Psychiatry Flashcards
What is schizophrenia?
Psychiatric condition characterised by disturbed thoughts, perception, mood and personality. There are positive and negative symptoms. The higher number of positive symptoms the more severe/poorer prognosis there is.
Positive symptoms are: delusions, hallucinations, disorganised thoughts/speech
Negative symptoms: decreased motivation, poor self care, social withdrawal
Risk factors for schizophrenia?
FH Premature birth Abnormal early development Social isolation Abnormal/disruptive family upbringing Drug use (e.g. cannabis)
What are the first rank symptoms of schizophrenia?
Auditory hallucinations, Thought broadcast Thought withdrawal Thought insertion Delusional perception and of control
How long do symptoms need to be present to make a diagnosis of schizophrenia?
For at least one month
How is a diagnosis made for Schizophrenia?
Based on clinical presentation + CT (to rule out pathological causes such as masses)
+ toxicology screen
Management of Psychosis?
1st line - Olanzapine, Risperidone and Clozapine are now first line (due to lower risk of extrapyrimdal symptoms)
2nd line (for medications)- Chlorpromazine (& other 1st gen)
+
CBT
3rd line - Clozapine
Treatment resistant schizophrenia may receive ECT
What are poor prognostic factors in schizophrenia?
FH of schizophrenia History of substance use Young age of onset Male gender Insidious (chronic) onset No recognised precipitant Chaotic/toxic home relationships/environment Poor employment record
What are good prognostic factors for schizophrenia?
Older age Acute onset Recognisable precipitant Stable and nurturing relationships/home environment FH of mood disorders
What is OCD?
An anxiety disorder characterised with obsessional thoughts and or compulsive acts.
Occurs most commonly in late adolescence/early 20s – can happen at any age though
Linked to inadequate serotonin regulation
How does it present?
Obsessions are thoughts/images that are: recurrent, persistent/intrusive, occurring against persons will, recognised as a product of ones own mind, if resisted – causes anxiety
Diagnosis of OCD?
Symptoms must be present on most days for at least 2 weeks to be diagnosed as OCD
Management of OCD?
First line – CBT or psychological therapies
2nd line – SSRI (Sertraline)
What does Section 5 (2) of the MHA refer to?
is the EDC – allows medical professionals to detain patient in hospital for up to 72 hours where they must be assessed by a senior psychiatrist or consultant
What does section 2 of the MHA refer to?
This is the equivalent of a STDC in Scotland – will detain a patient in hospital for up to 28 days to allow for full assessment and initiation of treatment
What is PTSD?
A condition that develops following a stressful/traumatic experience and typically seen in patients who were in armed forces, endured natural disasters/violent assault/sexual assault
Symptoms of PTSD?
Re-experiencing/flashbacks to the event, nightmares, intrusive memories
Avoidance: so avoiding place the event happened/situations similar
Hypervigilance, sleep problems, irritability, difficulty concentrating, feeling detached
Must be present for 1 month
Diagnosis of PTSD?
Clinical diagnosis. NICE guidance suggests PTSD can be mild, moderate or severe
Management of PTSD?
CBT or EMDR (eye movement desensitisation - not combat related Mx…)
Pharmacological – SSRI or venlafaxine
What is Capgras syndrome?
When a patient believes that a closely related person (family or close friend) has been replaced by an exact double
What is Othello syndrome?
Patients have a delusional belief that their partner is cheating on them despite no proof. Patients repeatedly accuse partners and test the, even stalk them to seek evidence.
What is Cotard syndrome?
Occurs when severely depressed or suicidal patients have intense nihilistic delusions (such as – belief that themselves of part f their body are dead or dying)
What is De Clerambault syndrome?
Patients believe that someone is deeply in love with them. They believe the person is so infatuated with them that they cannot live without them. Subject of their delusion is usually famous – athlete/movie star etc
What is Fregoli syndrome?
Fregoli syndrome is the delusional belief that one or more familiar persons, usually persecutors following the patient, repeatedly change their appearance.
