passmed Flashcards
what is akathisia
Akathisia is defined as an inability to remain still.
tardive dyskinesia
Tardive dyskinesia (TD) is a condition where your face, body or both make sudden, irregular movements which you cannot control. It
An acute dystonic reaction is characterized by involuntary contractions of muscles of the extremities, face, neck, abdomen- what cause these
antipsychotics - olanzapien
catonia
Catatonia is a symptom of mental illness and patients usually appear to be in a stupor, maintain odd postures and appear awake but unresponsive to external stimuli.
how do you treat an acute dystonic reaction
two things
Treatment is usually IV procyclidine and withdrawal of the causative medication.
haloperidol moa
blocks dompaime receptors
A 27-year-old female is recently started on olanzapine following a diagnosis of schizophrenia. Shortly after the initiation of the drugs she becomes restless and her mother states that she seems to be staring blankly. On examination you note an upward deviation of both eyes.
What is the cause of this?
Acute dystonia - sustained muscle contraction such as torticollis or oculogyric crisis
what is body dysmorphia
Body dysmorphic disorder (sometimes referred to as dysmorphophobia) is a mental disorder where patients have a significantly distorted body image
Diagnostic and Statistical Manual (DSM) IV criteria:
Preoccupation with an imagine defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive
The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)
A 19-year-old man is brought in by his family. They tell you he has become withdrawn and not left the house for several months and has been acting strangely. They think he is hearing voices and he often refuses to eat as he claims the food it is poisoned. Given the likely diagnosis, what would be the most appropriate first-line treatment?
why don’t you give clozapine first Line
Clozapine is only used for patients who are resistant to other antipsychotics due to its potential for serious side effects
olanzapine
unexplained symptoms what two thing major could be at cause
Unexplained symptoms
Somatisation = Symptoms
hypoChondria = Cancer
Somatisation disorder
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
Illness anxiety disorder (hypochondriasis)
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results
Conversion disorder
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
Dissociative disorder
dissociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder
Factitious disorder
also known as Munchausen’s syndrome
the intentional production of physical or psychological symptoms
Malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
1st line alcohol withdrawal
first-line: long-acting benzodiazepines e.g. chlordiazepoxide or diazepam. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose proto
A 61-year-old male with a long history of schizophrenia is seen in the clinic. He appears to be grimacing and exhibits rapid darting movements of his tongue. What is the mechanism of action of the medication that has most likely given rise to his symptoms?
Long term dopamine receptor blockade causing hypersensitivity of dopamine receptors in the nigrostriatal pathway
The scenario describes the features of tardive dyskinesia. This can result from long-term use of antipsychotic drugs, which is likely in this patient due to his long history of mental illness. It is suggested that blockade of the dopamine receptor promotes hypersensitivity of the D2 receptor in the nigrostriatal pathway, thus giving rise to excessive movements.
A 23-year-old male is recently started on risperidone for schizophrenia. Shortly after starting the medication he notices that his breasts have enlarged and there is some discharge. He also admits to a reduced libido and erectile dysfunction.
He is diagnosed with hyperprolactinaemia secondary to anti-psychotic use.
Which dopaminergic pathway is inhibited to cause this presentation?
Inhibition of the tuberoinfundibular pathway by antipsychotics causes hyperprolactinaemia
RAPD
Also known as the Marcus-Gunn pupil, a relative afferent pupillary defect is found by the ‘swinging light test’. It is caused by a lesion anterior to the optic chiasm i.e. optic nerve or retina
Finding
the affected and normal eye appears to dilate when light is shone on the affected
Causes
retina: detachment
optic nerve: optic neuritis e.g. multiple sclerosis
Pathway of pupillary light reflex
afferent: retina → optic nerve → lateral geniculate body → midbrain
efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve
