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3a Psychiatry > Disorders > Flashcards

Disorders Flashcards

1
Q

Define bipolar disorder

A

Recurrent episodes of depression + mania (or hypomania)

  • Symptoms usually start at younger age (under 25 years)
  • High suicide rate
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2
Q

Features of depressive episodes (in bipolar)

A
  • Low mood
  • Anhedonia
  • Low energy

Can be severe

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3
Q

Define features of manic episodes in bipolar

A

Excessively elevated mood + energy - significantly impacting their normal functions
(e.g. caring and work responsibilities)

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4
Q

What are hypomanic episodes in bipolar?

A

Milder symptoms of mania - without having a significant impact on their function

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5
Q

Features of mania

A
  • Abnormally elevated mood
  • Increased energy
  • Decreased sleep (sometimes days without sleeping)
  • Significant irritability
  • Grandiosity, ambitious plans, excessive spending, high risk-taking behaviours
  • Disinhibition + sexually inappropriate behaviour
  • Pressured speech (rapid + unrelenting speech)
  • Psychosis (delusions + hallucinations)
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6
Q

What are mixed episodes in bipolar?

A

Mix of symptoms or rapid cycling between mania and depression

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7
Q

Which criteria is a diagnosis of bipolar disorder made from?

A

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

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8
Q

Define Bipolar I disorder

A

Bipolar I disorder = at least one episode of mania

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9
Q

Define Bipolar II disorder

A

Bipolar II disorder = involves at least one episode of major depression + at least one episode of hypomania

Bipolar I = at least one episode of mania
Bipolar II = at least one major depression + mania episode each

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10
Q

Define cyclothymia

A

Cyclothymia = milder symptoms of hypomania + low mood

The symptoms = not severe enough to significantly impair their function

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11
Q

Define unipolar depression

A

Unipolar depression = when the person only has episodes of depression - without hypomania or mania

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12
Q

Management for an acute manic episode (bipolar disorder)

A
  • First line: Antipsychotic medications (olanzapine, quetiapine, risperidone, haloperidol)
  • Other options: Lithium + sodium valproate
  • Existing antidepressants = tapered + STOPPED!

Bipolar disorder - think OLANZAPINE!

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13
Q

Management for an acute depressive episodes (bipolar disorder)

A
  • Olanzapine + fluoxetine
  • Antipsychotic medications (olanzapine or quetiapine)
  • Lamotrigine
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14
Q

Long-term management for bipolar disorder

A

Lithium

Serum lithium levels (taken 12 hours after the most recent dose).
Target range = 0.6-0.8 mmol/L
If too high → lithium toxicity

Long term = Lithium

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15
Q

Name some side effects of lithium

A
  • Fine tremor
  • Weight gain
  • Chronic kideny disease
  • Hypothyroidism + goitre (it inhibits the production of thyroid hormones)
  • Hyperparathyroidism + hypercalcaemia
  • Nephrogenic diabetes insipidus
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15
Q

What are the alternatives to lithium for long-term management of bipolar disorder?

A

Sodium valoproate + olanzapine

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16
Q

A 30 year old woman has recently diagnosed with bipolar II disorder. What drug cannot be prescribed to her?

A

Sodium valproate

(Teratogenic → neural tube defects + developmental delay)

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17
Q

What plans can family members put in place for individuals with bipolar disorder?

A
  • Lasting power of attorneys
  • Advanced decisions
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18
Q

Define obsessions

A

Obsessions = unwanted + uncontrolled thoughts and intrusive images

E.g. overwhelming fear of contamination with dirt or germs or violent or explicit images that keep appearing in their mind

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19
Q

Define compulsions

A

Compulsions = repititive actions the personal feels they must do - generating anxiety if not done.

Often these compulsions are a way to handle their obsessions

20
Q

The OCD cycle

A
  • Obsessions
  • Anxiety
  • Compulsion
  • Temporary relief
21
Q

What are the criterias used in diagnosing OCD?

A
  • Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
  • International Classification of Diseases (ICD-11)

The Yale-Brown Obsessive Compulsive Scale (Y-BCOS) = can be used to assess the severity of symptoms

22
Q

Management of OCD

A

Mild OCD: Education + self-help

Significant OCD:
* Cognitive behavioural therapy (CBT) + exposure and response prevention (ERP)
* SSRIs
* Clomipramine (a tricyclic antidepressant)

Exposure and response prevention = involves gradually facing the obsessive thoughts and anxiety without completing the compulsions.

