PSYCH EXTRA CONDITIONS Flashcards
ACUTE STRESS REACTION
What is acute stress reaction?
- Transient disorder that can occur as an immediate response to exceptional stressor with threat to security or physical integrity (rape, natural catastrophe) but typically resolves once stressor removed/after few days
ACUTE STRESS REACTION
How does acute stress reaction present?
- Anger, depression/anxiety, excessive grief, social withdrawal, narrow attention
- Basically presents as PTSD but <1m so not called PTSD (only if no resolution >1m)
GRIEF REACTION
What is the normal grief reaction?
How does it present?
- Normal reaction after a sad event e.g. sad after death of loved one
- Usually occurs <6m from event (delayed grief = >2w until grieving, prolonged grief = hard to define but >12m)
GRIEF REACTION
What are the stages of a normal grief reaction?
- Denial incl. numbness, pseudohallucinations of deceased (auditory, visual), may focus on physical objects that remind them
- Anger usually to family or HCPs
- Bargaining, depression + acceptance (may not go through all 5 stages)
TIC DISORDERS
What is the epidemiology of tics?
- Transient simple tics affect 10% of children
- May be associated with OCD, ADHD + ASD
- M>F, usually present around or after 5y
TIC DISORDERS
What are the two types of tics?
How may they manifest?
- Simple
- Complex
- May be invisible to observer (abdo tensing, toe crunching)
TIC DISORDERS
Give some examples of simple tics
- Throat-clearing
- Blinking
- Sniffing
- Head jerking
- Eye rolling
TIC DISORDERS
Give some examples of complex tics
- Physical movements (twirling on spot, touching objects)
- Copropraxia (obscene gestures)
- Coprolalia (obscene words)
- Echolalia
TIC DISORDERS
What improves or worsens tics?
What sensations are felt before tics?
- Stress + stimulant meds worsen, distraction improves
- Premonitory = pts feel urge to perform tic, often several times to get relief from that urge (can be suppressed but internal tension builds)
TIC DISORDERS
What is the management of mild tics?
- Watch + wait (usually improve over time
- Education + reassurance
- Avoid caffeine + stress
TIC DISORDERS
What is the management of severe tics?
- Habit reversal training
- ERP
- Antipsychotics considered in VERY severe cases
CONDUCT DISORDER
What is conduct disorder?
What are the 2 types?
- Persistently, marked antisocial behaviours
- Socialised = child has peer group, often share antisocial behaviour
- Unsocialised = rejected by others so more isolated + hostile
CONDUCT DISORDER
What is the epidemiology of conduct disorder?
What are some risk factors?
- M>F, more common in adolescents
- Urban upbringing, deprivation, parental criminality, harsh or inconsistent parenting (behaviours often learned from parents)
CONDUCT DISORDER
What is the clinical presentation of conduct disorder?
- Aggression/violence towards people or animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules
CONDUCT DISORDER
How is conduct disorder managed?
- 3–11y = group parent training programme (focus on parenting skills to improve child’s behaviour)
- 9–14y = child-focused programmes (focus on child’s behaviours)
- Older = multimodal interventions with many services
CONDUCT DISORDER
What can be used as a last resort in conduct disorder?
- Antipsychotic like risperidone to reduce aggressive tendencies
ODD
What is oppositional defiant disorder (ODD)?
What may be linked to ODD?
- Negative, hostile + defiant behaviour particularly directed towards authority figures like parents + teachers
- Common in children with ADHD, may be linked to parenting styles
ODD
How can ODD and conduct disorder be differentiated?
- Less severe + more common
- Children are NOT aggressive and do NOT destroy property or steal etc.
ODD
What is the clinical presentation of ODD?
- Loses temper + argumentative
- Actively defies or refuses to comply with adult’s requests or rules
- Blames others for their mistakes or misbehaviour
ODD
What is the management of ODD?
- Child-focussed programmes + group parent training programmes
CONVERSION DISORDERS
What is a conversion disorder?
- Actual loss or disturbance of normal motor/sensory function which initially appears to have neuro or physical cause but is later credited to psychological
CONVERSION DISORDERS
What is the most severe form of dissociative/conversion disorders?
- Dissociative identity disorder (multiple personality disorder) = inability to recall personal information, may have loss of identity.
CONVERSION DISORDERS
What are the features of conversion disorders?
- Paralysis (any pattern)
- Aphonia (complete loss or whispered speech)
- Sensory loss (area may cover patient’s beliefs about anatomy)
- Seizure (NEAD)
- Amnesia (short-term memory loss usually too severe for forgetfulness)
CONVERSION DISORDERS
When would you suspect conversion disorder?
