Psychiatric Illness and Medical Comorbidities Flashcards
What are the risk factors for the development of psychosis in epilepsy?
- early onset of seizures
- female
- temporal lobe epilepsy - highest association with psychosis because associated with areas of the brain involved in emotion and behavior
- seizure frequency and severity
- duration of epilepsy
inadequate seizure control - some treatments have been associated with behavioral changes and psychotic symptoms.
Comment on the pathogenesis of psychosis in epilepsy
- Seizures that originate from the temporal and frontal loves can directly disrupt the neural circuits involved in regulating perception and behavior leading to psychotic symptoms
- Glutamate often elevated in epilepsy which can cause psychotic symptoms by overstimulation of certain brain circuits
- GABA (major inhibitory neurotransmitter in the brain) reduced levels in epilepsy which leads to an overall increase in the neural excitability and contribute to both seizure activity and psychosis
- Dopamine - seizures mainly from the temporal lobe can indirectly affect dopamine pathways leading to symptoms similar to those observes in schizophrenia
- Inflammatory responses - seizures can trigger inflammatory processes and chronic inflammation could potentially alter brain function in a way that predisposes individuals to psychosis
- Genetic factors - certain genetic factors may predispose individuals to both epilepsy and psychosis. These predispositions can affect the development and function of neural circuits, neurotransmitter systems and the brains response to injury and inflammation.
Comment of the different ways that psychiatric symptoms may present in epilepsy?
ICTAL
- ictal fear - intense fear and panic that arises as part of the seizure
- ictal psychosis - rare hallucinations or delusions that occur during a seizure
POST ICTAL
- post ictal psychosis typically emerges 12-72 hours after a seizure and can last several days
- post ictal depression - meets MDD criterion A
INTER ICTAL
- interictal psychosis
- interictal depression
- anxiety disorders - such as panic disorder due to fear of fit
- personality and behavior change
- cognitive disorders
What are some psychiatric conditions affecting those with HIV
- depressive disorders
- anxiety disorders
- bipolar disorder - not caused by HIV infection but may worsen. Manic brought on by stage 4 HIV. Irritable mood is more characteristic than elevated mood. Psychomotor slowing with cognitive slowing of AIDS dementia will replace the expected hyperactivity of mania
- HAND - HIV associated neurocognitive disorder
- psychotic disorder
Comment on the etiology of psychiatric manifestations of HIV
- direct effect of the HIV on the brain causes neuronal damage
- immunosuppression and opportunistic infections (CCM, toxoplasmosis, TBM)
- psychological stressors - diagnosis related stigma, isolation, chronic illness stress
- antiretroviral therapy - side effects may include neuropsychiatric symptoms
Describe the mechanism of TBI
- TBI - cell death in the hippocampus and other medial temporal lobe structures that occur through both necrotic and apoptotic cascades
- diffuse neuronal damage and cell loss may progress over weeks to months
- the initial insult is selectively in vulnerable regions of the prefrontal cortex, hippocampus, thalamus, striatum, amygdala and forebrain nuclei.
What are some of the DSM-5 classifications of some of the behavioral syndromes occurring after a TBI?
Delirium due to TBI
Major and minor neurocognitive disorder due to TBI
Depressive disorder due to TBI
Bipolar and related disorder due to TBI
Anxiety disorder due to TBI
Psychotic disorder due to TBI
In the treatment of HIV and psychosis, which two drugs used together can cause a potential for increased bone marrow suppression?
Zidovudine - causes anaemia and neutropenia
Clozapine causes myelosuppression and neutropenia
Which class of drugs are important to avoid in concomitant use of tenofovir disoproxil fumarate with regards to bone mineral density?
Prolactin elevating antipsychotics may cause reduced bone mineral density
Which ARVs are associated with elevated CK and why is this important in psychiatry?
Dolutegravir, emtricitabine, raltegravir
May be important to
acknowledge associated link
if diagnosis of NMS is being
considered
Which ARVs are associated with ECG changes and should therefore be avoided in psychotropic drugs causing QT prolongation
Atazanavir, efavirenz, lopinavir, ritonavir
Which ARVs cause an increased risk of seizures and should therefore not be used in conjunction with psychotropics that lower seizure thresh hold?
Efavirenz, ritonavir, zidovudine
Which ARVs are associated with metabolic abnormalities such as hypertiglyceridaemia, hypercholesterolemia, insulin resistance, hyperglycaemia, hyperlactataemia?
All combination ARVs
