Psychiatry Flashcards
Conditions that can result from thiamine deficiency
Wernicke’s encephalopathy
Korsakoff Syndrome
Symptoms of Wernicke’s encephalopathy
Classic triad of symptoms (note not everyone will have all three)
Acute confusion
Ocular-motor signs e.g. ophthalmoplegia, nystagmus
Ataxic gait
Other associated symptoms:
Peripheral neuropathy
Resting tachycardia
Signs of nutritional deficiency
Treatment of Wernicke’s encephalopathy
Prophylaxis for ALL patients at risk:
IV Pabrinex BD infusion over 30 minutes for 3-7 days
Replace magnesium
DO NOT rehydrate with glucose as it exacerbates thiamine deficiency
Treat alcohol withdrawal if necessary
Can progress to Korsakoff syndrome
Symptoms of Korsakoff syndrome
Significant anterograde amnesia
Retrograde amnesia can be present but less pronounced
Confabulation
Apathy
Causes of Korsakoff syndrome
Thiamine deficiency
Untreated Wernicke’s encephalopathy
Head injury
CO poisoning
Physical health screening in alcohol use disorder
Check for stigmata of liver disease
Check for cerebellar signs (ataxia, tremor, nystagmus etc.)
Raised MCV which stays raised for up to 6 months post abstinence
Raised GGT which is the most sensitive LFT for alcohol related liver inflammation
Liver US if needed
Screening tests for substance abuse
Fast Alcoholic Screening Test
CAGE (alcohol)
CAGE-AID (alcohol and drugs)
Principles of motivational interviewing
Develop discrepancy (develop goals)
Express empathy
Support self-efficacy
Roll with resistance
Medications to prevent alcohol consumption
Disulfiram - irreversible inhibition of ALDH so alcohol cannot be converted leading to build up of acetaldehyde and symptoms such as nausea, vomiting, tachycardia, headache, flushing etc.
Acamprosate - reduces alcohol cravings by enhancing GABA transmission
Opiate replacement therapies
Methadone - long acting synthetic opioid
Buprenorphine - partial opiate agonist
Medication for opiate withdrawal
Lofexidine
MRI findings in heavy drinkers
Cortical and subcortical atrophy
Prominent white matter loss
Investigation in opioid use disorder
Urine drug screen
Gas chromatography mass spectrometry if urine screen is positive
Rapid plasma reagent if IV use suspected
HIV, Hepatitis and TB serology
Cultures to check for infection
Cannabis MOA
THC binds to cannabinoid CB1 receptors in brain
Heroin MOA
Crosses BBB and is powerful mu opioid receptor agonist
Inhibits release of GABA thus reducing the inhibitory effect of GABA on dopamine
Leads to increase in dopamine
Topics to cover when assessing alcohol misuse
Lifetime pattern of consumption - e.g. age of first drink, age of regular drinking, periods of abstinence
Current consumption - e.g. how many days a week, how much per day
Signs of dependence - e.g. withdrawal, tolerance
Social and occupational issues due to alcohol
Previous attempts to stop
Physical and mental health
Six stages of change
Pre-contemplation Contemplation Preparation Action Maintenance Relapse
Prodrome
Subtle signs such as social withdrawal, behavioural changes and functional impairment which can foreshadow schizophrenia
Negative Symptoms
Affective flattening
Alogia (poverty of speech)
Avolition (lack of motivation)
Anhedonia
Anergia (lack of energy)
Apathy
Social withdrawal
Catatonia
First rank symptoms of schizophrenia
Auditory hallucinations – especially 3rd person (people talking about you) or running commentary types
Thought abnormalities – insertion, broadcast, block, echo
Delusional perceptions
Somatic passivity – feeling that you are not in control of your thoughts and actions and/or are being influenced by another source
Diagnostic criteria for schizophrenia
At least one of the following for a month:
Thought symptoms – insertion, echo, withdrawal or broadcast
Delusional symptoms – delusions of control, passivity or perception
Hallucinations – running commentary, discussing patient, talking to patient
OR least two of the below for a month:
Persistent hallucinations of any modality
Broken train of thought leading to incoherent or irrelevant speech
Catatonic behaviour
Negative symptoms such as marked apathy, blunting or withdrawal
Significant and persistent change in behaviour
