General Flashcards
3 drugs used in the treatment of Alzheimer’s
Donepezil
Galantamine
Rivastigmine
4 Antimuscarinic side effects
Dry mouth
Constipation
Blurred vision
Urinary retention
What is neuroleptic malignant syndrome
In response to antipsychotics as a result of rapid fall in dopaminergic activity.
Muscle stiffness andrigidity, autonomic dysfunction(pyrexia, tachycardia, Labile BP)
Rhabdomyalysis leading to kidney failure
Side effects of benzodiazepines
Withdrawal syndrome: Similar to alcohol withdrawal Insomnia Irritability Anxiety Tremor Loss of appetite Tinnitus Perspiration Perceptual disturbances Seizures
May appear up to 3 weeks after stopping as some very long acting
Hypnagogic and hypnopompic
Before(usually with narcolepsy) and after sleeping
What is the time course for side effects in alcohol withdrawal
Symptoms - 6-12 hours
Seizures 36 hours
Delirium tremens 72 hrs
What medications are given in delirium tremens
Long acting benzodiazepines such as chlordiazepoxide
6 features of dependency
Tolerance
Strong compulsion to use
Difficulties controlling use
Withdrawal symptoms
Continue despite knowing the risk
Prioritise it over other things eg money to buy
(Reduced variability of habits and narrowing of repertpoire not in criteria but are a feature)
Triad of wernickes
Ataxia
Confusion
Opthalmaplegia
Types of dementia
Cortical - Alzheimer’s
Subcortical - Huntingtons
Key feature of normal pressure hydrocephalus
Urinary incontinence
Sub cortical dementia and ataxia
Features of HIV encephalitis
Early apathy and withdrawal
Ataxia
Tremors
Seizures
Myoclonus
Features of sporadic cjd
Rapid onset neurological and psychiatric symptoms
Occurs in 40-60 year olds
Triphasic sharp wave eeg.
Tonsillor biopsy?
What is amnesiac syndrome
Characterised by inability to lay down new memories and there may be some retrograde memory loss.
Korsakoffs is most common type
Triad in Parkinson’s
Pill rolling tremor
Rigidity
Bradykinesia
Stooped walk
Mask like face
Falls
Constipation
80% develop dementia first signs are bradyphrenia
50 % develop depression
40% get psychotic symptoms
MS
50 percent get depression
60 of late stage ms get dementia
Name 3 associations of restless leg syndrome
wittmack ekbom syndrome - associated with rheumatoid arthritis, uraemia, iron deficiency anaemia.
3 assocaitions of nocturnal leg cramps
diabetes, pregnancy, arthritis
what is adjustment sleep disorder
lack of sleep associated with stress conflict or environmental change - goes whenanxiety is diminished
what is limit setting sleep disorder
usually due to a stubborn child, where refusal to go to sleep when the time is set.
Describe othello syndrome
Commonly occurs in alcoholics and they devlop pathological or morbid jealousy in reference to their partner. they often adopt extreme measures to prove it
give an example of when Central pontine myelinolysis can occur
during fast recorrection of a hyponatraemia. often occurs in alcoholics. presents with quadriplegia.
what is kleine levin syndrome
associated with hypersomnia and binge eating, also sexual disinhibition
what is the IQ range of mild learning disability
50-69
moderate = 35-49 severe = 20-34 profound = <20
what is diagnostic overshadowing
tendency to explain someones current symtpoms with a preexisting diagnosis
causes of LD
antenatal: drugs, smoking, alcohol, medications, onfection
perinatal - hypoxia, hypoglycaemia, prematurity, trauma.
Postnatally - social deprivation, malnutrition, infection, head injury. lead posiing
What are the 4 types of delusions of diagnostic significance in schizophrenia?
perception - 2 stage process where interpret surroundings to mean something odd.
Passivity - controlled by others
Interference - thoughts under contol of someone else, they are being tampered with
formal though disorder - vagueness/loosening of association/poverty/word salad
What are the negative symptoms of schizophrenia and when do they occur?
more commonly in the chronic phase of the disorder
apathy blunted affect anhedonia social withdrawal poverty of thought and speech.
(may manifest as lack of attention to personal hygiene or limited repertoire of daily activities )
What are the different types of schizophrenia
PARANOID - stable paranoid delusions (catatonic sx relatively small)
CATATONIC - extremes of hyperkinesis and hypokinesis may have aggressive outbursts of excitement, resistance to passive movement, dream like state.
