Other Psych Flashcards
Hypothyroidism’s psychiatric effects
Dementia
Depression
Anxiety
Acute agitation (“myxoedema madness”)
Hyperthyroidism’s effect on mood
Anxiety, depression, apathy
Psych effects hypercortisolemia
Depression or mania
“Steroid psychosis”
Psych effects of hypocortisolemia (Addison’s)
Depression, apathy
Pysch effects of pheochromocytoma
Episodic anxiety
Psych effects of hyperparathyroidism
Depression
Apathy
Memory deficits
Psychotic symptoms
Psych effects of B12 deficiency
Subacute combined degeneration of spinal cord'Slowing of mental processes Confusion Memory problems Intellectual impairment Paranoid delusions
Psych complications MS
Depression (>50%), stress-related
Suicidal ideation
Increased incidence BPAD
Transient psychoses and elation, related to disease progress
Early cognitive impairment and late progressive dementia
Psych complications SLE
Transient fluctuating psych disturbances, esp acute confusional states
Depressive psychoses less frequently
Steroid tx may further psych complications
Psych complications-Wilson’s
May be presenting feature in >50%
Affective and behavioral changes most commonly
Cognitive changes
Psych complications Acute Intermittent Porphyria
Delirium (50%)
Depression
Emotional lability
Schizophrenia-like psychoses (esp paranoid)
Simmond’s disease
Hypopituitarism causing depression, irritability, impaired memory
PMS
Physical and behavioral sxs that recur in 2nd half menstrual cycle and first few days menses. Sxs must be severe enough to impair social and occupational functioning
PMDD
Prominent presence of 1 or more marked affective syndromes (depression, anxiety, affective lability, anger, irritability). Related to menses
Menopause-psych complications
Increased anxiety and depression–experience itself, not hormones, OR hormones exacerbating pre-existing mood disorders
Ix-PMS
Prospective charting daily sxs for at least two menstrual cycles essential to confirm.
Rule out migraine, chronic fatigue, gynae conditions
Tx-PMS
Fluoxetine, starting in luteal phase
Pseudocyesis
Woman firmly believes herslef to be pregnant and develops objective pregnancy signs in absence pregnancy
Somatoform disorder, variant depression.
Presents as complication of post-partum depression or psychosis with amenorrhea.
Rule out ectopic, corpus luteal cyst, placenta previa, pituitary/pelvic tumor
Psych tx: supportive or insight-oriented psychotherapy
Postnatal depression
Signif depressive episode, within 6/12 postpartum.
RFs: personal or FHx depression, old age, single mother, poor relationship with own mother, ambivalence toward or unwanted pregnancy, poor support, signif other stressors, previous postpartum psychosis
Edinburgh Postnatal Depression Scale
Bio: antidepressants
Psychosocial: psychoeducation, CBT, support (health visitors, social workers)
Postpartum psychosis
Acute psychotic episode, peak at 2/52 postpartum
RF: personal/FHx major psych disorder, lack support, single parent, previous PPP
Lability of sxs, insomnia, perplexity, bewilderment, disorientation, thoughts suicide/infanticide
Bio: ECT, mood stabilizers (carbamazepine), early use antidepressants. Antipsychotics
ADMIT.
Sexual dysfunction
Persistent impairment normal patterns of sexual interest/response.
Bio causes: drugs/EtOH, med side effects, pain/discomfort, feeling tired, recent childbirth
Psych causes: relationship problems, performance anxiety, excessive monitoring self-arousal, guilt, fear preg or STIs, lack knowledge, previous rape or childhood abuse
Social: fear interruption, partner (attractiveness), disinterest, criticism, sexual inexperience, sexually incompatible
Sexual aversion
Strong negative feelings, fear, anxiety due to prospect of sexual interaction, of sufficient intensity to lead to active avoidance of sexual activity
Excessive sexual desire
Nymphomania in women, satyriasis in men.
