Psych Flashcards
What are the features of dementia with lewy bodies?
This is a cause of dementia
This will usually present with extrapyramidal symptoms and visual hallucinations
The patient will have gait or movement abnormalities on examination which makes Parkinson plus syndromes more likely
Wilson’s disease is a possible cause of dementia, what features would present with this?
This would usually present with psychosis, extrapyramidal symptoms, jaundice, Kayser-fleischer rings and a history of onset at a younger age
What features would present with Progressive Supranuclear Palsy?
Whilst this is a possible cause of dementia, there would usually be speech disturbance and vertical gaze dysfunction mentioned
Normal-pressure hydrocephalus is one of the causes of dementia, what features would it present with?
Would usually present with incontinence and ataxia of gait. (Triad of “Wet, Wobbly & Weird”)
Wernicke’s encephalopathy presents with which classic tetrad:
Ataxia, opthalmoplegia, nystagmus and acute confusional state and is associated with lesions in the mamillary bodies.
Vascular Dementia happens as a result of what? What type of patients present with cv illnesses?
Vascular dementia, a result of multiple infarcts in the brain tends to present with sudden onset cognitive decline and stepwise deterioration in someone with previous cardiovascular illness or events, as a result of the developing infarcts.
What is Lewy body dementia?
In Lewy Body Dementia, abnormal protein deposits called Lewy Bodies cause cognitive decline associated with parkinsonism (rigidity, tremor, bradykinesia)
Fronto-temporal Dementia (also known as Pick’s disease) presents with:
Cognitive impairment, personality change and disinbition, in keeping with the frontal area of the brain which is affected
Atrophy of the frontal and temporal lobes is seen
Risk factors and Signs on clinical examination of bulimia nervosa:
- Number of risk factors for an eating disorder (previous diagnoses of depression and anxiety, previous self-harm)
- Tooth decay and laxative use point towards a habit of purging
- This patient needs to be investigated for the likely diagnosis of bulimia nervosa
- Parotid gland swelling
- Russell’s sign (scarring on fingers from induced vomiting)
The repeated vomiting leading to tooth decay is more characteristic of bulimia nervosa than anorexia nervosa.
Management: All patients should be referred for specialist care and CBT is the first line treatment.
Features of bulimia nervosa vs anorexia nervosa:
- The repeated vomiting leading to tooth decay is more characteristic of bulimia nervosa than anorexia nervosa
- Unlike anorexia nervosa, sufferers may have a normal BMI
- Bulimia nervosa has features of binge eating and purging
Delusions of grandeur/grandiose delusions is seen:
mania
delusions with a strong positive affect where patients believe they have highly positive traits e.g “I’m rich” “I’m the Prime Minister”. Associated with mania.
Nihilistic delusions is seen in:
depressed patients
feelings of hopelessness
negative delusions that are typically mood-congruent and see in depressed patients.
Delusions of control is and is seen in:
to a sensation that an external party is controlling an individuals thoughts or actions
Seen in psychosis
Persecutory delusions is seen in:
a set of delusional conditions in which the patient believes they are being persecuted.
May be seen in psychosis.
Delusions is seen:
They are seen in a number of psychiatric conditions, such as schizophrenia, bipolar disorder and psychotic depression.
Delusions can be defined as a belief that is held in spite of superior evidence to the contrary.
Cotard’s syndrome is:
Cotard’s syndrome is the fixed, false belief that the person themselves is dying or dead
Fregoli delusion is:
the fixed, false belief that strangers are familiar to the individual and may even all be the same person
Capgras delusion is:
the fixed, false belief that a close relative or partner has been replaced by an impostor
Othello syndrome, otherwise known as delusional jealousy, or pathological jealousy, is a
form of delusional disorder in which an individual believes their partner is unfaithful, despite the absence of proof
It usually affects males and can result in stalking behaviour or even homicide.