HEBEPHRENIC - erratic unpredictable, disorganised thought. negative symptoms come fast with loss of volition. normally in young adults. hallucinations are non predominant.
SIMPLE - just neg without any evidence of previous positives
RESIDUAL - just neg sx post hallucinations
POST SCHIZOPHRENIC DEPRESSION - some small residual features of schizophrenia but not gone or florid. depression is key element.
What are the disorders of psychoactive substance use?
ACUTE INTOXICATION
HARMFUL USE - repetetive use which is leading to damaging health effects, mental or physical.
DEPENDENCE SYNDROME - strong desire to use, struggles to regulate use, persistence despite knowledge of harmful conequences, increased tolerance, prioritise it.
WITHDRAWAL - time limited and specific to the substance
WITHDRAWAL WITH DELIRIUM - with disturbance of conciousness and attnetion, perception, thinking, memory, behaviour, emotion, sleep wake cycle.
PSYCHOTIC DISORDER - hallucination, persecutary or paranoid delusions, abnormal affect, psychomotor disturbance excitememnt or stupor)
AMNESIC SYNDROME - chronic impairment of recent and remote memory. recent is worst. difficulty learning new material, confabulation mmay be evident
LATE ONSET PSYCHOTIC DISORDER
What are the affective disorders?
MANIC EPISODE
BIPOLAR AFFECTIVE DISORDER
DEPRESSIVE EPISODE
RECURRENT DEPRESSIVE DISORDER with current episode: (essentially BPAD without the mania)
PERSISTENT MOOD DISORDER - cyclothymia/dysthmia
What are the core features of depression
anergia
anhedinia
low mood.
What are the other associated symptoms of depression which are used to determine severity?
COGNITIVE - wothlessness, guilty, poor concentration, slow thinking.
BIOLOGICAL altered sleep, appetite, weight, libido, ocnstipation, aches, pains.
PSYCHOTIC hallucination and delusions.
What makes a depressive episode severe?
usually suicidal thoughts or severe hopelessness with a large number of associated cognitive and biological symptoms which are marked and distressing.
What are the phobic anxiety disorders?
Agoraphobia
Social phobia
specific phobia
What are the other anxiety disorders?
Panic disorder
Generalised anxiety disorder
Mixed anxiety and depressive disorder
What is autobiographical memory
relating to onselef e.g grandchild, birthday.
what is procedural memory
act of doing things.
what is topographical memory
to orientate oneself - common in dememntia
When is ‘preservation’ seen most commonly
organic brain disease such as dementia
note it may not just be seen in word form - may be motor actions too
In what condition is deja vu commonly seen?
temporal lobe epilepsy
ganser syndrome
approximations despite understaning the question
What is jamais vu?
familiar event has never happened before
what is a pareidolic illusion?
where shapes are found wihtin other objects such as shapes in the sky. one which becomes more real with concentration
what is a complete illuion
one which occurs due to not concentrating. incorrect interpretation
What is an extracampine hallucination
one which arises outside the usual range of senstion as apposed to a functional hallucination which may occur as a reulst of a specific external symptom(that is of the same modality)
What is a reflex hallucaination
one which happens as a result of a stimulus of a different modaility
What is a delusional atmosphere
idea that there are ‘goings on’ which often cant be explained. often occurs before a delusion forms
What is deulsional memory
reinterpretation of past events with a delusion
Knights move or derailment is what?
losening of association and is a formal thought disorder.
At what intervals do blood tests need to be taken for clozapine?
weekly for 18 weeks
2 weekly til end of year 1
then monthly
What is the traffic light system for clozapine?
GREEN -
WBC>3.5 neut>2
AMBER
WBC 3< x <3.5 and neut 1.5< x > 2.0
RED WBC <3 neut <1.5
What are the risks in pregancy of SSRI’s
first trimester use can increase loss, persistent pulmonary hypertension of the newborn and congenital heart disease
what is formication
feeling of insects under skin
what is micropsia
seeing things smaller than they are
macropsia - bigger
what is pelopsia
seeing things closer than they are
mechanism of action for amphetamines and cocaine
dopamine increased by reducing removal from synapse
MOA of caffeine
blocks inhibitoy receptor of adenosine causing neurostimulation. increased glutamate activity.
also increases serotonin and norepinephrine.
