pot pourri Flashcards
capgras syndrome
delusions that familiar people have been replaced by imposters
Fregoli’s syndrome
delusion that strangers have taken on the psychological identity of a familiar person
Cotard’s syndrome
nihilistic delusion in which posits that a person’s possessions, friends, or parts of their own body does not exist or are about to not exist; most common in psychotic depression
sleep changes in depression
-disturbed REM sleep
-longer sleep latency, but, shortened REM latency
-Increased percentage of REM sleep
-REM sleep in 1st half of the night
(SSRI are super selective REM inhibitors)
neurobiology of OCD
changes in orbitofrontal cortex, anterior cingulate cortex and striatum
cortico-striato-thalamo-cortical pathway
catatonia associated with another mental disorder (specifier)
Clinical picture is dominated by 3 or more of the following:
1. stupor (ie no psychomotor activity; not relating to environment)
2. catalepsy (ie passive induction of a posture held against gravity)
3. waxy flexibility (eg slight, even resistance to positioning)
4. mutism (ie no/very little verbal response; exclude if known aphasia)
5. negativism (ie opposition/no response to instructions or external stimuli)
6. posturing (ie spontaneous and active maintenance of a posture against gravity)
7. mannerisms (ie odd, circumstantial caricature of normal actions)
8. stereotypy (ie repetitive abnormally frequent, non-goal-directed movements)
9. agitation, not influenced by external stimuli
10. grimacing
11. echolalia (ie mimicking another’s speech)
12 Echopraxia (ie mimicking another’s movements
note: disorder X, catatonia associated with disorder X
Schneiderian First Rank Symptoms
Kurt Schneider (1887-1967)
Concerned with making diagnosis of schizophrenia more reliable
*First Rank Symptoms (not sufficient or necessary)
-Audible thoughts/hallucinations
-Voices arguing/discussing
-Voices commenting on actions
- Somatic passivity-tactile/visceral/somatic hallucinations imposed by an external agent
- Thought withdrawal
-Thought insertion
-Thought broadcasting
- Made feelings– feelings imposed by an external agent
-Made impulses/drive- impulse for action imposed by external agent
-Made volitional acts- actions are from and controlled by external agent
-Delusional perception- perception has an unique/idiosycractic meaning leading to delusional interpretation
NMS criteria
Symptoms/Signs (Tetrad of symptoms-‐ FARM, Symptoms+ Signs-‐FAALTER M) § Fever § Autonomic Instability § Rigidity § Mental status change (agitated delirium) § Leukocytosis § Tremor § Elevated CK § Altered LOC
NMS treatment
Treatment
§ Stop causative agent (as
well as other psychotropics, lithium, serotonergic agents, anticholinergics)
§ Supportive care (ICU, cardio/resp stabilization,IV fluids, cooling blankets, BP control, heparin, benzos for agitation)
§ Medications (use is controversial and unsupported;
case reports only)
• Dantrolene (muscle relaxant)
• Bromocriptine (dopamine agonist -‐2.5mg q8-‐12h Max 45 mg/day)
§ ECT (controversial; only useif no response in 1-‐3)
o You can re-‐challenge patients who have had NMS. Have to wait 2 weeks. Lean toward low potency, oral formulation, no Li, low dose, slow increase, monitor and avoid dehydration
NMS risk factors
Risk factors: § History of NMS (strongest) § Meds that block dopamine transmission (typical > atypicals, antiemetics) § Recent dose change or aggressive dosing § Parenteral administration § Depots § Concomitant lithium § Comorbid substance use § Acute illness § Dehydration § Neurological disease § Age and sex are NOT risk factors. More young males affected because they are more frequently exposed to medications.
Delusional d/o Risk factors
Advanced age Sensory impairment or isolation Family history Social isolation Personality features (e.g., unusual interpersonal sensitivity) Recent immigration
CT head changes in schizophrenia
Indicated with focal neurological findings
Findings:
• Increase in volume of ventricles (third and lateral)
• Decrease in volume of
hippocampus (results in decreased glutamate transmission), amygdala, thalamus, cortical grey matter
• Decrease in brain symmetry and volume of temporal, frontal, & occipital lobes
• Uncertain changes in cerebellum and basal ganglia
• These findings are present before onset of full syndrome
and before intiation of
medications
• Progression throughout the first few yearsof illness
Degree of grey matter atrophy
correlates with disease severity
(EXAM) (ie increased ventricles, sulci)
o Related to cannabis use,
medication use, and psychotic relapses
Good prognostic factors for schizophrenia
Late Onset Obvious precipitating factors Acute onset Good premorbid social, sexual, and work histories Mood disorder symptoms (especially depressive disorders) Married Family History of mood disorders Good support systems Positive Symptoms
Bad Prognostic Factors for Schizophrenia
Young onset No precipitating factors Insidious onset Poor premorbid social, sexual, and work histories Withdrawn, autistic behavior Single, divorced or widowed Family history of scz Poor support systems Negative symptoms Neurological signs and symptoms History of perinatal trauma No remissions in 3 years Many relapses History of assaultiveness
Anorexia/Bulimia Labs
Increased: Cr/BUN (Dehydration), amylase (vomiting), cholesterol (starvation), LFTs (starvation), T3 (high or low)
Decreased: RBCs (starvation), WBC (starvation), Na, K, Cl (vomiting, laxatives), LH, FSH, estrogen (starvation), T3/4 (sick euthyroid syndrome), testosterone (males), Mg, Zinc, PO4 (starvation), bone mineral density (assess if amenorrhic x 6/12)