- Clinically inconsistent nature (or absence) of signs
- Excluded underlying organic disease
- Convincing psychological explanation for deficit (can be induced by stressful event)
CONVERSION DISORDERS
What is the management of conversion disorder?
- Present Dx of positive (emphasise likelihood of recovery)
- May need physio
- CBT, interpersonal therapy, supportive psychotherapy or family therapy may help
HYPOCHONDRIASIS
What is hypochondriacal disorder?
- Preoccupation with fear of having a serious disease (C = condition) which persists despite -ve Ix + appropriate reassurance
HYPOCHONDRIASIS
What is the clinical presentation of hypochondriasis?
- Over-valued idea of having serious medical condition, often fatal
- Ruminates on possibility, misinterprets insignificant bodily abnormalities as signs of serious disease needing investigation
- Unable to be reassured by negative investigations
HYPOCHONDRIASIS
What is the management of hypochondriasis?
- Clarify Sx real but emphasise absence of organic cause
- SSRIs may help
- ERP to illness cues, CBT to identify + challenge misinterpretations + substitute realistic interpretations
SOMATOFORM PAIN
What is somatoform pain disorder?
- Complaint of persistent + distressing pain which is not adequately explained by organic pathology
SOMATOFORM PAIN
What is the management of somatoform pain disorder?
- Atheoretical “see what works” approach
- Pain clinics (anaesthetics led, antidepressants, transcutaneous electrical nerve stimulation/TENS, local + regional nerve blocks)
- Relaxation training, CBT, hypnotherapy
MUNCHAUSEN’S
What is Munchausen’s (factitious disorder)?
- Pt intentionally falsifies their Sx, past Hx + fabricate signs of physical or mental disorder with primary aim of obtaining medical attention + Tx
- May flee when story questioned
MUNCHAUSEN’S
What are the 3 subtypes of Munchausen’s?
- Wandering
- Non-wandering
- By proxy
MUNCHAUSEN’S
What is wandering Munchausen’s?
- M>F
- Move hospital-hospital, job-job, place-place, makes elaborate stories, changes name
MUNCHAUSEN’S
What is non-wandering Munchausen’s?
- F>M
- More stable lifestyles, less dramatic presentations
- Often paramedical professionals
- Associated with EUPD
MUNCHAUSEN’S
What is Munchausen’s by proxy?
- F>M
- Mothers, carers, paramedic staff who simulate or prolong illness in their dependents
- Clinical focus to prevent further harm on the dependent
MUNCHAUSEN’S
What is the management of Munchausen’s?
- Reduce iatrogenic harm from inappropriate tests + treatment
- Challenge pt in non-punitive manner
- Healthcare systems change to prevent harm (blacklisting)
MALINGERING
What is malingering?
Give some examples
- Fraudulent simulation or exaggeration of Sx for personal gain
- Drug-seeking behaviours, avoid army service, compensation
SLEEP DISORDERS
What is insomnia?
- Issues with – falling to, maintaining or poor quality of sleep (≥3d/week for 1m)
SLEEP DISORDERS
What are the 2 types of insomnia?
- Primary = intrinsic + Extrinsic factors (fear of falling asleep, poor sleep hygiene, change of environment)
- Secondary = to illness or substance misuse (sleep apneoa, circadian rhythm disorder, shift work)
SLEEP DISORDERS
What is the management of insomnia?
- Rx with zopiclone if good sleep hygiene unsuccessful
- Mirtazapine
SLEEP DISORDERS
What is narcolepsy?
What is cataplexy?
- Hypersomnolence, sleep paralysis, hypnogogic + hypnopompic hallucinations
- Cataplexy = sudden loss of muscle tone often triggered by emotion
SLEEP DISORDERS
What is the management of narcolepsy?
- Multiple sleep latency EEG, early onset REM sleep
- Rx with daytime stimulants (modafinil) + night-time sodium oxybate
SLEEP DISORDERS
What is circadian rhythm disorder?
- Mismatch between sleep-wake cycle + circadian rhythms (jet lag, shift work)
SLEEP DISORDERS
What is parasomnia?
- Restless leg syndrome
- Nightmares + night tremors
- Sleep walking + talking
SLEEP DISORDERS
What are some sleep hygiene advice?
- Limit caffeine, alcohol + cigarettes
- Reduce noise, lights + phone use, wind down before bed
- Reduce sleep during day + try establish regular pattern
