohol dependence. How does it work and when would you prescribe it?
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Acamprosate agonises GABA receptors and antagonises NDMA receptors. It is best used with complete alcohol abstinence.
It's good for those who use alcohol to stop feeling bad. |
