Psychiatry Flashcards
Somatisation disorder
Somatisation=Symptoms
For how long the symptoms are suppose to be going on for it to be called somatisation disorder?
Multiple physical symptoms from at least 2 years.
In this patient refuses to accept reassurance or negative test results
Hypochondrial disorder is also known as
Illness anxiety disorder
Hypochondrial disorder is a
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient refuses to accept reassurance or negative test results
Conversion disorder is aka
Factitious disorder
Conversation disorder is
typically involves loss of motor or sensory function.
the patient doesn’t consciously feign the symptoms or seek material gain (malingering)
Dissociative disorder knew name is
Multiple personality disorder
Dissociative disorder is
is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
Features of Schizophrenia
Auditory hallucinations
passivity phenomena
Thought disorder
Delusional perceptions(2 stage process)=traffic light is green
other features;
impaired insight
impaired incongruity
decreased speech
Neolgism; new made up words or expressions
Catatonia; repetitive or purposeless overactivity,
Negative symptoms;
Alogia;poverty of speech
Anhedonia; lack of pleasure
Avolition; lack of motivation.
PTSD Features
re-experiencing:
avoidance:
hyperarousal:
emotional numbing
PTSD treatment
Debriefing(one time sessions not recommended)
Mild; watchful waiting for 4 weeks
Severe; trauma-focused cognitive behavioural therapy (CBT) or
eye movement desensitisation and reprocessing (EMDR) therapy
Medicine treatment; venlafaxine, SSRI’s eg sertraline or Risperidone
sections
This is used for someone over the age of 16 years who will not be admitted voluntarily. Patients who are under the influence of alcohol or drugs are specifically excluded
Section 2
admission for assessment for up to 28 days, not renewable
an Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors
one of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
treatment can be given against a patient’s wishes
Section 3
admission for treatment for up to 6 months, can be renewed
AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours
treatment can be given against a patient’s wishes
Section 4
72 hour assessment order
used as an emergency, when a section 2 would involve an unacceptable delay
a GP and an AMHP or NR
often changed to a section 2 upon arrival at hospital
Section 5(2)
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
Section 5(4)
similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
Section 17a
Supervised Community Treatment (Community Treatment Order)
can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication
Section 135
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
Section 136
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
Depression vs dementia
Depression has ( BWR MSG; biologic, worried, reluctant, MMSE, short hx,global memory loss)
S=short history, rapid onset
B=biological symptoms e.g. weight loss, sleep disturbance
W=patient worried about poor memory
R=reluctant to take tests, disappointed with results
M=mini-mental test score: variable
G=global memory loss (dementia characteristically causes recent memory loss)
Cotard syndrome?
bandy ko lagta k usk andar organs mar rahay hain,
vo non existent hai ya mar gaya hai
isliye vo khana peena bhi chor deta hai
ye severe depression aur psychotic disorders mein hota hai
Othello syndrome
remember by OH HELLO MR
delusional belief that a patients partner is committing infidelity despite no evidence of this. It can often result in violence and controlling behaviour.
De Cleram bault syndrome aka Erotomania
a person of a higher social or professional standing is in love with them. Often this presents with people who believe celebrities are in love with them.
Ekbom Syndrome
pt ko lagt aha usi skin k neechay bugs hain
the user can ‘see’ bugs crawling under their skin or can be a patient who believes that they are infested with snakes.
Capgras delusion
friends or family members have been replaced by an identical looking imposter.
MOA of Benzodiazepines
enhances the effect of GABA
increases the frequency of chloride channels
Benzodiazipines are prescribed for only how much period of time?
2-4 weeks
How to withdraw benzodiazepines?
give 1/8th every fortnight
or convert to equal dose of diazepam
or reduce dose of diazepam gradually every 2-3 weeks in steps of 2 or 2.5 mg
“time needed for withdrawal can vary from 4 weeks to a year or more”
withdrawal effects from benzodiapines can occur till?
uptown 3 weeks
Benzodiazpine MOA
Barbiturate MOA
increases the frequency of chloride channel
increases the duration of chloride channels.
most common side effect of olanzapine (atypical antipsychotics) is ?
weight gain and dyslipidemia
common side effects of atypical antipsychotics?
wt gain
agranulocytosis(clozapine)
hyperprolactinemia
names of atypical antipsychotics?
olanzapine
clozapine
quetiapine
resperidone
aripiprazole(good drug specially in case of increased prolactin)
when should clozapine be started?
clozapine should be introduced if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs (one of which should be a second-generation antipsychotic drug), each for at least 6–8 weeks.
adverse effects of clozapine(atypical antipsychotic)?
“C”LOZAPINE=DIFFICULT TO “C”ONTROL(HENCE ALOT OF SE)
CLOZAPINE IS USED FOR TREATMENT RESISTANT SCHIZOPHRENIA
BLOOD=agranulocytosis, neutropenia
BRAIN=reduced seizure threshold
HEART=myocarditis(sweating, chest pain), arrhythmia’s, GASTRO=constipation and hyper-salivation.
SSRI’s(eg Sertraline) cause which electrolyte imbalance?
