Psych Flashcards
Alzheimer’s Dx
Non pharm mx:
- Well being
- Group therapy
Pharm:
1) ACHEI - Donepezil/glanatamine/rivastigmine
2) Memantine = NMDA antag:
- Use as mono if ACHEI CI or v.sev alzheimers
- Use as +on in mod - sev
Ranking - MMSE score:
26 - 18 mild
17 - 10 = mode
<9 =- severe
Donepezi;:
- S.e insomnia
- relative CI = hypotension
Vascular dementia
Subtypes:
- stroke - related
- subcortical - SVD
- mixed - VD + Alzheimers
RF: smoking lipids AF HTN Past HX - stroke/TIA DB CHD FHx
NINDS-AIREN Criteria:
- Cerberovascular dx
- Intefernece of ADL not secondary effects of cerebrovasc event
- Relationship between above 2
Mx - Non harm:
- Mx CV risk factors
- specific
- Mx challenging behaviour
Pharm - mx
- not typically used
- only if assoc alzheimers.
F-T dementia
common ft:
- <65 yrs
- insidious onset
- Preserved memory and visuospatial skills
- Pernsonality change and social conduct
Pick’s dx = most common type:
- Focal gyral atrophy –> KNIFE BLADE APPEARANCE
Macroscopic changes of Pick’s:
- Atrophy of F + T lobes
Microscopic: = pcik boies - tau protein = SILVER STAINING - Gliosis - NFTs - Senile plaques.
Other types of f-t dementia:
- CPA - non-fluent speech
- Semantic - fluent speech with empty meaning - LT memeory affected (unlike Alzheimer’s)
Lewy body demenetia
Parkinson plus synbdrome
alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the SUBSTANTIA NIGRA/PARALIMBIC/.NEOCORTICAL AREAS
Ft:
- progressive CI
- parkinsonism
- Visual hallucination
Diagnosis
- clinical
- SPECT
Mx:
- Alzheimer tx
- DO NOT USE NEUROLEPTICS –> irreversible parkinsonism.
Q stem - may give someone with acute deterioration after starting antipsychotic –> LBD
Charles bonnet syndrome
Persistent or recurrent complex auditory or visual hallucinations.
Retajn insight
Rf
- age
- visual impairment
- social isolation
- sensory deprivation
- early conginitive impairment
First rank symptoms of schizo
ATPD
Aim. To pass definitely
Auditory hallucinations:
- 3rd person
- running commentary
- thought echo
Thought disorder +:
- insertion
- withdrawal
- broadcast
Passivity:..
- bodily sensations
- actions, feelings, impulses
Delusional:
- sudden, intense, self referential delusion
- In response to common things.
-
RF for Schizo
FHx Blac/carribean migration urban cannabis
Poor prognostic ft of schizo
\+ FHx Gradual onset Low IQ Premorbid social withdrawl no precipitant
MX of sschizo
PO Atypicl antipsychotics
CBT
CV risk
Atypical Antipsychotics
Adverse effects:
- WG
- Raised PRL
- Clozapine –> Agranulocytosis.
In elderly pt:
- Inc. stroke risk
- Inc VTE
Examples:
- Clozapine
- Onlazapine –> raised obesity/WG
- Quetiapine
- Risperidone
- Amisulpride
- Risperidone
- Aripiprazoel
Clozapine
S.e = agranulocytosis –> monitor FBC
Only use after fx >/= 2 antipsych for 6-8/52
other adverse affects:
- Decrease seizure threshold
- constipation
- Myocarditis –> ECG prior
- hypersalivations
Hypomania vs mania
Mania:
- > /= 7/7
- imoact fn/social/worj
- hospitalition
- psychotic sx
hypomania - <7/7 out of all the others.
Mx - short term:
- BZD
- Onloanzapine
- Li
- ECT - prolonged + resistant
Mx - Long term:
- Li –> fx/rapid cycling –> Carbemezapan
- depressive sx +++ - Valproc acid/lamotrigine.
