Psych Flashcards
Delirium Tremens
ETOH withdrawal
low serum B12
Acute delirium
Mx - Cause, otehrwise haloperidol
Pharm causes of depression
Prednisolone
Frontal lobe injury
Px - Hyperphagia, lability&irritability, hypersexuality, inappropriate affect
Wilson’s
Ax - Cu accumulation
Px - jaundice, KF rings, Psych=aggression, disinhibition
Huntington’s
Ax - chromosome 4p triplet repeat. Cell loss in basal ganglia, sunstantia nigra and verebellum
Px movement disorder, choreiod and athetoid movements dementia, personality changes
Stroke psych complications
Depression
Schizophrenia subtypes
Hebephrenic/disorganized: predominance of thought disorder and affective symptoms. social withdrawal, fatuous affect, negative symptoms develop rapidly
Catatonic: psychomotor disturbances or catatonic behaviour, waxy flexibility, negativism, aversion
Paranoid: delusions and hallucinations
Residual: +ve Sx are replaced by -ve Sx
Simple: insidious development of oddities of conduct, inability to meet demands of society and decline in total performance
Lifetime risk is 0.4% twins 50%
Neuroleptic malignant syndrome
Emergency
Ax - complicaiton of antipsychotics dopamine blockage.
Px - Confused, dec GCS, extra-pyramidal Sx, fever, hypotension, tachycardia
Mx - stop antipsychotic
Aripiprazole
Newer antipsychotic, less SE’s
SE: Nausea, insomnia
Olanzapine
2nd gen antipsychotic
Treating +ve Sx
SE: wt gain and diabteic control
Clozapine
Treatment resistant schizophrenia
SE: Neutropenia or agranulocytosis
Sertraline
SSRI antidepressant
Section 3
Detain for 6 mnths, when the person is known to mental health services
Section 2
Detain for 28 days, initial assessment
Section 135
Warrant permitting police to search premises and remove pts from those premises
Section 4
Detained for 72hrs, emergency, should be converted to section 2. 1 medical recommendation
Section 5(2)
(Dr) Detain for 72hrs on inpts for a full mental health assessment
Lewy body dementia
Second most common after Alzheimer’s
Day to day fluctuation of cognition, visual hallucinations, parkinsonian
Antipsychotics avoided
Normal pressure hydrocephalus
Gait, urinary incontinence, dementia
Hippocampal atrophy on MRI
Alzheimer’s
MOA of drugs targeting cognitive symptoms of dementia
Drugs that Inc ACh i.e. ACh esterase inhibitors
Day to day fluctuating consciousness, visual hallucinations, Parkinsonism
Lewy body dementia
Excessive worry over memory loss in old people.
Depression
Somatization is a common presentation of ……… in old age
Depression
Partition delusions ‘radiation through ceiling’
VLOSP
Body fat in elderly increases/decreases
Fat soluble drugs will have a longer/shorter duration of effect in older people
Increases
Longer
Px - pyrexia, rigidity, tachycardia, raised WCC, raised CK, fluctuating consciousness, younger male pts
Ax - antipsychotics
Mx - stop antipsychotics, IV fluids (bromocriptine/dopamine agonist may be used)
Neuroleptic malignant syndrome
Wake up screaming w/ no recollection the next day
Night terror
Wake up screaming w/ recollection
Nightmares
Suicide RF’s
Male 45 divorced, single, widowed unemployed psych illness prev episode of self harm chronic physical illness adverse life events
Annual rsk of suicide
Annual incidence of self-harm
1 in 10,000
3-1000
Delusional psychosis infected w/ parasites
Ekbom’s
Nihilistic delusion that one is dead, does not exist, is decaying etc
Cotard syndrome
Delusional belief that someone of a higher social status is in love with you
De Clerambault’s
Mimicking ideas of crazy w/ approximate answers showing understanding of underlying Q
Prison inmates before trial
Ganser’s
Delusion that persecutor can change form
Fregoli’s
Delusional jealousy
Othello syndrome
Px - >2years of multiple, variable physical Sx of no underlying cause, refusal to accept Dr’s reassurance, impairment of social function, Sx not intentionally produced,
Somatization disorder
Px - dazed and inability to process external stimuli after exceptional physical or mentally stressful stimuli
Acute stress reaction
Restless legs
Akathisia
Px - Lip smacking, sucking, chewing
Ax - extrapyramidal SE of antipsychotics e.g. haloperidol
Tardive dyskinesia
Atypical antipsychotics (2) MOA
Olanzapine, Clozapine
Block dopamine D1+D4 receptors
Px - severe HTN, tachycardia, pyrexia, hyperreflexia, SSRI + St Johns Wort
Serotonin syndrome
Snapshot low mood
Dysphoria
Snapshot exaggerated high mood
Euphoria
Distorted recall of past experiences
Paramnesia
Inability to recall past experiences
Amnesia
Exaggerated retention of detail in past recall
Hypermnesia
Copying movements
Echopraxia
Repeated non goal directed movements
Sterotypies
Motionless resistance to commands and attempts to be moved
Negativism
Pt remains motionless but allows their posture to be manipulated, the limbs remain in the new posture
Waxy flexibility
Bizarre body posture adopted for inappropriately long time
Posturing
Tentative incomplete movements i.e. when shaking hands
Ambitendency
Px - Auditory hallucinations, Thought disorder, passivity, delusion
Schizophrenia
Auditory hallucinations - running commentary third person auditory hallucination
Though disorders - insertion, withdrawal, broadcasting
Passivity - movement/emotion/sensation being controlled by external influences
Delusion - fixed belief despite evidence to the contrary
Px - Mood disorder + schizophrenic Sx. Classified into manic and depressive
Schizoaffective disorder
Delusion that parts of the body are rotting away
Psychotic depression ?Cotard
Px - Stupor, excitement, posturing, negativism, rigidity,
Catatonic Schizophrenia
Px - predominantly positive Sx’s (delusions and hallucinations), w/ inc suicide risk
Paranoid schizophrenia
Px - earlier age, mainly negative Sx’s (thought disorders and incongruent affect)
Hebephrenic schizophrenia
Px - gradual decline in functioning, negative w/o positive
Simple Schizophrenia
Cluster A
Paranoid/schizoid
Cluster B
Histrionic, emotionally unstable, dissocial
Cluster C
Anankastic, anxious, dependent
Sensitive, Unforgiving, Suspicious, Possesive and jealous of partners, Excessive self-importance, Conspiracy theories, Tenacious sense of rights
Paranoid PD
Anhedonic, Limited emotional range, Little sexual interest, Apparent indifference to praise/criticism, Lacks close relationships, One-player activities, Normal social conventions ignored, Excessive fantasy worlds
Schizoid PD
Attention seeking, Concerned with own appearance, Theatrical, Open to suggestion, Racy and seductive, Shallow affect
Histrionic PD
Affective instability, Expolsive behaviour, Impulsive, Outbursts of anger, Unable to plan or consider consequences
Emotionally unstable personality disorder
Doubtful, Excessive detail, Tasks not completed, Adheres to rules, Inflexible, Likes own way, Excludes pleasure and relationships, Dominated by intrusive thoughts
Anankastic
Carbemazepine
Lamotrigine
Lithium carbonate
Sodium valproate
Mood stabilizers
Chlorpromazine
1st gen antipsychotics
Potent anti-cholinergic effects
Trimipramine
TCAD
risk of inducing manic episode in BPAD
Quetiapine
2nd gen/atypical antipsychotic
Donepezil
Acetylcholinesterase inhibitor
Cognitive and non-cognitive Sx’s of dementia
Haloperidol
Antipsychotic dopamine antagonist
Procyclidine
Antimuscarinic agent
Parkinson’s, parkinsonian/extra pyramidal SE Tx
Mild depression 1st line
CBT
Severe depressive illness Tx
ECT
Fluoxetine
SSRI 1st line depression medication
SE: GI, insomnia, sexual dysfunction
Resistant depression, mania prophylaxis,
SE: fine tremor, dry mouth, metallic taste, wt gain
Lithium
TCA
SE: drowsiness, wt gain, dry mouth, blurred vision
Amitriptyline
Malaysian man runs around killing people and takes own life
Amok
Assian men w/ retracting penis
Koro
Arctic circle, violence, hysteria and bizarre behaviour followed by amnesia
Piblokto
Indian, masturbation bad, semen+vital fluid
Dhat
North African women, exaggerated startle response, echolocia, obeying comands
Latah
South american, severe depressive episode, separation of soul from the body
Susto
North American tribes, cannibalism, possessed
Windigo
Section 136
Allows police to detain a Pt in a public place
Section 5 (4)
Nurses holding power lasts 6 hrs on inPts
TCAD SE’s
Drowsiness Dry mouth Blurred vision Constipation Urinary retention
Eye movement desensitization and reprocessing therapy
PTSD
Severe depression criteria
Decreased concentration Reduced self-esteem Guilt Pessimism about the future Self-harm ideation Disturbed sleep Reduced appetite
poor memory, difficulty in word finding and difficulty in planning
Alzheimer’s
management of an unconscious patient without capacity to consent to surgery
The involvement of close family members in decision-making is crucial in such cases.
Citalopram
SSRI
SE: Insomnia, GI
Mirtazapine
NSSRI
Indication Warfarin
Delusions congruent w/ pt mood
Mania
Bullimia BMI
> 18
Anorexia BMI
<17.5
Episode of self harm after suicide attempt % (1 yr)
20%
Heroin withdrawal Sx
Dilated pupils sweaty runny nose
Non-identical twin risk of schizophrenia lifetime rsk
10%
Clinical depression inpts
25%
Scizophrenia young full recovery %
20%
Who can make the application for section2+3
Approved social worker
Wernicke’s Sx
Opthalmoplegia, ataxia (heel-toe), confusion
Korsakoff’s Sx
Confabulation, amnesia
Acute dystonia
Procylidine
Tardive dyskinesia
Stop depot start Olanzepine
Anorexia Mx
Specialist diet clinic, nutritional advice, individual+family therapy
PD criteria
REPORT Relationship affected Enduring Pervasive Onset since childhood Results in distress Trouble in occupation/social life
Hebephrenc
Young and mood
MMSE 25-20
Mild = Donepezil
MMSE 20-10
Moderate = Donepezil or straight to memantine
MMse <10
Severe = Memantine
Care programme approach
Key worker
Hypothyroidsim
Lithium
Extra-pyramidal
Typical antipsychotics
Benzo overdose
Flumazanil
Previous failed inpt detox
Outpt detox
