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3 - Psychiatry > Psych: Small Conditions > Flashcards

Psych: Small Conditions Flashcards

1
Q

The most severe form of ethanol withdrawal

presentation + mortality

A

Delirium tremens

Presentation: profound confusion, psychosis, sleeplessness, autonomic over-activity,
Onset is usually 2-3 days after alcohol stopped

Mortality = 5% (by CV collapse, infection, hyperthermia, seizures, self-injury)

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2
Q

An acute neurological condition caused by thiamine (Vit B1) deficiency (common in chronic alcoholics*)

presentation + management

A

Wernicke’s encephalopathy

Presentation: confusion, ataxia. nystagmus, ophthalmoplegia (eye paralysis)

Management: thiamine

*Increased requirement of thiamine for alcohol metabolism

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3
Q

A chronic neurological condition (acute sequela of Wernicke’s encephalopathy) caused by thiamine deficiency (common in alcoholics*)

Presentation + management

A

Korsakoff’s Psychosis

Presentation: impaired recent+remote memory, impaired learning, disorientation, no general cognitive impairment

Management: thiamine

  • Increased requirement of thiamine for alcohol metabolism
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4
Q

Alcohol withdrawal state

Presentation + pharma manegement

A

Presentation: Tremor, weakness, nausea, vomiting, anxiety, agitation, confusion, seizures, death

Management: benzodiazepines (commonly chlordiazepoxide)

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5
Q

Low-risk drinking guidelines advise what as the weekly limit for alcohol consumption

A

No more than 14 units per week for men AND women

= 6 pints of beer/ 6 glasses of wine / 14 shots

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6
Q

In cluster A personality disorders, the prominent problems are with…

e.g….

A

the perceived safety of interpersonal relationships

E.g...
Paranoid Personality Disorder
 - assume everyone has malintent towards them
Schizoid Personality Disorder
 - very afraid of emotional closeness 
Schizotypal Personality Disorder
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7
Q

A syndrome characterised by an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

A symptom of which conditions?

A

Psychosis

a SYMPTOM of:
 - schizophrenia
 - delirium
 - severe affective disorder
   (depressive or manic episode w/ psychotic symptoms)

NOT present in personality disorders

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8
Q

In cluster B personality disorders, the prominent problems are with…

e.g….

A

keeping feelings tolerable without acting

E.g…
Antisocial Personality Disorder
- violate others’ rights (often criminal behaviour)
Narcissistic Personality Disorder
- very entitled + grandiose, unable to see others’ needs
Borderline Personality Disorder
- try to manage feelings with self-harm
Histrionic Personality Disorder
- attention seeking driven by anxiety over how they seem

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9
Q

In cluster C personality disorders, the prominent problems are with…

e.g….

A

anxiety and how it is managed (in relationships)
(far less dramatic than A + B)

E.g.
Obsessive-Compulsive (Anankastic) Personality Disorder
- obsession with orderliness, perfectionism and control
Avoidant Personality Disorder
- social inhibition, feeling of inadequacy
Dependent Personality Disorder
- clinging + fear of separation

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10
Q

Management of Borderline Personality Disorder

A

Dialectic Behavioural Therapy (DBT)
- aims to change behavioural patterns

Mentalization-Based Treatment

  • focuses on separating their own and others’ thoughts and feelings
  • often successful in a group

Symptomatic prescribing

Treatment of co-occurring mental illness

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11
Q

A neurodevelopmental disorder defined by persistent, pervasive* and distinctive behavioural abnormalities

Cause, presentation, management

A

Autism spectrum disorder

Cause: Highly heritable

Presentation: deficits in reciprocity and communication, repetitive behaviour

Management: recognition of disability, establish needs, appreciate can’ts vs won’ts, psychopharmacology

Male:female = 3:1
*Pervasive = across life span (onset <3yrs) and across settings
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12
Q

a childhood disorder that is defined by a pattern of hostile, disobedient, and defiant behaviors directed at adults or other authority figures

features

A

Oppositional Defiant Disorder (ODD)

Features:

  • irritable and “headstrong” temperament
  • behaviour is learned
  • enacted to obtain a result
  • associated with adversity
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13
Q

Attention deficit hyperactivity disorder (ADHD)

Features

A
  • aggression (if present) is impulsive
  • poor control and ability to obtain a goal
  • often remorseful
  • resistant to behavioural management
  • stronger genetic (than environmental) component
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14
Q

A condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts
But their brain is structurally normal

Management

A

Functional Neurological Disorder (FND)

Treatment:
explanation!, medications for comorbid mental health problems, CBT/IPT, other therapies (e.g. OT)

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15
Q

Repeated (2+) episodes of depression and mania or hypomania

Management

A

Bipolar affective disorder (just called bipolar disorder if no depression)

Management: Stop/ do not prescribe antidepressants (even in depressed phase)

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16
Q

Persistent (several months) symptoms of human anxiety, not confined to a situation or object

Presentation, diagnosis + management

A

Generalised Anxiety Disorder (GAD)

Presentation: psychological arousal, autonomic arousal, muscle tension, hyperventilation and sleep disturbance

Diagnosis: GAD-7 questionnaire

Management:
Step 1: identification + assessment
Step 2: *Self-help/ psychoeducational groups
Step 3: **CBT/ applied relaxation or drug therapy (SSRI/SNRI/pregabalin)
Step 4: specialist CMHT referral

  • Low-intensity psychological intervention
  • *High-intensity psychological intervention
17
Q

A condition with the same core features as GAD but only in specific circumstances

Examples, presentations and management

A

Phobic Anxiety Disorders (e.g. specific phobias, social phobia, agoraphobia)

Presentation: phobic avoidance

Management: CBT, SSRIs

18
Q

Inappropriate anxiety in a situation where pt. feels observed/ could be criticised (restaurants, shops, queues, public speaking)

Presentation

A

Social phobia

Presentation: blushing and tremor predominate

19
Q

Obsessions or compulsions (usually both) which must impair function

presentation + management

A

Obsessive Compulsive Disorder (OCD)

Presentation:

  • Recurrent, unwanted, intrusive, obsessional thoughts
  • Compulsive, repetitive acts or rituals
  • above must be ONE of the following:
    1. time consuming (>1hr)
    2. significantly distressing
    3. causing functional impairment
Management:
1st Line: CBT (including Exposure and Response Prevention)
2nd Line: High dose SSRIs
3rd Line: Clomipramine (TCA)
4th Line: Buspirone + SSRI
20
Q

Delayed and or protracted reaction to a stressor of exceptional severity

Presentation + management

A

Post-Traumatic Stress Disorder (PTSD)

Presentation:

  • Hyperarousal (anxiety, irritability)
  • Re-experiencing phenomena (flashbacks, nightmares)
  • Avoidance of reminders (emotional numbness, cue avoidance, recall difficulties)

Management: survivors screened at 1 month, trauma focused CBT, medication (SSRIs, sedatives)

21
Q

Recurrent panic attacks and persistent worry about further attacks

Management

A

Panic disorder

Management:

  • mild-mod: self-help
  • mod-severe: psychological therapy (CBT)/ meds (SSRI)
22
Q

Mental disorders due to common, demonstrable aetiology leading to cerebral dysfunction

Types

A

Organic Mental Disorders

Primary – direct effect on the brain (e.g. cerebral disease, head injury)

Secondary – systemic disease affecting the brain (e.g. endocrine conditions)

23
Q

Encephalopathy (delirium) seen in advanced liver disease due to build up of toxic products (e.g. ammonia)

Presentation

A

Hepatic encephalopathy

Presentation: general psychomotor retardation, drowsiness, fluctuating confusion, asterixis

((improves as liver function improves))

24
Q

Syndrome of impairment of recent and remote memory

Cause, presentation and management

A

Amnesic syndrome

Cause:

  • Diencephalic damage (korsakoff’s syndrome, SAH)
  • Hippocampal damage (HSV encephalitis, anoxia)

Presentation: immediate recall preserved, anterograde and retrograde amnesia, confabulation, other cognitive function preserved)

Management: treat cause, parenteral vit B1 and then oral thiamine for high risk alcoholics (prevention of alcoholic amnesic syndrome)

((almost complete recovery is possible))

25
Q

Eating disorder similar to bulimia nervosa but absence of purging behaviours

presentation

A

Binge eating disorder

presentation: eating fast, large amounts, alone. “buzzed” but uncomfortably full after eating. Followed by embarassment, shame, guilt and depression

26
Q

Bulimia Nervosa

presentation, physical symptoms, management

A

Presentation:

  • Episodes of binge eating with a sense of loss of control followed by compensatory (purging) behaviour (self-induced vomiting, laxative/diuretic abuse, excessive exercise, fasting/ strict diets)
  • occurring at least twice a week for 3 months
  • Dissatisfaction with body shape + weight
Physical symptoms:
 o	Mouth sores
o	Pharyngeal trauma
o	Dental caries
o	Heartburn/ chest pain
o	Oesophageal rupture
o	Impulsivity (stealing, alcohol abuse, drugs/ tobacco) 
o	Muscle cramps + weakness
o	Bloody diarrhoea
o	Irregular periods
o	Hypotension + fainting
o      Electrolyte imbalance (hypokalaemia)
o	Swollen parotid glands
o      Russel sign (calluses over knuckles from using hand to induce vomiting)

Management: high dose SSRI (serotonin important in modulation of appetite and satiety)

27
Q

Marked distress and disability caused by the grief reaction for > 6 months after bereavement

Management

A

Prolonged Grief Disorder

Management: counselling, behavioural/cognitive/exposure therapies, refer if significant impairment of functioning

28
Q

Insomnia

Causes + management

A

Causes*:
o Anxiety/ depression
o Physical health problems (pain, dyspnoea)
o Obstructive sleep apnoea
o Excess alcohol/ illicit drugs
o Parasomnias (restless legs, sleep walking/talking/sleep terrors/teeth grinding etc.)
o Circadian rhythm disorder (esp. in shift workers)

Management: sleep hygiene, CBT (online, cost), medication (melatonin/hypnotics - noy routinely advised)

((*rarely primary, must screen for causes))

29
Q

Binge eating =

A

eating an excessive amount within 2 hrs with a feeling of loss of control

3 - Psychiatry (2 decks)

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