23
Q

PTSD can result from any event that the individual finds traumatic. Examples include….

A
  • Violence (e.g., sexual assault, domestic violence, abuse or physical attacks)
  • Major car accidents
  • Major health events (e.g., traumatic childbirth, serious illness or death of a loved one)
  • Natural disasters
  • Military, combat and war zone events
24
Q

Features of how PTSD presents

A

The symptoms vary between patients based on their individual experiences and responses. The history will contain exposure to one or repeated traumatic events.

Key symptoms include:
* Intrusive thoughts relating to the event
* Re-experiencing (experiencing flashbacks, images, sensations and nightmares of the event)
* Hyperarousal (feeling on edge, irritable and easily startled)
* Avoidance of triggers that remind them of the event (e.g., people, places or talking about the event)
* Negative emotions (e.g., fear, anger, guilt or worthlessness)
* Negative beliefs (e.g., the world is dangerous)
* Difficulty with sleep
* Depersonalisation (feeling separated or detached)
* Derealisation (feeling the world around them is not real)
* Emotional numbing (unable to experience feelings)

25
Q

What is the diagnostic criteria for PTSD based on?

Name a PTSD screening tool?

A

Diagnosis:
* Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
* International Classification of Diseases (ICD-11)

Screening tool:
* Trauma screening Questionnaire (TSQ)

26
Q

Management for PTSD

A
  • Psychological therapy (e.g. trauma-focused CBT)
  • Medication (e.g. SSRIs, venlafaxine, antipsychotics)
  • Eye movement desensitisation and reprocessing (EDMR)

Eye movement densenitisation and reprocesses (EDMR) = involves processing traumatic memories while performing specific eye movements. The theory is that the improperly stored traumatic memories are reprocessed and stored again in a more normal way so that they no longer cause as much negative emotion and distress.

27
Q

Define dissociative symptoms

A

Dissociative symptoms = involve a sense of disruption to how these things fit together.
* They often occur in response to stress or a traumatic event and can last anywhere from a few minutes to many years

28
Q

Name some conditions in which patients can experience dissociative disorder

A
  • Borderline personality disorder
  • Post-traumatic stress disorder
29
Q

Name the 3 types of dissociative disorder

A
  • Depersionalisation-derealisation disorder
  • Dissociative amnesia
  • Dissociative identity disorder
30
Q

What is depersonalisation-derealisation disorder?

A
  • Depersonalisation = feeling of being separated or outside of their body
  • Derealisation = feeling that the world is not real
31
Q

What is dissociative amnesia

A

Dissociative amnesia = involves forgetting autobiographical information (details about themselves and events that have happened to them) - typically following a traumatic experience → leading to gaps in their memory.

32
Q

What is dissociative identity disorder?

Previously called multiple personality disorder

A

Lack of a clear individual identity + multiple separate identities with unique names, personalities and memories.

Often associatied with severe stress + trauma in childhood

33
Q

How does catatonia present?

A

Catatonia = involves abnormal movement + communication + behaviour

Presents:
* Hold unsusal postures
* Perform odd actions
* Repeat sounds or words
* Remain blank + unresponsive

34
Q

Common causes of catatonia

A
  • Severe depression
  • Bipolar disorder
  • Psychosis e.g. schizophrenia
  • Rarely - Health conditions e.g. strokes or brain tumours
35
Q

What is reactive attachment disorder?

A

Reactive attachment disorder
Causes:
* Severe neglect + trauma in early childhood

Results in:
* Emotional withdrawal + inhibition
* **Sadness **
* Fearfulness
* **Irritability **
* Impaired cognition

Struggle to form close relationships or attachments - do not respond well to affection or discipline

36
Q

What is attachment theory?

A

Attachment theory describes the importance of creating healthy, consistent and secure attachments to at least one nurturing individual during early childhood, particularly for the first two years of life. This creates a stable and secure base for the child to grow and develop. Reactive attachment disorder is a consequence of a severe absence of healthy attachments.

37
Q

What is factitious disorder?

