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CASC > Liaison > Flashcards

Liaison Flashcards

1
Q

Describe PMS

A

Collection of psychological and somatic symptoms occurring during the luteal phase of menstrual
cycle.

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2
Q

How many women with PMS suffer from severe symptoms

A

5%

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3
Q

How many women of reproductive age suffer from PMS

A

3-8%

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4
Q

Co-morbidities of PMS

A

30-70% mood disorder

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5
Q

When do symptoms of PMS occur

A

Peak is 2 days before start of menses

Last several days to 2 weeks

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6
Q

Aetiology of PMS

A

Possible increased sensitivity to normal, fluctuation of gonadal hormones

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7
Q

Treatment of mild PMS

A

Lifestyle changes
CBT
Exercise and dietary regulation

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8
Q

Treatment of severe PMS

A

SSRIs

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9
Q

Response rate of PMS to SSRIs

A

60-90%

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10
Q

Medications for PMS

A 
Fluoxetine
Sertraline
Citalopram
Escitalopram
Clomipramine
Venlafaxine
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11
Q

What is intermittent dosing in PMS

A

Taking meds during luteal phase os menstrual cycle; can be effective

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12
Q

Non-antidepressant meds for PMS

A

Long-acting GnRH agonist, estrogen and other contraceptives; use as last resort as can introduce early menopause

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13
Q

How many patients with coronary heart disease have comorbid depression?

A

20%

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14
Q

Prevalence of depression in patients with heart failure

A

21.5% - 2-3 times the rate of general population

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15
Q

Relative risk of mortality in patients with CCF who have depression

A

2:1 compared to non-depressed patients

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16
Q

Prevalence of depression in advanced cancer

A

5-15%

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17
Q

Lifetime risk of MS in UK

A

1 in 8000

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18
Q

M:F ratio in MS

A

1:2

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19
Q

How many patients with MS have steady progression with no remission

A

5-10%

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20
Q

How many patients with MS have relapsing-remitting course

A

20-30%

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21
Q

How many patients with MS have progressive deterioration following relapsing-remitting course

A

60%

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22
Q

Lifetime prevalence of depression in MS

A

40-50%

3x higher than general population

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23
Q

Risk of trigging relapse of MS if given ECT

A

20%

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24
Q

How many deaths in MS are due to suicide

A

15%

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25
Q

Treatment of pathological laughing/crying in MS

A

Amitriptyline

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26
Q

Prevalence of depression post-stroke

A

35% - more subcortical lesions

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27
Q

Prevalence of anxiety post-stroke

A

25% - more cortical lesions

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28
Q

Prevalence of apathy without depression post-stroke

A

20%

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29
Q

Prevalence of emotional incontinence post-stroke

A

20%

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30
Q

Mean duration of post stroke depression

A

34 weeks

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31
Q

Which type of stroke is depression common in

A

Infarcts of basal ganglia, especially on left hemisphere

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32
Q

Treatment of mild-moderate depression post-stroke

A

Increase social interaction
Exercise
Psychosocial interventions

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33
Q

Treatment of severe depression post stroke or emotionalism

A

Anti-depressants; continue at least 4 months post-recovery

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34
Q

Prevalence of depression in epilepsy

A

30-50%

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35
Q

Prevalence of panic disorder in epilepsy

A

20%

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36
Q

Prevalence of psychosis in epilepsy

A

3-7%

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37
Q

Prevalence of depression in Parkinsons

A

40-50%

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38
Q

Prevalence of hypomania in Parkinsons

A

2%

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39
Q

Prevalence of anxiety in Parkinsons

A

50-65%

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40
Q

Prevalence of psychosis in Parkinsons

A

40% - drug-related

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41
Q

Prevalence of cognitive impairment in Parkinsons

A

19% with no dementia

25-40% with dementia

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42
Q

Risk factors for depression in Parkinsons

A 
Female
Younger onset
Right-sided lesions
Bradykinesia and gait disturbance
Rapid disease progression
Poorer cognitve status and ADLs
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43
Q

What antipsychotics can help in Parkinsons without worsening Parkinsonism

A

Clozapine <100mg/day

Quetiapine

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44
Q

Risk factors for cognitive impairment in Parkinsons

A

Older age
Late onset Parkinsons
Low socio-economic status and education
Presence of severe EPSEs

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45
Q

Medications for Parkinsons dementia

A

None licensed

46
Q

Commonest cause of viral encephalitis

A

Herpes simplex - commonest cause of limbic encephalitis affecting temporal lobe and limbic circuit.
70% caused by HSV1.

47
Q

How many patients with HSV encephalitis show psychiatric sx

A

70%

48
Q

Common psych sx in HSV encephalitis

A

Acute confusion
Depression
Psychosis

49
Q

Neuroimaging of HSV encephalitis

A

Swelling of temporal lobes, can cause raised ICP

50
Q

Gold standard diagnosis of HSV encephalitis

A

CSF PCR for herpes virus

51
Q

What are classifications of TBI?

A

Mild - PTA<60 mins
Moderate - PTA 1-24 hours
Severe - PTA 1-7 days
Very severe - PTA >7 days

52
Q

Functional outcomes of TBI

A

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

53
Q

When is personality change in HI most common?

A

Injury to orbitofrontal or temporal lobe

54
Q

How many patients with HI develop depression and anxiety?

A

25%

55
Q

In which HI is paranoia common

A

Left temporal injury

56
Q

In which HI is affective psychosis common

A

Right temporal or orbitofrontal injury

57
Q

How many people with HI develop schizophrenia

A

2.5%

58
Q

How many people with HI develop epilepsy

A

Closed 5%

Open 30%

59
Q

Recovery rate of post-concussion

A

50% within 3 months

60
Q

Risk factors of developing post-concussion syndrome

A

Depression and anxiety

Female gender

61
Q

Treatment of post-concussion syndrome

A

Early intervention - few weeks - with education and reassurance

62
Q

What are dyssomnias?

