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Year 5 Psych > Neuropsychiatry and Substance Use > Flashcards

Neuropsychiatry and Substance Use Flashcards

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1
Q

Depressant misuse-tx

A

Medical stabilization if needed
Safe injection practices/needle exchange
If dependent-managed detox, maintenance prescribing

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2
Q

Solvent misuse

A

Red rash around nose and mouth
Mostly young boys
Initial euphoria then drowsines
Psych dependence > physical dependence

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3
Q

Short acting benzos

A

More addicting, although sometimes better for old folks

Temazepam, oxazepam

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4
Q

Medium acting benzos

A

Lorazepam, alprazolam

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5
Q

Long acting benzos

A

Least addicting. Caution in elderly

Diazepam, nitrazepam, chlordiazepoxide

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6
Q

PCP

A

Angel dust
Smoked
Euphoria and peripheral analgesia, impaired consciousness or psychosis

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7
Q

Khat

A

Men from Somali/Yemeni communities
Contains cathionine, an amphetamine-like stimulant
Excitement and euphoria
Not a controlled substance in UK

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8
Q

Nicotine

A

1/4 British adults smoke

Tx-counselling, nicotine replacement therapy, varenicline, bupripion may help cessation

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9
Q

Cannabis

A

Most commonly used illegal drug
Can exacerbate chronic psychotic illness
THC is active ingredient-acts on cannabinoid receptor. Also opiate-like effects and barbiturate-like effects
Mild euphoria, sense of well-being, subjective sense enhanced sensation, relaxation, altered time sense, increased appetite

Not associated with physical dependency but heavy users if suddenly stop can get insomnia, anxiety, irritability

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10
Q

Alcohol abuse

A

Regular or binge consumption alcohol sufficient to cause physical, neuropsychiatric, or social damage

Safe limits: 21u/week for men, 14u/week for women

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11
Q

Alcohol-MOA

A

Enhancement GABA-A transmission (anxiolytic)
Release Da in mesolimbic pathway (reward)
Inhibition NMDA-mediated glutaminergic transmission (amnesic)

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12
Q

Bio-Psycho-Social causes EtOH dependence

A

Genetics: high acetaldehyde producers less likely to abuse (worse hangover). E.g. Japanses people and “flush reaction”
Psycho: FHx depression, other psych or physical illness, esp chronic pain. Imitation, classical conditioning, social reinforcement
Social: Occupation (armed forces, doctors, publicans, journalists), culture (Scots, Irish high whereas Jewish, Muslim low)

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13
Q

Wernicke’s encephalopathy

A

EtOH.
Thiamine deficiency causes mamillary body damage
Ataxia, ophthalmoplegia, acute confusion

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14
Q

Depressants (misuse)

A

Benzos.
Pleasurable anxiolytic and relaxant properties
Used to come down after stimulant use

Can cause forgetfulness, drowsiness, impaired coordination
Chronically- impaired concentration and memory, depressed mood
Dependency after 3-6w regular use
Withdrawal can be complicated by seizures and delirium

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15
Q

Korsakoff’s psychosis

A

Profound short-term memory loss characterized by confabulation

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16
Q

Viral encephalitis

A

Herpes simplex
50% survivors experience disturbaces of behavior, concentration, or social adjustment
May have chronic cognitive impairment

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17
Q

Tertiary syphilis

A

Rare
Neurosyph “general paralysis of the insane”:
Personality change (disinhibition, irritability, lability)
Cognitive impairment and poor concentration
Dementia
Depression
Grandiosity
Rarely, mania and schizophrenia-lie psychoses

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18
Q

Prion disease

A

Human forms of spongiform encephalopathy are rare.
vCJD, kuru,
Rapidly fatal dementia
Classic CJD presents with physical sxs
vCJD starts with psych sxs–mood swings, fatigue, social withdrawal

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19
Q

HIV and AIDS

A

Worried well: preoccupation with possibility of becoming infected

Psychological reactions to HIV infection: periods of crisis after learning of infection, starting HAART, tests indicating problem with tx, development HIV-related illness. Adjustment disorder, acute stress reaction, risk deliberate self-harm

Psychiartirc illness: depression (NB AIDS-like dementia can present similarly), acute mania, schizophrenia-like psychoses

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20
Q

Epilepsy-psychological aspects

A

Psychosocial consequences of dx, psych syndromes directly attributed to epilepsy, neuropsych effects of medications

Prodromal sxs: tension, dysphoria, insomnia days-hrs before
Ictal:
-automatisms. Usu

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21
Q

Anti-epileptics that also improve mood

A

Carbamazepine and lamotrigine

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22
Q

Post-concussional syndrome

A

Anxiety, depression, irritability, emotional lability, insomnia, hypersensitivity to noise and light, reduced concentration, chronic tiredness

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23
Q

Punch-drunk syndrome

A

Repeated minor head injuries.
Clinical picture of dementia with movement disorder
Retired boxers

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24
Q

Psych complications to cerebrovascular disease

A

1/3 develop depression within 1 year
May also have anxiety disorder, apathy, emotional incontinence
Progressive CVSs can lead to picture of dementia

25
Q

Brain tumors–psych effects

A

Behavioral, affective, psychotic, personality, and cognitive disturbances via mass effect, hydrocephalus etc

26
Q

Parkinson’s-psych complications

A

Dementia: 20-30% develop some cognitive deterioration.
usually subcortical dementia with slowing, impaired executive function, personality change, memory impairment

Depression: 40-70%. Partly disease, partly experience thereof

Can have psychosis (psychotic depression) and delirium

27
Q

Huntington’s-psych complications

A

Subcortical dementia: mental slowing, impaired executive function. Speech deteriorates faster than comprehension

Psych disturbances v common-changes in personality and behavior. Affective disorders, schizophreniform psychoses. Not related to severity of disease.

