Psychiatry Flashcards
Extrapyramidal SE: name and define
Extrapyramidal side effects are
a group of symptoms that can occur in people taking antipsychotic medications
an inability to sit still,
involuntary muscle contraction,
tremors, stiff muscles,
involuntary facial movements.
What is?
Parkinsonism
is an umbrella term that refers to brain conditions that cause slowed movements, rigidity (stiffness) and tremors.
These conditions can happen for many reasons, including genetic mutations, reactions to medications and infections.
Lewy body dementia (LBD)
is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain.
These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood.
Pseudomnesia (pseudomemories):
consists of 2 examples
confabulations - false memories filling memory gaps. They are not intentional (they are never a lie) - a person is convinced of the truth of the confabulations; however, he/she can withdraw from them under the influence of evidence of their falseness (often replacing them with new confabulations);
memory hallucinations - the patient describes experiences that have never taken place and he is convinced that he has experienced them. They are also known as delusions projected into the past.
Qualitative memory disorders (paramnesia) are divided into:
Allomnesia (distorted memories)
Pseudomnesia (pseudomemories)
quantitative memory disorders (dysmnesia)
hypermnesia (overactive memory)
hypomnesia (poor memory)
amnesia (lack of memory, memory gap)
Qualitative memory disorders (paramnesia)
Allomnesia (distorted memories):
memory illusions- memories distorted by strong emotions, diseases (including mental disorders). In contrast to the physiological state, pathological memory illusions have a fixed character;
cryptomnesia - “unconscious memories”, situations, events from the past are perceived as present and completely new, e.g. unconscious plagiarism;
memory illusions of identification - the perception of events, which have never taken place as well-known (deja vu - I have already seen, deja entendu - I have already heard, deja vecu - I have already experienced), or perception of a known situation as new or unknown (jamais vu - I have never seen, jamais vecu -I have never experienced).
definition & symptoms
A schizoid personality disorder
Def: is characterized by a pattern of behaviors dominated by lack of interest in interpersonal relations and limited expression of emotions in interpersonal contacts with the onset most often in adolescence.
Symptoms: The main symptom is the limitation of interpersonal relations, which are usually confined to the family.
Other features:
**emotional coldness **that gives the impression of isolation from the surroundings, perceived as a flattening of affect.
insensitivity to prevailing social norms and conventions,low libido, indifferent to either praise or criticism from others the inability (and lack of need) to express both positive and negative feelings towards others
The REM phase
- is a sleep phase with Rapid Eye Movement.
-At this stage of sleep, there is a high brain activity (comparable to that in the state of wakefulness),
-the breathing is irregular, the heart rate increases, dreams arise, and the tension of striated muscles is abolished (episodic muscle contractions appear in EMG).
The NREM phase (Non-Rapid Eye Movement) is a sleep phase with no rapid eye movements, which is divided into:
**NREM 1 **- state of transition from wakefulness to sleep; eye movements are slow, floating, and EMG recording is medium-voltage;
**NREM 2 **- a state in which a person has already fallen asleep, but the sleep is light and the sleeper is quite easily awakened; eye motions become slower and finally- completely disappear, EMG recording is low-voltage;
NREM 3 - deep sleep, during which the body relaxes most and it is the hardest to wake up the sleeper; a short period of disorientation is observed after waking up; lack of eye movements, EMG recording is low-voltage.
We divide physical activity disorders into quantitative and qualitative:
Quantitative:
psychomotor agitation
psychomotor retardation
stupor
Qualitative:
We divide physical activity disorders into quantitative and qualitative:
Qualitative:
cataplexy
catatonia
catalepsy
mannerisms
grimacing
posturing
echopraxia
tics
Donepezil and rivastigmine
- are acetylcholinesterase inhibitors, which are included in the group of pro-cognitive drugs.
- These drugs are used in Alzheimer’s disease
- their task is to extend the period of better functioning and independence
- and to reduce behavioral disorders.
Memantine
- an NMDA receptor antagonist is also included in the group of pro-cognitive drugs.
-In case of mild to moderate dementia, therapy starts with an acetylcholinesterase inhibitor, and if one of the AChEIs does not work, it can be changed to another one.
-In case of moderate to severe dementia, memantine or combination therapy is used. Memantine monotherapy is recommended in case of contraindications to AChEIs, poor tolerability or documented lack of efficacy.
Quetiapine
is a second generation mood-stabilizer with antidepressive effect.
