Core conditions Flashcards
Alzheimers Dementia
Treatment
Gradual onset, Memory loss, increased ventricles, neurofibrilly tangles,
Treatment: ACh inhibitors Donpenezil
alZheimers donpeneZil
Vascular Dementia
signs
TX
Stepwise decrease in function
caused by infarcts and thrombolytic
TX: Aspirin and manage HTN
Fronto-temperal
syx
Treatment
Picks - earlier onset
Sx = personality disorder, social disinhibition, intellectual sparing, emotional blunting
SSRIs
Delerium
Transient change + acute disorientation
Causes: infection, neurological eg stroke, drugs
Illicit drugs
Key effects + withdrawal
Opiates: heroine, codine, morphine Cannabinoids: cannabis Hypnotics: bzs, barbiturates Stimulants: cocaine, MDMA Hallucinogens: lsd, shrooms
what brings pupils big vs down?
Opiate: Effect-decrease HR and BP + pinpoint pupils
Withdrawal: increase HR and BP and big pupils + runny nose + cravings
Cannabinoids: dry mouth, inc HR + appetite
Withdrawal: anxiety, irritability,, tremor, sweating
Hypnotics: Slurred speech,nystagmus, decreased temp (brings you down)
Withdrawal: tremor, inc HR, headache (brings u up)
Stimulant: increase moood + energy, inc HR + BP
Withdrawal: lethargy, craving, inc appeitie
Hallucinations: anxiety, depersonalisation, inc HR and pupils dialte
heroin and bzs = down and small pupil,
cocaine and lsd = big pupils
Schizophrenia
1st rank syx?
Diagnosis
Types
Treatment
- First rank symptoms Auditory hallucinations 3rd person Broadcasting of thoughts and echo Control - mood and behaviours Delusional perception
Diagnosis;: symptoms for 1 month with no drugs
PAranoid: delusions are evident
Catatonic: psychomotor distrubances
Hebephrenic: early onset, inappropriate mood, incongrious giggling
Treatment
- Antipsychotic
- CBT and family therapy and art therapy
Schizoaffective disorder
Affective (depression) and Schizophrenic symptoms occur together with equal prominence
Delusional disorder
A fixed delusion with unshakable belief
Depression
Syx
Treatment
Drug order
3 Core symptmoms= 2 needed for 2 weeks
1. Anhedonia 2. Low mood 3. Decreased energy
+ appetite, sleep disturbances, hopelessness etc
Mild = 4 syx, moderate = 6 syx, severe = 8syx
Management:
- mild = CBT
- Moderate CBT + SSRI for 6 months
- Severe = CBT + SSRIfor 6 months + ECT if catatonic
Drug order 1. SSRI -fluoxeteine (younger) or citalopram - 6 months (will know if working by 4 weeks) \+ review 1 week 2. Change SSRI to another one 3. Add SNRI eg Venlafaxine or Duloxetine 4. Try Mirtazapine Nassa if insomnia too 5. MAOI
Mania
Features
Appearance: flamboyant clothing, hats, heavy makeuup
Behaviour: hyperactive, flirty, disinhibited
Speech: Pressured, neologism
Thoughts: Grandiode, flight of ideas
Mood: euphoric, irritabble
reduced need for sleep
Bipolar affective disorder
Diagnosis
Treatment
- mainc episodes 1st line and 2nd line
- longer term
At least 2 episodes including at least one hypo/manic episode
type 1 = mani and type 2 = hypomania
Management
1. Manic episodes = 1st line Haloperidol, Risperione, Olanzpoine or Queitapine
2. Lithium or Valproate 2nd line if antipsychotics ineffective
BZs used in acute behavioural disturbance
3. Longterm = LITHIUM or valproate
Or women childbearing age use LAMOTRAGINE long term
GAD
Diagnosis
Management
- At least 6 months with prominent tension, worry and apprehension, irritability, tiredness
Managemnt:
1st line CBT, self help
2nd line SSRI Sertraline 1 year
Panic disorder
Severe panic attacks occuring unpredictably lasting 1 month and causing MALADAPTIVE behaviour
SYX: palpitations, sweating, tremor, N+V, last a few mins
TX: CBT + SSRIs
Phobia
- specific + tx
- agorophobia + tx
- social + tx
Specific = Eg heights, spiders TX = Graded exposure therapy and response prevention. Short term use of BZs eg if flight
Agorphobia = fear of crowds and public places TX = CBT
Social: most common, fear of social situations
TX = CBT, self help and SSRI if no improvement
PTSD
time frame?