28
Q

Acute alcohol intoxication

A

Slurred speech, impaired coordination and judgment, labile affect
Severe: hypoglycemia, stupor, coma

29
Q

Acute alcohol withdrawal

A

Within 1-2 days abstinence
Malaise, nausea, autonomic hyperactivity, tremulousness, labile mood, imsomnia, transient hallucinations
DTs in 5% with mortality up to 15%

5-15%-tonic clonic seizures 6-48hrs after last drink

30
Q

DTs

A

Peak incidence 48 hrs
Features wthdrawal plus clouding consciousness, disorientation, amnesia for recent events, psychomotor agitation, visual/auditory/tactile halluc (Lilliputian common)
Hourly fluctuations (worse at night)
If severe, heavy sweating, fear, paranoid delusions, agitation, suggestibility, temp, sudden CV collapse

31
Q

Alcohol dependence

A 
Compulsion to drink
Loss ability to regulate drinking
Altered tolerance
Withdrawal phenomena
Persistence after attempted abstinence
32
Q

Biological Tx-alcohol withdrawal

A

Benzos: Chlordiazepoxide if outpt, diazepam for inpatient
Antipsychotics: prn haloperidol if increasing dose benzos does not manage hallucinations
Vitamins: B1 parenterally. BEFORE glucose

Most pts outpatient. Can follow up daily if worried about compliance, drinking on top of drugs
Inpts if hx complicated withdrawal, comorbidities, suicide risk, Wernicke-Korsakoffs, severe N&V, lack stable home environment

Provide written advice, inform GP, emergency contact #, followup

33
Q

Disulfiram

A

Inhibits acetaldehyde dehydrogenase, therefore acetaldehyde builds up (causing hangover sxs). Prescribe once abstinence achieved

34
Q

Acamprosate

A

Enhances GABA transmission and diminishes alcohol cravings

35
Q

Naltrexone in alcohol misuse

A

Diminishes high from alcohol

36
Q

Pysch tx for alcohol misuse

A

Motivational interviewing: aid pt in explaining why they need to change their behavior
Plan interventions with pt

Weekly limits-no saving up
None if pregnant, driving
Do not drink alone, avoid heavy drinkers, don’t buy rounds, alternate soft drinks and alcohol, drink with meal, rehearse declining drink, plan non-drinking activities (social skills training)
Problem-solving skills, relaxation training, anger management, cognitive restructuring
ALCOHOLICS ANONYMOUS

37
Q

Definition-dependence

A

Includes withdrawal state and tolerance

usually reduction or neglect of social, occupational, or recreational activities

38
Q

Dependence syndrome

A

Drug-seeking behavior
Narrowing of drug repertoire (e.g. instead of different drinks, now only Stella)
Increased tolerance
Loss control of consumption
Withdrawal
Drug taken to avoid withdrawal sxs
Continued drug use despite negative consequences
Rapid reinstatement previous pattern of drug use after abstinence

39
Q

Opiates

A

E.g. heroin
Virtually immediate euphoria. Diminished pain, feelings detachment
10% become dependent, 2-3% die annually
Medical problems: N&V, constipation, resp depression, LOC with aspiration. Injected–local abscesses, cellulitis, osteomyelitis, bacterial endocarditis, septicemia, infection
Withdrawal sxs: craving, flu-like, sweating, piloerection, yawning

40
Q

Tx-opiate misuse

A

Bio: methadone, buprenorphine for detox. Naltrexone can be used acutely and to prevent relapse
Psychosocial: safer injecting advice

41
Q

Hallucinogens

A

Heightened perception, dilated pupils, periph vasoconstricton, increased temp.
No dependence
LSD, PCP, magic muschrooms (“liberty cap”), ketamine

42
Q

Autobiographical memory

A

Aka episodic memory

Relates to specific events and issues in one’s life

43
Q

Procedural memory

A

Aka implicit memory.
“How to do things”
E.g. drive a car

44
Q

Semantic memory

A

Knowledge base

E.g. nine times table

45
Q

Topographical memory

A

Orientation

E.g. me forgetting how to get to St Mary’s

46
Q

Confabulation

A

False memories

47
Q

Deja vu

A

Sense of familiarity

Seen in temporal lobe epilepsy and non-pathological states

48
Q

Ganser’s syndrome

A

Give approximate answers.

E.g. when asked how many legs a cow has, answers “5”

49
Q

Jamais vu

A

Sense that a familiar place has never before been encountered

50
Q

Perseveration

A

“Capital of UK?”
“London”
“Dates of WWII?”
“London”

Seen in organic brain disease

51
Q

Logoclonia

A

Repeating last syllable-ble-ble-ble

Seen in parkinsons-sons-sons

52
Q

Harmful use

A

Misuse of drug >1/12 despite damage to user’s physical or mental health

53
Q

Complicated withdrawal

A

Associated with delirium, seizures, or psychotic features

54
Q

Wernickes triad

A

Ataxia, ophthalmoplegia, confusion

55
Q

Korsakoff’s

A

Amnesia, normal level consciousness

56
Q

Marchiafava-Bignami syndrome

A

Corpus callosum demyelinization
Associated with chronic alcoholism
Sudden stupor, coma, seizures, dementia, incontinence, aphasia, apraxia

57
Q

Charles-Bonnet syndrome

A

Complex visual hallucinations in people with severe vision impairment.
Insight retained

58
Q

Gerstman’s syndrome

A

L-R disorientation, dyscalculia, agraphia, finger agnosia

Parietal lobe injury

Year 5 Psych (5 decks)

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