MOA nicotine
act at nicotinic recepters causing dopamine rise in the MCLP
ketamine
NMDA blockade - glutamine
What ahppens to the brain as it gets older?
reduces in size and loss of grey matter.
ventricle size increases
how long do PTSD symptoms need to persevere for diagnosis?
1 month
increased arousal
exposure to life threatening event
reexperiencing the evnt.
what is an adjustment disorder
inability to cope with daily tasks due to adjustment to new surroundings or circumstances. it has symptoms of depression and anxiety.
how long may an acute stress reaction persist for?
hours or days.
What is the cat sat on my hat sack and ate the bait to wait in hate? an example of?
clanging - not a symptom of catatonia
what is cataLEPSY?
state of rigidity and they can be moved
what is cataplexy?
loss of muscle tone sudden and transient
what is negativism
doing exactl the oppostie of what they are being told to do. resisting.
often seen in catatonia
what is nominal dysphasia
being able to describe what something is for but unable to say the name. common in dementia
what is circumstentiality
talking in a roundabout manour before ever getting to the answer. too much additional info. mania
what is the difference between loosening of assocaition and flight of ideas?
flight of ideas still shows some association which is logical between ideas however the objective changes. derailment however there is no association between the words they are disjointed.
What things are associated with frontal lobe malfunction?
hyperphagia hypersexuality childishness mood swings forced utilization
what do keiser fleisher rings look like?
brown or greenish golden rings in the eye.
They can also occur in PBC
What features would a tumour around the third ventricle produce
amnesia and confabulation
near the hypothalamus and thalamus which is likely to cause increase in eating and drinking and sleeping. and temperature dysregulation
vitamin b 3 deficiency?
pellagra - niacin deficiency - GI upset, bullous skin disease on sun exposed areas, depression/apathy/irritability. - may be a differential fr dementia
what is the correlation between epilepsy and psychiatric conditions?
associated with increase in psychotic symptoms aswell as depression
what vitamin is b1
thiamine
what symptoms might someone with post concussion syndrome have?
cognitive: poor concentration and memory
mood: anxiety depression irritability.
somatic: headaches dizziness fatigue, insomnia
What percentage of parkinsons suffferers get psychotic symptoms?
40% visual hallucinations are common of people or animals
may result from use of dopaminergic drugs too. is a strong predictor of home placement.
what part is demyelinated in MS
white matter of the CNS.
What psychiatric illnesses are often seen in MS?
memory and concentration problems
dementia (60% of late stage)
depression and suicide
mania
What are the 7 organic causes of a depression
Addisons b12 deficiency corticosteroids cushings syndrome hypothyroidism hypo/hyperparathyroidism SLE
what are the organic causes of mania
corticosteroids
cushings
hypothyroid
what are the 5 organic causes of psychosis?
Acute porphyria corticosteroids cushings hypothyroid SLE
What are the 5 organic causes of anxiety
arythmias caffeine hypoglycaemia hyperthyroid phaeo
What are the 6 organic causes of dementia?
Addisons disease b12 deficiency cushings folate deficiency hypothyroid hypo/hyper parathyroidism.
What is autoprosopagnosia
inability to recognise onselef in the mirror
what is sun downing and who gets it?
worseing of confusion as evening draws in - dementia
what is the most important feature in diagnosing dementia
interfereance with ADLs.
small mistakes in ADLs become more and more frequent.
What is found in alzheimers plaques?
beta amyloid core with surrounding dystrophic neuritis with hyperphosphylated tau protein. this also forms intercellular neurofibrillary tangles (NFTs)
what is prosopagnosia
inability to recognise faces
what are the 4A’s of alzheimers presentation?
Amnesia - recent mems go first
Aphasia - word finding problems with speach becoming muddled
Agnosia - inability to interpret things and recognise.
Apraxia - inability to carry out skilled tasks despite normal motor function.
what is the pathology of alzhgeimers
neuronal loss (mainly cholinergic pathways) leading to brain shrinkage dysfunction related to loss and deposition of beta amyloid and hyperphosphorylated tau protein these also create neurofibrillary tanges which further abet neuronal death.
what is strategic infarct demantia
one single stroke which leads to dementia - may be associated with vascular dementia or a stroke. the symptoms reflect the site of the lesion
what is a lewy body maed up of?
lewy bodies are eosinophilic intracytoplasmic neuronal structures made up of alpha synuclein and ubiquitin
where are lewy bodies found in parkinsons and lewy body dementia
PD: brainstem
DLB: cingulate gyrus and the neocortex
why should you avoid antipsychotics in DLB?
increases mortality
What are the risk factors for alzheimers?
