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ALS > Psych > Flashcards

Psych Flashcards

1
Q

Tangentiality

A

Wandering off of a topic without ever returning to it

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2
Q

Circumstantiality

A

Excessive and unnecessary detail but eventually returns to point.

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3
Q

Schizophrenia: Prognosis

A

Poor:
Strong FHx
Gradual Onset
Low IQ
Prodromal phase of social withdrawal
Lack of cause

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4
Q

Lewy Body Dementia

A

20% of all cases, death within 7 years

Lewy bodies in the substantia nigra, paralimbic and neocortical areas

Link - Alzheimer’s, Parkinson’s

= progressive cognitive impairment (normally before parkinsonism), fluctuating cognition (early loss of attention and exec function), visual hallucinations

*In PD - motor symptoms come >1yr before dementia

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5
Q

Management of Lewy Body dementia

A

Inv - normally clinical, may use SPECT

-> AChE inhibitors (donepazil, rivastigmine) and memantine

Avoid antipsychotics - cause irreversible parkinsonism

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6
Q

Alzheimer’s

A

Progressive degenerative disease of the brain

RF - age, white, FHx, Down’s, 5% AD (amyloid precursor protein), apoprotein E allele E4

Changes:
Macro - widespread cerebral atrophy (cortex and hippocampus, temporal lobe)
Micro - cortical plaques (deposition of beta amyloid protein and neurofibrillary triangles, aggregation of tau protein)
Bio - Ach deficit

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7
Q

Alzheimer’s: Management

A

-> Group cognitive stimulation therapy and activities

-> Drugs

  1. AChE inhibitors e.g., donepezil (not if v HR. SE: insomnia), galantamine and rivastigmine.
  2. NMDA antagonist e.g., memantine
  3. AP only if risk of self harm or harming others (^mort)
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8
Q

Vascular Dementia

A

Second most common, cognitive impairment caused by ischaemia/ haemorrhage 2nd to cerebrovascular disease

Subtypes: stroke-related (infarct), subcortical (small vessel disease) or mixed (VD and AD)

RF - same as CVD, inherited rarely (CADASIL)

= months or years of sudden or stepwise deterioration in cognitive function

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9
Q

Vascular Dementia: Management

A

Inv - NINDS-AIREN criteria, MRI

-> manage CVD to slow progression

Only use AChE inhibitors or memantine if co-existing lewy body, AD or PD

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10
Q

Frontotemporal Lobar Degeneration

A

Types:
1 - FT dementia (picks)
2 - Progressive non fluent aphasia
3 - Semantic

= onset <65yrs, insidious, personality change and social conduct issues but preserved memory and visuospatial skills

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11
Q

Pick’s Disease

A

Most common FTD

= personality change, social conduct issues, hyperorality, disinhibition, ^appetite, perseveration

Inv - focal gyral atrophy with knife-blades, macro FT atrophy, micro (pick bodies, gliosis, NF triangles, senile plaques)

Avoid AChE inhibitors and memantine

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12
Q

CPA

A

= non fluent speech, comprehension is preserved

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13
Q

Semantic dementia

A

= fluent progressive aphasia, fluent but empty meaning, memory is better for recent events than longer term

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14
Q

Schizophrenia

A

Psychotic disorder

RF - FHx, black, migration, urban area, cannabis

Schneiders first rank symptoms
- 3rd person auditory hallucinations
- Thought disorder: insertion, withdrawal, BC
- Passivity phenomenon: external control
- Delusional perception: meaning of normal object

Others = impaired insight, negative (alogia, blunt affect, anhedonia and avolition, withdrawal), neologisms, catatonia

-> oral atypical AP, offer CBT to all, consider ^CVD risk

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15
Q

Alcohol Withdrawal

A

Less inhibitory GABA and more NMDA glutamate

6-12 hours - tremor, headache, nausea and agitation
12-24 hours - hallucinations
36 hours - seizures
72 hours - delirium tremens (coarse tremor, confused, delusions, hallucinate, fever, tachy)

High mort without treatment

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16
Q

Anorexia Nervosa

A

Restriction of energy intake relative to requirement, fear of weight gain/ fatness, disturbance in experience of weight

