Other Psychiatric Problems Flashcards
What cardiovascular disorders can cause delirium?
Intracranial/Subdural bleed
MI
PE
CCF
What GI disorders can cause delirium?
Liver failure
Pancreatitis
What endocrine disorders can cause delirium?
Diabetic complications
Thyroid disorders
What GU disorders can cause delirium?
UTI
Renal failure
What neurlogical disorders can cause delirium?
Head injury Meningitis Encephalitis Tumours Epilepsy
What is the NHS Tayside Protocol for pharmacological management of delirium?
Haloperidol 0.5-5mg PO then IM:
- Up to 10mg in 24 hours
What drug, in the NHS Tayside Protocol for pharmacological management of delirium, is used in Parkinson’s, Lewy Body Dementia and Neuroleptic sensitivity?
Lorazepam 0.5-2mg, up to 2 times in 24 hours
What is the mean duration of delirium?
1-4 weeks:
- Often longer in elderly
- Some can become chronic
What is the most common neuropsychiatric complication of a stroke?
Post-Stroke depression
How many patients have depressive symptoms following an MRI?
65%
What is anterograde amnesia?
Difficulty in acquiring new material
Difficulty in remembering events since illness/injury onset
What is retrograde amnesia?
Difficulty remembering info prior to illness/injury onset
What is it important to assess in cognition of memory problems?
Memory Attention and concentration Executive functioning Visuospatial functioning Language
In individuals with suspected cognitive impairment, what should be carried out?
MMSE
What examination approves initial testing?
Addenbrookes Cognitive Examination
What is MMSE scored out of?
30
What is the cut off for MMSE?
> 27 vs <24
What are the 4 criteria assessed in an MMSE?
Orientation
Memory
Visuospatial
Language
What are the advantages of MMSE?
Quick
Different languages
What are the disadvantages of MMSE?
Not adjusted for age Poor for executive functioning Poor in severe cases -> 'Floor effect' Poor in high premorbid functioning Not sensitive in early stages Exclusion of non-verbal skills
What domains are assessed in the Addenbrookes Cognitive Examination III?
Orientation Attention Memory Executive functioning Language Visuospatial functioning
How long does the Addenbrookes Cognitive Examination III take?
~15 minutes
What domains are assessed in Neuropsychological Assessments?
Pre-morbid functioning Orientation and attention Memory and new learning Visuospatial and constructional functioning Language Executive functioning Emotional status
What is the diagnostic triad in ADHD?
Inattention
Hyperactivity
Impulsivity
What do the triad of features in the diagnosis if ADHD have to be to diagnose ‘combined-type’ ADHD (aka Hyperkinetic Disorder)?
Developmentally inappropriate
Impairing
Pervasive
Longstanding
What structured diagnostic questionnaires can be used in the diagnosis of ADHD?
Conners Rating Scale
ADHD Rating Scale
What are some risk factors for ADHD?
Family history
Male gender
Socioeconomic status
What are the first line psychological therapies for ADHD?
Parent training (New Forest parenting programme) Classroom strategies
What are the second line psychological therapies for ADHD?
Social skills
Sleep and diet
When might psychological therapies be useful and not sufficient?
Useful for secondary difficulties at home
Not sufficient in most cases
What are the first line pharmacological treatments for ADHD?
Methylphenidate (‘Ritalin’)
Dexamfetamine
Lisdexamfetamine
How do the first line pharmacological treatments for ADHD work?
‘Stimulants’
- Increase DA transmission in executive functioning networks to prefrontal cortex
- Directly improve symptoms
What are the side effects of the first line pharmacological treatments for ADHD?
Reduced appetite Reduced sleep Dysphoria Anxiety Tics
What is the second line pharmacological treatment for ADHD?
Atomoxetine
What are the third line pharmacological treatments for ADHD?
Antidepressants
Antihypertensives
Antipsychotics
What weeks of the New Forest Parenting Programme are parent only?
Week 1
Week 2
Week 5
Week 8
What weeks of the New Forest Parenting Programme are parent and child?
Week 3
Week 4
Week 6
Week 7
What techniques do parents learn during week 2 of the New Forest Parenting Programme?
Routines
Clear communication
Limit setting
Ability to avoid confrontation
How can a parent learn to manage a child’s temper during week 3 of the New Forest Parenting Programme?
Firm limits
Distraction strategies
What do parents learn to use during week 4 of the New Forest Parenting Programme?
Time out
Quiet time
During weeks 6 and 7, how long does the practitioner of the New Forest Parenting Programme observe the parent and child alone for?
15 minutes
How common is Autism Spectrum Disorder?
1/68
Is Autism Spectrum Disorder more common males or females?
Males
What are the triad of impairments in Autism Spectrum Disorder?
- Qualitative impairments in reciprocal social interaction
- Language impairment
- Thought and behaviour
How is Autism Spectrum Disorder defined in DSM-IV-TR?
> =6 symptoms including:
- > =2 of qualitative impairment in social interaction
- > =1 of qualitative impairment in communication
- > =1 symptoms of restricted/repetitive behaviour
When is Risperidone used in Autism Spectrum Disorder?
Short-term for:
- Aggression
- Tantrums
- Self-injury
If there are ADHD symptoms in Autism Spectrum Disorder, what drug can be used?
Methylphenidate
If there are sleep problems in Autism Spectrum Disorder, what drug can be used?
Melatonin
