Core Conditions Flashcards
Anxiety
When is it pathological?
Presentation - Psychological: Classic... 5 Types of the point above, think what could trigger! Now think about the experience 2 Now link to another disorder 2
Differential Diagnoses
3 physiological
4 psychological
- Physiological 6/9
Types of Anxiety
-
- symptoms: 2
-
Anxiety
When is it pathological?
- When it impacts on daily living/ disrupts normal levels of function
Presentation - Psychological: (Classic) Apprehension + fear Anticipatory Anxiety- worries or foreboding Situational/ Exposure based Specific stimuli based free-floating/ generalised Random/ panic attack
Derealisation- seems unreal
Depersonalisation- out of body
Obsessions- repetitive and intrusive thoughts
Compulsions- taking specific actions to reduce anxiety
- Physiological: Muscular tension Inc HR Sweating Trembling Palpitations Chest pain Difficulty breathing Dec libido Dizzy
Diff Diag:
1) Hyperthyroidism
2) Hypoglycemia
3) Pheochromocytoma - neuro tumour
4) OCD, PTSD, Drug/ Alchol Dep such as Benzo, Pre-senile dementia
Types of Anxiety:
1) Generalised Anxiety Disorder
- No specific trigger. stimuli
- Take a long time to sleep and wake during the night
2) Panic Disorder
- Repeated + sudden + RANDOM ATTACKS of overwhelming anxiety
- Symptoms: hyperventilate, overactive Sympathetic NS
3) Phobia/ Agoraphobia
- Intense fear triggered by stimulus
- PREDICTABLE
Anxiety
Management Non-Pharmacological
5 different techniques with a brief description of each
Management Pharmacological
1) First step…
2) ….. MOA
- eg 3/4
- could also use…
3)….. MOA
- eg 2/3
Adverse affects: 4
4) In serious cases
5)
Anxiety
Management Non-Pharmacological
1) CBT- Identify mental cues, provoke exacerbation, identify and change patients ‘schema’ and their perception
2) Behaviour - Graded exposure/ systemic desensitisation
3) Biofeedback- Feedback to patient how physiologically anxious they are so they are aware of it
40 Anxiety Management- Stage 1 Verbal cues to arouse anxiety, Stage 2 trained to dec anxiety by relaxation
5) Relaxation technique- yoga, breathing, imagery
Management Pharmacological
- First decrease caffeine and alcohol use!
- Most SSRIs: Decrease Serotonin reuptake
Fluoxetine, Sertraline, Citalopram, escitalopram (could also use SNRIs, added bonus of dec depression risk)
- Benzodiazapines: Agonist to GABA, therefore increase inhibitory signals therefore anxiolytic
eg. Diazepam, Alprazolam, Chlordiazepoxide
Adverse affects: Sedation, don’t drive! memory, dependence - Antipsychotics- olanzapine, arirpiprazole for more serious cases
- B blockers- dampen physiological effects but don’t tackle the anxiety
Unipolar Depression
Presentation
Psychological: 6
Think of history!
Physiological 6
Think of history!
What is dysthymia?
Diff Diagnosis:
6/8!!
5 Steps/ Stages of assessing risk
Bipolar Disorder
Bipolar I -
Bipolar II -
Bipolar III -
Questionaire to assess mania- Name
Hypomania def-
Mania Presentation
8/11
- Circumstantial thought process
- Tangential thought process
Differential Diagnosis 5
Presentation Psychological: - Low mood - Anhedonia - Feeling of guilt - Dec motivation - Low self-esteem - Thoughts/ acts of self-harm
Physiological:
- Dec appetite
- Psychomotor retardation
- Constipation
- Dec libido
- Menstrual cycle changes
- Lack of eye contact
Dysthymia- Mild depression, lasts intermittentl for 2 years. tired, dec mood, anhedonia
But it could be seasonal affective disorder: Hypersomnia, inc weight gain + apetite
Diff Diagnosis:
- Hyperthyroidism
- Corticosteroid treatment
- Cushings Syndrome
- Pituitary treatment
- Alcohol/ amphetamine use
- Dementia
- Schizophrenia
- Personality disorder - EUPD
Assessing Risk:
- Thoughts of suicide fleeting
- Thoughts of suicide everyday
- Intent
- Plan
- Attempt
Bipolar Disorder
Bipolar I - one or more manic/ mixed episode
Bipolar II - depressive episode with at least one hypomanic episode
Bipolar III - Depressive disorder with but mania when taking anti-depressive
Young Mania Rating Scale (YMRS)
Hypomania- no functional impairment/ hospital, no psychosis, short lived
Mania Presentation
- Elevated mood
- Increased energy
- Grandiose
- Over familiarity/ over social
- Increased libido
- Pressure of speech: speak rapidly and frenziedly
- Flight of ideas: Change of topic via association, distraction or word play
- Disinhibition
- Reckless behaviour
- Delusions: False, firm belief out of religious or social norms
- Hallucinations
- Circumstantial thought process- added unrelavent info but finally reach point
- Tangential thought process- added unrelevant info but never reach point
Differential Diagnosis
- Amphetamine use (+ derrivatives)
- Cocaine
- Cushings syndrome
- Corticosteroid use
- Dopamine agonist
Management of Acute Depression: do 1 of 3 things
1)
2)
3)
Management of Acute Mania
1)
2)
3)
Long term management of Mania =
Management of Acute Depression: Can do 1 of 3 things
1) SSRI (fluoxetine) + Anti-psyc (Olanzapine)
2) Quitiapine ( 2nd Gen/ atpyical anti-psychotic)
3) Olanzipine
(add lamotrogrine = mood stabilizer)
Long term management Depression
- Lithium/ Valporate or Olanzipine/ Quitiapine
Management of Acute Mania
1) Stop any anti-depressants
2) 2nd Gen/ Atypical anti-psychotic (neuroleptic) = Aripiprazole, olanzapine, quitiapine, risperidone, haloperidol
3) Volproic acid useful in hypomania but DON’T USE IF PREG RISK
Long term management of Mania
1) Mood stabilizer: Sodium Valporate or Lithium
Psychosis Aetiology: - - - -
Most common type of schizophrenia?