Treatment?
Must be present for 1 month and onset within 6 months of the trauma
syx - persistent, intrusive thoughtd / flash backs, increase arousal, detatchment
treatment: EYE MOVEMENT DEREALISATION + REPROCESSING THERAPY
+ antidepressant
ADJUSTMENT
Depressive symtoms and inability to cope with major life event
Ususually self limiting and resolved by 6 months
TX: may respond to talking therapy
Abnormal bereavement
Delayed or unusually prolonged lasting over 6 months of inability to accept or cope with the loss
Somatisation disorder
multiple PHYSICAL symtoms present for over 2 years that has no organic cause
- spends excessive tme devoted to concerns
Patient often refuses to accept negative results
Conversion Disorder
Voluntary motor/sensory functional deficits that suggest neurologiclal conditions but doesnt fit on medical exam
Anorexia Nervosa
Signs
Management
BMI < 18.5
Signs: dry skin, fine hair, anaemia, Amenorrhea, bradycardia, risk of suicide, LOW WHITE CELL COUNT
management:
- fix BMI with refeeding 0.5kg/week
- FAMILY therapy and guided self help
- MARSIPAN guidance
- MANTRA = CBT + Motivational therapy
Complications: low K, low Na,
Hypophosphataemia is the hallmark of refeeding syndrome
Bullimia Nervosa
BMI > 18.5
Morbid fear of fatness, distorted body image, craving for food, binge and purging, self loathing
Signs: Depression, Low K, renal damage, russels sign = calluses on knuckles, mallory weis tear
Management: guided self help CBT + IPT
Fluoxetine SSRI 60mg
SSRI eg Fluoxetieine, Sertraline
SE
CI?
1st line for depression (fluoxetine in teens and longer half life)
SE: GI bleed, lowers Na, prolonged QT and increased risk of suicide
CI: epilepsy, peptic ulcer disease, under 24s, renal imparrment
SNRI
Venlafaxine 2nd line
Used for resistant depression
SE: SSRI Se + hypertension and heart disease
CI = hyptertension and heart disease
SNRI = VENLAFAXINE = HEART DISEASE
TCA eg Amitryptilline
noradrenaline AND seretonin
SE
CI
OVerdose TX
- for moderate-severe depression
- Treatment for neuropathic pain
SE: Antimuscarinic - cant shit, cant spit, cant pee cant see
sedation, hypotension, GI upset, prolonged QT
CI : ovoid in those with high risk of overdose, epilepsy, CVD, and constipation
TX: Iv bicarbonate + gastric lavage
MAOI
Example?
when indicated?
SE?
Example drug;? Phenelzine
- Given in resistant depression
SE: must adhere to dietary restrictons (low cheese and meat) to prevent TYRAMINE reaction = high BP and SA Haem
hypertensive crisis
MAOI=PHENELZINE=TYRAMINE
NASSA eg Mirtazapine
noradrenalnie and seretonin specific
SE: Sedating, weight, gain dry mouth
LESS sexual SE
(Picture Miranda going to space in a NaSSa spacee ship falling asleep)
1st gen Antipsychotic
D2
e.g Haloperidol, Chlorpromazine, Fluphenazine
MESOLIMBIC
Extrapyramidal syx, neurological EPSE
TREAT +ve symtoms only
2nd gen antipsychotic
D2 + 5HT2A
E.g Aripiprazole, = drowsiness, N+V tiredness
Clozapine = most effective, SE agranulocytosis and myocarditis
Quietapine: Also sedates
Rispiridone: Causes gynaecomastia
Olanzopine: causes weight gain
MESOCORTICAL
Treat +ve and -ve
SE for all: Weight gain, diabetes, metabolic
blurred vision, constipation,
Lithium
Therapeutic window?