Can be secondary to mood disorder (mania), in early dementia, associated with LD, secondary to brain injury, drug side effect
Erectile failure
Inability to develop/maintain erection.
RF: moral/religious views on sex, previous negative experiences, performance anxiety, EtOH/drugs, stress/fatigue
Physical causes: older, gradual onset, no erections, lost RFs (smoking, DM, obesity, HTN, EtOH etc)
Psych causes: younger, sudden onset, erections present at morning, on masturbation
Conduct disorder
One or more of following:
- Aggression/cruelty to people/animals
- Destruction property
- Deceitfulness
- Theft
- Fire-setting
- Truancy
- Running away from home
- Severe provocative or disobedient behavior
Oppositional defiant disorder
Enduring pattern negative, hostile, defiant behavior
No serious violation societal norms or rights of others
May occur in one situation only
Tx conduct disorder and oppositional defiant disorder
Functional family therapy Behavioral management aggression Parent training (positive parenting program, incredible years program) Remedial teaching Alternative peer group activities
Separation anxiety disorder
Increased and inappropriate anxiety around separation from attachment figures or home
School refusal
Not a dx
May have somatization
Peak ages 5-6 (separation anxiety) and 10-11 (school transition), adolescents (low self-esteem, depression)
Most common emotional disorder in childhood
Generalized anxiety
Somatization common
Temperament and parental overprotection may predispose
Pervasive development disorder
Severe impairments social interactions and communication skills. Restricted stereotyped interests and behaviors
Includes autism, asperger’s, rett’s, childhood disintegrative disorder
Autism
Abn reciprocal social interaction, communication, language impairment.
Repetitive repertoire of interests and activities
RFs: Downs, Fragile X, obstetric complications, toxic agents, pre or post-natal infection (rubella), neuro disorders (e.g. tuberous sclerosis)
Three characteristic features within first three years life:
- Impairment in social interaction (poor use non-verbal behaviors)
- Impairment in communication
- Restricted stereotyped interests and behaviors
Asperger’s
Similar to autism but no signif abnormalities in language acquisition or cognitive development/intelligence
Childhood disintegrative disorder (heller’s syndrome)
M>F
2 years normal development followed by loss previously acquired skills before age 10.
Assoc with autism-like impairment of social interaction and repetitive stereotyped interests and mannerisms
After deterioration, may resemble autism
Tx-autism
Antipsychotics for stereotypies
SSRIs for compulsive and self-harming behavior
Behavioral interventions: behavioral modification, social skills training, CBT
Social therapies include educational and vocational interventions
Rett’s syndrome
Almost all are women
Initially normal development then motor deterioration and severe LD from 6/12
Progressive and destructive encephalopathy and stereotyped hand movements (midline hand-wringing)
MECP2 gene on X chromo implicated
ADHD/Hyperkinetic disorder: RFs and sxs
80% genetically inherited. Increased risk with low birth weight, maternal substance use in pregnancy, head injury, metabolic disorders, prolonged emotional deprivation.
Three core sxs:
- Inattention
- Hyperactivity
- Impulsiveness
Ix-ADHD
Interview family and child Observe child in more than one setting Collateral information (SCHOOL REPORT) Conner's rating scale Screen for comorbidities Neuro exam
Tx-ADHD
Methylphenidate (Ritalin)
Atomoxetine
Psychoeducation
Behavioral interventions
School interventions
Elective mutism
Selectivity in vocal communication depending on social circumstances
Small percentage have speech/articulation problem
Psycho-social: psych stress, social anxiety, oppositional behavior
Tic disorders
Sudden, repetitive, non-rhythmic movements or vocalizations
Involuntary but can be suppressed for brief periods
More prominent during times stress
Simple motor tics, e.g. blinking, neck jerking
Simple vocal tics, e.g. grunting, coughing
Complex motor tics, e.g. jumping
Complex vocal tics, e.g. senseless repetition of words
Gilles de la Tourette’s syndrome
Multiple motor and one or more vocal tics
At least one year
Causes distress and impaired function
Usu develops by age 7
Tx with antipsychs, alpha adrenergics if severe and impairing
Treat comorbid conditions (OCD, ADHD)
Psychoeducation
Awareness and relaxation training, habit reversal traning
School liaison
Non-organic enuresis
Involuntary voiding of urine in children who have established bladder control according to devel age.
