passmed Flashcards
Charles Bonnet Syndrome?
persistent or recurrent complex - - hallucinations (usually visual or auditory)
background of visual impairment (although visual impairment is not mandatory for a diagnosis).
Insight is usually preserved.
Bipolar types?
type I disorder: mania and depression (most common)
type II disorder: hypomania and depression
Mania?
severe functional impairment or psychotic symptoms for 7 days or more
Hypomania?
decreased or increased function for 4 days or more
Key differentiation of mania and hypomania?
key differentiation is psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations) which suggest mania
Mood stabiliser of choice for bipolar?
lithium (valproate as alternative)
Management of mania/hypomania?
consider stopping antidepressant if the patient takes one;
antipsychotic therapy e.g. olanzapine or haloperidol
Management of depression in bipolar?
talking therapies
fluoxetine is the antidepressant of choice
Bipolar px are 2-3x more at risk of what? (x3)
Diabetes
CVS disease
COPD
Referral - if symptoms suggest hypomania?
community mental health team (CMHT) - routine referral
Referral - mania or severe depression?
urgent referral to CMHT
Cotard syndrome?
believes that they (or in some cases just a part of their body) is either dead or non-existent
Capgras syndrome?
patients believe that a relative or friend has been replaced by an identical impostor.
De Clérambault syndrome
erotomania, is a rare delusion disorder where patients believe another individual is infatuated with them, often despite the individual being imaginary, deceased or someone the patient has never met.
Is gradual or sudden onset schizophrenia associated with worse prognosis?
- GRADUAL
Others:
- strong family history
- low IQ
- prodromal phase of social withdrawal
- lack of obvious precipitant
increased risk of completed suicide at a future date?
- efforts to avoid discovery
- planning
- leaving a written note
- final acts such as sorting out finances
- violent method
What’s a pseudo hallucination, commonly occur in what?
false sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating.
–> NORMAL GIREF RESPONSE
Bipolar: speech/thought?
pressured
flight of ideas: characterised by rapid speech with frequent changes in topic based on associations, distractions or word play
poor attention
Bipolar: behaviour?
insomnia
loss of inhibitions: sexual promiscuity, overspending, risk-taking
increased appetite
Peak incidence of delirium tremens?
72 hours
Peak incidence of seizures (in alcohol withdrawal)?
36 hours
Peak incidence of symptoms of alcohol withdrawal? Name them?
6-12hrs -> tremor, sweating, tachycardia, anxiety
Difference between acute stress reaction and PTSD?
acute - within 4 weeks of traumatic event
PTSD - after 4 weeks
Risk of developing schizophrenia:
a) monozygotic twin with schizo?
b) parent with schizo?
c) sibling with schizo?
d) no relatives?
a) 50%
b) 10-15%
c) 10%
d) 1%
Sx of post-concussion disorder?
headache
fatigue
anxiety/depression
dizziness
Which antidepressant may increase appetite and therefore useful to increase weight?
moa?
MIRTAZEPINE
alpha2-adrenergic receptors
Scoring system to assess severity of alcohol withdrawal?
CIWA-Ar (clinical institute withdrawal assessment)
Common features of PTSD?
1) re-experiencing (flashbacks, nightmares)
2) avoidance (people or situations)
3) hyperarousal (hypervigilance, sleep problems)
OCD 1st line medication if CBT/exposure + response therapy is unsuccessful?
SSRI e.g, SERTRALINE
fluoxetine if suffers body dysmorphia
Which antidepressant warrants addition of PPI if the px takes an NSAID?
SSRI’s
When does Wernicke’s become Korsakoff?
anterograde amnesia, retrograde amnesia, and confabulation
Diagnosis of chronic insomnia?
- trouble falling asleep at least 3x a week for at least 3 months
Short-term side effects of ECT?
- headache
- nausea
- short term memory impairment
- memory loss of events prior to ECT
cardiac arrhythmia
ECT indications?
catatonia
prolonged or severe mania
severe depression that is life-threatening
Sign to differentiate orange vs. non-organic cause of limb paresis?
HOOVER’S sign