Hyponatremia
MOA of Sertraline(SSRI’s)
increasing the production of, or potentiating the action of antidiuretic hormone (ADH)
Most common drugs causing hyponatremia
D CANS
Diuretics
SSRI’s
NSAIDs
antipsychotics(eg Haloperidol)
Carbamazepine
SE of SSRI’s
gastrointestinal symptoms are the most common side-effect
there is an increased risk of gastrointestinal bleeding in patients taking SSRIs. A proton pump inhibitor should be prescribed if a patient is also taking a NSAID
patients should be counselled to be vigilant for increased anxiety and agitation after starting a SSRI
Hyponatremia,gi bleed, anxiety
dose of citalopram
the maximum daily dose is now 40 mg for adults; 20 mg for patients older than 65 years; and 20 mg for those with hepatic impairment
Contraindications of SSRI’s
NSAIDs
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin
triptans/MOAI s; both increase the risk of serotonin syndrome if taken with saris
Benzodiazepines should be prescribed for what period of time?
shorter period of time(2-4 weeks)
Symptoms common in both mania and hypomania
Mood
predominately elevated
irritable
Speech and thought
pressured
flight of ideas: characterised by rapid speech with frequent changes in topic based on associations, distractions or word play
poor attention
Behaviour; khana nada aur sona kum
insomnia
risk-taking
increased appetite
Difference in mani and hypomania depends on?
Lasts for at least 7 days - Causes severe functional impairment in social and work setting
May require hospitalization due to risk of harm to self or others
May present with psychotic symptoms
Hypomania:
Lasts for < 7 days, typically 3-4 days. Can be high functioning and does not impair functional capacity in social or work setting
Unlikely to require hospitalization
Does not exhibit any psychotic symptoms(eg delusion of grandeur and auditory hallucinations)
somatisation disorder?
physical symptoms jab 2 years set nada ho satay rain
Dissociative disorder?
banda apni normal conscious life see differentiate nae kr skate api us state ko jo “fugue,amnetic ya stupor” main hot hai
isko multiple personality disorder bhi kehtay hain
ya phr dissociative anxiety disorder kehtay rain
Maunchsens syndrome aka?
factitious
means feign karna/fake karma=f3
apnay symptoms ko
jb factitious mein Matlab a Jane usko kya kehtay hain/for financial gain
malingering
Diagnosis of OCD
OCD requires the individual to have either obsessional symptoms of compulsive acts (or both) on most days for at least 2 weeks (ICD-10).
Imp points about OCD
Alcohol is sometimes used in individuals with OCD as an attempt to resist the thoughts and can have short term benefit.
up to 50% of individuals with OCD can have suicidal thoughts,
OCD determining factor/
“impairment in social functioning”
+
adherence to repetitive behaviours, routines or interests.
How to differentiate a depressive episode from OCD?
depressive episode mein mood symptoms bhi batten gey question mean where as in OCD there is a just a repetitive pattern of something
associations of OCD
depression (30%)
schizophrenia (3%)
Sydenham’s chorea
Tourette’s syndrome
anorexia nervosa
Management of OCD
If functional impairment is mild;
1.CBT and ERP.
If this is insufficient or can’t engage in psychological therapy;
2.either a course of an SSRI or more intensive CBT+ERP
If moderate functional impairment;
either a course of an SSRI (any SSRI for OCD but fluoxetine specifically for body dysmorphic disorder) or more intensive CBT+ERP
If severe functional impairment
SSRI+CBT+ ERP
if treatment with SSRI is effective then continue for at least 12 months to prevent relapse and allow time for improvement
If SSRI ineffective or not tolerated try either another SSRI
a normal grief reaction lasts unto how much time usually?
and upto?
6 months usually
sometimes it may go uptown 12 months and beyond but this is not normal, it is prolonged
delayed greif reaction
when grief starts 2 weeks after the tragedy
Imp SE of Benzos;
Anterograde amnesia
what is mood?
(climate)
Mood is the overall emotional state over a sustained period, such as the last month.
What is affect?
(Day’s condition)
Affect is the current, observed emotional state of the patient at the time of the assessment.
Restricted affect
“reduction” in the range and intensity of emotions shown.
Blunted affect
“severe” reduction in emotional expression
flat affect
“no” signs of emotional expression at all.
This can be displayed as an immobile, expressionless face, monotonous voice with no intonation and lack of animation in movement.
Labile affect
abrupt shifts, such as rapidly changing from tearful to euphoric.
Bulimia nervosa
Episodes of binge eating followed by compensatory mechanisms such as intentional vomiting, excessive wt loss, laxatives and insulin.
it is associated with low self-esteem with depressive thoughts/episodes(being withdrawn)
For the diagnosis these binge eating and compensatory mechanism has to happen every week for 3 months
Examination findings of Bulimia
- dental erosion due to the recurrent passage of gastric acid over the teeth.
- scars over the metacarpophalangeal joints due to the fingers scraping the front teeth during episodes of induced vomiting. This is known as Russell’s sign.
- Parotid gland enlargement is also seen, which would explain the patient’s facial swellings on examination.
Difference between anorexia and Bulimia
In bulimia pt has a normal bmi where as in anorexia it is less(unhealthy intentional wt loss)
Kleine-Levin syndrome
irregularly recurring hypersomnia
binge-eating
sexual behaviour disinhibition
mood disorders.
Management of Bulimia
focused guided self-help for adults
If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, NICE recommend that we consider;(CBT-ED)
children should be offered bulimia-nervosa-focused family therapy (FT-BN)
pharmacological treatments have a limited role - Fluoxetine
difference between frontotemporal dementia and Alzheimers dis
frontotemporal dementia presents early;45-60 as compared to Alzheimers and there are no visuospatial skills and day to day memory problems in FT dementia.
risk factors for vascular dementia
htn
mi
stroke
also it occurs in stepwise fashion, like the development is slowly towards dementia.
It includes shuffling gait.
delirium tremens
agitation
amnesia
hallucinations
physical symptoms;tachycarida,raised bp, pyrexia
Bipolar 1
manic episodes with severe depression
pt requires hospitalization
Biploar 2
