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Phase 3a > Psych 1 - Organic, Psychoses, and Mood > Flashcards

Psych 1 - Organic, Psychoses, and Mood Flashcards

1
Q

Define dementia

A

Generalised psychological dysfunction of higher cortical functions without impairment of consciousness

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2
Q

Give three reversible causes of dementia

A

Vitamin B3 or B12 deficiency
Subdural haematoma
Hypothyroidism

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3
Q

Give three domains that dementia affects

A 
Memory
Orientation
Language
Thinking and judgement
Emotional control
Social behaviour
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4
Q

How does delirium differ from dementia?

A

Acute onset
Impaired consciousness
Fluctuating course with lucid intervals
Reversible

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5
Q

How is memory assessed in dementia?

A

Mini mental state examination

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6
Q

What part of the cortex does Alzheimer’s disease and Pick’s disease affect?

A

Posterior-parietal

Fronto-temporal

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7
Q

Give three risk factors for Alzheimer’s disease

A 
Family history
Female
Down's syndrome
Age
Risk factors for vascular disease
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8
Q

What is seen on MRI of Alzheimer’s patients?

A

Global atrophy
Ventricular enlargement
Widened sulci

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9
Q

Where are neurofibrillary tangles found in AD, and what do they contain?

A

Cortex, hippocampus, substantia nigra

Tau protein

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10
Q

What are Hirano bodies?

A

Silver staining neuritic plaques (senile plaques) seen in Alzheimer’s disease, containing a core of beta-amyloid protein

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11
Q

Which enzyme has reduced activity in Alzheimer’s disease?

A

AChE

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12
Q

Give three early symptoms of AD

A

Disorientation
Failing memory
Wandering and irritability

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13
Q

Give three middle symptoms of AD

A

Intellectual and personality deterioration
Aphasia, apraxia, agnosia
Impaired visuo-spatial skills and executive function

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14
Q

Give three late symptoms of AD

A

Physical deterioration including seizures and tremor
Incontinence
Depression and aggression

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15
Q

In diagnosis of AD, what investigation excludes delirium and CJD?

A

EEG

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16
Q

What does a PET scan show in AD?

A

20-30% reduction in oxygen and glucose metabolism in temporal and parietal lobes

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17
Q

What are the initial investigations for dementia?

A

Physical examination and history
Bloods and urine to exclude reversible causes
Cognitive testing
Specialist: PET or SPECT

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18
Q

What is the pharmacological treatment of AD and what is a possible side effect??

A

AChE inhibitor: donezpezil/galantamine/rivastigmine

Heart block

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19
Q

What is 2nd line treatment for severe AD?

A

NMDA antagonist: memantine

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20
Q

What subgroups are used in AD?

A

Mayeux

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21
Q

What are the risk factors for vascular dementia?

A 
Family or personal history of CV disease
Smoking
Hypertension
Diabetes mellitus
Hyperlipidaemia
Polycythaemia
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22
Q

What are the characteristics of vascular dementia?

A

Emotional and personality changes, followed by a stepwise decline in cognition and memory
Sundowning

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23
Q

Vascular dementia may follow…

A

CVA

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24
Q

What signs occur in vascular dementia?

A

Rigidity, akinesia, brisk reflexes, PBP, seizures

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25
Q

What is Biswanger disease?

A

Progressive small vessel disease

Lacunae formation from multiple microinfarcts

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26
Q

What are the three subtypes of vascular dementia?

A

Cognitive deficits following a single stroke
Multi-infarct dementia
Progressive small vessel disease

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27
Q

What are the symptoms of Lewy Body dementia?

A 
Dementia with lucid episodes
Parkinsonism
Visual people and animals hallucinations
Depression
Autonomic dysfunction - constipation
REM sleep disorder - acting out dreams
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28
Q

What are Lewy-Bodies?

A

Eosinophilic intracytoplasmic neuronal inclusions of abnormally phosphorylated neurofilament proteins aggregated with ubiquitin and alpha-synuclein

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29
Q

What is seen on SPECT FP-CIT in Lewy Body dementia?

A

Decreased putamen

Reduced dopamine transporter uptake

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30
Q

Why are anti-psychotics avoided in Lewy-Body dementia?

A

Severe sensitivity reactions e.g. irreversible 4Parkinsonism

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31
Q

What medications are used in Lewy-Body dementia?

A

Rivastigmine for cognitive decline
Clonazepam for REM sleep disorder
Levodopa can help with movement problems but may worsen psychosis

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32
Q

When does Pick’s disease present?

A

Early - 50s

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33
Q

What are the three forms of Pick’s disease?

A

Disinhibited
Apathetic
Stereotypic

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34
Q

What is the pathophysiology of Pick’s disease?

A

Bilateral atrophy of frontal and anterior temporal lobes

Striatal degeneration

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35
Q

What are the most common symptoms of Pick’s disease?

A

Impaired social conduct and insight
Dietary, speech, and perserverative changes
Cognitive decline

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36
Q

What medications are prescribed to control the behavioural symptoms of dementia?

A

SSRIs

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37
Q

What is a prion and in what disease is it seen?

A

Small infectious pathogen lacking nucleic acid

CJD

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38
Q

What percentage of CJD cases are sporadic?

A

85% (15% hereditary)

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39
Q

What is the pathophysiology of CJD?

A

Grey matter of cortex gets vacuoles from prion infection

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40
Q

Give three symptoms of CJD

A

Dementia
Motor changes including paralysis and tremor
Seizures
Dysarthria and dysphagia

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41
Q

What is seen on EEG in CJD?

A

Periodic wave complexes, triphasic pattern

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42
Q

What does neurosyphilis typically present as?

A

Progressive frontal dementia

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43
Q

Give three symptoms of neurosyphilis

A

Grandiosity, euphoria, mania, disinhibition

Personality change

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44
Q

Give three signs of neurosyphilis

A 
Argyll-Robertson pupils
Tremor
Hyperreflexia
Ataxia
Dysarthria
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45
Q

Give three psychiatric symptoms of Wilson disease

A

Mood disturbance
Subcortical dementia
Psychosis

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46
Q

What are three causes of frontal-lobe syndrome

A

Head injury
CVA
Neoplasm

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47
Q

Give three symptom of frontal-lobe syndrome

A

Anhedonia
Loss of abstract thought
Change of affect

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48
Q

What is echopraxia and in what conditions is it seen?

A

Meaningless repetition/imitation of movements

Frontal lobe syndrome, AD

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49
Q

What is normal pressure hydrocephalus?

A

Dilatation of cerebral ventricles but normal CSF pressure at lumbar puncture

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50
Q

What are the causes of NP hydrocephalus?

A

50% idiopathic

50% mechanical obstruction of CSF flow e.g. SAH

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51
Q

What is the triad of NP hydrocephalus?

A

Ataxia
Urinary incontinence
Dementia

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52
Q

What is the cause of gait ataxia in NP hydrocephalus?

A

Pyramidal UMN paraparesis

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53
Q

What is the treatment of NP hydrocephalus?

A

Ventriculoperitoneal shunt

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54
Q

What is the most common form of psychosis?

A

Schizophrenia

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55
Q

Give three risk factors of schizophrenia

A

Family history
Prematurity
Psychosocial stress

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56
Q

What is the typical age of onset in schizophrenia?

A

15-45 years, males earlier

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57
Q

What is the cause of the clinical symptoms of schizophrenia?

A

Central dopaminergic hyperactivity in the mesolimbic mesocortical system

58
Q

What is schizophrenia?

A

Mental disorder characterized by abnormal social behaviour and failure to understand what is real

59
Q

What brain pathology is seen in patients with schizophrenia?

A

Ventricular enlargement
Decreased cortical grey matter
Reduced hippocampal size and neurones

60
Q

What are the first rank symptoms of schizophrenia?

A

Thought alienation
Passivity phenomena
3rd person auditory hallucinations
Delusional perception

61
Q

What type of auditory hallucinations do patients with schizophrenia experience?

A

Running commentary
Talking/arguing amongst selves
Thought-repeating voices

62
Q

How many first rank symptoms are required to indicate schizophrenia?

A

> 1

63
Q

Name three secondary symptoms of schizophrenia

A

Other persistent delusions or hallucinations
Breaks in train of thought
Catatonic behaviour
Negative symptoms
Change in personal behaviour e.g. anhedonia, social withdrawal

64
Q

What is catatonic behaviour?

A

Stupor and excitement
Posturing
Waxy flexibility

65
Q

What are the negative symptoms of schizophrenia?

A 
Decrease or absence of normal function:
Lack of emotion
Neglect of personal hygiene
Loss of motivation/interest
Social withdrawal
66
Q

What type of schizophrenic symptoms present first?

A

Negative

67
Q

What type of schizophrenic symptoms respond better to anti-psychotics?

A

Positive

68
Q

What are the five types of schizophrenia?

A 
Paranoid
Hebephrenic/disorganised
Catatonic
Residual
Simple
69
Q

What does paranoid schizophrenia consist of?

A

False beliefs and hearing things that aren’t there

Delusions

70
Q

The schizophrenic type that consists of inappropriate/incomprehensible thoughts, speech and behaviour is…

A

Hebephrenic

71
Q

What are three differentials for schizophrenia?