Age
FHx
low IQ and poor education
head injury and vsascular risk factors
What are the genes involved in Alzheimer susceptibility
EARLY ONSET:
presenilin 1 and 2
beta amyloid precursor protein (APP)
LATE ONSET:
apolipoprtein allele E4 - also assocaited with arteriosclerosis.
What are the additional features of DLB
syncope
autonomic instability
recurrent falls
neuroleptic sensitivity
what is pseudodementia?
sever depression which can cause dementia like symptoms - often the patient is very worried about their memory loss as they retain a level of insight tht demtia patients do not. it is more likely in the elderly population. and is a result of poor concentration and attention that this memory loss occurs.
what is an obsession
recurrent unwanted intrusive thought which is recognised as ones own often making them feel very uncomfortable or anxious. the anxiety and tension of obsessions are often relieved by compulsions.
what is a compulsion
activity carried out repeatedly which neutralises anxiety. they are purposeful rituals that the patient feels they must carry out. they are often irrational and lack any link to the obsession.
What are the features exhibited in PTSD
re-experiencing: daydreams, flashbacks, nightmares
avoidance: avoid reminding of the event
hyperarousal: irritability, quick to startle, insomnia, poor concentration, cant relax or sleep. hypervigilant
Others: emotional detachment, decreased interest in acxtivites
what are the expected time frames of adjustment disorder
1 month to 6 months - support is all that is needed
who is more at risk of experiecning medically unexplained symptoms?
women, shorter duration of formal education. adverse events in childhood
what is ME?
myalgic encephalomyelitis or chronic fatigue syndrome.
extreme fatigue
aches and pains
mx = cbt and exercise
what is malingering?
feigning symptoms to gain external reward. e.g getting out of military servce
how do you distinguish picks disease with fronto temporal dementia?
tau present in picks
FTLD - ubiquinated inclusions which are tau negative similar to those in motor neurone disease.
These diseases come on much earlier than normal dementias in 40-60 year olds and have a strong inherited assocaition. around 40% are thought to be autosomal. death usually occurs within 5-10 years.
factors of poor prognosis in schizophrenia?
slow/gradual onset
male
young age at onset
lack of mood symptoms
what are the long term consequences of a raised prolactin
osteoporosis
what is a metonym
an existing word used in an unusual way
How do you distinguish hypomania?
affects daily life but not assocaited with psychotic symptoms or SEVERE disruption
hwo would agitated depression present?
irritable and anxioous but not with elevated or manic symptoms
risk factors for suicide?
have they tried before
male
unemployment
OCD is apparently protective. age is not a factor as is equal accross the board.
what is nihilism
nihilism is a psychological feature of depression characterized by
an overwhelming feeling of hopelessness and negativity which may
amount to delusional intensity
what is dysthmia
chronic depression of mood which is not severe enough to diagnose depressive episode. often may have small episodes which are not individually lasting long enough to diagnose depressive episode or recurrent depressive disorder. they must have the core symptoms for that.
biological treatment in OCD
SSRI
what are conversion disorders also known as
dissociative disorders
they have much better outcomes compared to somatiform dsorders.
internal conlict becomes unconsciously converted into neurological symptoms such as collapse or paralysis.
acute specific and dramatic presentations
Broadly speaking, dissociation refers
to a loss of integration between consciousness, memory, perception,
identity and bodily movements
What are the theories behind anxious disorders?
attachment: those who are insecurely attached as children go on to become anxious
Cognitive theory: automatic worrying thoughts repeatedly induce and maintain the anxiety
Negative reinforcement: running away for example helps the anxiety and does not allow for habituation.
triad of DLB?
parkinsonism
fluctuating conciousness and cognition
hallucinations
(greater risk of falls)
What are the contraindications to ECT
RELATIVE CONTRAINDICATIONS:
Heart disease
Riased ICP
High anaesthetic risk
what are you at risk of with chronic kidney disease
Depression and therefore diabetes is a risk too
What is very late onset schizphrenia like psychosis
condition of the elderly where partition delusions occur usually (where objects become permeable to people or substances)
they are often eldery and isolated individuals.
periventricular white matter lesions?
vascular dememntia
What is the difference between denial and repression?
