Mental Health 2 Flashcards
What are first rank symptoms of schizophrenia and what are their drawbacks?
Symptoms that, if present, are strongly suggestive of schizophrenia
However are also present in other disorders e.g. Dissociative identity disorder
4 areas of positive symptoms of schizophrenia?
Delusions
Hallucinations
Formal thought disorders
Thought passivity phenomena - withdrawal, echo, insertion, broadcasting
What is a delusion?
A fixed belief (conviction) held on inadequate grounds and not susceptible to rational argument or conflicting evidence to the contrary, not culturally emissable
5As of negative symptoms of schizophrenia?
Alogia Anhedonia Avolition Affective blunting Amotivation
What group of schizophrenic patients are highest risk of suicide?
Young males who have insight
If someone has delusions but no other disturbances, do they have schizophrenia?
No, they have a delusional disorder
What if psychotic symptoms last for less than a month?
Acute and transient psychotic disorder
What if someone develops psychotic and affective symptoms at the same time?
Probably schizoaffective disorder
PAD THCNeg of schizophrenia criteria?
Passivity phenomena
Auditory hallucinations (running commentary, 3rd person)
Delusions - bizarre, control or perception
Thought disorder
Hallucinations of any modality
Catatonia
Negative symptoms
What is delusional perception?
Normal stimulus -> irrational conclusion
How many of PAD must be present and for how long to make a diagnosis of schizophrenia?
At least 1 for at least a month
How many of THCNeg must be present and for how long to make schizophrenia diagnosis?
At least 2 for at least a month
What is a typical schizophrenia prodrome?
Withdrawal, lack of interest in personal appearance and hygiene, anxiety, depression, pre-occupation
What characterises paranoid schizophrenia?
Prominent positive symptoms often with paranoid background e.g. Persecutory delusions, running commentary, thought withdrawal/echo/insertion/control
Apart from the prominence of positive symptoms, what else differentiates paranoid schizophrenia from other types?
Often no affective blunting or formal thought disorder
Negative symptoms uncommon
What characterises hebephrenic/disorganised schizophrenia?
Earlier onset (~age 20), rapid progression of negative symptoms
Affective blunting and avolition with marked formal thought disorder
Inappropriate emotional responses and behaviour
What does someone with a shy and solitary premorbid personality who develops negative symptoms and a major FTD around age of 20 suggest?
Hebephrenic schizophrenia
What characterises catatonic schizophrenia?
Marked psychomotor disturbance with at least one dominant feature over the other positive and negative symptoms of schizophrenia
What are some examples of catatonic behaviour?
Stupor and mutism Violent excitement Bizarre posturing Waxy flexibility Negativism Perseveration, echolalia
What is residual schizophrenia?
Have initial positive symptoms which subside and then at least a year later prominent negative symptoms present
What is simple schizophrenia?
Slowly progressive negative symptoms in absence of major psychotic symptoms, with massive behaviour change and vagrancy
What is expressed emotion EE and is it a good or bad thing?
Level of emotional expression and family and social support not helping in schizophrenia
Bad thing
What are the 3 components of thought form?
Associations
Determinate tendency
Goal
Disorders of thought form - association? What are these typical of?
Loosening of associations, which include concepts such as knights move thinking
More suggestive of schizophrenia
What are some disorders of determinate tendency and goal in thought form? What are they suggestive of?
Tangentiality or circumferential thinking
Flight of ideas
Word salad
Concrete thinking
More suggestive of mania, however word salad is often schizophrenic
What are common causes of secondary delusions?
Severe depression and mania
What are primary delusions?
No underlying cause of delusion - strongly suggestive of schizophrenia
What is Capgras delusion?
That close friends and loved ones have been replaced with identical clones
What is Othello’s syndrome?
Delusional jealousy
Other disorders of thought content besides delusions?
Preoccupations
Overvalued ideas and obsessions
Confabulation
What is an illusion?
False processing of a normal stimulus that is not delusional (not believed to be true)
What is perception?
The ability to integrate and process external stimuli
What are hallucinations?