A

Drug-induced psychosis - LSD, cannabis
Encephalitis
Psychotic depression
Personality disorder

72
Q

What is the first line treatment for schizophrenia?

A

Antipsychotics: risperidone or olanzapine AND

CBT

73
Q

What is second line treatment for schizophrenia?

A

Change anti-psychotic (up to two times)

THEN clozapine

74
Q

What is associated with poor prognosis in schizophrenia?

A 
Childhood/adolescent onset
Gradual onset
Low IQ
Strong family history
Lack of obvious precipitant
75
Q

What medication is used if rapid tranquilization is necessary?

A

Benzodiazepines (short acting)

76
Q

Some antipsychotics have Parkinsonian side effects. What medication is used to combat this?

A

Procyclidine (anti-cholinergic)

77
Q

What is the name of the condition characterized by non-bizarre delusions, but not hallucinations, thought, or mood disorder?

A

Delusional disorder

78
Q

What are three risk factors for delusional disorder?

A

Low socioeconomic status
Substance abuse
Paranoid personality disorder

79
Q

How does delusional disorder present?

A

Delusions influence thought and behaviour; impaired insight and judgement

80
Q

What is the treatment of delusional disorder?

A

Anti-psychotics

81
Q

What is schizoaffective disorder?

A

Features of affective disorder and schizophrenia present in equal proportions

82
Q

How is schizoaffective disorder treated?

A

As for schizophrenia

Treat manic or depressive symptoms as for bipolar disorder

83
Q

What does depression consist of?

A

Negative affect (low mood) and/or absence of positive affect (loss of pleasure and interest)

84
Q

For a diagnosis of depression to be made, DSM-IV states that the core symptoms present must fulfil what criteria?

A

Present >2 weeks and different from normal
Not secondary to drugs, medication, or bereavement
Cause significant distress and impairment of functioning

85
Q

What are the core symptoms of depression?

A 
FLIP WAP
F: feelings of worthlessness/hopelessness/guilt, fatigue
L: libido decreased
I: insomnia/hypersomnia
P: persistent sadness or low mood every day
W: weight and appetite change
A: anhedonia
P: psychomotor retardation or agitation

AND decreased concentration, suicidal thoughts

86
Q

What symptoms are seen in psychotic depression that are different to depression?

A

Negative hallucinations
Delusions of poverty, inadequacy, guilt, deserving of punishment, nilhilism, responsibility for world events
Marked catatonic symptoms

87
Q

Which groups may present atypically with depression?

A

Elderly - agitation and confusion

Children - irritability and social withdrawal

88
Q

What are three risk factors for depression?

A 
Family history
Bad childhood experiences
Separation or divorce
Unemployment
Adverse life events
Physical illness especially if chronic or painful
89
Q

What model is used in the aetiology of depression?

A

Biopsychosocial

90
Q

What neurotransmitter is found to decrease in function in depression?

A

GABA

91
Q

What theory of depression involves neurotransmitters?

A

Monoamine theory of depression

92
Q

What are some organic differentials for depression?

A 
Anaemia
Addison's disease
Hypo/hyperthyroidism
Porphryia 
Syphilis or HIV
MS/Huntington's/Parkinson's
93
Q

What treatment is used for first line mild depression?

A

Low intensity psychosocial interventions or group CBT

94
Q

What treatment is used for first line moderate to severe depression?

A

High intensity psychosocial interventions such as individual CBT OR

SSRIs e.g. citalopram

95
Q

What is the treatment of psychotic depression?

A

Anti psychotic started a few days before anti depressant to avoid worsening of psychosis

96
Q

What is the management of treatment resistant depression?

A

Change class of anti-D
Combine two types of anti-D
Consider lithium
Consider ECT

97
Q

What is bipolar disorder?

A

Chronic episodic illness associated with behavioural disturbances
Episodes of mania/hypomania and depression

98
Q

What are the two types of bipolar disorder?

A

Type 1: manic and major depressive episodes

Type 2: hypomanic (less severe and no psychoses) and depressive episodes

99
Q

What is rapid cycling bipolar disorder?

A

4+ cycles of depression and mania a year, with no intervening asymptomatic episodes

100
Q

Describe the treatment of acute manic, acute depressive, and acute mixed bipolar episodes.

A

Manic - antipsychotics (haloperidol, olanzapine, quetiapine, risperidone), stop anti-Ds
Dep - anti depressant with antipsychotic
Mixed - anti-psychotics

101
Q

What is the treatment of rapid cycling bipolar disorder?

A

Lithium and sodium valproate

102
Q

What is the long term treatment of bipolar disorder?

A

Lithium

Lithium and valproate 2nd line

103
Q

When does post-natal depression usually develop?