What is Folie a deux?
‘Shared psychosis’
Two people who live close to each other share a delusion. Typically a family member has a true psychosis and another family member living with them starts to develop their own psychosis.
What is Korsakoff’s amnesia?
Occurs usually in patients who have a long history of alcohol abuse
They develop severe thiamine deficiency (Vit b1) and this presents as anterograde amnesia, confabulations and history of alcoholism.
Can also lead to beriberi
What is beri beri?
Deficiency in thiamine (Vit B1) All the D's Dementia, Difficulty walking... Loss of muscle function Nystagmus
What is the key type of history technique they use in Korsakoff’s?
Confabulation
Cluster A personality disorders…
Odd & eccentric.
Includes: Schizoid personality disorder and Paranoid personality disorders. Can be emotionally cold, introspective and unable to form close relationships
Cluster B personality disorders…
Dramatic and erratic/emotional personality disorders.
Includes: borderline & histrionic (regina George - vain, easily influenced). Intense unstable relationships, impulsive people who are attention seeking.
Cluster C personality disorders…
Anxious personality traits such as OCPD
Includes OCPD, Avoidant personality disorder
What is Bipolar disorder?
A relapsing and remitting mood disorder which has periods of elated mood (mania & hypomania) and periods of depressed mood
Symptoms of hypomania?
elated mood in excess of what would be expected + less need for sleep, impaired concentration and distractibility
Symptoms must be present for at least 4 days
Should be relatively mild/moderate and not impair daily functioning
Insight should be maintained + no psychotic features
Symptoms of Mania?
Elevated mood impairing daily functioning + flight of ideas + pressured speech
Symptoms must be present for at least 7 days
Symptoms have massive consequences: excessive spending, promiscuity etc
No insight + may have mood congruent psychotic features (grandiose delusions)
Mx of Acute phase (when hypomanic/manic)
If on Olanzapine and Fluoxetine and then develops acute mania - what Mx advice?
1st line - Olanazpine (mania/hypomania)
1st depressive - Quetiapine
If they are on depressive Mx - stop in mania/hypomania
Long term management of Bipolar?
Mood stabilisers
1st line - Lithium (test 12 hrs after dose weekly for 4 weeks), then monthly for 6 months then 3 months
2nd line - Lamotrigine (if pregnant)
Side effects of Lithium
Tremor, metallic taste, dry mouth, polyuria, weight gain and hypothyroidism
Lithium is also the most common cause of nephrogenic diabetes insipidus
Overdose of lithium - Stop Lithium & IV fluids
Monitoring of Lithium
Initially weekly, then once stabilised - 3 monthly
Lithium can cause neural defects so switch to Lamotrigine if patient becomes pregnant
Look at previous slide for correct answer!
Generalised anxiety disorder is..
A group of anxiety disorders in which symptoms of anxiety are inappropriate and excessive. Can lead to avoidant behaviour and low mood.
How does GAD present?
Presents with varying symptoms: Sweating Palpitations/accelerated heart rate Difficulty breathing Irritability Muscle tension Chest pain/discomfort Feeling loss of control Excessive fear of death Hypervigilance
How is GAD diagnosed?
Symptoms and signs must be present for at least 6 months with 3 of the following: Irritability Nervousness Poor concentration Insomnia Easily fatigues Muscle tension Restless
Management of GAD?
1st line - CBT
1st line Meds - SSRIs
2nd line Meds - Venlafaxine
Drug Side effects
…
What is tardive dyskinesia?
Which drugs give you tardive dyskinesia?
Treatment?
Tardive dyskinesia
- repetitive, involuntary & purposeless movements such as lip smacking or grimacing
Haloperidol & prochlorperazine
Mx - tetrabenazine
Which drug has a risk of agranulocytosis?
Clozapine
Main side effects of SSRI’s (sertraline)?
Feeling weak,
Lethargic
Muscle cramps
*Hyponatraemia