Doxepin
-is a tricyclic antidepressant, non-selective monoamine reuptake inhibitor (mainly noradrenaline), which also inhibits serotonin reuptake.
-It has anxiolytic and sedative effects.
-It has a weaker antidepressant effect and much weaker cholinolytic effect than amitriptyli
Carbamazepine
- is a derivative of dibenzoazepine with a structure similar to tricyclic antidepressants
- it is an anticonvulsant
- anticonvulsant effect, it has a mood-stabilizing effect
- used in the treatment of mania in the course of bipolar disorder.
Depressive syndrome
-manifests itself with thoughts and tendencies to suicide, but the source of these thoughts are not voices in the head
-it is the feeling of hopelessness, negative thinking about oneself and the environment.
Paranoid (delusional-hallucinatory) syndrome
- consists of delusions of a non-systematic nature (i.e., exposure, overwhelming, referring and persecuting) and hallucinations or pseudo-hallucinations (usually auscultatory).
- ** Auditory hallucinations** are common in paranoid syndrome.
- The sick hear voices from outside commenting on his behavior, calling him names, persistently ordering him to perform an action (in this case, to commit suicide).
- Such symptoms are characteristic of** paranoid schizophrenia**
Paranoic syndrome (paranoia, insanity)
- is characterized by a coherent system of delusions with a specific and defined content (delusions of grandeur, somatic, jealousy, persecutory) that inspire the patient to take consistent action.
- Referred to as “persistent delusional disorder” in ICD-10.
- Paranoid delusions can be proved logically, they are synthymic (adapted to mood) or catatonic (wishful, detached from reality).
- They are consistent with the nature of the patient and have a fairly probable content.
Alcohol dependence syndrome
- is a group of symptoms, especially vegetative symptoms, of behavioral and cognitive disorders.
- Drinking alcohol dominates over other activities and is accompanied by a strong craving for alcohol which is difficult to control.
In the catatonic syndrome
-the most common are movement disorders:
-slowing down and reducing reactivity in response to stimuli, up to extreme forms such as stupor and mustism or motor agitation
-Qualitative disorders of activity include:
-catalepsy (waxy flexibility, active and passive negativism, freezing, prescriptive automatism, -echopraxia
-echomimia
-echolalia.
alcohol hallucinosis TX
**The treatment of choice are neuroleptics, primarily haloperidol.
The mood stabilizers with an antidepressant effect, which should be the first-line drugs in the therapy of depression in the course of bipolar disorder, include
lithium
quetiapine
lamotrigine (the last one additionally intensifies effects of antidepressants
Which meds are used to treat manic phase of bipolar disorder.
Valproic acid and haloperidol
Define & SE
Clozapine
- is the most effective antipsychotic drug
- serious side effects:
- including leukopenia, convulsions
- tachycardia, drowsiness,
- sedation, dizziness,
- constipation, excessive production of saliva.
- The most serious complication of clozapine treatment is agranulocytosis (neutrophil count <500 / mm3).
- For this reason, the complete blood count is monitored in patients during pharmacotherapy.
- Note: due to its severe complications, is used in treatment-resistant psychosis
The clinical presentation consists of:
neuroleptic malignant syndrome
disturbances of consciousness
increased body temperature
increased muscle tone
vegetative symptoms (sweating, tachycardia)
increased level of CPK (creatinine phosphatase)
Capgras syndrome
one of the identification disorders
patient thinks that someone he knows is actually a doppelganger
Othello syndrome
-otherwise alcohol paranoia , morbid jealousy, pathological jealousy
-it is more common in men
-caused by many years of intense alcohol use
often among those addicted with suspicious, jealous nature
-the diagnosis is based on absurd delusions
-the diseased questions his spouse’s fidelity, can be aggressive towards him or his alleged lover
Cotard’s syndrome
- also known as walking corpse syndrome
-the delusion of negation
-patient thinks that his internal organs are rotten, atrophic or non existent
-patient might believe he is dead
-most often accompanied by severe depression with psychotic symptoms
Korsakoff syndrome
-otherwise referred to as Korsakoff psychosis or alcoholic amnestic syndrome
-deep, organic brain damage, mostly persistent, caused by alcohol abuse
-it manifests itself as amnesia and filling memory gaps with confabulations
-relatively good recall of events that took place before the illness
-no criticism when it comes to realising the disease
-an important cause of its occurrence is a chronic vitamin B1 deficiency leading to damage to the brain regions responsible for memory
Ganser’s syndrome
-one of dissociative disorders
-it may be linked with severe stress
-the patient provides approximate but incorrect answers to simpler questions, he may not have a problem with answering complex questions
-it should be differentiated with simulation (it often concerns people who are in danger of being imprisoned)
parahallucinations (hallucinoids)
-perception disorder, the patient realizes his perceptions are not real
-characteristic for CNS disorders of an organic nature
-may accompany epilepsy or brain tumors
cenesthetic hallucinations (somatic, body sensation)
-there is a false perception of sensations
-the patient feels tingling, waves passing through his body, worms walking on/under the skin, etc.
