Liaison Flashcards
Describe PMS
Collection of psychological and somatic symptoms occurring during the luteal phase of menstrual
cycle.
How many women with PMS suffer from severe symptoms
5%
How many women of reproductive age suffer from PMS
3-8%
Co-morbidities of PMS
30-70% mood disorder
When do symptoms of PMS occur
Peak is 2 days before start of menses
Last several days to 2 weeks
Aetiology of PMS
Possible increased sensitivity to normal, fluctuation of gonadal hormones
Treatment of mild PMS
Lifestyle changes
CBT
Exercise and dietary regulation
Treatment of severe PMS
SSRIs
Response rate of PMS to SSRIs
60-90%
Medications for PMS
Fluoxetine Sertraline Citalopram Escitalopram Clomipramine Venlafaxine
What is intermittent dosing in PMS
Taking meds during luteal phase os menstrual cycle; can be effective
Non-antidepressant meds for PMS
Long-acting GnRH agonist, estrogen and other contraceptives; use as last resort as can introduce early menopause
How many patients with coronary heart disease have comorbid depression?
20%
Prevalence of depression in patients with heart failure
21.5% - 2-3 times the rate of general population
Relative risk of mortality in patients with CCF who have depression
2:1 compared to non-depressed patients
Prevalence of depression in advanced cancer
5-15%
Lifetime risk of MS in UK
1 in 8000
M:F ratio in MS
1:2
How many patients with MS have steady progression with no remission
5-10%
How many patients with MS have relapsing-remitting course
20-30%
How many patients with MS have progressive deterioration following relapsing-remitting course
60%
Lifetime prevalence of depression in MS
40-50%
3x higher than general population
Risk of trigging relapse of MS if given ECT
20%
How many deaths in MS are due to suicide
15%
Treatment of pathological laughing/crying in MS
Amitriptyline
Prevalence of depression post-stroke
35% - more subcortical lesions
Prevalence of anxiety post-stroke
25% - more cortical lesions
Prevalence of apathy without depression post-stroke
20%
Prevalence of emotional incontinence post-stroke
20%
Mean duration of post stroke depression
34 weeks
Which type of stroke is depression common in
Infarcts of basal ganglia, especially on left hemisphere
Treatment of mild-moderate depression post-stroke
Increase social interaction
Exercise
Psychosocial interventions
Treatment of severe depression post stroke or emotionalism
Anti-depressants; continue at least 4 months post-recovery
Prevalence of depression in epilepsy
30-50%
Prevalence of panic disorder in epilepsy
20%
Prevalence of psychosis in epilepsy
3-7%
Prevalence of depression in Parkinsons
40-50%
Prevalence of hypomania in Parkinsons
2%
Prevalence of anxiety in Parkinsons
50-65%
Prevalence of psychosis in Parkinsons
40% - drug-related
Prevalence of cognitive impairment in Parkinsons
19% with no dementia
25-40% with dementia
Risk factors for depression in Parkinsons
Female Younger onset Right-sided lesions Bradykinesia and gait disturbance Rapid disease progression Poorer cognitve status and ADLs
What antipsychotics can help in Parkinsons without worsening Parkinsonism
Clozapine <100mg/day
Quetiapine
Risk factors for cognitive impairment in Parkinsons
Older age
Late onset Parkinsons
Low socio-economic status and education
Presence of severe EPSEs
Medications for Parkinsons dementia
None licensed
Commonest cause of viral encephalitis
Herpes simplex - commonest cause of limbic encephalitis affecting temporal lobe and limbic circuit.
70% caused by HSV1.
How many patients with HSV encephalitis show psychiatric sx
70%
Common psych sx in HSV encephalitis
Acute confusion
Depression
Psychosis
Neuroimaging of HSV encephalitis
Swelling of temporal lobes, can cause raised ICP
Gold standard diagnosis of HSV encephalitis
CSF PCR for herpes virus
What are classifications of TBI?
Mild - PTA<60 mins
Moderate - PTA 1-24 hours
Severe - PTA 1-7 days
Very severe - PTA >7 days
Functional outcomes of TBI
Mild - return to work <1 month
Moderate - return to work in 2 months
Severe - return to work in 4 months
Very severe - may require >1 year to return to work
When is personality change in HI most common?
Injury to orbitofrontal or temporal lobe
How many patients with HI develop depression and anxiety?
25%
In which HI is paranoia common
Left temporal injury
In which HI is affective psychosis common
Right temporal or orbitofrontal injury
How many people with HI develop schizophrenia
2.5%
How many people with HI develop epilepsy
Closed 5%
Open 30%
Recovery rate of post-concussion
50% within 3 months
Risk factors of developing post-concussion syndrome
Depression and anxiety
Female gender
Treatment of post-concussion syndrome
Early intervention - few weeks - with education and reassurance
What are dyssomnias?
Primary sleep disorders which cause difficulty getting to or remaining asleep or excessive sleeping during the day
Types of parasomnias
Arousal disorders - arising from NREM sleep
Sleep-wake transition disorders
REM sleep parasomnias
What are parasomnias?
