Other Disorders

Question 1

What is the management of mild/persistent subthreshold depressive symptoms?

Answer 1

Initial presentation + symptoms lasting < 2years =
CBT/Group CBT

If unresponsive/patient had severe depression in the past/symptoms >2y = SSRIs

Question 2

What is NEUROLEPTIC MALIGNANT SYNDROME?

Answer 2

An adverse effect of antipsychotics - a MEDICAL EMERGENCY

• Altered mental state
• Generalised rigidity
• Fever
• Fluctuating BP

Question 3

What is CONVERSION DISORDER?

Answer 3

Typically involves loss of sensation or movement in limbs
The patient does not consciously feign symptoms
Patients may be indifferent to their disorder (‘la belle indifference’)

Question 4

What is DISSOCIATIVE DISORDER?

Answer 4

Separating off certain memories from normal consciousness

May involve amnesia/stupor

Question 5

What is FACTITIOUS/MUNCHAUSENS DISORDER?

Answer 5

Intentional production of symptoms. It is normally associated with emotional difficulties. Often dramatic medical history with inconsistent details.
Symptoms may fit a diagnosis ‘too’ perfectly, or a lack of signs that go with symptoms

Question 6

What is SOMATISATION DISORDER?

Answer 6

Multiple physical symptoms that are unexplained for at least 2 years (+ refusal to accept reassurance)

Question 7

What is the diagnostic criteria for BULIMIA NERVOSA?

Answer 7

• Binge eating MORE than the usual amount
• Methods to purge the calories (e.g. vomiting, laxatives, exercise)
• At least once a week for 3 months
• Overvalued ideas on body shape

Question 8

What is the management for BULIMIA NERVOSA?

Answer 8

• Referral for specialist care
• CBT (eating disorder)
• Children should be offered for family therapy

Question 9

What is OCD associated with?

Answer 9

Most to least common:

• Depression
• Schizophrenia
• Sydenham’s Chorea
• Tourettes’
• Anorexia Nervosa

Question 10

What is the treatment for OCD?

Answer 10

MILD = CBT with ERP

MODERATE/UNRESPONSIVE = SSRIs or more intensive CBT with ERP (any but fluoxetine for body dysmorphia)

SEVERE - SSRI and more intensive CBT with ERP

Question 11

What are the features of PTSD?

Answer 11

1. Re-experiencing: Flashbacks/Nightmares/Repetitive + DIstressing intrusive images
2. Avoidance; Avoiding people/situations/circumstances resembling/associated with the event
3. Hyperarousal: Hypervigilance for threat, exaggerated startle response, sleep problems, irritability, difficulty concentrating/anger problems
4. Emotional Numbing: Lack of ability to experience feelings, feeling detached from other people
5. Depression
6. Drug/Alcohol Misuse
7. Unexplained medical/physical symptoms

Question 12

What is PANIC DISORDER?

Answer 12

Recurrent + spontaneous panic attacks - a feeling of intense fear without any actual danger
Often felt with physical sensations: dizziness/nausea/trembling/palpitations/SOB/hot flashes

Question 13

How is PTSD differentiated from PANIC DISORDER?

Answer 13

PTSD’s physical symptoms are brought on by ‘Re-experiencing’ the traumatic event, such as through dreams, thoughts or flashbacks

Hyperarousal symptoms in PTSD (such as panicking after a loud noise) can also cause panic attacks

Question 14

What is the management of PTSD?

Answer 14

1. Debriefing not recommended
2. Trauma-focused CBT or EMDR therapy can be used
3. If not responsive can use VENLAFAXINE/SSRIs
4. If severe, use RESPIRIDONE