CL Flashcards
echelle pour mesurer sévérité de dépression postpartum
Montgomery Asberg depression rating scale (MADRS)
Edinburgh postnatal depression scale is a screening instrument and not very sensitive to change in symptoms that is expected with treatment.
frequence et risque de postpartum psychosis
1-2 sur 1000
risque de MAB
A 32-year-old school teacher is admitted for constipation and acute abdominal pain. She develops motor weakness of her legs on the administration of hypnotics and diclofenac. She experiences visual and tactile hallucinations with intense anxiety. Which of the following laboratory test is indicated?
Urine porphyrins
The scenario depicts acute intermittent porphyria (AIP). It is one of the groups of disorders of haem metabolism, characterised by neurological and psychiatric manifestations without obvious cutaneous markers. AIP manifests as abdominal pain, neuropathies, and constipation, Unlike other types of porphyria, AIP does not present with a rash. It is an autosomal dominant disorder with the presentation starting between ages 18 and 40. It is episodic in nature, and the episodes are often triggered by certain medications including estrogens, barbiturates and benzodiazepines. Diclofenac can precipitate an episode. Psychiatric manifestations include depression, anxiety, delirium and psychosis. The most important lab test is demonstrating increased urinary porphobilinogen during acute attacks. Treatment is aimed at reducing haem synthesis by administering haemin.
Trouble à symptomatologie somatique: specifiers
Avec douleur prédominante
Chronique (>6mo)
sévérité: léger (1 crit B), moyen (2 et plus B), grave (2 et+ B + plusieurs symptomes)
facteurs de risque pour TSS
neuroticism
anxiety/depression
stressful events
low SES (?)
cognitive FF (sensible à la dlr, interpretative des sensations, attribution à une maladie)
ne sont pas facteurs de risque de TSS
gender
education
marital status
quel syndrome est le plus probable apres stroke proche de lobe frontal gauche
depression
post-stroke depression: onset and prevalence
2 to 24 mo
33%
risk of malformation on lithium: prevalence
10%
lithium increases the risk of all types of malformation of approximately three-fold and with a weighting towards cardiac malformations of around eight-fold
drugs causing hypoNa
SSRI (RR 3)
elderly female on diuretics: at risk
tableau clinique de cataplexie, Dx
sleep attacks, sleep paralysis, cataplexy and hallucinations. The hallucinations reported are primarily visual, and mimic vivid dreams.
only 30% present this picture
An overnight polysomnography (often shows fragmented sleep and sleep-onset but a normal volume of REM) followed by multiple sleep latency test (often shows reduced sleep latency <8 minutes, or at least 2 sleep-onset REM periods) is essential for confirming the diagnosis of narcolepsy. These tests have >99% sensitivity for diagnosis.
Features which are common in pseudoseizures but not seen consistently in epilepsy
biting the tip of the tongue,
last more than 2 minutes,
gradual onset, a fluctuating course of illness severity, closed eyes during a seizure,
side to side (rather than flexion/extension) head movements.
Recommendation Rx for breastfeeding mothers
Antidepressant- Paroxetine or Sertraline;
Antipsychotic -Sulpiride or olanzapine;
Mood stabilizer- avoid, if possible, and use valproate if essential;
Sedatives- Lorazepam for anxiety;
Zolpidem for sleep
TX pour PMS
Sertraline et fluoxetine
Neonatal complication in babies who were born to mothers prescribed lithium in pregnancy
Ebstein’s anomaly, ASD, VSD, Neonatal goiter, hypotonia, lethargy and cardiac arrhthymias