Primary: never established urinary continence
Secondary: continence achieved in past
Causes non-organic enuresis
Genetics (75% have 1st degree relative with same problem)
Devel delay
Stress
Inadequate toilet training
Tx-non-organic enuresis
Medication is last resort: desmopressin, imipramine
Psych: enuresis alarms, STAR CHART! for good behavior (e.g. using bathroom before bed), not outcomes
Social: parental education, educate about toilet training esp if primary
Non-organic encoparesis
Deposition feces in inappropriate places in children who should have established consistent bowel control
Primary-when bowel control never been achieved
Secondary-after period normal bowel control
Non-organic encoparesis: causes
Devel delay Coercive or punitive potty training Emotional, physical, or sexual abuse Disturbed parent-child relationship Parental marital conflict Other psych disturbance, e.g. autism
Non-organic encoparesis: tx
Medical management if appropriate e.g. laxatives Change in diet if appropriate Education child and family STAR CHARTS Sneaky Poo therapy
Learning Disability-definition
Devel condition characterized by global impairment intelligence and signif difficulties in socially adaptive functioning
impairment-definition
Loss or abnormality of psych, physiological, or anatomical structure or function
Disability-definition
Restriction or lack (from impairment) of ability to perform an activity in manner and range considered normal
handicap-definition
Disadvantage for given individual, resulting from impairment or disability that limits or prevents the fulfilment of role that is normal to that individual
Mild learning disabilities
Language alright but delayed
Live independently
Struggle academically
Variable emotional/social immaturity
Moderate learning disabilities
Speech delayed; deficits in speech and comprehension
Few have numeracy/literacy
Can do simple, supervised work
Reduced self-care and limited motor skills
Majority have identifiable organic cause
Severe learning disabilities
Marked impairment motor fn
Little/no speech in childhood–may develop some later
24hr care
Profound learning disabilities
Severely limited language, communication, self-care and mobility
Significant associated medical problems, higher level support
Organic etiology clear in most cases
Down’s syndrome
Trisomy 21
Intell impairment, characteristic facies and habitus
Dx’d at birth but intell disability evident end 1st year life
Delayed milestones
Many associated physical problems
Psychiatric comorbidities common–depression, BPAD, Tourette’s, schizophrenia, autism, DEMENTIA–early onset
Genetic conditions causing LD
Prader-Wili
Angelman ("Happy Puppet syndrome")
Cri du chat
DiGeorge
Noonan's
Tuberous sclerosis
Neurofibromatosis
Sturge-Weber
PKU
Fragile XTurners
Trisomy X
Klinefleters
XYY male
AutismNon-genetic causes LD
FAS Iodine deficiency and congenital hypothyroidism Toxins infective agents (TORCH infections) Hypoxic damage CNS and skull devel abnormalities
Biological causes dementia
Parenchymal degeneration
intracranial mass
Infection (vCJD, syph)
Endo-hypothyroid, hyperparathyroid, Cushings, addisons
Metabolic-uremia, hepatic encephalopathy, hypoglycemia, Mg derangement, electrolyte imbalance, B12 defic
Toxins-heavy metal, EtOH
Sxs dementia
Short to long term memory impairment
Personality change: forgetful, social withdrawal, mood lability, disinhibition, silliness, reduced self-care, apathy, fatigue, deteriorating executive fn
Dysphagia, agnosia, apraxia
Anxiety and/or depression
Ddx-depression
Delirium Depression (pseudodementia) Amnestic disorders LD Psychosis Normal aging
Reversible causes dementia
Hematomas SOL NPH Endocrine causes Vitamin deficiencies
Ix-dementia
Bloods: FBC, LFT, U&Es, gluc, ESR, TSH, Ca, Mg, PO4, VDRL, HIV, B12, folate, CRP, blood culture,