SSRIs
Cause hyponatraemia
GI effects
Increased vigillant
Lithium
Mood stabiliser –> narrow therapeutic indec = 0.4 -1.0
Excreted by KIDNEYS
S.e. - L.I.T.H.I.U.M.S:
Levels + leucocytosis/inc urine (DI) + inc wt/tremor + thirst/Hypothyroid + hair thin/interaction/upset stomac/Muscle weakness/ Skin - Acne + psoriasis
Li - Toxicity
Symptoms:
- Tremor
- Hyperreflexia
- Acute confusion
- Seizure
- Coma
Mx:
- IVI
- HAemodialysis - (if severe Li >2.0)
- +/- NaHCO3-
Depression
DSM IV grading
> /= 2 weeks
PHQ - 9:
- 0-7 = normal
- 8-10 = borderline
- > 11 = +ve
Biological - important as predictor of response to Tx:
- Diurnal variation
- loss of libido
- loss of appetite
- Loss of energy
- WL
- psychomotor retardation
OTher sx:
- low mood
- annehedonia
- low energy
- insomnia
Psychotic symptoms
Depression grading
Subthreshold - <5 sx
Mild - 5 sx - mild impairment of fn
Mod: Mild – > Sev sx/fn’al impairment
Sev = Fnal impairmenet sev +/- psychotic sx
Depression Mx
SSRI –> try 2nd –> try ALT
ECT
Depression vs dementia
Dementia:
- LT
- Recent memory loss
- Makes stuff up
- consistent
Generalised anxiety disorder
Alway rule out physical cause first - Thyroid/hear/meds (theophylline, salbutamol, steroid, antidepressant, caffeine)
Mx:
1) Educate/active monitoring
2) low intensity psychology - self help/group
3) high intensity psychology (CBT) +/- drug therapy
4) specialist inout
Drugs:
- SSRI –> sertraline (if <30 will have initialsuicidal rxn)
Panic disorder
Mx:
1) Recog + diagnose
2) TX in primary care
3) R/v + consider alt
4) R/V + Referral to specialist
5) care in specialist MH service
1st line SSRI for 12 weeks –> imipramine + clomipramine
Phobias
Mx - Behavioural therapy = graded eposure
SSRI/beta block/BZD
PTSD
> 1/12 - an event that a patient fines stresful.
HARE = Hypervigillant, avoidance, re-exposure, emotional numbing
Mild =- <4/52 –> W/W
Sev - Trauma focused CBT or EMDR
2nd line:
BEnlafexine or Sertraline
–> Fx/ severe –> Risperidone
OCD
Obsession:
- recurrent
- persistent and intrusice
- Occurs vs pt’s will
- Regarded as absurd - INSIGHT
- Pt own thoughts
- resisting –> anx
Compulsions = irresistable
Assoc:
- Depression
- schixophrenia
- Anorexia nervosa
- organic brain disorder.
Mx:
1) Psychological –> EXPOSURE RESPONSE PREVENTION
2) SSRI or clomipramine +/- CBT
Somatoform disorder
Somatisation:
- > 2 physical SYMPTOMS w/o medical eplamatio/
- Fn’al impairment
Hypochondrial dx:
- Persistenet belief that they have specific DISEASE(S)
Mx:
- psychological
- anti-depressants.