A

After the 3rd week following delivery

104
Q

What are the risk factors for postnatal depression?

A

Previous psychiatric disorder
Family history
Physical problems during pregnancy

105
Q

What scale is used to identify mothers at risk of post natal depression?

A

Edinburgh

106
Q

What extra features occur with post-natal depression?

A

Despondency and tearfulness
Fatigue and anxiety
Fears about baby
Symptoms worse at night

107
Q

What is the treatment of post-natal depression?

A

Anti-depressants and CBT

108
Q

When does puerperal psychosis occur post partum?

A

2 weeks

109
Q

What occurs in the prodrome of puerperal psychosis?

A

Insomnia
Irritability
Restlessness
Refusal of food

110
Q

What type of psychoses occur in puerperal psychosis?

A

Depressive psychosis
Schizophrenia
Manic episode

111
Q

What is the management of puerperal psychosis?

A

Treat the psychotic cause e.g. treat mania

112
Q

What is the recurrence risk of puerperal psychosis?

A

50%

113
Q

What is cyclothymia?

A

Mood disorder characterised by persistent instability of mood (mild depression and elation)

114
Q

How long must symptoms be present for to diagnose cyclothymia?

A

2 years

115
Q

When does cyclothymia present?

A

Teens-early adulthood

116
Q

What is the treatment of cyclothymia?

A

Lithium

Psychotherapy such as CBT

117
Q

What is baby blues?

A

Short-lived disturbance of emotion 3-5 days after delivery

118
Q

What is mania?

A

A distinct period (>1w) of abnormally and persistently elevated or irritable mood

119
Q

Give three symptoms of mania

A 
Increased energy
Elevated mood
Increased self esteem
Reduced attention
Inappropriate spending/sexual behaviours
120
Q

How might increased energy present in mania?

A 
Overactivity
Pressure of speech
Flight of ideas
Racing thoughts
Decreased need for sleep
121
Q

Give three psychotic symptoms of mania

A 
Delusional grandiose ideas
Incomprehensible speech
Violent behaviour
Manic stupor
Total loss of insight
122
Q

How is mania treated?

A

Lithium, valproate, or carbamazepine

123
Q

How is hypomania treated?

A

Atypical antipsychotics such as risperidone,

Lithium

124
Q

What is the difference between mania and hypomania?

A

Lesser extent

No psychoses

125
Q

What is word salad?

A

Disorganised speech, sentences do not make sense

126
Q

What is neologism?

A

Making up new words

127
Q

What is Cotard syndrome?

A

Patient believes they are dead

128
Q

When is ECT indicated?

A

Catatonia
Severe depression
Severe mania
Treatment resistant schizophrenia

129
Q

If a patient is started on an anti-psychotic, what are the regular investigations that should be done regularly to monitor for side effects?

A

BMI
ECG
Bloods - FBC, UE, LFT, lipids, glucose, HbA1c, prolactin

130
Q

What receptors do atypical antipsychotics target?

A

Serotonin-dopaminergic D2 receptor

131
Q

What delusions are seen in paranoid schizophrenia?

A

Persecutory delusions
Grandiose delusions
Delusions of reference

132
Q

What are three mild symptoms of lithium toxicity?

A

D+V
Dystonia
Weakness/tremor
Hypothyroidism

133
Q

What are three symptoms of severe lithium toxicity?

A

Brisk tendon reflexes
Seizures
Hypotension
Coma and death

134
Q

Which SSRI has the highest risk of congenital malformations in the first trimester?

A

Paroxetine

135
Q

What is the risk of taking SSRIs in pregnancy?

A

1st trimester - small increased risk of heart defects
2nd trimester - no increased risk
3rd trimester - risk of persistent pulmonary hypertension in the newborn

136
Q

In which conditions are flight of ideas, and knight’s move seen?

A

Flight of ideas - mania

Knight’s move - schizophrenia

137
Q

Which medication can be used to treat sleep paralysis?

A

Clonazepam

138
Q

What is a short term side effect of ECT?

A

Arrhythmias

139
Q

What drug is used to combat cardiovascular complications caused by overdose of TCAs?

A

Bicarbonates

140
Q

What are the first and second line treatments of catatonia?

A
  1. ECT

2. 2nd/3rd gen anti-D e.g. fluoxetine or citalopram

141
Q

Which tool is used to monitor patients in alcohol withdrawal?

A

Clinical Institute Withdrawal Assessment

142
Q

What does a PET scan of a patient with schizophrenia and OCD show?

A

Schizo - hypoactivity of the prefrontal cortex, symmetrical enlargement of ventricles
OCD - hyperactivity of the prefrontal cortex

Phase 3a (18 decks)

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