Psychiatric Conditions 1 Flashcards
Acute Stress Disorder
- What is it?
- How does this differ to PTSD?
- What clinical features are seen?
- How is it managed?
- acute stress reaction occurring within 4 weeks of a traumatic event (e.g. threatened death, serious injury…)
- acute stress <4 weeks
PTSD >4 weeks - intrusive thoughts (flashbacks or nightmares)
- arousal (hyper vigilance, sleep disturbance)
- dissociation (being in a daze / time slowing)
- negative mood
- avoidance
- CBT first line
benzodiazepines can be used for agitation or sleep disturbance
-> however only with caution due to addictive potential and possible detrimental adaption
Alcohol withdrawal
- What is the mechanism in
a) chronic alcohol consumption
b) alcohol withdrawal - What clinical features are seen?
- How is it managed?
- a) enhances GABA mediated inhibition of CNS, inhibits NMDA glutamate receptors
b) the opposite - 6-12 hrs: anxiety, tremor, sweating, tachycardia
- 36 hrs: peak time of seizures
- 48-72 hrs: course tremor, tachycardia, confusion, delusions, visual + auditory hallucinations, fever
- admit to hospital if delirium tremens, seizures or blackouts
- long acting benzodiazepines e.g. chlordiazepoxide, diazepam
- IM vit B replacement
- carbamazepine may also be effective
Anorexia Nervosa
- What is the diagnostic criteria in this disease?
- What other clinical features can be seen?
- What physiological abnormalities can be seen in this disease?
- How is it managed?
- DSM 5 criteria
- restriction of energy intake relative to requirements leading to a significantly low body weight
- intense fear of gaining weight or becoming fat even though underweight
- disturbance of the way in which body shape is experienced, undue influence of body weight on self-evaluation, denial of the seriousness of low body weight - low BMI
- tachycardia
- hypotension
- enlarged salivary glands
- bloods:
- hypercholesterolaemia
- impaired glucose tolerance
- hypokalaemia
- hypercarotinaemia
hormones:
- low FSH, LH, testosterone + oestrogen
- low T3
- raised growth hormone and cortisol
mnemonic: most things low, Gs + Cs raised
Gs: glucose, growth hormone, salivary Glands
Cs: carotinaemia, cortisol, cholesterol
- Adults one of:
- eating disorder focused CBT
- Maudsley anorexia nervosa treatment for adults
- specialist supportive clinical management
Children:
1st line: anorexia family focused therapy
2nd line: CBT
Bipolar
- When does it typically develop?
- What is the definition of type I and type II and state the difference between them.
- What is the management choice for the following:
a) mood stabilisation
b) mania / hypomania
c) depression - What type of referral should be made when?
- late teen years
- type I: mania + depression (most common)
type II: hypomania + depression
main differences between mania and hypomania:
- the presence of psychotic symptoms (e.g. delusions of grandeur or auditory hallucinations)
- mania is minimum 7 days hypomania minimum 4 days
3.
a) first line: lithium
2nd line: antipsychotics can be used - valproate
b) antipsychotic + consider stopping antidepressant
c) fluoxetine
- hypomania then routine referral to community mental health team
mania or severe depression urgent referral to community mental health team
Describe the possible symptoms of
- Hypomania
- Mania
- increased activity / physical restlessness
- increased talkativeness
- difficulty concentrating
- decreased need for sleep
- increased sex drive
- irresponsible behaviour e.g. spending spree
2. all of above plus \+ inflated self-esteem / grandiosity \+ lack of social inhibitions leading to behaviour inappropriate to the circumstances \+ flight of ideas / racing thoughts
Bulimia Nervosa
- What is the diagnostic criteria?
- What clinical features might be seen in recurrent vomiting?
- How should it be managed?
- recurrent episodes of binge eating
- sense of lack of control during the episode
- compensatory behaviours: vomiting, laxatives, diuretics, fasting + exercise
- at least once a week for 3 months
- self evaluation unduly towards body shape and weight
- erosion of teeth
- Russell’s sign: calluses on knuckles and back of hands due to repeated self-induced vomiting
- ALL require referral to specialist
- bulimia self help
- if contraindicated / not working after 4 weeks give eating disorder focused CBT
- children: family focused CBT
Charles-Bonnet Syndrome
- What is it?
- What are the risk factors for it?
- complex hallucinations (often visual or auditory) occurring in clear consciousness. Insight is often preserved and usually patients have visual impairment
- peripheral visual defect
- advanced age
- sensory deprivation
- social isolation
- early cognitive impairment
mnemonic: need to know CBS to PASSE
- What is the diagnosis in a patient that believes they or part of their body is dead / non-existent?
- Why can this be dangerous and difficult to treat?
- What is diseases is this diagnosis associated with?
- cotard syndrome
- as patient can stop drinking and eating as they do not believe not to be necessary
- severe depression or psychotic disorders
What is De Clerambault’s syndrome?
paranoid delusion with amorous quality
-> typically single woman that believes celebrity is in love with her
NOTE: can also be referred to as erotomania
What is the diagnosis in a patient which believes they are infested by bugs e.g. worms, parasites, mites, bacteria or fungus?
delusional parasitosis
What is meant by the following terms?
- anhedonia
- anergia
- amotivation
- psychomotor retardation
- stupor
- lack of enjoyment / pleasure
- lack of energy
- lack of motivation
- slowing of thoughts / movement
- absence of action or speech
Describe the classic findings on mental state examination for depression
Appearance and Behaviour
- limited gesturing
- limited eye contact
- furrowed brow
- reduced facial expression
Speech reduced: - rate - pitch - volume - intonation - content \+ increased speech latency (increased time between end of your question and them starting to speak)
mood: “miserable” “empty” “black” “numb”
affect: low
Thoughts flow = slow content: - self accusatory - failure - pessimism delusions - guilt - nihilism (life pointless / doesn't exist) paranoia: increased sensitive to criticism of other + self blame
perception
increased self-referential thinking
accusatory 2nd person auditory hallucinations can occur
Cognition
slow
decreased memory + attention
Insight
preserved
Depression symptoms
- What are the 3 core features?
- What are the additional features?
- How are the following diagnosed:
a) moderate depression
b) severe depression
- depressed mood (present for most of the day most days for at least 2 weeks)
- loss of enjoyment / pleasure
- decreased energy
mnemonic: MEE (mood, enjoyment, energy)
- loss of confidence
- unreasonable guilt
- suicidal thoughts
- inability to concentrate
- increased agitation / retardation
- inability to sleep
- change in appetite (with associated weight change)
- moderate: 2 core + 4
severe: 3 core + 6
Depression in the elderly
- Older patients are much less likely to complain of low mood. What can they present with?
- How are they managed?
- physical complaints (hypochondriasis)
- agitation
- insomnia
- SSRIs
-> since TCA side effect profile much more of issue in the elderly
What factors can suggest a diagnosis of depression over dementia?
- short, rapid onset of symptoms
- global memory loss (dementia tends to be recent memory loss)
- physical symptoms: sleep disturbance, weight loss
NOTE: global memory loss + normal MMSE even more so