Disorders which intrude into the sleep process
Prevalence of narcolepsy
0.025%
Symptoms of narcolepsy
Sudden sleep attacks (refreshing as REM)
Cataplexy - 75% of patients
Sleep paralysis - 30%
Hypnagogic hallucinations
Prevalence of obstructive sleep apnoea
Men - 4%
Women - 2.5%
When does sleep walking occur during sleep
In slow-wave stages 3 and 4 - first third stage of sleep period
When do night terrors occur during sleep
Stages 3 and 4 of NREM sleep - first third of the night
What happens in REM sleep behavioural disorder
No loss of muscle tone during REM and dreams are acted as complex behaviours.
Episodes occur during middle - latter third of night during REM.
Which disorders is REM sleep behavioural disorder occur in?
Idiopathic Parkinsons Diffuse LBD Multiple system atrophy Guillian Barre
Treatment of REM sleep behavioural disorder?
Clonazepam
Make sleep environment safe
Prevalence of restless legs syndrome
3-15%
M:F ratio of restless legs syndrome
1:2
Familial pattern in restless legs syndrome
In >50% patients
Diagnostic criteria of restless leg syndrome
Aged >12 with akathisia (usually with paraesthesia), motor restlessness, worse at rest and at night
Treatment of restless leg syndrome
Sleep hygiene Relaxation techniques D2 agonists - Ropinirole (licensed), Pramipexole Anticonvulsants - Gabapentin, CBZ Opioids - oxycodone Clonazepam
Predisposing factors of restless leg syndrome
Iron deficiency Peripheral neuropathy Sedating antihistamines Central dopamine antagonists - metoclopramide, prochlorperazine Antipsychotics Caffeine Antidepressants
Prevalence of CFS
0.5%
M:F ratio of CFS
1:3
Mean illness duration of CFS
3-9 years
Diagnostic criteria of CFS
Persistent or relapsing, unexplained chronic fatigue of new onset, lasting at least 6 months
Four or more of the following symptoms, concurrently present for more than 6
months: impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle
pain, pain in several joints, new headaches,
unrefreshing sleep, or malaise after exertion.
Predictors of poor outcome in CFS
- Claiming a disability related benefit
- Low sense of control
- Strong focus on physical symptoms
- Being passive with reduced activity
- Membership of self help group (does not
mean self help groups worsen CFS,
membership may be an indicator of
perceived severity)
Predisposing factors of CFS
Neuroticism
Childhood inactivity or illness
Precipitating factors of CFS
In
Serious life eventsfectious mononucleosis, Q fever, Lyme disease
Perpetuating factors of CFS
Strong belief in physical cause Activity avoidance Poor self-control Primary/secondary gains Low self-perception of cognitive ability
Suggested biological aetiology of CFS
Abnormal HPA axis and serotonin pathway suggest altered physiological response to stress
33% have low cortisol
Evidence based treatment of CFS
CBT
Graded exercise therapy
Components of CBT for CFS
Explanation of aetiological model
Motivation for CBT
Challenging and changing of fatigue related
cognition
Achievement and maintenance of basic
amount of physical activity
Gradual increase in physical activity
Rehabilitation e.g., rigorous self-
monitoring, a safety behaviour in social
phobia, can feed to the core symptoms.
Aims of graded exercise therapy in CFS
Based physiological model of deconditioning. Muscles strength, autonomic
response and perception of exercise related sensations are affected by inactivity. Therapy aims to
gradually increase the exercise and other activities thus reducing the unwanted consequences of inactivity.
Improvement rate of CFS with CBT
70%
Improvement rate of CFS with graded exercise therapy
55%
Use of antidepressants in CFS
Should not be used
Prognosis of CFS
17-65% patients improve over 5 years
<10% recover for 5 years
10-20% worsen over time
Increased mortality with CFS?
No
Prevalence of depression in patients with CFS
23%
50-75% have a history of depression
Lifetime prevalence of GAD in CFS
2-30%
Prevalence of somatisation in CFS
28%
How many patients with CFS meet criteria for fibromyalgia?
35-70%
Prevalence of depression in patients with chronic pain
10-15%
Non-medical treatment of chronic pain
CBT
Components of CBT in chronic pain
Cognitive
restructuring; relaxation training; time-based activity pacing; and graded homework assignments to
decrease avoidance and to encourage a more active lifestyle.
Prevalence of mental disorder in HIV patients
38-73%
Prevalence of anxiety in HIV patients
11-25%
Most common mental illness in HIV patients
Depression - 30-60% lifetime prevalence
Antidepressants for depression in HIV
SSRIs
TCAS
Antipsychotic treatment in HIV
Risperidone
Causes of mania in HIV
Illicit drug use
Iatrogenic - meds like steroids and antivirals
Advaned HIV
Prevalence of dementia in AIDS
3%
How many patients with AIDS develop dementia in the course of their illness
15%
Risk factors for dementia in HIV
Older age
Decreased body mass
History of IV drug use