Denial is the refusal to accept the reality depite logical evidence.
Repression is hiding of a memory in order to protect yourself from the feelings which that memory elicits.
what is systemic therapy also known as
family therapy - it aims to explore the interactions and relationships between people as apposed to the individuals inner world
subtypes include:
narrative therapy
solutionfocused therapy
strategic family therapy
Who is affected more by eating disorders
women that are WHITE!
if they were abused as a child this can manifest in this way. or any family which was overprotective or enmeshed.
what is the most common eating disorder
Binge eating disorder 2.8% (lifetime)
BN:1%
AN0.6%
what is the genetic component in anorexia
58% heretability.
You are more likely to get AN if you are :
a perfectionist
have low self esteem
In this domain if you lose weight it enhances your sense of achievement and gives you a chance to be autonomaous and a perfectionist
What are the 4 main diagnostic criteria for AN?
BMI less than 17.5
endocrine dysfunction
intended weight loss and disorted body image.
when would you admit anorexia
BMI less than 13 weight loss >1kg per week hypothermia <34.5 purpuric rash cold peripheries brady <40 K <2.5 cant stand up
What should be paid more attention when investigating BN
electrolyte changes - because they are vomiting
what are the 4 features of BN?
BMI>17.5
binge eating
purging
distorted body image - usually of a reasonably normal weight with maintained menses
What is thrombocytosis?
lack of platelets and is common in AN
What is the treatment for eating disrders
SSRI
treat comorbid conditions such as depression or self harm
CBT
What is motivational interviewing?
empowering an individual to see the change required and give them the ocnfidence to undertake it.
Wjhat are the baby blues
50-75% of mothers get it and feel down day 3 doesnt usually last more than a week.
What percentage of mothers get postnatal depression
10%
commonly relate to the baby
use paroxitine becuase lower amount in milk
they are increased risk of PND but not depression
Who gets peurperal psychosis
0.1% of births around 2 weeks post. admission required. those with a family history of BPAD or PND.
treat with antipsychotics, antidepressants and even lithium if needed. can give benzos too in short term to calm
What is the prognosis of puerperal psychosis?
patients recover in 6-12 weeks and there is a 1 in 3 chance of recurrance
What does adhd frequently coexist with?
conduct disorder
how many points on the MMSE would you expect someone to lose a year in dementia?
2/3 per year.
7 years is the median survival
What do you need to diagnose GAD
4 clincal features of(with atleast 1 autonomic):
autonomic arousal: sweating palp, shaking
physical symptoms: breathing dif, choking, chest pain/discomfort
mental state symptoms
General symptoms: numbness tingling
Tension symptoms: muscle aches, restlessness
Other: startle, concentration difficulties, sleep difficulty
Why should you aska forensic history in an alcohol station?
because they may have been done for drink driving or for violence when drunk.
What is pathalogical drunkness
when an alcoholic dependant gets liver damage and so gets drunk really easily now rather than exhibitng the tolerance he once had
Why shouldnt you give IV dextrose in wernickes?
can cause brain odema without the b1. give oral afterwards
What monitoring does one neeed on lithium
once stabilised 3/6 monthly depending on reliability of paitent. thyroid and U+Es
signs of refeeding syndrome
low BP with an increase in heart rate
2 pints of milk helps with phosphate intake
feeding too quickly on a slowly digesting stomach does what?
causes gastric ischemia
important things to avoid refeeding syndrome
too much fluid
too much volume (6 meals)
too hard to digest
high phophate diet
What do you need to think about before diagnosing someone
Time line
Symptoms
What can you not give in first line treatment for schizophrenia?
injectables should not be given as a firt line. if you are having trouble getting them to take it, atypical antipsychotics come in a liquid or disolvable tab form
What are the main side effects of SSRI’s
nausea vomiting, insomnia, irritability, anxiety
Which EPSEs should you treat with procyclidine?
acute dystonias and you can use them in parkinsons too. they should not be used in tardive dyskinesias
What would you expect to see in huntingtons disease?
chorea
athetosis (involuntary writhing movements)
dementia
depression
affects women and men equally
Autosomal dominant
more likely to get younger in
What condition has a better prognosis in the developing world?
schizophrenia
What disease has a 60-70 percent monozygotic concordance rate?
schizophrenia
peak age of onset of depression?
late 30’s
which disorder confers no inheritability?
agoraphobia