RF - 90% F, teenage/ young adult

G’s and C’s are high
Growth hormone
Glucose
Glands - salivary
Cortisol
Cholesterol
Carotene

Low - HR, BP, potassium, FSH, LH, oes, T, T3

-> CBT ED in adults and focused family therapy in kids

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17
Q

Refeeding syndrome

A

Metabolic abnormalities that occur on feeding someone following a period of starvation

Catabolism abruptly switches to carb metabolism

= v PO3 (weak muscles, HF/ resp failure), v K (arrhythmia), hypomagnesaemia (torsades de pointes),
abnormal fluid balance, seizures, coma

-> if hasn’t eaten for >5days, re-feed at no more than 50% of requirements for 2 days

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18
Q

PTSD

A

Symptoms >4wks

Hyperarousal
Emotional numbing
Avoidance
Re-experiencing

-> watch and wait if mild or symptoms under 4 weeks, trauma CBT or EMDR if severe

Drugs not first line but if used - venlafaxine or SSRI

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19
Q

Acute Stress disorder

A

Acute stress reaction <4 weeks from traumatic event

= intrusive thoughts (flashback, nightmare), dissociation, negative mood, avoidance, hyperarousal (vigilent, v sleep)

-> trauma focused CBT, benzos

20
Q

Bipolar Disorder

A

Periods of mania / hypomania alongside episodes of depression

2% get it, usually late teen

Type 1 (most common): mania and depression
= urgent referral to CMHT
Type 2: hypomania (>4d) and depression
= routine referral

Mania: severe functional impairment or psychotic symptoms >7 days e.g., grandeur, auditory hall

-> lithium best once stable
Mania/ hypomania - stop AD and start AP (olanzapine, haloperidol)
Depressive - talking therapies and fluoxetine

2-3x ^risk of DM, CVD and COPD

21
Q

Bulimia Nervosa

A

Episodes of binge eating followed by purgative behaviour

= erosion of teeth, Russell’s sign (calluses on the knuckles)

-> refer all to specialist, BN-focused guided self-help for 4wks, CBT-ED, family therapy in kids, may try fluoxetine

22
Q

Charles-Bonnet Syndrome

A

Persistent or recurrent hallucinations in clear consciousness

RF - age, peripheral visual impairment (ARMD), social isolation, sensory deprivation

23
Q

Cotard Syndrome

A

Person believes they are dead or non existent

RF - severe depression, psychosis

24
Q

De Clerambault’s Syndrome

A

Erotomania, paranoid delusion with an amorous quality
E.g., believe someone famous is in love with them

25
Q

Delusional Parasitosis

A

Fixed false belief (delusion) that they are infested with bugs

Presents alone or with other psych conditions

26
Q

Management of Depression

A

Less severe - PHQ-9 score <16
-> guided self help, CBT, behavioural activation, SSRI first line drug

More severe - PHQ-9 16+
-> individual CBT and SSRI

27
Q

ECT

A

Treatment of severe depression e.g., catatonia or psychosis refractory to medication

Raised ICP is absolute contraindication

SE: headache, nausea, ST memory issues, memory loss of events prior to ECT, arrythmia

28
Q

GAD Management

A

Excessive worry about a number of different events associated with heightened tension

  1. Education, active monitoring
  2. Low intensity psych (self-help)
  3. high intensity psych (CBT) or drugs (SSRI, SNRI, pregabalin)
  4. specialist
29
Q

Panic Disorder Management

A
  1. recognise and diagnose
  2. primary care (CBT or SSRI, at 12wks try clomipramine)
  3. review and consider other treatments
  4. refer
    `
30
Q

Grief Reaction

A

Denial, Anger, Bargaining, Depression, Acceptance

Delayed: occurs >2 weeks since death
Prolonged: normal reaction can be 1yr+
Atypical: more likely if F, sudden/ unexpected death, lack of support

Psuedohallucination: false sensory perception in the absence of external stimuli, insight preserved

31
Q

Insomnia

A

Difficulty initiating or maintaining sleep

Acute: related to life event, resolves itself
Chronic: 3x per week for 3 months

RF - F, old, lower education, unemployed, alcohol, stimulants, steroids

Inv - interview, sleep diary

-> identify cause, sleep hygiene, consider hypnotic e.g., benzo or Z drug if daytime impairment is severe (review at 2wks, consider CBT)