namee 3
What type of delusions occur in schizophrenia
Persecutory delusions, control delusions, grandiose delusions
Nihilistic delusions
-also known as délires de négation, are specific
-sychopathological entities characterized by the delusional belief of being dead, decomposed or annihilated,
-having lost one’s own internal organs or even not existing entirely as a human being
Fluoxetine -
-SSRI (selective serotonin reuptake inhibitor)
-used to treat depression, obsessive-compulsive disorder, bulimia
Reboxetine
- NRI (selective norepinephrine reuptake inhibitor),
- used in the initial and maintenance treatment of depression
Quetiapine
- a benzodiazepine derivative, an atypical antipsychotic (mainly by blocking dopaminergic and serotonergic 5-HT2 receptors)
Trazodone
- a serotonin reuptake inhibitor, 5-HT2 antagonist
- used to treat depression, also with anxiety
Venlafaxine
- is a drug that inhibits the re-uptake of serotonin and noradrenaline (SNRI) , a weak dopamine uptake inhibitor
- Used in the treatment of depression, depression with anxiety, generalized anxiety disorder, social phobia, panic disorder.
Korsakoff syndrome
-otherwise described as Korsakoff psychosis or alcoholic amnestic syndrome
-Deep, organic brain damage, mostly persistent, caused by alcohol abuse
-manifested by memory disorder and filling memory gaps with confabulations
-Relatively good recall of pre-illness events
-Lack of insight
-An important cause of its occurrence is a chronic vitamin B1 deficiency leading to CNS damage
emergency treatment for Panick Attack
-
short-acting benzodiazepines: alprazolam,lorazepam
applied up to 6-8 weeks
-chronic treatment includes the use of SSRIs and SNRIs (paroxetine, venlafaxine)
-psychotherapy
Beck’s test - Beck Depression Scale
- a questionnaire consisting of 21 questions, helping to assess the severity of depression and to control the course of treatment.
- The test itself does not allow us to recognize depression in a patient, it only assesses his mood, the most important thing is the examination by a psychiatrist or psychologist.
The MADRS scale (Montgomery-Åsberg Depression Rating Scale)
is used to assess the severity of depressive symptoms.
MMPI - Minesocki Multidimensional Personality Inventory
- is a very extensive (> 500 questions) self-report questionnaire (filled in by the patient) that allows to define the personality and the occurrence of mental disorders in a given person, e.g. anxiety disorders, depression, hypochondria.
- Useful in screening candidates for certain job positions (e.g. military), college, etc.
Mini Mental State Examination test
- is a short screening test for assessing the presence of cognitive impairment in patients.
- The test takes approximately 5 minutes to complete.
- Assesses orientation, memory, attention, counting, linguistic and visual-spatial functions.
- A diagnosis of dementia cannot be made on the basis of the test alone. Its result may be influenced, among others, by age, gender or education of the patient.
HAMA-A Scale
-is also known as the Hamilton Rating Scale for Anxiety -HAMA,
-used to assess the clinical features of anxiety and to assess its severity.
It is not recommended to combine moclobemide with:
-serotonergic drugs: SSRI, clomipramine, pethidine
-sympathomimetic drugs
-anti-migraine drugs
Clomipramine
- belongs to the tricyclic antidepressants, it works by inhibiting the reuptake of monoamines: serotonin and norepinephrine
- the effect of which is an increase in the concentration of these substances in the synaptic spa
Moklobemide
- is a** reversible monoamine oxidase A inhibitor**
-is responsible for inhibiting the breakdown of catecholamines such as dopamine, serotonin and norepinephrine in the CNS.
-Increased concentration of amines in the synaptic cleft improves motor work, mood and quality of sleep, but the simultaneous administration of drugs that increase the concentration of serotonin (SSRI, TLPD, pethidine) is associated with the risk of serotonergic syndrome.
-For its prevention, after stopping treatment with an SSRI, you should wait 4-5 t1/2 before starting treatment with moclobemide.