Peak age onset?
Clinical Features- 5 First Rank Symptoms (diagnostic) 1) 2) 3) 4) 5)
Positive symptoms - - - -
Negative Symptoms - - - ->
Diff Diagnoses 5
Pro-dromal S + S
- 2 symptoms
- 2 things you need to know!
(Schizo)Psycho-affective disorder def-
Delusion vs Over-valued idea
Psychosis Aetiology: - Genetic link 60% - Early use and lots of cannabis use - Pre-frontal abnormality, enlarged lateral ventricles - D2 excess! +ve symptoms
Paranoid!
Peak onset age is in 20s, rarely before puberty
Clinical Features- 5 First Rank Symptoms (diagnostic)
1) Distorted perception aka Auditory hallucinations - third person/ commentary
2) Thought withdrawal, insertion, echo or broadcasting
3) Primary delusion (arising from nothing)
4) Delusional perception
5) Mood (not current affective disorder), feelings, thoughts controlled by someone else
Positive symptoms
- Acute onset
- Prominent delusions + hallucinations
- Normal brain structure, D2 abnormalities (too much)
- Good response to neuroleptics
Negative Symptoms
- Slow and insideous onset
- Apathy, socially withdrawn, dec motivation,
- Brain structure abnormalities, poor neuroleptic response -> Chronic schizophrenia!
Diff Diagnoses
- Organic mental disorder (prefrontal epilepsy)
- Affective disorder - Depression
- Drug pyschosis
- Personality disorder EUPD
- Elderly think dementia, as schizophrenia doesn’t cause altered consciousness or memory problems
Pro-dromal S + S: the early (-ve symptoms_ of schizophrenia
- ‘not self’ seen as others like depression
- vague paranoid hallucinations
- need collateral hisotry!
- need to know the baseline
(Schizo)Psycho-affective disorder def- clear cut schizophrenia + affective symptoms, can co-exist in same episode
Delusion vs Over-valued idea
Delusion- fixed, false, firm belief not inkeeping with religion or culture
Over-valued idea- Abnormal belief, not as severe, can be persuaded not to believe, obsessions (repetitive) and usually perceived by self as abnormal
Management Schizophrenia
Drug class = Anti-psychotics
General MOA=
1) Name of subgroup... What do they do? Key point! 2/4 Oral egs 2/4 Depot egs
2) Name of subgroup…
- What do they do?
4/6 Oral egs
2/3 LAI egs
What is the best anti-psychotic?
But what are 8 adverse affects of it?
Management Schizophrenia
MOA; Block D2 and D1 receptors and therefore DA won’t bind as have too much DA! (+ve symp)
1) First Gen: Block D2 Rec.
- Not selective so cause a range of side effects such as EPSE, Inc prolactin
- Oral:
Haloperidol
Chloropramazine
Pimozide
Trifluperazine
- Depot:
Haloperidol
Flupentinol
Zuclopenthixol
2) Second Gen/ Atypical Anti-psychotics
-Act on a range of receptors including serotonin
- Oral:
Clozipine
Olanzipine
Aripiprazole
Quitiapine
Risperiodone/ Palperidone
Amisulperide
LAI:
- Olanzipine
-Risperiodone/ Palperidone
- Aripiprazole
Best- Clozipine
1) Constipation- fatality risk with bowel impaction
2) Inc salivation
3) Inc seizures
4) Hyperthermia
5) Tachycardia
6) Agranulomacytosis (dec granulocytes and WBC)
7) Myocarditits
8) EPSE
