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Psychiatry > Core Conditions 3 > Flashcards

Core Conditions 3 Flashcards

1
Q

What is a conversion disorder?

A

Voluntary motor or sensory function deficits that suggest neurological or medical conditions but are rather associated with clinical findings that are not compatible with such conditions

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2
Q

What are the signs & symptoms of a conversion disorder?

A 
Unconventional behaviour during Hx
Emotional processing problems
Recent/remote life stressors
Multiple illness behaviours
Give-way weakness
Unusual neuro deficits
Inconsistent exam findings
False sensory findings
Distractible symptoms
Bizarre movements
Generalised seizure-like motor movements without loss of awareness
Gait disorders
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3
Q

How is a conversion disorder managed?

A

CBT
Hypnosis
Biofeedback training
Benzos: Lorazepam

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4
Q

What are the 5 stages of grief?

A
  • Denial
  • Anger
  • Bargaining
  • Depression (>50%)
  • Acceptance
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5
Q 
Define: 
Learning Disability
Learning Difficulty
Mental retardation
Cognitive impairment
A

LDi: Occuring before 18 with loss of adaptive social functioning and an IQ under 70 (Same as mental retardation- ICD-10)
LDif: E.g dyslexia/dysphraxia, specific learning disability, used by educational services
CI: Below average IQ

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6
Q

What is serotonin syndrome?

A

An excess of synaptic serotonin in the central nervous system that clinically manifests as the triad of neuromuscular excitation, autonomic effects, and altered mental status.

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7
Q

What are the causes of serotonin syndrome?

A

Drug overdose (SSRI)
Drug interactions (MAOIs)
Therapeutic meds
Mixing medications: e.g St John’s Wort & SSRI

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8
Q

What is the pathophysiology of serotonin syndrome?

A
  • Exposure to any med that increases the intrasynaptic serotonin conc in the CNS
  • Has effects on 5HT receptor subtypes
  • Mechanisms:
  • Increased serotonin production
  • Serotonin release
  • Serotonin reuptake inhibition
  • Decreased serotonin metabolism (MAOI)
  • Severe almost always due to synergistic effects of 2 serotonergic drugs via different mechanisms (usually SSRI & MAOI)
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9
Q

What are the signs & symptoms of serotonin syndrome?

A 
Severe HTN
Tachycardia
High pyrexia (sweating)
Anxiety & agitation
Confusion
Tremor, shivering, muscle jerks
Headache
Neuromuscular: Increased tone, myoclonus, hyper-reflexia
Hypertonia/rigidity
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10
Q

How is serotonin syndrome investigated?

A 
Hx & Ex
Other investigations (FBC, CPK, Urine tox to rule other causes out)
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11
Q

How is serotonin syndrome treated?

A

MILD: Cessation of causative drug
MOD: Cessation of drug, Diazepam5-10mg/Cyproheptadine 12mg
SEVERE: Cessation of drug, Activated charcoal 25-100mg, Chlorpromazine 12.5-50mg
Rhabdomyolysis: Muscle paralysis & cooling

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12
Q

What are the complications of serotonin syndrome?

A

Rhabdomyolysis

Multi-organ failure

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13
Q

How is the severity of serotonin syndrome categorised?

A

Mild: Hyper-reflexia (almost always with SSRI use), tremor, inducible clonus, non-specific (headache, sweating), diaphoresis, myoclonic jerks
Moderate: Cause signif distress, patient requires treatment, anxiety & agitation, tachycardia, meet HSTC criteria
Severe: MEDICAL EMERGENCY, multiorgan failure if not treated, hyperthermia, hypertonia, meet HSTC criteria

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14
Q

What are examples of functional somatic syndromes?

A 
GI: IBS
Gynae: Pre-menstrual syndrome, chronic pelvic pain
Rheumatology: Fibromyalgia
Cardio: Atypical/ Non-cardiac chest pain
Resp: Hyperventilation
Infectious: Chronic fatigue syndrome
Neuro: Tension headache
ENT: Globus syndrome 
Allergy: Multiple chemical sensitivity
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15
Q

What are the criteria for chronic fatigue syndrome?