32
Q

OCD

A

Obsessions and/or compulsions causing significant functional impairment or distress

Obsession - repeated unwanted intrusive thought
Compulsions - acts that they feel drive to perform

RF - FHx, 10-20yrs, preg/ post-natal, abuse

-> Y-BOCS scale
Mild: low intensity psych (CBT, ERP), then SSRI
Moderate: SSRI (consider clomipramine) or more intensive CBT
Severe: refer to secondary care for assess, offer SSRI and CBT (w/ ERP) whilst waiting

33
Q

Othello’s Syndrome

A

Pathological jealousy and socially unacceptable behaviour linked to this claim

34
Q

SAD

A

Depression that occurs in winter months

-> same as depression, do not give sleeping tabs

35
Q

Sleep Paralysis

A

Transient paralysis of skeletal muscles which occurs when awakening from sleep or when falling to sleep

-> clonazepam if troublesome

36
Q

Unexplained symptoms

A

Somatisation Disorder
= multiple physical symptoms present >2 years, don’t accept reassurance/ neg test results

Illness Anxiety (Hypochondriasis)
= persistent belief of serious underlying disease

Conversion Disorder
= Loss of motor or sensory function, not factitious, may be la belle indifference

Dissociative disorder
= psychiatric symptoms e.g., amnesia, fugue, stupor, DID most severe form

Factitious Disorder (Munchausen’s)
= intentional production of symptoms

Malingering
= fraudulent simulation of symptoms for gain

37
Q

MHA Sectioning

A

2 - admit for assessment <28 days, 2 doctors recommend (1 ‘approved’) and AMHP applies, can treat against wishes

3 - treatment for 6 months, , 2 doctors (seen <24hrs) and AMHP

4 - emergency 72 hour assessment order (GP + AMHP), change to 2 when in hopsital

5(2) - detained by doctor for 72 hours (voluntarily in hosp)

5(4) - detained by a nurse for 6 hours (voluntarily in hosp)

17a - supervised community treatment order, recall to hosp for treatment e.g., if not complying with meds

135 - court order to remove person from their property to place of safety (police)

136 - from public space to place of safety, <24hrs

38
Q

Cluster A Personality Disorders

A

Paranoid: hypersensitive and unforgiving when insulted, reluctant to confide, hidden meanings

Schizoid: indifference to praise or critique, lack interest in sex, emotionally cold, few interests/ friends

Schizotypal: odd beliefs and magical thinking, lack friends, paranoid/ suspicious, eccentric

39
Q

Cluster B

A

Antisocial: repeatedly break laws, impulsive, reckless, lack of remorse, deceptive, ^M

Borderline (EUPD): unstable interpersonal relationships, affective instability, impulsive (spending, sex), chronic emptiness, suicidal

Histrionic: inappropriate seductiveness, centre of attention, shallow emotions, self dramatisation

Narcissistic: grandiose self importance, entitled, take advantage of others for own gain, arrogant

40
Q

Cluster C

A

Obsessive-compulsive: occupied with rules, rigid about morality and ethics, perfectionist

Avoidant: fears of criticism or rejection socially, views self as inept/ inferior, isolated but crave social contact

Dependent: need constant reassurance, others to take responsibility, lack initiative, fear being alone

41
Q

Serotonin Syndrome

A

Excessive serotonin, normally due to combined use of serotonin based drugs (SSRI, MAOI)

= NM excitability (rigidity, myoclonus, hyperreflexia), autonomic excitability (fever, HTN), confusion

-> IV fluids, BZ

42
Q

Alcohol Binge and Sodium

A

Alcohol binge suppresses ADH release from the posterior pituitary leading to hypernatraemia

43
Q

Korsakoff’s Syndrome

A

Marked memory disorder, ^alcoholics due to thiamine deficiency

= anterograde and retrograde amnesia, confabulation

44
Q

Other causes of psychosis

A

Brief psychotic disorder: symptoms <1mth, return to baseline
Steroid-induced psychosis: sudden onset
Depression with psychosis: ^elderly

45
Q

Suicide Risk

A

RF - M, Hx self-harm, alcohol/ drugs, depression, schizophrenia, older age, unemployed, not married

-> family support, children at home, religion

ALS (22 decks)

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