Psych Flashcards
Tangentiality
Wandering off of a topic without ever returning to it
Circumstantiality
Excessive and unnecessary detail but eventually returns to point.
Schizophrenia: Prognosis
Poor:
Strong FHx
Gradual Onset
Low IQ
Prodromal phase of social withdrawal
Lack of cause
Lewy Body Dementia
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
Management of Lewy Body dementia
Inv - normally clinical, may use SPECT
-> AChE inhibitors (donepazil, rivastigmine) and memantine
Avoid antipsychotics - cause irreversible parkinsonism
Alzheimer’s
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
Alzheimer’s: Management
-> Group cognitive stimulation therapy and activities
-> Drugs
- AChE inhibitors e.g., donepezil (not if v HR. SE: insomnia), galantamine and rivastigmine.
- NMDA antagonist e.g., memantine
- AP only if risk of self harm or harming others (^mort)
Vascular Dementia
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
Vascular Dementia: Management
Inv - NINDS-AIREN criteria, MRI
-> manage CVD to slow progression
Only use AChE inhibitors or memantine if co-existing lewy body, AD or PD
Frontotemporal Lobar Degeneration
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
Pick’s Disease
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
CPA
= non fluent speech, comprehension is preserved
Semantic dementia
= fluent progressive aphasia, fluent but empty meaning, memory is better for recent events than longer term
Schizophrenia
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
Alcohol Withdrawal
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
Anorexia Nervosa
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
Refeeding syndrome
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
PTSD
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
Acute Stress disorder
Acute stress reaction <4 weeks from traumatic event
= intrusive thoughts (flashback, nightmare), dissociation, negative mood, avoidance, hyperarousal (vigilent, v sleep)
-> trauma focused CBT, benzos
Bipolar Disorder
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
Bulimia Nervosa
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
Charles-Bonnet Syndrome
Persistent or recurrent hallucinations in clear consciousness
RF - age, peripheral visual impairment (ARMD), social isolation, sensory deprivation
Cotard Syndrome
Person believes they are dead or non existent
RF - severe depression, psychosis
De Clerambault’s Syndrome
Erotomania, paranoid delusion with an amorous quality
E.g., believe someone famous is in love with them
