Psychiatry Flashcards
Third-person auditory hallucinations
Schizophrenia
Mesocortical dopamine hypoactivity
negative and cognitive symptoms in
schizophrenia
subcortical dopamine hyperactivity
psychosis
Dopamine pathways in the brain
tuberoinfundibular (concerned with prolactin release), nigrostriatal (extra pyramidal motor movements), subcortical and mesocortical (sometimes known as mesolimbic system) (motivation and reward). The latter is dysregulated in schizophrenia (see above point).
Mesolimbic
Da blockade - Depression
- Da agonism - psychosis
Clozapine
Need to try 2 other anti-psych and be a consultant to prescribe. Lots of monitoring once a week for the first 6/12, then once every 2 weeks for the next 6/12 then every four weeks thereafter and one month after discontinuation.
Limbic system functions
(M2OVE - Motivation, memory, olfaction, visceral afferents and Emotion)
Brain changes in schizophrenia
educed frontal lobe volume (and grey matter), enlarged lateral ventricles, reduced grey matter in the temporal cortex.
Pressure of thought
varied ideas in abundance (characteristic of mania but can also be seen in schizophrenia)
Poverty of thought:
patient reports lack/absence of thoughts
thought blocking:
abrupt and complete interruption of stream (strongly associated with schizophrenia)
Flight of ideas
quickly moving from one topic to another but there is a link unlike in
knight’s move thinking where there does not appear to be a link between point A and
point B. - seen in bipolar during manic phase
Treat EPSE with
procyclidine
Amygdala
involved in normal response to threat
PFC
dampen downs amygdala response to threat ( fewer connections less effective)
Management of OCD
- SSRI, 2. SSRI, 3. TCA or SSRI, 4. SSRI or TCA - (TCA used is
chlomipramine) so essentially an SSRI and if there is a partial response at any of those
points, consider CBT as an adjunct
Learning disabilities
borderline 70-80 ish, mild 50-69, moderate 35-49, severe 20-34,
profound <20
Beck’s triad
-ve feelings about self, world and future
NMDA antagonists produce
psychotic symptoms
Alcohol withdrawal
use chlordiazepoxide ( 30mg QDS, 25mg QDS, 20 mg QDS, 15mg QDS, 10mg QDS, 10mg TDS, 10mg BD, 10mg OD - nocte).
alcohol withdrawal seizures
within 48 hours
Delirium tremens
between 48 and 72 h
Eosinophilic inclusions
Lewy bodies (LBD and PD)
