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Year 5 😊✌🏼 > Psych 2 > Flashcards

Psych 2 Flashcards

1
Q

Where can you see impairments in personality disorders?

A
  • aspects of the self
  • problems in interpersonal functioning
  • impariemtns in self-functioning and/or interpersonal functioning

complete this FC from slides

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2
Q

Exclusion criteria for PD

A
  • If organic causes
  • developmentally appropriate
  • can be primarily explained by social or cultural factors incl. socio-political conflict
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3
Q

Levels of PD

A
  • mild
  • moderate
  • severe (global impairment of all social, cognitive and behavioural disturbance; likely to include self-harm or harm to others)
  • Personality difficulty
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4
Q

What is personalty difficulty?

A
  • poeple may have traits
  • not a pervasive, chronic course like in PD
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5
Q

PD clusters

A

A - odd and eccentric

B - dramatic, emotional or erratic

C - fearful, avoidant

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6
Q

Paranoid PD features

A
  • excessive sensitivity to setbacks
  • suspicious
  • can perceive others as hostile or contemptuous (misconstruing neutral or friendly actions)
  • can easily feel rejected
  • tend to hold grudges
  • may have excessive self-importance
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7
Q

Schizoid PD

A
  • cut off
  • perceived emotionally as ‘cold’
  • preference for fantasy, solitary activities and introspection
  • limited capacity to express feelings and experience pleasure
  • some overlap with ASD
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8
Q

Schizotypal PD

A
  • cluster A PD
  • inappropriate or constricted affects
  • socially withdrawn
  • bahevioue or appearance that is off, eccentric or peculiar
  • odd beliefs, magical thinking

etc.

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9
Q

Classification of Schizotypal PD

A
  • in ICD-10 used to be under schizophrenia
  • in ICD-11 it is under Cluster A PD
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10
Q

Antisocial PD

A
  • Cluster A
  • persistent disregard for morals, social norms and the rights of others
  • callous about the feelings of others
  • low tolerance to frustration
  • aggressive tendencies
  • frequently offenders,
  • impulsive
  • lack of remorse, do not forgive
  • behaviour that is not readily changed by adverse events
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11
Q

What is the difference between borderline PD and EUPD?

A
  • EUPD can be classified into:
  1. borderline PD
  2. impulsive PD
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12
Q

Borderline PD

A
  • difficulties managing emotions and behaviour
  • impulsive without consideration of consequences
  • unpredictable mood
  • emotional instability
  • very sensitive to rejection and criticism
  • chronic feelings of emptiness
  • intense and unstable interpersonal relationships
  • really interrupted interpersonal relationships! difficult to have mutually satisfying relationships
  • describe feeling numb/empty/worthless at times
  • difficult internally - imagine your emotions being like that.
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13
Q

Histrionic PD

A
  • shallow and labile affects
  • self-dramatisation, theatricality, exaggerated expression of emotions
  • seeking attention

add more info

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14
Q

Narcissistic PD

A
  • grandiosity with expectations of superior treatment from other people
  • fixation n fantasies pf power, success, intelligence, attractiveness
  • self-perception of being unique, superior, and associated with high-status people and institutions
  • constant need for admiration from others
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15
Q

Avoidant PD

A
  • likely had difficulties with attachment when growing up
  • want to fit in
  • want to be liked
  • sensitive to criticism and rejection
  • feelings of tension and apprehension
  • insecurity and inferiority
  • tendency to avoid certain activities by habitual exaggeration of the potential dangers or risk in everyday situations
  • restricted personal attachments
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16
Q

dependant PD

A
  • pervasive passive reliance on others to make decisions
  • great fear of abandonment
  • constantly seeking reassurance
  • a feeling of helplessness and incompetence
  • passive compliance with the wishes of elders and others
  • weak response to the demands of daily life
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17
Q

obsessive compulsive PD (anakastic PD)

A
  • feelings of doubt
  • perfectionism
  • excessive conscientiousness
  • checking and preoccupation with details
  • stubbornness, caution and rigidity
  • there may be insistent and unwelcome thoughts or impulses that do not attain the severity of an OCD (less intense in the PD; not as strict rituals etc)
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18
Q

Treatment of PD

A
  • psychological therapy
  • psychotropic medication
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19
Q

Psychological therapies for PD (especially cluster B)

A
  • MBT
  • CBT
  • DBT
  • dynamic psychotherapy
  • cognitive analytical therapy
  • therapeutic community
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20
Q

Which medications may be useful in personality disorders?

A

Nothing is licensed for PD!

  • is the medication for the PD or for a co-morbid disorder?
  • some benefit of antidepressants
  • low dose antipsychotics can help with impulse control
  • mood stabilisers
  • sedatives (short term use, can dampen arousal and high level of stress they are feeeling)
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21
Q

psychodynamic psychotherapy

A
  • long term therapy
  • looks at relationship between the patient and the therapist
  • looks at early childhood and relationships and how these relationships are now showing themselves
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22
Q

Therapeutic community therapy

A

lots of people with similar illness come together, speak about it and do activities together

probably mostly used in addiction etc

can be useful to speak to ex-patients etc.

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23
Q

What is the HCR-20?

A

used to assess violence

used in forensic psychiatry

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24
Q

What tool do you use to assess psychopathic traits?

A

PCL-R

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25
Q

How do you assess if someone is fit to plead?

A

Pritchard’s criteria for fitness to plead

(1. understanding the charge/charges)
2. deciding whether to plead guilty / not
3. exercising the right to challenge juniors
4. instructing solicitors to counsel
5.

)

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26
Q

“Not guilty by reason of insanity”

A
  • rare

M’naughten rules 1843
1. a defect to reason
2. due to a disease of mind
3 leading to loss of appreciation of nature and quality of an act
4. so the accused did not realise what he was doing was not

usually results with a hospital order

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27
Q

What medication is good at treating negative sx of schizophrenia?

A

clozapine

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28
Q

Splitting

A
  • a primitive way of dealing with ambiguity
  • objects and/or the self are either wholly good or wholly bad
    ‘black and white’
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29
Q

Projection

A
  • intolerable feelings/aspects of self are externalised to reduce anxiety (e.g. I’m not angry, you’re angry)
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30
Q

Severities of ID

A
  • mild
  • moderate
  • severe
    -profound
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31
Q

How is ID diagnosed?

A
  • formal diagnosis
  • clinical assessment
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32
Q

prevalence of mild ID

A

2-3/100

no specific cause

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33
Q

prevalence of severe ID

A

3/1000

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34
Q

causes of severe ID

A

usually specific cause e.g. brain damage

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35
Q

What are people with Down syndrome at higher risk of?

A

Poeple with Down syndrome are at higher risk of developing dementia (sometimes in their 30s)

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36
Q

What physical condition are people with ID at higher risk of?

A

Epilepsy

(higher rate of brain damage is linked to higher rate of seizures?)

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37
Q

What psychiatric conditions are more prevanent in people with ID?

A

Schizophrenia prevalence 3% (compared to 1% gen pop)

Mood disorders and anxiety (4x more likely)

autism (75% have learning disability)

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38
Q

Core domains in ASD

A
  • reciprocal social interaction
  • restricted and repetitive behaviours or interests
  • verbal and nonverbal communication
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39
Q

Prevalence of ASD

A

1%

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40
Q

Heritability of ASD

A

HIGH

80-90%

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41
Q

Diagnosis of ASD

A
  • usually involves MDT
  • autism diagnostic inventory - revised (ADI-R)
  • autism diagnostic observatory schedule (ADOS)
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41
Q

Diagnosis of ASD

A
  • usually involves MDT
  • autism diagnostic inventory - revised (ADI-R)
  • autism diagnostic observatory schedule (ADOS)
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42
Q

Are pharmacological approaches used in ASD?

A

only used for comorbid conditions such as anxiety

dopamine antagonists often help stereotypical behaviour (motor)

irritability can be treated with low dose risperidone or aripiprazole

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43
Q

IQ in mild ID

A

50-69 (mental age from 9-12yo)

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44
Q

moderate ID IQ and mental age

A

35-49

mental age from 6-9

need support to live and work

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45
Q

severe ID IQ and mental age

A

20-34

mental age 3-6 yo

likely to result in continuous need of support

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46
Q

Profound ID IQ and mental age

A

below 20

under 3yo

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47
Q

Patient with LD presenting for psych review - what do you have to assess?

A
  • current situation
  • pre-morbid situation
  • Risk assessment
  • detailed developmental hx
  • physical health (rule out physical illness)
  • triggers
  • what is going into a hospital environment going to do with QoL
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48
Q

Alzheimer’s disease

A
  • insidious onset
  • slowly getting worse over time
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49
Q

Vacsular demenita

A
  • rapid onset
  • fluctuant (can have good or bad days)

AF is a RF

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50
Q

Dementia with Lewy Bodies

A
  • Lewy Bodies – alpha synuclein and ubiquitin positive inclusions
  • In Parkinson’s Lewy Bodies are confined to the substantia nigra, in DLB they are more widespread and also involve cortical regions
  • Often thought of hybrid of PD and AD
  • Visual hallucinations
  • REM behavioural sleep disorder
  • Autonomic dysfunction (postural hypotension) - Neuroleptic sensitivity
    MRI – similar to AD
    SPECT – may show disproportionately severe occipital hypoperfusion
    DatSCAN – to differentiate AD from PD (shows reduction in dopamine transportation in PD)
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50
Q

What are Lewy bodies?

A

alpha synuclein and ubiquitin positive inclusions

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51
Q

DDx for dementa

A

Delirium
Depression

more?

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52
Q

DDx for dementa

A

Depression
Delirium

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53
Q

What is BPSD?

A

behavioural and psychological symptoms in dementia

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54
Q

What medications can be used in Alzheimer’s dementia?

A

Donepezil, Galantamine and Rivastigmine (reversible AChE inhibitors, cause ~50% reduction)

Memantine
(Non-competitive Glutamate receptor and antagonist; recommended for moderate AD unresponsive to AChEi or with CI to AChEi or severe AD).

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55
Q

signs and symptoms of delirium tremens

A
  • coarse tremor
  • sweating
  • insomnia
  • tachycardia
  • visual and auditory (lilliputian) hallucinations
  • N&V
  • psychomotor agitation
  • marked alteration in severity hour by hour, usually worse at night
56
Q

Why would you chose mirtazapine first line in some people with depression:

A

it helps with biological symptoms

helps with sleep and with appetite and weight gain

57
Q

SSRIs and bleeding

A

serotonin inhibits platelet aggregation, increases the risk of bleedng

58
Q

What are the 6 ICD-10 diagnostic criteria for dependence syndrome?

A
  1. string desire or sense of compulsion to take the substance
  2. difficulties in controlling substance taking behaviour: onset, termination, levels of use
  3. Physiological withdrawal state when substance use has been ceased or reduced
  4. evidence of tolerance, such as increased doses of the psychoactive substance are required in order to achieve effects originally produced by low doses
  5. progressive neglect of alternative pleasures or interests because of psychoactive substance use increased amount of time necessary to obtain or take the substance or to recover from its effects
  6. persisting with substance use despite clear evidence of overly harmful consequences, such as harm to the liver through excessive drinking, depressive m mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning

you need 3 or 4 of these 6 to diagnose the dependence

59
Q

Screeing tests for alcohol use

A
  • FAST
  • AUDIT
  • CAGE
  • MAST
  • SADQ
60
Q

Questions to ask in alcohol history

A
61
Q

How do you calculate units of alcohol?

A

ABV x Volume (in liters)

or ABV x Volume (in ml) / 1000

62
Q

What medication can you give to people if they want to stay abstinent from alcohol?

A

disulfiram
naltrexone
acamprosate

(nalfamene)

63
Q

What medication do you give in alcohol withdrawal?

A

chlordiazepoxide

64
Q

What is pabrinex?

A
  • used for Wernicke’s prophylaxis
  • Vitamin B and C
65
Q

Do you give IV dextrose to a heavy drinker?

A

not before giving pabrinex

(glucose loading can precipitate wernicke’s in thiamine deficient patients)

66
Q

How do you decide if you treat alcohol dependence/withdrawal in IP/OP setting?

A
  • ?
  • poly drugs users
  • severity of dependence
  • social support
  • previous experiences with detox
67
Q

What questionnaire can you use to determine the management of alcohol withdrawal?

A

CIWA-Ar

68
Q

Risk factors

A
  • co-existing infection
  • previous DT
  • precious hx of alcohol withdrawal seizures
  • pancreatitis/hepatitis
  • recent higher than normal alcohol intake
  • older age
  • abnormal liver function
  • more severe withdrawal symptoms on presentation
69
Q

What causes Wernicke’s and Korsakoff? which one is reversible?

A

arise from thiamine (B1) deficiency

Wernicke’s is reversible, but without thiamine supplementation in will develop into Korsakoff psychosis

69
Q

What causes Wernicke’s and Korsakoff? which one is reversible?

A

arise from thiamine (B1) deficiency

Wernicke’s is reversible, but without thiamine supplementation in will develop into Korsakoff psychosis

70
Q

Wernicke’s encephalopathy triad

A

confusion (80%)
ophthalmoplegia - nystagmus or 6th cranial nerve palsy usually (30%)
ataxia (25%)

May not have all three!

71
Q

What is methadone?

A

an opioid

72
Q

How do you manage opioid overdose?

A

ABC approach (incl. airway management and IV fluids)
naloxone

73
Q

Name opioids

A

illicit (heroin)
methadone/buprenorphine
codeine
oxycodone
tramadol
morphine
fentanyl

74
Q

clinical features of opioid OD

A
  • reduced GCS
  • resp Depression
  • hypotension (accompanied by tachycardia)
  • pin poin pupils (miosis)
  • hypotonic/hyporeflexic coma
75
Q

What medications do you use for OST (opiate substitution therapy)?

A

methadone (long acting, half life 24h; less euphoria than heroid;)

Buprenorphine (partial agonist, long half life, OD)

Suboxone (combination of buprenorphone, naloxone - NO LONGER USED)

76
Q

SE of methadone as OST

A
  • lethargy
  • resp depression at high disease
  • constipation
  • reduced saline (contributes to poor dental hygiene)
77
Q

Buprenorphine as OST

A
  • partial agonist, long half life
  • attenuates the effects of opiates (timing in initiation is important to avoid precipitated withdrawals)
78
Q

How can death occur in opioid withdrawal?

A

dehydration due to diarrhoea and vomiting

79
Q

is opiate withdrawal lethal?

A

not lethal

80
Q

Negative symptoms of schizophrenia

A

impaired motivation
lack of drive and initiative
social withdrawal and loss of interest in other people
emotional bluntness and reduced reactivity
poverty of speech
self neglect

81
Q

Are patients with PDs more likely to experience psychotic mental illness?

A

yes

82
Q

Physical causes of psychosis

A

any cause of delirium
head injury or other intracranial pathology
degenerating dementias
epilepsy
acute intermittent porphyria
hyperthyroidism

83
Q

What is the MoA of typical and atypical antipsychotics?

A

typical: inhibit D2 receptors

atypical: inhibit D2 and 5HT receptors

84
Q

What SE are atypical antipsychotics likely to cause?

A
  • HTN
  • central obesity
  • raised fasting glucose
  • weight gain
  • dyslipidaemia
85
Q

How do you manage the metabolic SE caused by SGAs?

A
  • decerase or change drug
  • diet, exercise
  • anti-HTN drugs, statins, hypoglycaemic,
  • add metformin to aripiprazole to help weight loss
86
Q

What measurements should you do before starting an antipsychotic?

A

weight (plotted on a chart)

waist circumference

pulse and blood pressure

fasting blood glucose or glycosylated haemoglobin (HbA1c)

blood lipid profile and prolactin levels

assessment of any movement disorders

assessment of nutritional status, diet and level of physical activity.

+/- ECG

[NICE https://www.nice.org.uk/guidance/cg178/chapter/recommendations#choice-of-antipsychotic-medication 1.3.6.1]

87
Q

‘rapid neuroleptisation’

A
88
Q

Which of the ESPEs is an indication to stop the antipsychotic right away and why?

A

tardive dyskinesia (rhythmic, involuntary movements)

because it can be irreversible

89
Q

What should you warm patients about when prescribing chlorpromazine?

A

If prescribing chlorpromazine, warn of its potential to cause skin photosensitivity. Advise using sunscreen if necessary.

90
Q

Examples of depot antipsychotics

A

first generation
- flupentixol decanoate
- fluphenazine decanoate
- haloperidol decanoate
- zuclopenthixol decanoate

91
Q

When is it recommended to give depot antipsychotics?

A

if…
- you find it difficult to swallow medication
- you find it difficult remembering to take medication regularly
- you prefer not to have to think about taking medication every day.

92
Q

Examples of typical antipsychotics

A

haloperidol
chlorpromazine
sulpiride
zuclopenthixol
trifluopenalzine

93
Q

Examples of atypical antipsychotics

A

olanzapine
aripiprazole
risperidone
quetiapine
amisulpride
lurasidone
clozapine

94
Q

How common is agranulocytosis in clozapine use?

A

0.7% patients experience it

95
Q

Summarise all side effects associated with antispsychotics and which antipsychotics are likely to cause them

A
  • ESPEs (akathisia, dystonia, Parkinsonism, tardive dyskinesia) - FGAs; risperidone for dystonia, aripiprazole for akathisia;
  • hyper-PRL - FGAs; amisulrpride; risperidone;
  • metabolic SE (weight gain, central obesity, increased fasting glucose, dyslipidaemia) - SGAs [clozapine > olanzapine > risperidone > quetiapine - CORQ)
  • sedation - chlorpromazine, clozapine, olanzapine, quetiapine
  • anticholinergic effects -trifluoperazine, clozapine (clozapine can cause hypersalivation rather than dry mouth which can be associated with an increased risk of aspiration pneumonia)
  • increased QTc on ECG - haloperidol, quetiapine
  • decreased seizure threshold - clozapine
  • neuroleptic malignant syndrome - FGAs
96
Q

Which SGAs are more likely to cause metabolic SEs than others?

A

CORQ

clozapine > olanzapine > risperidone > quetiapine

97
Q

Symptoms of neuroleptic malignant syndrome?

A

confusion
drowsiness
diaphoresis
rigidity
pyrexia
tachycardia
tachypnoea
high BP

98
Q

What could you see on blood findings in a patient with neuroleptic malignant syndrome?

A
  • high CK
  • raised WCC
99
Q

Management of neuroleptic malignant syndrome

A

STOP antipsychotic
supportive care (may need ICU, cooling, fluid resuscitation)
dantrolene, amantadine,bromocriptine

careful: can develop rhabdomyolysis which can cause AKI

once well try a different SGA if antipsychotic still needed

100
Q

What can cause neuroleptic malignant syndrome?

A

new antipsychotic / increased dose

mainly FGA

101
Q

Which brain haematoma presents with a lucid interval?

A

extradural haematoma

102
Q

Features of TCA overdose

A
  • confusion
  • seizure
  • tachycardia
  • hypotension
  • mydriasis (dilated pupils)
  • metabolic acidosis
  • QRS prolonged
  • QTc prolongation
103
Q

Name of the delusions when someone thinks that someone of higher status (e.g. celebrity/politician) is in love with them?

A

erotomanic

104
Q

What is echopraxia?

A

In echopraxia, the patient involuntarily imitates another person’s movements. This is a rare feature of schizophrenia.

105
Q

In schizophrenia, if the patient is involuntarily mimicking another person’s movements, what is this called?

A

Echopraxia

106
Q

Logoclonia

A

Logoclonia describes a phenomenon in Parkinson’s Disease where the patient gets ‘stuck’ on a particular word of a sentence and repeats it.

107
Q

What is la belle indifference?

A

La belle indifference is a syndrome where patients do not show any concern over the symptoms they are experiencing. An example is not worrying whether they cannot move a limb. This is associated with conversion disorder.

108
Q

Common side effects of SSRIs

A
  • headache
  • GI disturbance (nausea, diarrhoea/constipation)
  • sleep disturbance/vivid dreams
  • sexual dysfunction

Risk of suicidality in the first 2 weeks

109
Q

Which SSRI is used in children?

A

fluoxetine

110
Q

What are contraindications to SSRIs?

A
  • GI bleeding
  • hyponatraemia
111
Q

Duration of treatment with SSRIs?

A

once well, same dose for 6-12 months

if there is a high risk of relapse continue for 2 years

review initially 2-weekly, then regularly

111
Q

What are the symptoms of SSRI overdose?

A
112
Q

What are the side effects of TCAs?

A

anti-cholinergic/muscarinic SE:
- dry mouth
- blurred vision
- constipation
- urinary retention

Cardiotoxic:
- QT prolongation
- AV block
- ST elevation

Anti-histaminergic
- sedation
- postural hypotension
- weight gain

113
Q

What are the dangers/disadvantages of SSRIs

A
  • discontinuation syndrome
  • can be lethal in overdose
  • act on more receptors than e.g. SSRIs -> more SE (including higher cardiotoxicity)
114
Q

Venaflaxine / Duloxetine drug class

A

SNRI

(patients require monitoring of BP)

115
Q

Which class of antidepressants requires patients to each a diet low in tyramine?

A

MOAIs

116
Q

What is the cheese reaction?

A

a hypertensive crisis as a results of ingestion of tyramine rich foods and MAOIs

Patients taking MAOIs should have a diet low in tyramine

Cheese is tyramine rich

If people on MAOIs eat a lot of tyramine containing foods,

117
Q

Mirtazapine drug class

A

NsSSA

118
Q

Symptoms of discontinuation syndrome with antidepressants

A
  • headache
  • dizziness
  • GI-symptoms
  • anxiety
  • double sleeping
  • flu-like symptoms
  • electric shocks
119
Q

Risk factors for serotonin syndrome

A
  • antidepressant use (esp higher dose),
  • combination antidepressants
  • overdose of antidepressants
    -lithium
  • ECT
  • opiates, antiemetics (metoclopramide, odansetron), illicit drugs
120
Q

Complications of serotonin syndrome

A

o DIC,
o Rhabdomyolysis,
o renal failure/Metabolic
acidosis
o seizures

121
Q

Management of serotonin syndrome

A

➢ Management of severe cases in the general hospital
➢ Stop the offending medications
➢ Supportive measures (ABCDE)- airway management, renal care, IV fluids, temp control
➢ ?Cyproheptadine (antihistamine and also serotonin antagonist)

122
Q

What drugs belong to mood stabilisers

A
  • lithium
  • anti-epileptics
  • atypical antipsychotics
123
Q

Adverse effects of lithium

A

Common
- fine tremor
- mild GI upset
- metallic taste
- sedation

Persistent
- renal disease (polyuria, polydipsia CKD)
- hypothyroidism
- lethargy
- weight gain
- persistent tremor
- T-wave flattening on ECG
- mild cognitive impairment
- change in hair texture
- leukocytosis

123
Q

Adverse effects of lithium

A

Common
- fine tremor
- mild GI upset
- metallic taste
- sedation

Persistent
- renal disease (polyuria, polydipsia CKD)
- hypothyroidism
- lethargy
- weight gain
- persistent tremor
- T-wave flattening on ECG
- mild cognitive impairment
- change in hair texture
- leukocytosis

124
Q

symptoms of lithium toxicity

A
  • coarse tremor
  • marked GI upset
  • ataxia
  • dysarthria
  • impaired conciousness
  • epileptic seizures
  • nystagmus
  • renal failure

Lithium toxicity if potentially fatal

125
Q

SE of sodium valproate

A

GI upset (nausea, vomiting, dyspepsia, diarrhoea), tremor, sedation, weight gain, curly/loss hair, ankle swelling FBC abnormalities (leucopenia, thrombocytopenia), abnormal LFTS

126
Q

which anticonvulsants can be used as mood stabilisers?

A

carbamazepine (used for prophylaxis but not really mentioned in NICE guidelines)

lamotrigine (for prophylaxis and in bipolar depression)

127
Q

SE of carbamazepine

A

Nausea and vomiting, blurred vision, ataxia/, fatigue, hepatic failure, antidiuretic effect
(hyponatraemia), FBC abnormalities (leucopenia, thrombocytopenia), skin rashes, abnormal LFTS

128
Q

SE of lamotrigine

A

Nausea and vomiting, rash, headache, sedation, insomnia, aggression

can rarely cause Steven Johnson syndrome

129
Q

Which antipsychotics can you give in mania?

A

HORQ

haloperidol
olanzapine
risperidone
quetiapine

130
Q

negative symptoms of schizophrenaia

A

5 As

blunted Affect (little or no emotion)
Alogia (speech lacks content)
Anhedonia (lack of pleasure)
Asociality (lack of desire for social interaction and relationships)
Avolition (lack of motivation)

131
Q

Cognitive sx of schizophrenai

A
  • low attention
  • poor decision making
  • lack of problem solving abilities

good predictor of day to day functioning
often first symptoms to appear

132
Q

Cognitive sx of schizophrenai

A
  • low attention
  • poor decision making
  • lack of problem solving abilities

good predictor of day to day functioning
often first symptoms to appear

133
Q

What is the prodromal phase in schizophrenia?

A
  • gradual cognitive and negative symptoms then followed by the first episode of psychosis

this is followed by a residual phase where they come back to baseline (then they can have another decline)

134
Q

DSM V criteria for schizophrenia

A

at least 2 of the 5 (1 must be 1-3)

  1. delusions
  2. hallucinations
  3. disorganised speech
  4. disorganised/catatonic behaviour
  5. negative symptoms

must have been present for most of the time for at least 1 month
significant impairment for 6 months

not as a result of substance abuse or medical conditions

135
Q

What are the most consistent MRI findings can be seen in patients with Schizophrenia

A
  • Lateral cerebral ventricles enlargement (up to 30% larger than normal)
  • decreased cortical volume

The specific reason for ventricular enlargement is not known, but it seems to stem from diffusely decreased cortical volume and shrinkage of the thalamus and putamen.

136
Q

When can ventricle enlargement on MRI be seen?

A
  • schizophrenia (esp if younger Age, here the ventricles tend to enlarge at a more rapid rate)
  • Alzheimer’s disease
  • normal pressure hydrocephalus
  • ageing
137
Q

Can you give sleeping pills in SAD?

A

No

makes Sx worse

Year 5 😊✌🏼 (53 decks)

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