Core Conditions 3 Flashcards
What is a conversion disorder?
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
What are the signs & symptoms of a conversion disorder?
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
How is a conversion disorder managed?
CBT
Hypnosis
Biofeedback training
Benzos: Lorazepam
What are the 5 stages of grief?
- Denial
- Anger
- Bargaining
- Depression (>50%)
- Acceptance
Define: Learning Disability Learning Difficulty Mental retardation Cognitive impairment
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
What is serotonin syndrome?
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.
What are the causes of serotonin syndrome?
Drug overdose (SSRI)
Drug interactions (MAOIs)
Therapeutic meds
Mixing medications: e.g St John’s Wort & SSRI
What is the pathophysiology of serotonin syndrome?
- 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)
What are the signs & symptoms of serotonin syndrome?
Severe HTN Tachycardia High pyrexia (sweating) Anxiety & agitation Confusion Tremor, shivering, muscle jerks Headache Neuromuscular: Increased tone, myoclonus, hyper-reflexia Hypertonia/rigidity
How is serotonin syndrome investigated?
Hx & Ex Other investigations (FBC, CPK, Urine tox to rule other causes out)
How is serotonin syndrome treated?
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
What are the complications of serotonin syndrome?
Rhabdomyolysis
Multi-organ failure
How is the severity of serotonin syndrome categorised?
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
What are examples of functional somatic syndromes?
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
What are the criteria for chronic fatigue syndrome?
>4 more: Headache Unrefreshing sleep Joint/muscle pain Tender lymph nodes Subjective memory impairment Postexertional malaise >24hours
What are the aetiological factors associated with functional somatic syndromes?
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
What are the different liaison psychiatry services?
– ALPS (acute liaison psychiatric service)
– HMHT (Hospital mental health team)
– OP
– YCPM (inpatient unit)
What are the degrees of learning disability?
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.
What are 3 common causes of learning disabilities?
Trisomy 21: Most common genetic cause
Fetal Alcohol Syndrome
Fragile X Syndrome: Most common inherited cause
What conditions are associated with learning disabilities?
Prada-Willi Cerebral Palsy Tuberous Sclerosis: >50% Autism 30% with epilepsy have a learning disability
What is Akathisia?
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
What causes akathisia?
Neuroleptic drug use
What is the pathophysiology of akathisia?
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
How is akathisia managed?
Remove/reduce offending medication
Beta Blockers: Propanolol (Other lipophilic β blockers)
Benzodiazepines: Diazepam
Define: Expressive aphasia Receptive aphasia Global aphasia Dysarthria
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
What are Schneider’s features of normal thought?
Constancy
Organisation
Consistency
What are the 5 features of a formal thought disorder?
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
How long does grief normally last?
<6months
What are the signs of complicated grief?
> 6month duration
Hallucinations
Suicidal ideation
Functional impairment
In what psychiatric conditions can ‘stupor’ occur?
Depression Mania Catatonia Hysteria Epilepsy
What is the prodromal period of psychosis?
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
What are the causes of psychosis?
Genetics (twin studies)
Drug induced
Impaired foetal/neonatal development
Environmental: Winter/spring births, urbanisation, complications during pregnancy/delivery
