PSYCH 1: Intro to Psych - Cognitive disorders, psychosis, schizophrenia, mood disorders, anxiety disorders Flashcards
What does orientation mean?
Knowledge of: person, time and place
What can cause a patient to become disorientated?
Infection, alcohol/drugs, hypoglycaemia, electrolyte abnormalities, delirium, dementia
What is amnesia and what are the different types?
Loss of memory - often caused by CNS injury
RETROGRADE = loss of memories in the past, retained ability to make new memories
ANTEROGRADE = inability to make new memories, remembers past
DISSOCIATIVE = special form not caused by CNS injury, usually result of psychological trauma/stress, inability to remember autobiographical info
What is the difference between Wernicke’s and Korsakoff’s?
Both assoc. w/vitamin B1 (Thiamine) deficiency and alcoholism
WERNICKE = acute encephalopathy, triad of confusion, ataxia + ophthalmoplegia, rx is thiamine/B1 infusion
KORSAKOFF = permanent neurologic condition, consequence of Wernicke’s, same features + amnesia + confabulation (making things up) and personality changes
What is dementia and what can it be caused by?
Chronic progressive decline, irreversible, no LOC, impaired judgement, memory deficits, personality changes.
CAUSES =
- alzheimer’s
- vascular dementia
- lewy body
- rare = pick’s disease, CJD, HIV, vitamin deficiencies, Wilson’s
- pseudodementia
What is delirium and what is it caused by?
Acute condition, reversible, loss of focus and attention, disorganised thinking, hallucinations, sleep-wake disturbance
CAUSES =
- infection classically
- alcohol use or withdrawal
- certain drugs e.g. anticholinergics, benzodiazepines, antihistamines, antidepressants in elderly population
How is delirium investigated and managed?
EEG is normal in dementia, abnormal in delirium, but mainly clinical signs
Rx = fix underlying cause
- abx for infection
- meds for withdrawal
- treat pain
- hydrate, calm and quiet environment
- haloperidol (vit H) if everything else has failed
What are symptoms of psychosis?
Loss of perception of reality:
- delusions (expressed in speech content)
- disorganised thoughts (expressed by speech pattern)
- hallucinations (subtype for each of 5 senses)
What is schizophrenia?
Chronic illness causing functional impairment characterised by:
1. cognitive dysfunction (reduced ability to make plans, diminished memory, inattention)
2. +ve sx i.e. psychosis
3. -ve sx (absence of normal behaviours, flat affects, alogia, asociality, avolition = lack of motivation, anhedonia)
Continuous signs for 6 months
What is the dopamine theory?
Aetiology behind psychosis/schizophrenia
MESOCORTICAL PATHWAY = decreased activity leading to negative sx
MESOLIMBIC = increased activity causes positive sx
NIGROSTRIATAL = decreased activity leads to EPSEs
TUBEROINFUNDIBULAR = decreased activity leads to increased prolactin which leads to prolactin related SEs
What is schizophreniform disorder?
Milder form of schizophrenia, less than 6mths
What is brief psychotic disorder?
Milder than schizophreniform disorder, less than 1 month, affects W>M, following stressful life events
What is delusional disorder?
one or more delusions, one month or longer but no other abnormal behaviours
Folie a deux = close friends share delusion
What is major depressive disorder?
Chronically depressed mood, anhedonia, fatigue/loss of energy, feeling worthless/guilty, suicidal ideation/attempt, inability to concentrate/make decisions, appetite changes, weight loss/gain, sleep disturbances
Subtypes inc:
- seasonal
- psychotic
- atypical (mood reactivity = core feature, hyperphagia, hypersomnia, leaden feeling in limbs, hypersensitivity to rejection)
Assessed using PHQ-9
How is MDD treated?
CBT always
Antidepressants: SSRIs or SNRIs
ECT if severe
What is ECT and when is it indicated?
Treatment-refractory depression, catatonia etc.
Inducing a seizure under general anaesthesia in controlled circumstances
May be used in pregnancy
May cause retrograde amnesia
What are sx of a manic episode and how long does it last?
DIG FAST
Distractibility
Irresponsibility
Grandiosity
Flight of ideas
Agitation
Less sleep
Talking too much (pressured speech)
Lasting at least 1 week, w/ disruption of social functioning
What is a hypomanic episode?
Similar to manic but less severe.
Little or no impairment in social functioning
No delusions of grandeur
Lasts min. 4d
NO PSYCHOTIC SX otherwise automatically mania
What is bipolar disorder?
Mood fluctuates between depression, (hypo)mania and periods of euthymia (normal mood) in between.
BIPOLAR I = manic +/- depression +/- hypomania
BIPOLAR II = hypomania and depression
How is bipolar disorder treated?
CBT
Mood stabilisers e.g lithium, sodium valproate, carbamazepine, lamotrigine
Antipsychotics
What is generalised anxiety disorder?
Chronic persistent anxiety about many different activities/events
Lasts > 6 months and need to have sx more days than not
Sx (need 3+ of these w/persistent anxiety) = restlessness, anxiety, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
How is GAD diagnosed and treated?
Clinical diagnosis, GAD-7 questionnaire in GP setting
Rx =
1st line - CBT
2nd line - SSRI/SNRI (sertraline)
no long term benzos due to high risk of dependence
Beta blocker may be used to treat adrenergic sx in absence of CIs like asthma
What is OCD?
Obsessions + Compulsions
OBSESSIONS = recurrent persistent thoughts, urges or images, intrusive + unwanted, pt attempts to ignore but is unsuccessful, causes distress
COMPULSIONS = repetitive behaviours or mental acts done to relieve obsessions, pt feels driven to engage in compulsions in response to obsessions
How is OCD treated?
First line = CBT w/Exposure and response therapy (ERP) - exposes pts to obsessive thoughts/images and they have to respond w/non-compulsive behaviour
2nd line = SSRI (fluoxetine, high dose)
3rd line = Clomipramine (TCA) after 12w