AKA Munchausen syndrome

A

A conscious effort to fake illness + seek medical attention for personal gain

  • Symptoms = invented, exaggerated or induced (through self-injury)
  • Faking symptoms = provides attention, affection, relationships and care from others → The sick role offers a sense of identity.
  • They may get satisfaction from puzzling medical professionals. It can lead to significant and unnecessary investigations and interventions.

Patients with factitious disorder = may have repeated presentations with inconsistent and dramatic symptoms that do not fit with examination + investigation findings.

38
Q

What is hoarding disorder?

A

Hoarding disorder = excessive accumulation of possessions + emotional difficulty getting rid of items
* The volume of clutter in the home increases the risk of food contamination, falls, fires, and infestations.

Those with hoarding disorder may not see the behaviour as a problem or appreciate its impact on themselves and others. They may have insight and experience feelings of guilt or embarrassment. It may be associated with self-neglect, depression and anxiety.

39
Q

What is Alien Hand Syndrome?

A

Alien hand syndrome = involves the patient losing control of one of their hands
* The hand acts = independently, with a mind of its own → it may perform spontaneous actions, such as touching body parts or grabbing objects.

Cause:
* Underlying brain injury e.g. brain tumours, injuries, aneurysms, following brain surgery

40
Q

What is Cotard delusion?

AKA walking corpse syndrome

A

Cotard delusion = delusion that they are dead or actively dying

Cause:
* Psychiatric conditions (depression + schizophrenia)
* Neurological conditions (brain tumours + migraines)

41
Q

What is Capgras syndrome?

A

Capgras syndrome = delusion that an identical duplicate has replaced someone close to them (spouse, family member, close friend)
* The person may be suspicious + aggressive towards the imposter

Capgras syndrome = a delusional misidentification syndrome

Seen with:
* Psychotic conditions (schizophrenia)
* Dementia
* Other neurological conditions

42
Q

What is De Clerambault’s syndrome?

AKA erotomania

A

De Clerambault’s syndrome = delusion that a famus or high-social-status individual is in love with the patient

  • Can lead to inappropriate harassment of the individual by the patient.
  • The patient is most often a young, single woman
  • The patient usually has little or no contact with the individual and no objective evidence to support their belief.
  • Frequently, it occurs without other psychiatric or neurological disease.
43
Q

What is Alice in Wonderland Syndrome?

AKA Todd syndrome

A

Alice in Wonderland syndrome = incorrectly perceiving the sizes of body parts or objects (e.g: the person may perceive their hands as being excessively large or small)

Also associated with:
* Changes to the perception of time (e.g. time passing fast or slow)
* Symptoms of migraines (e.g. aura + headache (Symptoms = intermittent)

Causes:
* Migraine
* Epilepsy
* Brain tumours

44
Q

What is body integrity dysphoria?

AKA apotemnophelia

A

Body integrity dysphoria = strong feeling that part of the body does not belong to them e.g. one or both of the legs
* The healthy body part = causes them distress, and they typically want to remove that part of their body.
* They may have a desire to be disabled or paralysed and to use a wheelchair.
* It is not associated with psychiatric or neurological conditions.

44
Q

What is Koro syndrome?

A

Koro syndrome = delusion that the sex organs (particularly the penis) are retracting or shrinking → eventually leading to death
* Causes anxiety + panic attacks

Cases are primarily reported in Asia, particularly China and India, and Koro has been linked to cultural beliefs in these regions.

45
Q

What is foreign accent syndrome?

A

Foregin accent syndrome = sudden change in a person’s voice → perceived as changed accent
* They are aware that their voice has changed

The new speech pattern or accent is not connected with someone’s previous experience (e.g., speaking a second language associated with the new accent).

Common cause = stroke in the left hemisphere

46
Q

What is functional neurological disorder?

AKA conversion disorder

A

Functional neurological disorder = sensory + motor symptoms - that are no explained by any neurological disease

Cause: Underlying psychosocial factors - may have a history of significant trauma or stress

Symptoms:
* Weakness
* Gait disturbance
* Seizures
* Senory loss
* Vision disturbances

  • Symptoms = not under the patient’s control + can cause considerable distress + functional impairment
47
Q
A

3a Psychiatry (9 decks)

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