A 
>4 more:
Headache 
Unrefreshing sleep
Joint/muscle pain
Tender lymph nodes
Subjective memory impairment
Postexertional malaise >24hours
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16
Q

What are the aetiological factors associated with functional somatic syndromes?

A

Predisposing: Genetic, Personality traits, Illness belief: Childhood experience, family attitudes, own knowledge, Major physical illness
Precipitating: Inactivity, poor sleep, psychiatric disorder, stressful life events, poor social support, epidemics of health anxiety
Perpetuating: Reactions to others, psychiatric disorder

17
Q

What are the different liaison psychiatry services?

A

– ALPS (acute liaison psychiatric service)
– HMHT (Hospital mental health team)
– OP
– YCPM (inpatient unit)

18
Q

What are the degrees of learning disability?

A

MILD: IQ 50-69, Language fair. Sensory or motor deficits slight, reasonable level of independence.
MODERATE: IQ 35-49, Generally better receptive than expressive language.
SEVERE: IQ 20-34, Increased sensory and motor deficits. 50% will have epilepsy.
PROFOUND: IQ < 20, Increased need and vulnerability. Developmental level about 12 months.

19
Q

What are 3 common causes of learning disabilities?

A

Trisomy 21: Most common genetic cause
Fetal Alcohol Syndrome
Fragile X Syndrome: Most common inherited cause

20
Q

What conditions are associated with learning disabilities?

A 
Prada-Willi
Cerebral Palsy
Tuberous Sclerosis: >50%
Autism
30% with epilepsy have a learning disability
21
Q

What is Akathisia?

A

The subjective aspect consists of feelings of inner tension and restlessness, with a desire to move. The objective component is manifest by clinical evidence of restlessness

22
Q

What causes akathisia?

A

Neuroleptic drug use

23
Q

What is the pathophysiology of akathisia?

A

Caused by drugs that diminish dopamine receptor stimulation
May be able to suppress motor activity for a while but this results in a build-up of inner tension & distress forcing them to move. The more severe the shorter the time of immobility tolerated

24
Q

How is akathisia managed?

A

Remove/reduce offending medication
Beta Blockers: Propanolol (Other lipophilic β blockers)
Benzodiazepines: Diazepam

25
Q 
Define: 
Expressive aphasia
Receptive aphasia
Global aphasia
Dysarthria
A

E: Difficulty vocalising words, comprehension is intact
R: Difficulty understanding even though pt feels they are speaking fluently
G: Both receptive & expressive aphasia
D: Physical difficulty in controlling movements of the mouth in order to articulate words

26
Q

What are Schneider’s features of normal thought?

A

Constancy
Organisation
Consistency

27
Q

What are the 5 features of a formal thought disorder?

A

1) Derailment: Thought derails onto a subsidiary thought
2) Drivelling: Disordered mixture of constituent parts of a thought
3) Fusion: Different thoughts woven together
4) Omission: Part of the thought missing
5) Substitution: Major thought substituted with a more minor thought

28
Q

How long does grief normally last?

A

<6months

29
Q

What are the signs of complicated grief?

A

> 6month duration
Hallucinations
Suicidal ideation
Functional impairment

30
Q

In what psychiatric conditions can ‘stupor’ occur?

A 
Depression
Mania
Catatonia
Hysteria
Epilepsy
31
Q

What is the prodromal period of psychosis?

A

Precedes first episode of psychosis
Days- 18months
Some deterioration in personal functioning: Emergence of transient/attenuated psychotic symptoms, unusual behaviour, apathy, social withdrawal, reduced interest, concentration problems

32
Q

What are the causes of psychosis?

A

Genetics (twin studies)
Drug induced
Impaired foetal/neonatal development
Environmental: Winter/spring births, urbanisation, complications during pregnancy/delivery

Psychiatry (19 decks)

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