Delusions of persecutions is also known as paranoid delusions, what do patients believe:
Most common type of delusions
Classically seen in schizophrenia
Patients believe they are being followed, spied on, or conspired against
If a patient they deserve to be punished, what delusion is this called:
Delusion of guilt, it is usually an innocent error out of proportion to the guilt felt
Typically associated with severe depression
Referred to as delusions of sin or worthlessness
Psychiatric differential diagnoses include for depression:
- Bipolar disorder
- Schizophrenia
- Dementia
- Seasonal affective disorder
- Bereavement
- Anxiety
Patients who have benefitted from antidepressants should be continued for at least how many months after remission to reduce the risk of relapse:
6 months
Delusion of thought possession is what and is seen in what patients:
These are false beliefs around the ownership of your thoughts
They can be subdivided into insertion, withdrawal, and broad-casting
They are classically seen in schizophrenia
A 42 year old lady assessed for a chronic decline in memory. On examination she has a protruding tongue, prominent epicanthal folds and a single transverse palmar crease. Cognitive testing shows profound decline in memory. She has Down’s syndrome confirmed on karyotyping when she was an infant. Pathological examination of her brain would show changes in keeping with which of the following conditions?
Alzheimer’s disease is caused by an accumulation of amyoid plaques, and the tau protein is also implicated. Down Syndrome is caused by Trisomy 21, and the amyloid precursor protein is found on chromosome 21
The extra copy of APP leads to early onset beta-amyloid plaques
Parkinson’s disease is caused by build up of:
It frequently leads to which type of dementia:
It is also in the same spectrum as:
alpha-synuclein, starting in the substantia nigra and then progressing often to include the majority of the cerebral cortex
It frequently leads to Parkinson’s disease dementia, and is also in the same spectrum as Dementia with Lewy Bodies (where dementia precedes or occurs within 1 year of the onset of motor symptoms)
It is a synucleinopathy not an amyloid related pathology
Symptoms of Anxiety in symptoms:
Psychological: Fears, worries, poor concentration, irritability, depersonalization, derealisation, insomnia (can’t fall asleep), night terrors
Motor symptoms: Restlessness, fidgeting, feeling on edge
Neuromuscular: tremor, tension headache, muscle ache, dizziness, tinnitus
GI: Dry mouth, can’t swallow, nausea, indigestion, butterflies, flatulence, frequent or loose motions
CVS: Chest discomfort, palpitation
Respiratory: Difficulty inhaling, Tight/constricted chest
GI: Urinary frequency, erectile dysfunction, Amenorrhoea
Patients with severe anxiety which treatment is the first line of patients:
Selective Serotonin reuptake inhibitors (SSRIs) are first-line in patients with severe anxiety or those in which psychological interventions have not led to improvement.
They target the cognitive aspect, not the somatic manifestations which beta blockers will such as propranolol, these include hand tremors and sweating
Benzodiazepines such as Diazepam are a controlled drug due to the high burden of dependence, and NICE explicitly advises against their use in anxiety disorders. They are only recommended as a short-term measure during crises.
Which is the second line choice in those whom SSRIs or Serotinin-Norepinephrine reuptake inhibitors (SNRIs) are unsuitable for anxiety:
Pregabalin
Baclofen is used for what:
muscle relaxant used in MS
What are the two side effects of Salbutamol:
it is a beta agonist
side effects include anxiety and hand tremors
What anticholinergic can be used to treat extrapyramidal side effects in Parkinson’s medications?
Benzhexol
B-blockers effective in patients with somatic anxiety symptoms, it is CI in what?
Asthma
Heart block
Chlordiazepoxide is used for:
Is a benzodiazepine used in the medical management of alcohol withdrawal
Loperamide is a:
medication used to treat diarrhoea
Following acute management, what treatments is most appropriate to treat this patient’s drug dependence of opoids?
If acute opiate intoxication and is likely to have intravenously injected heroin.
Methadone or Buprenorphine can be used as pharmacological support in the detoxification from opiates, and in maintenance therapy in order to prevent further use.
Both Methadone and Buprenorphine are opioids.