A

Primary sleep disorders which cause difficulty getting to or remaining asleep or excessive sleeping during the day

63
Q

Types of parasomnias

A

Arousal disorders - arising from NREM sleep
Sleep-wake transition disorders
REM sleep parasomnias

64
Q

What are parasomnias?

A

Disorders which intrude into the sleep process

65
Q

Prevalence of narcolepsy

A

0.025%

66
Q

Symptoms of narcolepsy

A

Sudden sleep attacks (refreshing as REM)
Cataplexy - 75% of patients
Sleep paralysis - 30%
Hypnagogic hallucinations

67
Q

Prevalence of obstructive sleep apnoea

A

Men - 4%

Women - 2.5%

68
Q

When does sleep walking occur during sleep

A

In slow-wave stages 3 and 4 - first third stage of sleep period

69
Q

When do night terrors occur during sleep

A

Stages 3 and 4 of NREM sleep - first third of the night

70
Q

What happens in REM sleep behavioural disorder

A

No loss of muscle tone during REM and dreams are acted as complex behaviours.
Episodes occur during middle - latter third of night during REM.

71
Q

Which disorders is REM sleep behavioural disorder occur in?

A 
Idiopathic
Parkinsons
Diffuse LBD
Multiple system atrophy
Guillian Barre
72
Q

Treatment of REM sleep behavioural disorder?

A

Clonazepam

Make sleep environment safe

73
Q

Prevalence of restless legs syndrome

A

3-15%

74
Q

M:F ratio of restless legs syndrome

A

1:2

75
Q

Familial pattern in restless legs syndrome

A

In >50% patients

76
Q

Diagnostic criteria of restless leg syndrome

A

Aged >12 with akathisia (usually with paraesthesia), motor restlessness, worse at rest and at night

77
Q

Treatment of restless leg syndrome

A 
Sleep hygiene
Relaxation techniques
D2 agonists - Ropinirole (licensed), Pramipexole
Anticonvulsants - Gabapentin, CBZ
Opioids - oxycodone
Clonazepam
78
Q

Predisposing factors of restless leg syndrome

A 
Iron deficiency
Peripheral neuropathy
Sedating antihistamines
Central dopamine antagonists - metoclopramide, prochlorperazine
Antipsychotics
Caffeine
Antidepressants
79
Q

Prevalence of CFS

A

0.5%

80
Q

M:F ratio of CFS

A

1:3

81
Q

Mean illness duration of CFS

A

3-9 years

82
Q

Diagnostic criteria of CFS

A

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.

83
Q

Predictors of poor outcome in CFS

A
  1. Claiming a disability related benefit
  2. Low sense of control
  3. Strong focus on physical symptoms
  4. Being passive with reduced activity
  5. Membership of self help group (does not
    mean self help groups worsen CFS,
    membership may be an indicator of
    perceived severity)
84
Q

Predisposing factors of CFS

A

Neuroticism

Childhood inactivity or illness

85
Q

Precipitating factors of CFS

A

In

Serious life eventsfectious mononucleosis, Q fever, Lyme disease

86
Q

Perpetuating factors of CFS

A 
Strong belief in physical cause
Activity avoidance
Poor self-control
Primary/secondary gains
Low self-perception of cognitive ability
87
Q

Suggested biological aetiology of CFS

A

Abnormal HPA axis and serotonin pathway suggest altered physiological response to stress
33% have low cortisol

88
Q

Evidence based treatment of CFS

A

CBT

Graded exercise therapy

89
Q

Components of CBT for CFS

A

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.

90
Q

Aims of graded exercise therapy in CFS

A

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.

91
Q

Improvement rate of CFS with CBT

A

70%

92
Q

Improvement rate of CFS with graded exercise therapy

A

55%

93
Q

Use of antidepressants in CFS

A

Should not be used

94
Q

Prognosis of CFS

A

17-65% patients improve over 5 years
<10% recover for 5 years
10-20% worsen over time

95
Q

Increased mortality with CFS?

A

No

96
Q

Prevalence of depression in patients with CFS

A

23%

50-75% have a history of depression

97
Q

Lifetime prevalence of GAD in CFS

A

2-30%

98
Q

Prevalence of somatisation in CFS

A

28%

99
Q

How many patients with CFS meet criteria for fibromyalgia?

A

35-70%

100
Q

Prevalence of depression in patients with chronic pain

A

10-15%

101
Q

Non-medical treatment of chronic pain

A

CBT

102
Q

Components of CBT in chronic pain

A

Cognitive
restructuring; relaxation training; time-based activity pacing; and graded homework assignments to
decrease avoidance and to encourage a more active lifestyle.

103
Q

Prevalence of mental disorder in HIV patients

A

38-73%

104
Q

Prevalence of anxiety in HIV patients

A

11-25%

105
Q

Most common mental illness in HIV patients

A

Depression - 30-60% lifetime prevalence

106
Q

Antidepressants for depression in HIV

A

SSRIs

TCAS

107
Q

Antipsychotic treatment in HIV

A

Risperidone

108
Q

Causes of mania in HIV

A

Illicit drug use
Iatrogenic - meds like steroids and antivirals
Advaned HIV

109
Q

Prevalence of dementia in AIDS

A

3%

110
Q

How many patients with AIDS develop dementia in the course of their illness

A

15%

111
Q

Risk factors for dementia in HIV

A

Older age
Decreased body mass
History of IV drug use

CASC (16 decks)

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