Dyskinesia
-(involuntary movements) is muscle movements that people with Parkinson’s can’t control.
-They can include twitches, jerks, twisting or writhing movements.
- can affect various parts of the body such as the arms, legs and torso.
“extrapyramidal effects”
- describes involuntary movements that you cannot control.
- These side effects are most common when taking antipsychotic medications?
- When you experience extrapyramidal effects, movements that were once voluntary happen without your control.
What are the 4 extrapyramidal symptoms?
- acute dyskinesias and dystonic reactions,
- tardive dyskinesia,
- Parkinsonism,
- akinesia,
- akathisia,
- neuroleptic malignant syndrome.
akathisia
-feeling of internal restlessness or jitteriness
-People with akathisia feel a strong compulsion or need to move — mainly, their lower extremities from their hips to their ankles.
-Cross and uncross your legs repetitively.
-What are examples of akinesia?
Akinesia
-diminished spontaneity characterized by motor slowness and stiffness,
-Akinesia is the absence of movement.
-A person with akinesia cannot move their muscles, even if they try
Depersonalization-derealization disorder
occurs when you persistently or repeatedly have the feeling that you’re observing yourself from outside your body or you have a sense that things around you aren’t real, or both
What disorders have derealization as a symptom?
Health conditions linked to derealization include:
Seizures.
Dementia.
Drug abuse.
Schizophrenia.
Panic attacks.
Depression.
like amnesia.
Apathy
-is a lack of feeling, emotion, interest, or concern about something. It is a state of indifference, or the suppression of emotions such as concern, excitement, motivation, or passion.
- This individual has an absence of interest in or concern about emotional
Akinetic mutism
- is a medical term describing patients tending neither to move (akinesia) nor speak (mutism).
- first described in 1941 as a mental state where patients lack the ability to move or speak.
- eyes may follow their observer or be diverted by sound.
- Patients lack most motor functions such as speech, facial expressions, and gestures, but demonstrate apparent alertness
abulia or aboulia
-(from Ancient Greek: βουλή, meaning “will”),
-refers to a lack of will or initiative and can be seen as a disorder of diminished motivation (DDM).
-falls in the middle of the spectrum of diminished motivation, with apathy being less extreme and akinetic mutism being more extreme than abulia.
-The condition was originally considered to be a disorder of the will, and these individuals are unable to act or make decisions independently; and their condition may range in severity from subtle to overwhelming.
Diskinesia
-involuntary movements of the limbs or mimic muscles, not occurring during sleep, which intensify on emotional stimuli and are the side effect of certain medications
-one of the more frequent complications of antipsychotic treatment (treatment with high doses of drugs with a strong affinity to DA rec.). They occur more often in the elderly and in women.
Clinical picture:
Diskinesia
- involuntary movements of the face, tongue and involuntary movements in the form of sudden spasms or dystonia in the limbs.
Distinctive feature: - involuntary movements intensify under the influence of emotions and do not occur during sleep
Division of memory disorders:
Division of memory disorders:
Quantitative (dysmnesia)
(poor memory)
hypermnesia
hypomnesia
amnesia
ecmnesia
Division of memory disorders: 2 types
Qualitative (paramnesia)
(a condition or phenomenon involving distorted memory or confusions of fact and fantasy, such as confabulation or déjà vu.)
allomnesia:
memory illusions
cryptomnesia
identifying illusions
pseudomnesia:
confabulation
memory hallucinations
Cryptomnesia -
receiving memories of the past as new, present
memory hallucinations -
these are delusions projected into the past. The events did not happen, but the patient is convinced of their realism
Paramnesia -
otherwise known as qualitative memory disorders
Allomnesia or memory illusion
- is a memory disorder, which involves distorted memories of a past situation. It is generally a physiological phenomenon, which is occasionally found in most subjects.
- Pathologically, it can occur frequently in subjects with mood disorders such as depression or mania and in those with schizophrenia, paranoia or other types of delirium.
Pseudomnesia
A subjective impression of memory of events that have not occurred
atypical antipsychotics.SE
Olanzapine -
-used to treat schizophrenia and mania.
-SE: weight gain, carbohydrate and lipid metabolism disorders, sedation
atypical antipsychotics. SE
Risperidone -
- used to treat schizophrenia and bipolar disorder
- It is taken either (subcutaneous or intramuscular)
- The injectable versions are long-acting and last for 2–4 weeks.
-Common SE:
movement problems, sleepiness, dizziness, trouble seeing, constipation, and increased weight.