Conversion disorder
Loss of MOTOR or SENSORY fn
NOT CONSCIOUSLY
Dissociative disorder
typically involves psychiatric sx = Seperating off certain memories
Fatcious disorder
MUNCHAUSEN = Intentional
Malingering
seek material gain = FRADULENT
Anorexi anervosa
Diagnostic criteria:
- WL >15% or BMI <17.5
- specific psychology - fear of fatness/low threshold for fatness
- Spec endocrine ft:
- delayed puberty, loss of libid, amennorhea
OTher ft:
- Low BP
- brady
- Enlarged salivary glands
- low K
- Low FSH/LH
- High GH /Cortisol
- High cholessterol
Bulimia nervosa
> once/week for 3/12
Recurrent episodes of binge
Lack of control whilst bingi g
recurrent compensatory
self evaluation by BW/Shape/
Mx:
- Refer all
Suicide Risk factors
SAD PERSONS
sex/age/depressive/psych hx/excess drug use/rationale loss/seperated/organised plan/no support/sickness
Delirium causes
I WATCH DEATH
Infection
Withdrawl = EtOH/BZD/sedatives Acute metabolic Toxins - Opiates/steroids/anticholinergic/osychotropics CNS Hypoxia
Deficiencies - B12/Thiamine Endocrine - thyroid/BGL/low adrenal Acute vascular Trauma Hearing
Delirium/Dementia
Delerium:
Low consciousness
Fluctuation
Perceptual changes
Drlusions
Alcohol withdrawl
Chronic –> increased GABA –| CNS/NMBDA glutamate receptors.
Ft:
- 6-12 hr - remor/sweatinf/anxietu
- 36 hr - Seizure
- 48-72 hr - DT
Mx - any pt with complex withddrawl hx (seizure/withdrawl) –> Admit
1) BZD = chlordiazepoxide
if liver fx - loazepam
Alcohol withdrawl syndroem
CAGE
- thought of cut down/annoyance at others for asking to/ guilt/ eye opener
Mx:
- Acute withdrawl - bzd
- Disulifram - inhibits Acetylaldehyde dehydrogenase -CI = IHD/PSYCHOSIS
- Acomprostate - weak NMDA receptor antag –> decrease craving
Wernickes - Korsakoffss
“thin thigh Gym mnemonic”
Thalamus + mamillary body
Wernickes - Ataxia/confusion/opthalmoplegia-nystagmus
Korsakoffs - confabulation
Dry and wet beri beri (wet –> Cariomyopathhy)
Mx of hepaticc encephalopathy
LActulose
Rifaximin
Sleep disorders:
Stages of sleep:
Awake –> REM –> 1 - 2- 3- 4= non-rem
REM sleep:
- EEG = ASYNHRONOUS beta waves
- bursts of conjugate eye movement
- high HR/BP/penile tumerscence
- low musc tone
NON-REM: - EEG = SYNCHRONOUS - stage 1 = theta waves 2 = sleep spindles/K complexes 3 = delta waves
= The Sleep Doctors BRain = theta/spindle/delta/beta
Sleep paralysis
TRansient = on waking and falling asleep = assox w/ REM
Ft = paralysis + hallucination
Mx if troubled –> clozapine
Typical antispyschoics
Chlorpromazine, haloperidole, flupentixol, zuuclopenthixol
S.E:
- EPSE
- antucholinergic
- anti-adrenergic
- anti-histamines
- hgih PRL
- prolonged QTc
- Reduced seizure threshold.
SSRIs
Fluoxetie, duloxetine, paroxetine, citalopram, setraline
S.e: - Seretonin syndrome nausea SEXUAL DYSFN inc anx initial inc suicide risk
TCA
Amtryptilline
imipramine
clomipramine
S.e:
- ANticholinergic
- anti-adrenergic
anti-histamine
antidepressant - SNRI
Venlafexine
s.e - NAusea/HTN
antidepressant - MAOI
Phenelezine
Anticholinergic
antiadrenergic
Mirtazapine
presynaptic alpha-2 receptor antag
Agranulocytosis
ECT
Catatonia
refractory sev depression
psychotic sx
CI = ICP raised
S.e
headache/nausea/ ST memory loss/cardiac arrythmia
LT - poor memory
Serotonin syndrome mx
IVI
BZD
if more sev - use seretonine antag - CRYOHEPTADINE and CHLORPROMAZIEN
Management of bipolar
1st line Lithium
2nd kine - Valproate