Integration and processing in the absence of external stimuli
What does a visual hallucination suggest?
Organic disease e.g. Substance use, LBD
What are pseudohallucinations?
A sensory experience that is as vivid as a true hallucination but recognised as not being real (a hallucination recognised as a hallucination)
What are pseudohallucinations commonly associated with?
Anxiety disorders - conversion disorder, somatisation disorder, dissociative disorders
What are common causes of olfactory hallucinations?
Organic cause - MTL epilepsy, tumours
What is the most common type of tactile hallucination? What are they typically associated with?
Formication (insects under skin)
Associated with cocaine, alcohol withdrawal (DT)
Infectious disease that can cause formication?
Lyme disease
Examples of general somatic hallucinations?
Bowels twisting
Flesh decomposing
What is Charles Bonnet syndrome?
Visual hallucinations in patients who can’t see (secondary to eye disease)
Signs of alcohol dependence?
Withdrawal symptoms if don't drink Compulsion to drink Mental or physical health problems resulting from drinking CAGE Amount of money being spent Impacting negatively on daily life
Timeline of alcohol withdrawal symptoms?
Usually peak around day 2 after significant fall in blood alcohol levels, easing by day 5
Early minor symptoms -> alcoholic hallucinosis -> withdrawal seizures -> DT
Early symptoms of alcohol withdrawal?
Nausea and vomiting, headache Craving for alcohol Insomnia and fatigue Anxiety, restlessness, agitation Sweating and palpitations, anaemia Mood lability
Common hallucination modalities in alcoholic hallucinosis?
Visual, auditory, tactile
Medication of choice for acute alcohol withdrawal?
Chlordiazepoxide
3 reasons why alcohol use may lead to thiamine deficiency?
It is a coenzyme in alcohol metabolism
Malabsorption
Gastritis
When does DT normally present in relation to stopping alcohol?
1-3 days after significant drop in blood alcohol
Sx of DT?
Hallucinations Delusions Confusion Agitation Seizures
What type of state is DT and what signs does it therefore produce?
Hyperadrenergic -> mydriasis, tachycardia, sweating, hypertension, hyperthermia and sweating, tremor, ataxia
What is an important metabolic abnormality that can occur as a result of alcohol withdrawal acutely?
Hypoglycaemia
What is Wernicke-Korsakoff disease?
Spectrum of pathology due to thiamine (B1) deficiency
Triad of Wernickes syndrome?
Ataxia (cerebellar signs)
Mental confusion - anterograde amnesia, hallucinations
Ophthalmoplegia - double vision, movement abnormalities, droopy lids
3 thought/memory problems characteristic of Wernickes syndrome?
Anterograde amnesia
Confabulation
Telescoping of ideas
What is Korsakoff’s syndrome?
Sort of chronic thiamine deficiency, causing neuronal loss and mammillary body haemorrhage
6 key symptoms of Korsakoff’s syndrome?
Anterograde amnesia Retrograde amnesia (long term and contextual) Confabulation Minimal conversational content Lack of insight Apathy
What are the ABCDS of Schneiderian first rank symptoms of schizophrenia?
Auditory hallucinations (third person running commentary)
Broadcasting of thought
Controlled thought (insertion, withdrawal, echo)
Delusional perception (normal stimulus -> bizarre conclusion)
Somatic hallucinations
3 endocrine causes of depression?
Addison’s disease
Cushing’s
Hypothyroidism
5 medications that can cause depression?
L dopa B blockers Steroids Digoxin OCP
What is Becks cognitive triad?
Negative views about self, world and future
3 core Sx of depression?
Low mood
Anhedonia
Low energy/tiredness
4 factors of low mood that makes it more likely depression than ‘normal low mood’?
Duration (>2 weeks)
Intensity
Additional Sx
Diurnal variation
GAPES of additional depression Sx?
Guilt Attention/concentration and Appetite Pessimism and psychomotor Esteem Sleep and Suicidal ideas
Besides sleep and appetite, examples of somatisation of depression?
Diurnal variation of mood
Loss of libido
Psychomotor retardation
Amenorrhea, constipation
4 examples of psychotic depression?
Stupor
Loss of insight
Hallucinations - auditory
Delusions - mood congruent
When classifying >1 episode of depression, what must be included?
Recurrent depressive disorder or BAD depending on presence of mania
Classification of current episode
What is dysthymia?
Low mood, not meeting criteria for depression
What is euthymia?
Normal mood
What is cyclothymia?
Persistently fluctuant mood never meeting criteria for depressive or manic/hypomanic episodes
Conservative management of mild-moderate depression?
Watchful waiting, review within 2 weeks
Low intensity CBT, psychodynamic psychotherapy
Indications for antidepressant use in mild-moderate depressive episode?
Previous severe illness
Refractory to other interventions
Interfering with physical health
Management of moderate-severe depression?
SSRI + CBT/interpersonal therapy
Risk assessment and consider MHA referral
3 things to advise patients starting an antidepressant?
Monitor for akithesia
Might get better before get worse - monitor for suicidal ideas
Monitor for agitation/anxiety
Second line treatment options after one SSRI for depression?
Another SSRI
Mertazapine (NaSSA)
Moclobemide (MAOI)
SNRI
Why are venlafaxine and TCAs best avoided if possible?
High risk in overdose
3 indications for ECT?
Severe depression with psychosis
Treatment resistant mania
Puerperal psychosis
How long does the average depressive episode last?
6-8m
2 major endocrine causes of mania?
Hyperthyroidism
Acute phase steroids
Which mood disorder does FH play a bigger role in?
Mania/BAD
Describe the mood and insight associated with hypomania?
Mildly elated mood but full insight retained - euphoric sociability
SADFIR of mania symptoms?
Speech (pressure), self esteem, sex Activity Disinhibition, distractibility Flight of ideas Insomnia Reckless behaviour
How long for and how many Sx must be present for mania diagnosis?
At least 3 symptoms for at least 7 days
For how long must mood disturbance last to diagnose depression?
2 weeks
For how long and how many symptoms of hypomania must be present to make diagnosis?
At least 3 Sx for at least 4 days
Mood and insight in mania?
May be elevated but may also be irritable
Insight may be present but often isn’t
Psychotic Sx associated with mania?
Delusions, often persecutory or grandiose Hallucinations (auditory) No sleep and neglecting of self care Incoherent speech Suspicion and violence Complete loss of insight
Psychomotor change in mania?
Psychomotor agitation
What 2 medications should be given in an acute manic episode?
Mood stabiliser +/- antipsychotic
4 examples of mood stabilisers?
Lithium
Valproate
Lamotrigine
Carbamazepine
Commonly used antipsychotics for mania?
Haloperidol
Resperidone
Olanzapine
Quetiapine
What is type I bipolar?
‘Classical’ type - recurrent manic episodes +/- depressive episodes
What is bipolar type II?
Hypomanic (less disabling) episodes and depressive episodes
Difference between bipolar II and cyclothymia?
Cyclothymia is BAD II but with less bad depressive episodes
How long do manic episodes typically last?
2 weeks - 4/5 months
What is rapid cycling BAD?
> 4 cycles of depression and mania in a year with no intervening asymptomatic episodes
6 features of alcohol dependence syndrome?
Tolerance
Withdrawal of stopped
Strong desire/compulsion
Difficulty stopping or avoiding
Lack of other activities or loss of interest
Continuation despite harmful consequences
Features of an alcohol Hx?
CAGE to screen
Explore - how much, when, where, who, what, why?
Any social complications incl jobs, law trouble
Physical health complications - liver + GI, anaemia, Neuro, CV
Previous attempts to stop and outcomes (incl withdrawal)
Motivation to change
MANIC of mania symptoms?
Mood elated Activity levels increased Naughty behaviour - sex, spending sprees, drugs/alc Insomnia Confidence and chatty
What are Schneiders first rank Sx of schizophrenia?
Thought interference
Auditory hallucinations
Delusional perception
Delusions of control
