MISCELLANEOUS FACTS FROM PASSMED Flashcards
What is the definition of somatisation disorder?
Presence of multiple physical symptoms for at least 2 years
Patient refuses to accept reassurance or negative test results
What is the definition of hypochondrial disorder?
Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
Like somatisation disorder the patient refuses to accept reassurance or negative test results
How is somatisation disorder different to hypochondrial disorder?
Somatisation disorder involves the presence of unexplained symptoms. In hypochondrial disorder there is a specific diagnosis that the patient feels they have despite negative test results.
What is conversion disorder?
This typically involves the loss of motor or sensory function as the presenting symptom, but where the organic cause is not found.
The patient is not consciously feigning the symptoms (factitious disorder) or seeking material gain (malingering)
Patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
What is dissociative disorder?
Dissociation is a process of ‘separating off’ certain memories from normal consciousness
A subtype of this is dissociative identity disorder (DID). DID is the new term for multiple personality disorder and is the most severe form of dissociative disorder.
What are the differences between conversion and dissociative disorder?
They are actually quite similar in some ways, but conversion disorder manifests as physical symptoms, whereas dissociation disorder manifests as psychological symptoms, e.g. Amnesia, fugue, stupor.
What is the difference between Munchausen’s disorder (or factitious disorder) and malingering?
They both involve the intentional production of symptoms or feigning of symptoms, however malingering is for material gain (eg insurance scam) whereas in Munchausen’s this in not the motive. The motive in Munchausen’s is often to assume the ‘sick role’ and be the centre of attention.
How do we medically manage someone who has taken an overdose of paracetamol?
Activated charcoal if ingested less than 1 hour ago
N-acetylcysteine (NAC)
Liver transplantation
How do we manage someone who has taken an overdose of salicylate (aspirin)?
Haemodialysis
Urinary alkalisation is now rarely used.
How do we medically manage someone who has taken an overdose of opioids?
Naloxone
How do we medically manage someone who has taken an overdose of benzodiazepines?
Flumazenil
How do we medically manage someone who has taken an overdose of tricyclic antidepressants such as amitriptyline and is showing a widening of the QRS interval?
IV bicarbonate to reverse acidosis
Which antiarrhythmic medications can be given to patients who have taken an overdose of tricyclic antidepressants such as amitriptyline?
Rarely given at all
Class 1a (e.g. Quinidine) and class Ic antiarrhythmics (e.g. Flecainide) are contraindicated as they prolong depolarisation. Class III drugs such as amiodarone should also be avoided as they prolong the QT interval. Response to lignocaine is variable and it should be emphasized that correction of acidosis is the first line in management of tricyclic induced arrhythmias
How do we manage someone who has taken an overdose of lithium?
Mild-moderate intoxication may respond to volume resuscitation
Haemodialysis is needed for toxicity
Sodium bicarbonate has a theoretical place here as increasing the alkalinity of the urine promotes lithium excretion.
How do we manage someone who has been poisoned with ethylene glycol (anti-freeze)?
Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.
Ethanol was used as first line for many years. It works by competing with ethylene glycol for the enzyme alcohol dehydrogenase. This limits the formation of toxic metabolites (e.g. Glycoaldehyde and glycolic acid) which are responsible for the haemodynamic/metabolic features of poisoning.
How do we manage someone who has been poisoned with methanol?
Fomepizole or ethanol