How often to take
Tests
Side effects
toxicity signs
- Acts as mood stabiliser via second messenger system
Window = 0.4-1 mml/L
Take once daily - takes 2 weeks to kick in
Tests: Before = FBC, U+E, TFT, Bhcg, ECG
Check lithium level after 12 hr post dose, 5 days, then weekly until stable, then every 3 months
Check TFT, Ca and U+E every 6 months
12 hr - 5 day - 7 day- 3 month - 6 month
Side effects: GI- abdo pain, nausea, metalic taste, weight gain, idiopathic intracranial hypertension
Water syx: Thirst, polyuria, odema
Toxicity = Anorexia, diarrhoea, dysarthria + renal complicaitons
tx; re-hydration and stopping lithium until symptoms resolve
CI = 1st trimerster in pregnancy, breastfeeding, renal imairment
Valproate
- Mood stabiliers and 2nd line for acute mania
SE: Nausea, gastric irritation, diarrhoea, weight gain, tremor
CI in pregnancy!!! change to lamotrigine
Benzodiazepine
Short acting ones
Longer acting ones
SE:
Overdose? Tx?
Glutamate = HYPER Gaba = chill
Increase GABA
Uses: insomnia, muscle relaxant hypnotic, alcohol detoxification, psychosis, anxiety disorders short term
Short acting: Lorazepam
Long acting: Diazepam, Chlordiazepoxide
SE: psychomotor retardation, memory impairment, resp depression, dependenace and withdrawal = anxiety and disturbed sleep
Overdose: over sedation
Antidote = FLUMAZENIL IV
Lewy Body
Syx triad
TX
Fluctuating cognition, visual hallucinations and fluctuating alterness
TX: Levodopa and Donpenezil
extra-pyramidal side effects
- Dystonia
- Torticollis
- Akathesia
- Parkinsoniansm
- Tardive dyskinesia
- Dystonia = painful spasms of eye, neck and trunk
- Torticollis = neck position is wrong
- Akathesia = inner restlessness of legs
- Parkinsoniansm = muscluar rigidity bradukinesia and tremor
- Tardive dyskinesia = involuntatu repetitis meaningless movements of tongue lips and face after years of use and irreversible
Neuroleptic malignant syndrome
caused by?
Syx?
RARE life threatening side effect of antipsychotics
Rigidity, confusion and pyrexia
Clozapine
SE
REgular monitoring?
Only use when one typical and atypical has been trialled first
SE: Hypersalivation, tachycardia, myocarditis, cardiomyopathy, convulsions, AGRANULOCYTOSIS = severely low WCC
Needs regular blood monitoring for WCC
- weekly for 4 months
- fortnightly for a year
- monthly
INFORM DOCTOR IF SMOKING HABITS CHANGE
Persecutary delusion
Being spied on
Capgras
Friend or family has been replaced by an imoposer
Wearing different caps
Fregoli
Indiviudal is disguising itself as stragers
perri the platypus evil man
- Dopplegangers
-Double of one self
Othello
partner is cheating
your signigicant OTHER is cheating
De Clarembault
Being secretly loved by a famous persion
usain Bolt loves me
Cotard
Delusion of being dead
Ekbombs
Skin infected with parasites
Seretonin syndrome
It is characterised by: Extremes of temperature (and in life threatening cases this can rise above 41.5°C) Mental agitation and confusion Hypertonia Hyperreflexia Clonus.
Treat tardive dyskinesia
- change typical to atypical antipsychotic
Give Benztropine or benzhexol = anticholinergic for syx
Treat Acute dystonic reactions
Procyclidine
EUPD - borderline
- self harm + suicide
unstable relationships
Chronic feelings of emptiness
EUPD - antisocial/ impulsive
Disregard for rules
Reckless disregard for safety of self or others
Antidepressant order
1. SSRI -fluoxeteine (younger) or citalopram - 6 months (will know if working by 4 weeks) \+ review 1 week 2. Change SSRI to another one 3. Add SNRI eg Venlafaxine or Duloxetine 4. Try Mirtazapine Nassa if insomnia too 5. MAOI
Where can you do a 5)2
inpatients- not in A&E- here you would have to do seciton 2
OCD treatment
Obsessions = thoughts
compulsions = acts
SSRIs +
A particular form of CBT called exposure-response prevention (ERP) is used in OCD:
