Psych Flashcards
Risk factors/ aetiology for Anorexia nervosa
Bio: Genetics Female (mid-adolescence Early menarche Starvation (endocrine) perpetuates Psycho: Sexual abuse Dieting in adolescence Low self esteem Premorbid anxiety or depression Perfectionism/ anankastic personality Criticism regarding eating/body shape/weight Social: Western society Stress Bullting at school involving weight Occupatione.g. ballet, models
Clinically defining features of Anorexia nervosa as defined by ICD10 and other features
Fear of weight gain
Amenorrhoea and loss of sexual interest and impotence in male.
BMI 15% below expected weight
Deliberate weight loss (food or exercise)
Distorted body image
All features present for 3 months and must be absence of binge eating and a preoccupation with eating/ craving to eat. (if not consider bulimia or EDNOS.
Other
Physical: Fatigue, hypothermia, bradycardia, arrhythmias, peripheral oedema, headache, lanugo hair.
Preoccupation with food: Dieting, making meals for ohers
Socially isolated, sexuality feared
Symptoms of depression and obsession
Thought in MSE of Anorexia nervosa
Preoccupation with food and overvalued ideas concerning dieting, appearance and weight loss (preoccupation differs from obsession in that with severe difficulty the thought can be put out of the mind).
Complications of Anorexia nervosa
Osteoporosis (DEXa), Proximal myopathy (upper and lower limbs)
Arrhythmias e.g. brady, Prolonged QT, changed caused by hypokalemia.
Hypoglycaemia, Hypercholesterolaemia, Hypothyroidism (TFTs)
Hepatitis/ LFTs Pancreatitis (amylase) Renal failure/ stones Enlarged salivary glands Constipation Peptic ulcers
Anaemia (iron), thrombocytopenia, leucopenia
Dry slin, brittle nairs, infections, suicide
Management of anorexia
Risk assessment for suicide and medical comps.
CBT, psychotherapy, DBT, mindfulness, groups, meal plannning, psychoeducation, interpersonal psychotherapy, family therapy
Treat medical complications. SSRIS for dep or OCD.
Volunatary organisations or Self-help groups.
Graded exposure to food.
Gain 0.5-1kg per week as inpatient and .5kg as outpatient
Risks of gaining weight in anorexia
Refeeding syndrome:
After prolonged starvation or malnourishment due to changes in phosphate, magnesium and potassium.
Insulin surge
Hypokalaemia, hypomag,, hypophos, abnormal glucose metab.
Phosphate depletion causes cardiac failure
How to prevent refeeding syndrome
Dailey bloods, start at 1200cals and gradually increase every 5 days, monitor for tacchycardia and oedema.
If low then oral or IV electrolyte replacement
When to hospitalise Anorexia nervosa
BMI
Define Bulimia nervosa
Repeated episodes of binge eating followed by compensatory weight loss behaviours with overvalued ideas regarding ideal body shape/ weight
How does BN aetiology and epidemiology differ from AN?
Less clear role of genetics
Vicous cycle of compensatory weight loss behaviours, sense of compulsion to eat, binge eating, fear of fatness.
AN in higher social class, BN in all.
Common psychiatric diseases with BN
Depression Anxiety DSH Substance misuse Emotionally unstable personality disorder
Clinical features of BN
ICD 10:
Compensatory behaviours - vomiting, starvation, drugs, omit insulin, exercise
Preoccupation with eating - compulsion followed by regret and shame.
Fear of fatness
Overeating - x2 per week for 3 months.
Other:
Normal weight
Depression/ low self esteem
irregular periods
dehydration - low bp, increased cap refil, low turgor, sunken eyes.
Hypokalaemia -
Subtypes of BN (not ICD10)
Purging and non purging (drugs/ vomiting vs diet and exercise)
Signs of BN
Russell’s sign - calluses on back of hands from repeated self-induced vomiting
Parotid swelling
Sunken eyes
Dental erosion
ECG - Increased PR, depressed/ inverted T, U wave
Complications of repeated vomiting
Arrythmias, mitral valve prolapse, peripheral oedema
Mallory-Weiss tears of the oesophagus, increased parotid
Dehydration, renal stones, renal failure
Erosion of teeth
Russells sign
Aspiration pneumonitis
Cognitive impairment, peripheral neuropathy, seizures.
Management of BN
Bio: Fluoxitine can reduce binge
Psycho: CBT, Psychoeducation, interpersonal therapy
Social: Food diary, techniques to avoid binging (eat with others, distractions), small regular meals, self-help programs
Monitor electrolytes.
If suicide risk or electrolyte imbalance then admit to hospital
Out of interest, improvement in eating disorders?
50% full recovery in BN
20% in AN.
Describe the cluster C personality disorders
Dependent: Seeks companionship Low self confidence Difficulty expressing disagreement Reassurance requred Needs other to assume responsibility
Anxious/avoidant: Approval needed before getting involved Social inhibition Embarrasment potential inhibits involvement in activites Restriction in life to maintain security Inadequacy felt
Anankastic: Perfectionism Loses purpose of tasks and focuses on detail Workaholic at expense of lesure Subborn Inflexible Fussy Rigid
Define Personality disorder
Deeply ingrained enduring pattern of behaviour that deviates markedly from a persons culture, is pervasive and inflexible, present from adolescenece/ early adulthood (as brain still develops until 17). Leads to distress or impairment
A pervasive inflexible pattern of behaviour and inner experience that deviates from an individuals’ cultural norms. Present from adolescence/ early adulthood. Stable over time and leads to distress or impairment
Clinical features of panic disorder
Severe, unpredictable, episodic panic attacks not associated with a specific situation or object.
Must last more than a couple of minutes (most peak at 10 and last less than one hour).
Starts abruptly.
Intense fear (fear of death often)
1 autonomic manifestation: palpitations, sweating, shaking/ tremor, dry mouth,
Other anxiety symptoms of GAD
Clinical features of GAD (ICD10)
Persistent feeling of worry, agitation for greater than 6 months. Presence of four symptoms including one autonomic. Autonomic: Palpitations, sweating, tremor, CVS/ GI: Butterflies/ abdominal discomfort Palpitations Lump in throat Loose stools Mind and brain: Lightheaded/ Dizzy Fear of dying/ losing control Derealisation and depersonalisation General symptoms: Hot flushing or cold chills numbness or tingling Headache Symptoms of tension: Muscle tensions Restlessness Feeling n edge Difficulty swallowing Sensation of lump in throat Non specific: Startled Poor concentration Sleep problems Irritability Mind blacks
Risk factors for panic disorders
Bio: Asthma, Benzo withdrawal, age 20-30, , female, white, cigarette smoking,
Psycho:adverse life event
Social: Fx
What is catatonia
State of ultered posure, immobility and stupor.
Seen in severe schizophreni.
It may involve repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism.
What is stupor
Inability to respond to internal (e.g. hunger) and external stimuli
What is catalepsy
State of the body which is in a trace with loss of sensation and consciousness and is rigid.
Pathophysiology of Schizo and drugs that could mimic this
Overactivity of D2 mesolimbic pathway - amphetamines, parkinsonism medications.
Describe dopamine pathways in the brain
Mesolimbic/ mesocortical: Addiction Reward Memory Motivation Emotional response (Mesolimbic positive in Schiz and mesocortical = neg)
Nigrostriatal: Motor control (Parkinson's)
Tuberoinfundibular:
Regular of hormones (particularly prolactin), pregnancy, maternal stuff
Term for low motivation
Avolition
Term for a quanitative and qualitative decrease in speech
Alogia or poverty in speech
Describe the negative symptoms of schizophrenia
Avolition Asocial behaviour Anhedonia Affect blunted Alogia Attention deficit
Describe the indications for ECT
Depression that is treatment resistant
Depression with high risk e.g. suicidal ideation or serious risk to others.
Life threathening depression when patient refuses to eat or drink
Catatonia
Prolonged, treatment resistant, manic period
Can only be used under the MHA if an emergency to save life or
How long should a seizure last in ECT?
30 seconds
Contraindications to ECT?
MI
Severe resp or CVS disease (anaesthetic)
Heart failure/ arrhythmia (hypertension)
History of status
Describe the sympathetic and parasympathetic activity after ECT
Transient parasympathetic followed by sympathetic resulting in raised BP hence contraindications
How many drugs are given during ECT?
2
A general anaesthetic (etomidate or propofol
A Muscle relaxant (suxamethonium)
How is ECT monitored
EEG. Pulse and BP both increase
Describe drugs that affect seizure threshold
Minimum electrical stimulus required to induce a seizure,
Increase threshold: Antiepileptics (mood stab), Benzos, anaesthetics
Decrease threshold: Antipsychotics, antidepresants, lithium
Side effects of ECT
Short term: N/V, Constipation, laryngospasm, sore throat Damaged teeth Muscular aches, headaches Mania in a depressed patient Cardiac arrythmias Confusion Peripheral erve palsies Short term memory impairment Status epilepticus
Long term:
Antereograde and reterograde memory loss
How can agrophobia and social phobias be differentiated
Agrophobia = fear of a public place whereby immediate escape would be difficult in the event of a panic attack. Fear of crowds, large spaces, leaving the house alone.
Social phobia is fear of social situations which may lead to embarrassing oneself, criticism or humiliation. Fear of being the focus of attention.
Describe the treatment of GAD
Bio: SSRI, SNRI, Pregabalin Psycho: Psychoeducation (low intensity) CBT and applied relaxation Social: Self help - writing things down and analysing, support groups, exercise
Treatment for phobias
CBT - graduated exposure (also homework)
Pharmacological interventions - SSRIs (not for specific).
Social phobia can benefit from psychodynamic therapy
Benzos for specific in emergency
3 differences between GAD and phobias and panic disorder
Response to stimulivs random ep vs most the time
2 Avoidance in phobias vs worry and agitation vs fear of death
3 Cognition - Constant worry about everyday life events vs fear about a particular situation
Organic DDX for panic disorder
Pheocromocytoma Hyperthyroidism Carcinoid syndrome (neuroendocrine tumours) Arrythmias Hypoglycaemia Alcohol/ substance withdrawral
Differences between PTSD and Adjustment
Catastophic vs non catastrophic event.
Symptom onset within 6 months vs within 1 month.
Symptoms less severe.
Adjustment disorder symptoms end within 6 months.
Treatment for PTSD
Within 3 months:
- Watch and wait
- Zopiclone for sleep
- Risk assess
> 3 months:
- CBT
- EMDR - Eye movement desensitisation and reprocessing
- Drugs - Paroxetine, Mirtazapine, amitryptilline and phenelzine. Only consider if therapy is not working.
What is an acute stress reaction
Exposure to an acute stressor. Symptom onset within 1 hour.?? Symptoms: - Any of GAD - Agitation/ aggression - Narrowing of attention - Disorientation - Despair or hopelessness - Uncontrollable or excessive grief. Transient stressors then symptoms must begin to diminish within 1 month
Dissociative symptoms unlike PTSD - e.g. detatchment/ derealisation
Avoidance of triggers e.g. people/ conversations
Flashbacks
Reaction <48hrs, Disorder >48hrs (DSM IV) <1 month
More stressful event that adjustment
Describe obsessions and compulsions
Obsessions = Unwanted intrusive thoughts, images or urges that repeatedly enter the mind. Cause distress. Inidiviual tries to resist them and knows them as absurd (egodystonic) and a product of their own mind.
Compulsion: Repetitive, sterotyped behaviours or mental acts that a person feels driven into performing. Overt or Covert. Gives some relief to anxiety. Exacerbates obsession (operant conditioning)
Epidemiology of OCD
M=F
Early adulthood
Fx
Abuse in childhood
Clinical features of OCD
Obsessions, compulsions or both most days for 2 weeks.
Cause distress or interfere with the patient’s social or indiviual functioning e.g. waste time.
Features of O/C:
Failure to resist (at least 1)
Originate from patient’s mind
Repetitive and distressing
Carryout reduces anxiety
Investigations into OCD
Questionnaires
DDX of OCD
O & C: Anorexia, Bulimia, body dysmorphia Anankastic PD O: Anxiety disorder, depressive disorder, hypochondriacal disorder, schizophrenia C: Tourette's Kleptomania (stealing things) Organic: Dementia Epilepsy Head injury
Treatment of OCD
CBT in the form of ERP (exposure and response prevention)
SSRIs (can add cloripramine or an antipsychotic)
Psychoeducation, self help material, distracting techniques
Describe Wernike’s and Kosakoffs psychosis
Caused by a thiamine deficiency (B1) Wernike's encephalopathy: Ataxia Ophthalamoplegia Nystagmus Delerium Hypothermia Korsakoff psychosis: Short term memory loss Confabulation (making up things to explain current events) DIsorientation to time
Define delerium
An acute, organically caused impairment of the CNS causing decreased cognition and attention
Presentation of conduct disorder
Sleep problems. Feeding problems - faddiness (fussy) Behaviour problems: Uncooperative Temper tantrums Aggressive, defiant, wilful.
Conduct disorder is different to oppositional defiance disorder as it is more severe and more common in children beyond 10 years old.
Socialised and unsocialised types. (socialised tends to be phasic- only wiht friends). Unsocialised tends to lead to antisocial PD
Commonly have comorbid mental health problems
core conduct disorders symptoms including:
patterns of negativistic, hostile, or defiant behaviour in children aged under
11 years
aggression to people and animals, destruction of property, deceitfulness or theft
and serious violations of rules in children aged over 11 years.
Associated with poor education performance, social isolation, substance misuse.
Management of conduct disorders
Parenting programmes
Systemic therapy
Agency imput
Psychoeducation and support
Prevalence of conduct disorders
Most common child psychiatric issue
Describe common emotional disorders in child psych
GAD Separation anxiety disorder Phobic dis OCD PTSD Depressive disorders
Presentation of GAD in children
Anxiety
Fears of death of themselves or others
Somatic manidestations - Nausea, abdopain, sickness, headaches, sweating, palpitations, tension
Panic attacks - sudden, extreme fear, physical symptoms, faintness
Presentation of separation anxiety
Fear of or anxity with separation from attachment figure
Somatic manifestation
Nightmares
School refusal.
Management of anxiety disorders in children
Behaviour - systemic desensitisation, flooding, response prevention
Psychotherapy - brief dynamic, family and cognitive therapy
Anxiolytics (last respore include beta blockers and diaepam)
Management for Depression in children
CBT, Fluoxitine
Medacation for psychosis and severe resistant behavioural disturbance with LD
Risperidone
can use lithium in Bipolar but very rare
Define somatoform disorder
An illness with a group of symptoms that closely resembles physical illness however there is no underlying physiological explaination.
Define a dissociative disorder and list types
A group of symptoms which cannot be explained by a medical disorder associated with stressful events. Include Dissociative... ..amnesia (of stressful events) ..Fugue (journey, good self care) ... motor disorder ... stupor ... convulsions ... Anaesthesia and sensory loss Trance and possession disorder
List some somatoform disorders
Somatotization disorder (Briquet's syndrome)- multiple, recurrent and frequently changing physical symptoms not explained by illness. GI, CVS, GU, skin, muscles, headache. Somatoform autonomic disorder. Autonomic symtoms only - patients attribute to illness e.g. palp, tremor, hypervent, flush, dry mouth, IBS. Hypochondriacial (body dysmorphic disorder) - misinterprets normal body sensations - non delusional preoccupation that they have a serious physical disease e.g. cancer. BDD = with small defects in physical appearence. Persistant somatoform pain disorder
List epidemiology of somatoform and dissociative
Female
Abuse
Psych history e.g. PTSD
General findings in somatoform disorders
Use of analgesics
Long history of contact with services
Causes physcial distress due to preoccupation with symptoms.
Refusal by patients to accept reassurance.
Describe the management of medically unexplained symptoms
Bio: SSRIs for mood disorder Exercise Psycho: CBT Coping skills Social: Family (if reinforcing sick role) Stress relief - walks, meditation e.c.t.
Briefly explain psychosexual disorder presentation
sexual dysfunction, paraphilias and gender identity disorders
Dysfunction is a sexual problem characterized by decreased desire, arousal or orgasm and lack of enjoyment or satisfaction derived from sex
unusual or abnormal sexual behavior that does not follow the normal standards. e.g. fetishism, paedophillia, zoophillia, necrophillia
Gender identity disorders exhibit variation between one’s sense of sexual identity and the biological one
May be linked with guilty conscience, stress, anxiety, nervousness, worry, fear, depression, physical or emotional trauma, abuse, rape, religious values, relationship with partner.
Treatment of psychosexual disorderder
Sex therapy, behaviour therapy, systemic therapy, psychodynamic therpay (both partners).
Androgen blockers (for paraphilias) and SSRIs
Groups e.g. sex addicts annonomous
Hormones and sex change surgery
What is a learning disability vs learning difficulty?
Learning disability = IQ
What causes a learning disability?
Insult to the brain
Describe Fagile X syndrome
Distinctive face Learning disability 20-30 autism Hyperactvity - behavioural Risk of other diseases
Link between Downs and psychiatry
20-30% autism
25-30years dementia (at 60 35% have dementia)
LD
Classifications of LDs
Mild IQ 49-69 (mental age 8-12)
Moderate IQ 30-49 (mental 4-8)
Severe mental age
Co morbidities with LD
20-30 ADHD 30 epilepsy 30-40 behavioural disorder 20-30 mobility problems Sensory impairment 3x risk of schio (3%) Depression de to adversity Phobias Abuse Metabolic syndrome
Describe the 4 principles of ethics and law
Non malefice
Benefice
Justice
Autonomy
Psychosis vs autism vs OCD
OCD - compulsions/ obsessions are egodystonic (dont want them) and they realsie they are from their own head.
Autism - Obsessions/ compulsions are enjoyable
Psychosis - No insight
Symptoms of asberges
Hypersensitive - firm but not light
Higher functioning autism.
Out of the ABC only A and B present and no impairment in cognition or intelligence.
Epidemiology of autism
Male Genetics Parental age Fx psych Premature Valporate
Define intellectual disability
Intellectual disability means a significantly reduced ability to understand new or complex information and to learn and apply new skills (impaired intelligence). This results in a reduced ability to cope independently (impaired social functioning), and begins before adulthood, with a lasting effect on development.
Clinical presentation of autism
Present
Describe Rett’s syndrome
Severe, progressive Language impairment. Repetitive hand movements. Loss of motor skill Irregular breathing. Seizures Girls only Genetics
Describe Heller’s syndrome (Childhood disintegrative disorder.
2 years of normal developments
Loss of previously learned skills (lang, social and motor)
Repetitive, sterotyped interests and behaviours and cognitive deterioration.
Management of autism
Local autism teams with key worker
CBT if possible and engagment
Daily life skills, coping strategies, and enabling access to education and community facilities
All physical mental and behavioural issues addressed
Social and emotional support
Self help - NAS
Special schooling
Melatonin for sleep
Social-communication intervention e..g play based
No pharmacology
For behaviour:
Modify environment things that create/ maintain behaviour
Antipsychotics when psychosocial interventions are insufficient
Describe management of LDs
MDT approach - psychiatrist, speech and lang, specialist nurse, psychologist, OT, social worker, teachers
Physical health followed up by GP
Antipsychotics for challenging behaviour
Behavioural techniques e.g. positive behaviour support and CBT
Family education- programmes and organisations
Prevention via genetic counselling and antenatal diagnosis.
Presentation of hyperkinetic disorder
Inattention
Hyperactivity
Impulsitity
Early onset before 7, persisent (>6 months), present in more than one situation(home and school or nursery), IQ above 50
Management of hyperkinetic disorder
Bio
If severe then give methylphenidate (ritalin)
Atomoxetine second line.
Monitor side effects:
CNS - headache, insomina, loss of appetite, weight loss.
Psycho
Psychoeducation and CBT, social skills training
Social
Food diary - may be linked
Support for parent and teahers including groups.
Parent training and eductation
Side effects of SSRIs
Mania in bipolar N/V Constipation/ diorrhea Suicide (motivation) Sleep disturbance Dyspepsia Weight loss
STRESS: Sweating Tremor Rash Extrapyradimal side effects (uncommon) Sexual dysfunction Somnolence Discontinuation syndrome
Serotonin syndrome
Contraindications for SSRIs
Warfarin, heparin, NSAIDs, NAC
Epilepsy Cardiac disease Glaucoma DM Bleeding
What is serotonin syndrome
Within minutes of taking medication (SSRIs, TCAs, Lithium)
Cognitive - headache, agitation, hypomania confusion, hallucinations, coma
Autonomic - shivering, sweating, hyperthermia, hypertension, tachycardia
Somatic - myoclonus, hyperreflexia, tremor
Manage: stop drugs and supportive
Mirtazapine indications and side effects
Second like, good for weight gain and insomnia.
Postural hypotension
Describe a NARI and side effets
Reboxetine
CAnt see, cant wee, cant shit cant spit.
Describe Trazodone use and side effects
Sedation!! (weight gain)
SARI - serotonin antagonist and reuptake inhibitor
Used in anxiety, dementia, with agitation and insomnia
TCA side effects/ contraindication
Cardiotoxicity -arrhythmias, postural hypotension, tachycardia, syncope
Convulsions
Anti cholinergic
Weight gain
MoA of TCAs
INhibit reuptake of adrenalin and serotonin - affinity fr cholinergic receptors
Side effects of MAOIs
CVS - arrythmias
Drowsi/ insomnia
Weight gain
Seual dysfunction
LFTs
Tyramine rich foods such as chees, herring, liver, marmite can cause a hypertensive crisis
Headache, palpitations, fever, convulsions, coma
Name typical antipsychotics
Haloperidol
Chlorpromazine
Flupentixol
Sulpiride
Difference between typical and atypical antipsychotics
EPSE
When should clozapine be prescribed?
Failure to respond to two other antipsychotics (treatment resistant schizophrenia)
MoA of antipsychotics
Blocking dopamine receptorsl
Atypicals have speciic dopaminergic properties (less nigostriatal. Atypicals also have serotonergic effects
Side effects of antipsychotics and explainatios
Antidopaminergic - nigostriatal:
- EPSE
- Bradykinesia
- Hypertonia/ cogwheel rigidity
- Tardive dyskinesia (years)
- Tremor
- Akathisia (restlessness)
- Dystonia - spasms of neck jaw and eyes
Antidopaminergic - tuberoinfundibular
- Osteoporosis
- Gyneaocomastia
- Lactation
- Amennorhea/ menstrual disturbance
- Sexual dysfunction
Antimuscurinic
- cant see, cant wee, cant spit, cant shit
Serotinergic
- Glucose intolerance/ hyperglycaemia?
- N/V
Antihistaminergic:
- Sedation
- Weight gain
Anit-adrenergic
- Postural hypotension
- Tachycardia
- Ejaculation failure
Haloperidol - Prolonged QT
Clozapine- Agranulocytosis and hypersalivation
Atypicals = anticholin/ metab Typical = EPSE and hyperprolactinaemia
Neuroleptic malignant syndrome
Metabolic syndrome, diabetes and stroke more likely in atypical.
CIs also include epilepsy (lower seizure threshold)
Describe neuroleptic malignant syndrome
Dopamine causes so also levodopa. Within 10 days of taking antipsychotics Rigidity, hyperthermia, delerium, convulsions, confusion, autonomic instabolity. CK, FBCs, LFTs Stop anti and supportive C: Renal failure, shock, PE.`
Antipsychotics that need glucose monitoring?
Clozapine and Olanzapine
Baseline investigations for antipsychotics
ECG LFTs FBCs, Us and Es Glucose (some) CK (incase of neurepileptic) Full physical Weight BP Blood lipids
Which antipsychotics can be given via depot?
Flupentixol, haloperidol, risperidone, olanzapine and aripiprazole
Chlorpromazine
Describe clinical presentation of dementia
Hyperactive, hypoactive or mixed.
Global disturbance in cognition
Impairment of consciousness and attention
Psychomotor disturbance
Emotional disturbance
Disordered sleep/ waking - hypervigilant in night, drowsiness in day
Other symptoms include visual hallucinations and fleeting delusions.
Describe the management of delerium
Bio:
Treat underlying cause
Antipsychotics if challenging behaviour
Psycho:
Reassurance and de-escalation techniques e.g. re directing
Social:
Move to quiet well lit room
Explain a capacity assessment
Understand
Retain
Weigh up positives and negatives
Communicate decision
Describe clinical features of dementia (ICD10) and Alz
Decrease in cognitive abilities e.g. judgement and thinking
Decrease in memory (tends to be short term at first then later somantic and episodic) (for 6 months)
Decrease in emotional control, motivation or social behaviour:
Emotional liability, irritation, apathy
Alz: slow gradual onset, predominance of memory loss over intellectual impairment.
Describe clinical features of vascular dementia
Decreases in stepwise fashion
CVS risk factor/ conditions often present
Emotional and personality changes earlier
Neuro signs/ symptoms as focal
Describe clinical presentation of dementia with Lewi Bodies
Daily fluctuations EPSE Visual hallucinations Falls, syncope, depression Protein buildup in neurones After 50 Life expectancy 8 years Cognitive function first unlike altzheimers which is memory first
How to differentiate between Dementia and depression
Which came first
Depression can cause memory loss
Management of Alz
Bio:
Acetylcholinesterase inhibitors early/mide.g. Galantamine, donepezil, rivastigmine
Non competitive antagonism at NMDA e.g. Memantine - late
SSRI/ antipsychotic for dep/behaviour
Modifiable RFs for vasc dementia
Psycho:
Education
Alternative therapies - music, aromatherapy, animal association
Support:
Groups - alzheimers society
Home support - OT
Future planing e.g. Lasting power of attourney and advanced directives
CIs and side effects of acetylcholinesterase inhibitors
Arrythmias (brady), myoclonus, EPSE,
CI: arrythmias, Peptic ulcer asthma
Describe types of memory
Short term
Long term:
- Proceedural/ implicit (knowing how to do things)
- Declarative (explicit
- Semantic (knowing things about the world)
- Episodic (remembering specific events)
Describe Memantine use and moa
NMDA receptor antagonist *glutamate and glycine)
Memantine side effects
• Hypertension, dyspnoea, headache, dizziness, drowsiness
Best therapies for EUPD
Dialectical behaviour therapy - coping and control, change pattern of behaviour
Group therapy
What is the difference between asperger’s syndrome and autism?
No impairment in language, cognition and normal IQ
Difference between mood disorder and normal mood?
Impairment in activities of daily living
Core symptoms of depression
Anhedonia
Low mood persistant (2 weeks)
lack of energy (anergia)
Cognitive symptoms of depression
Lack of motivation
Negative thoughts
Excessive guilt
Suicidal ideation
Biological symptoms of depression
Psychomotor retardation
Weight loss and appetite music
Loss of libido
Early morning waking
Diurnal variation in mood (usually morning is worse)
(may get hallucinations and delusions too)
Stages of depression
Mild = 2 core + 2 other
Mod = 2 core +3-4
Sev = 3 core and >4 other
Sev with psychosis = sev + psychosis
Describe cyclothymia
Chronic mood fluctuations over 2 years with elation and depression insufficient to met bipolar
Most common presentation of baby blues
primiparae
- reassure and support
3-7 days following birth
Anxious, tearful, irritable
Treatment of depression
Drugs only if moderate/ severe unless chronic, , history of mild-severe depression, failure of other interventions. In severe it may be augmented with lithium or antipsyhcotics. ECT. SSRI or SNRI 2nd. continue for 6 months in first, 2 years in second,
Self help, psychotherapy, physical activity
Social - support groups.
What is perseveration
Uncontrollable and inappropriate repetition of a particular response, word, phrase or gesture
Aetiology of bipolar
Stressful life events Genetic 19 years is average age of onset Higher in minorites Anxiety, depression Substance misus
Difference between hypomania and mania
Mildly elevated or iritable mood present for >4 days. No severe disruption. Partial insight
Mania: Symptoms >1 week, complete disruption of work, grandiose, sexual disinhibition, exhaustion
Also mania with psychosis
What is rapid cycling?
More than 4 mood swings in a 12 month eriod with no asymptomatic periods, poor prognosis
Treatment for bipolar
Bio: Antipsychotic (rapid onset, stop after 4 weeks for lithium), mood stabaliser (lamotrigene or lithium- lam in depress, lith inbetween and in mania).
Can add other stabalisers or atypicals if lithium does not work.
Psycho: psychoeducation, CBT
Social: Groups, self help, calming activities
Tests before starting lithium
TFTs, pregnancy, Us Es, ECG (arr
Side effects of lithium
polydipsia, polyuria, tremor, weight gain, oedema, hypothyroid, memory. tetatorogenic. Dehydration
Toxicity: N/V, coarse tremor, ataxia, muscle weakness, apathy, nystag, dysarthria, hyperreflexia, oligouria, hypotensio, convulsions, coma
Describe monitoring of lithium
12 hours first dose, weekly until .5-1mmol/L. Stable 4 weeks. Check every 3. UE every 6, tft every 12
Treatment for cyclothymia
Lithium and sodium valporate
Describe why DOLS might be used instead of a section
Treatment in best interest involves limiting freedoms e.g. locked wards if they lack capacity. Ensures no innappropriate restriction of freedom
What is a community treatment order
Person on section can leave hiospital to be treatd in the community, can be recalled if they do not comply with treatment and detained for 72hrs for assessment
Who needs to be present to do a section 2/3
AMHP - Approved medical health proffessional (not doctor) or NR (nearest relative)
AC: Section 12 approved clinician
Another doctor
What is an IMCA
Independent mental capacity advocate, appointed to peak on behalf if there is no next of kin or lasting power of attourney)
Why do you get sedation and increased appetite with mirtazapine?
Histamine
Tardive dyskinesia more commonly affects hands or feet?
Hands
Drugs excreted in breast milk?
Mood stabalisers, antipsychotics, benzos
Anti-adrenergic side effects of antipsychotics
postural hypo, tachycardia, ejaculatory failure
How long does it take for SSRIs to work?
2-3 days but not noticed until 2-6 weeks
Name TCAs
amitryptilline, lofepramine, doxepin, dosulepin, clomipramine
4 groups of symptoms in PTSD
Avoidance
Re living - nightmares and flashbacks
Hyperarousal - hypervigilance, insomnia, startle
Emotional blunting
What are the withdrawral symptoms of cocaine, MDMA, amphetamine
Dysphoric mood, lethargy, psychomotor agitations, insomnia/ hypersomnia, dreams, craving
What classifies withdrawral
3 signs needed
Withdrawral symptoms of opiates
Pilarerection Lacrimation Rhinnorrhea N/V Diarrhoea Myalgia Cramps Increased HR and BP
Withdrawal synptoms of cannabis use
Tremor when outstreched Myalgia Anxiety Irritability Sweating
Withdrawal symptoms of sedatives/ hypnotics
Agitation Grand mal convulsions Tremor Low BP (postural) Increased HR Paranoid Hallucinations
What can be used in Bio treatment opiod dependence
Bupramorphine or methadone (partial) for detox and maintainance.
Naltrexone (antagonist) after (Naloxone is for OD) to prevent relapse
Alchol withdrawral symptoms
Irritation Agitation Seizure Coma Death Tremor Nausea Insomina Autonomic overactity transient hallucinations 6-12 hours after abstinence COg impairment Paranoid delusions Sweating
What is a binge and recommended limits
> 8 uits men or 6 female (twice daily allowance
14 units per week (Jan 16)
Treatment for delirium tremens
Chlordiazepoxide Haloperidol for any psychotic features IV Pabrinex (vitamins)
Long term treatment for alcohol dependence
Disulfram (mod or severe)
Naltrexone or
Acamprosate - reduces GABA transmission (craving)
Psycho: MI, CBT
SOcial: AA
types of delusion seen in severe depression with psychosis
Nihilistic (worthless/ everything is non-existent), Guilt, hypochondriacal
What is Capgras’ syndrome
A familiar person or place has been replaced with an exact duplicate
What are schindler’s first rank symptoms
Hallucination
Delusion
Passivity phenomoenon
THought intertherence
Describe presentation of frontotemporal dementia
50-60 FX in 50% Early personality chnages e.g. disinhibition, apathy, restlessness Worsening of social behaviour Repetitive behaviour Language problems Memory is preserved
What is dysthymia
Persistent mild depression for at least 2 years which is not depression or the reslult of partially treated depression
Define neurosis
Group of psychiatric disorders characterised by distress, non-organic, discrete onset, psychosis absent
Define personality disorder
X
What is transference?
redirection of a patient’s feelings for a significant person to the therapist
What is paraphrenia?
araphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) without deterioration of intellect or personality
What is an encapsulated delusion?
a delusion that usually relates to one specific topic or belief but does not pervade a person’s life or level of functioning
Features of delerium tremens
Cognitive impairment Hallucinations and/ or illusions - vivid perceptual abnormalities paranoid delusions Tremor Autonomic
When may you get symptoms of alc withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