LP, EEG, CXR, ECG, CT, MRI, SPECT
Let’s just do all the tests
Assess with MMSE, ACE-III
Assess functionality and social functioning
Tx-dementia
Anticholinesterase inhibitors (tacrine, donepezil, rivastigmine)
Antioxidants (selegiline, Vit E)
Treat comorbidities
Alzheimers: pathology and cause
MCC dementia (2/3)
Amyloid plaques in hippocampus, cortex, substantia nigra
Neurofibrillary tangles (phosphorylated tau)
Loss neurons and synapses
Causes:
genetics: APP, apoE4
Age
Alzheimer’s-sxs
Four A’s: amnesia, aphasia, agnosia, apraxia
Early: failing memory, muddled efficiency with ADLs, spacial dysfn, wandering, irritability
Middle: intell and personality changes. Dysphasia, aphasia, apraxia, agnosia, impaired visospatial skills and executive fn
Late: fully dependent, physical deterioration, incontinecne, gait abnormalities, spasticity, seizures, tremor, weight loss, primitive reflects, EPS
Psych delusions and hallucinatins in a few
Depression comon
Lewy body dementia
15-20% senile dementia
Progressive cognitive decline of sufficient magnitude to interfere with normal functions
Lewy bodies: eosinophilic neuronal inclusions with alpha-synuclein and ubiquitin in brainstem nuclei, BG, paralimbic structures
Lewy body dementia-sxs
Fluctuating cognition with pronounced variations in attention and alertness
Recurrent visual hallucinations: well-formed and detailed
Spontaneous motor features parkinsonism
Lewy body dementia-tx
Don’t give with antipsychs (at least at our level)–neuroleptic malignant syndrome risk
Fronto-temporal dementia (Pick’s disease)
Early onset. Atrophy fronto-temporal regions
Associated with mutations in tua gene
Fronto-temporal dementia: sxs
insidious onset and gradual progression, early decline in social/interpersonal conduct. Emotional blunting, loss insight
All sorts of other signs too long to list but are exactly what you imagine they are.
vascular dementia
Infarcts caused by thromboemboli or arteriosclerosis (causing HTN) RFs are RFs for atherosclerosis STEP-WISE decline. May follow CVA. More acute than Alzheimer's Emotional and personality changes early.
Manage causative factors
Daily aspirin especially–delays progression
Delusional misidentification syndrome
Delusional belief that someone you know has been replaced by an imposter who is their exact double
Delusions that strangers or ppl pt meets are pt’s persecutors in disguise
Delusional parasitosis
Believe that insects are colonizing their bodies
Folie a deux
Shared delusion, usu within family
De Clerambault’s syndrome
Delusion that someone (usu man of higher status) is in love with her
Inappropriate advances. Can become angry and violent when rejected
Cotard’s syndrome
Nihilistic delusion where pt thinks parts of body are rotting and they’ve stopped existing
Believe themselves to be dead/unable to die, therefore eternally alive
Munchausens/Factitious disorder
Feigned illness
Can have munchausen’s by proxy
Couvade syndrome
Experience symptoms resembling pregnancy in expectant fathers
Ganser’s syndrome
Approximate, absurd, inconsistent answer to simple questions
Dissociative reaction against intolerable stress
Overrepresented in prison populations
Idealization
Part of splitting
Another individual has more positive traits/qualities than actually possesses
Sublimation
Transforms negative emotion into socially acceptable ones. E.g. art, sport
Projective identification
Self-fulfilling prophecy
Projected emotions/feelings alter behavior
Systemic therapy
Aka family therapy
Explores relationships between individuals (i.e. in systems).
Dialectical behavior therapy
Intended for borderline
CBT + distress tolerance + mindfulness
Arbitrary inference
Cognitive distortion where individual jumps to conclusion without evidence
