Psych Flashcards
Acute presentation of opiate overdose
DROWSINESS
- Resp depression leading to acidosis
- Hypotension
- possible Tachycardia
- PINPOINT PUPILS
Chronic opiate presentation
Constipation
Treatment for opiate overdose
ABCDE
IV NALOXONE IF COMA OR RESP DEPRESSION (Or IM if bad veins)
Oral activated charcoal if invested a lot
What are characteristics of OCD compulsions/obsessions
- present most days
- have lasted at least 2 weeks
Acknowledge they originate in the mind
- try to resist but it’s unsuccessful
- the act is unpleasurable
Interferes with functioning
Treatment for OCD
Mild - CBT/group CBT or Exposure and Response Prevention therapy. SSRIs only if not responding to treatment.
Moderate - high intensity CBT or ERP. Can have SSRIs instead of therapy.
Severe - high intensity CBT or ERP AND SSRIs (in combination)
Schizophrenia
Chronic / relapsing remitting for of psychosis caharacterised by both POSITIVE AND NEGATIVE Sx
Symptoms have to be present for AT LEAST 1 MONTH and causing SIGNIFICANT IMPAIRMENT
Subtypes of schizophrenia
- Paranoid schizophrenia (Delusions + hallucinations)
- Catatonic schizophrenia (motor disturbances + waxy? flexibility)
- Hebrephenic (disorganised thinking, emotions + behaviour)
- Residual schizophrenia (some sx persisting after major episode)
- Simple Sz (gradual decline in function WITHOUT prominent +ve sx)
Cause/RFx of Scz
- Genetic: FHx
- 50% risk if both parents or identical twin is affected
- 10% if one parent or sibling
- Environmental factors
- Childhood trauma
- Heavy childhood cannabis use
- Maternal health issues (malnutrition, infections)
- Birth trauma (hypoxia / blood loss)
- Urban living / immigration to more developed countries
Schz Sx
Positive:
- Auditory hallucinations
- Thought disorder (insertion, withdrawal)
- Passivity phenomenon etc
- Delusions
Negative:
- Speech poverty (Alogia)
- Anhedonia
- Affective incongruity / blunting
- Avolition (lack of motivation)
Risk indicators of Scz Sx
- Command hallucinations
- Hx of deliberate self-harm / Suicidal ideation
- Fixation on specific individuals
DDx for Schizophrenia
- Substance -induced psychotic disorder
- Organic psychosis (physical neuro change)
- Metabolic disorders
- Depression + dementia
- Autoimmune encephalitis
- Schizoaffective Disorder (mood disorder + psychotic Sx)
Schizophrenia Ix
Mainly clinical Dx - then Ix to exclude DDx:
- Brain imaging
- Blood tests to exclude infectious (e.g. syphilis) or metabolic causes (e.g. thyroid)
- DRUG SCREENING
Schezophrenia Mx
- Atypical (2nd gen) antipsychotics: RISPERIDONE
If acute
-> Sedatives (lorazepam / prometazine) OR Haloperidol - to manage dangerous behaviour
- Oral (sometimes IM/depot injection) ATYPICAL ANTIPSYCHOTICS
Maintainance antipsychotics determined on a person by person basis
Consider CLOZAPINE if resistant - INTENSIVE MONITORING due to potentially LETHAL SE
+ Psychotherapy
Schitzoaffective disorder
A disorder which is a combination of scz Sx alongside mood disorder Sx
2 types:
- Bipolar type (Mania + sometimes major depression)
- Depressive type (only major depression)
What is the bidirectional relationship to old age mental health
- Physical illnesses can cause/put at risk of mental health disorders
- Esp SENSORY IMPAIRMENT (direct risk factor)
- Consequences of mental health on physical health
Considerations for Tx in older adults
- ↑body fat; ↓ body muscle; ↓ relative body water
- ↓ renal blood flow and function
Bipolar definition
Chronic + combination of manic/hypomanic and Depressive episodes.
- Manic/hypomanic episodes should be characterised by a PRESISTENTLY ELEVATED, Expansive / Irritable mood
- Major depressive episode should last at least 2 wks
- There should be a marked disturbance of mood during episodes
Suptypes of Bipolar Affective Disorder
- BPAD Type 1: One or more manic episodes lasting longer than a week with or without depressive episodes.
- most common type
- BPAD Type 2: At least one major depressive episode (at least 2 weeks) AND hypomanic episodes (lasting at least 4 days).
- NO mania
- Cyclothymia: episodic depression and hypomania over the course of 2 years or more which doesn’t meet the criteria for BPD 1 or 2 diagnosis (symptoms usually less severe)
Mania vs hypomania
- Mania - severe functional impairment OR psychotic changes lasting AT LEAST 7 DAYS
- Hypomania - Change in functioning WITHOUT psychotic Sx or severe social/occupational impairment for at least 4 DAYS (but usually <7 days)
Mania is more likely to require hospital admission due to risk of harm
Both have EXPANSIVE, ELEVATED mood OR intense IRRITABILITY +/- PHYSICAL Sx (Increased energy / Decreased sleep)
Bipolar epid
- Typically develops in late teens
- Both genders affected equally
Causes/RFx of Bipolar/BPAD episodes
- GENETIC (FHx)
- TRIGGERS:
- stress / childhood trauma, physical illness, DRUG ABUSE, DEPRESSION/Anxiety - MEDICATION-INDUCED: antidepressants taken for a depressive episode can trigger a manic switch
Bipolar Sx
Depression:
- Low mood, ANHEDONIA, worthlessness, Decreased energy, Suicidal ideation
Mania/hypomania:
Mood:
- Elevated mood / Irritability
- expansive mood (unrestrained emotional expression)
Speech and thought:
- Inflated self-esteem
- PRESSURED speech
- Flight of ideas
- Poor attention
Behaviour:
- INSOMNIA (can also trigger an episode)
- IMPULSIVITY (pursuit of more dangerous activities)
- believes capable of more than they are actually able to do
- DISTRACTIBLE
- Psychomotor agitation (Pacing, wringing hands)
- LOSS OF INHIBITION (risk taking, overspending, sexual promiscuity)
Other features:
- Psychosis
DDx for mood disorder Sx
- Major depressive disorder
- Cyclothymic Disorder (chronic mood fluctuations over 2 yrs)
- Schizoaffective Disorder
- Generalised Anxiety Disorder
- Substance-induced Mood DIsorder (use OR withdrawal)
Bipolar Ix
- If first presentation -> RULE OUT DDx:
- Bloods
- CT/MRI
- Urine dip / toxicology
- TFTs
- Vitamin levels