Serious SE:
may include the potentially permanent movement disorder tardive dyskinesia, as well as neuroleptic malignant syndrome, an increased risk of suicide, and high blood sugar levels.
-significant side effects include extrapyramidal symptoms, hyperprolactinemia
atypical antipsychotics. SE
Quetiapine -
-free of side effects from the extrapyramidal system
-sedation, weight gain, hypotension
atypical antipsychotics. SE
Amisulpride -
one of the main side effects is hyperprolactinemia
atypical antipsychotics. SE
Aripiprazole -
side effects of the drug include sedation, weight gain
Cataplexy
-sudden loss of muscle tone while a person is awake leads to weakness and a loss of voluntary muscle control.
- often triggered by sudden, strong emotions such as laughter, fear, anger, stress, or excitement.
Disorders of physical activity
quantitative:
name 3
psychomotor agitation (agitation)
stupor
psychomotor slowing
Disorders of physical activity
qualitative
name 10
cataplexy
catatonia
catalepsy (waxy flexibility)
motion stereotypes
Manners
grimaces
posturizations
echopraxia
echomimia
tics
quantitative
psychomotor agitation (agitation)
- excessive physical activity, usually together with the acceleration of the pace of thinking.
- This activity is usually pointless and chaotic (drilling, “plucking” clothes, twisting hands), but it can also be performed for some purpose (eg, discharge of tension) - then the patient’s behavior is cohesive;
quantitative
psychomotor slowing
- lowering the range and pace of physical activity, thinking and speech. Every movement in the patient’s sense requires a lot of effort;
quantitative
stupor
- immobility connected with mutism and reduction / elimination of reactivity to stimuli, which may be accompanied by disturbances of consciousness.
- Causes:
- mental diseases (catatonic schizophrenia, depression, dissociative disorders), organic changes in the CNS (tumors, inflammation, condition after stroke);
qualitative
cataplexy
- sudden loss of muscle tone, which leads to a fall; it is a symptom of narcolepsy;
Qualitative
catatonia
- a resting increase in muscle tone which disappears during active or passive movements;
Qualitative
catalepsy (waxy flexibility)
- increased muscle tone connected with keeping the body or part of the body (eg limbs) in the position given by another person (freezing);
Qualitative
motion stereotypes
- persistently repeated, seemingly deliberate but non-functional movements or actions (eg rocking, shaking hands)
Qualitative
Manners
- bizarre, inadequate to the situation and gestures / movements incomprehensible to others;
Qualitative
grimaces
- bizarre, inadequate to the situation and mimic expression unintelligible to others;
Qualitative
posturizations
- adopting bizarre, often uncomfortable body positions;
Qualitative
echopraxia
- recreation of other people’s movements;
Qualitative
echomimia
- reproduction of other people’s facial expressions;
Qualitative
tics
- sudden, involuntary, non-rhythmic cramps of specific muscles or muscle groups (muscles of the face, neck, shoulder girdle).
- Complex tics are, for example, involuntary bouncing, hitting. We can also distinguish vocal tics: simple (grunting, hissing) and complex (repeating words / sentences).
negative symptoms of schizophrenia, according to Bleuler, belong (4xA)
- autism - self-closeness, focus on internal life
- blunt affect- emotional rigidity, an impression as if the patient was separated from the environment and their own feelings
- association disorders - derailment, patient’s statements are inaccurate, there is no logical sequence
- symptoms of** “ambi”**
ambivalence** - coexistence of conflicting, mutually exclusive feelings,
ambisentency - coexistence of conflicting judgments,
**ambitendency **- coexistence of conflicting aspirations
What is negative and positive symptoms of schizophrenia?
-The** positive symptoms** include hallucinations, delusions, illogical changes in behavior or thoughts, hyperactivity, and thought disorder.
-The** negative symptoms** include apathy, lethargy, and withdrawal from social events or settings
euthymia
is a normal, tranquil mental state or mood.
Normothymic drugs of the first generation:
lithium salts,
valproate,
carbamazepine.
Normothymic drugs of the second generation:
lamotrigine,
some atypical neuroleptics:
(olanzapine, quetiapine, aripiprazole)
prodromeal symptoms
early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms
According to the ICD-10 classification, in order to determine the occurrence of a depressive episode, there must be at least two of the following three symptoms for at least two weeks :
-depressed mood, ·
-loss of interest and ability to enjoy (anhedonia), ·
-reduction of energy leading to increased fatigability, reduced activity,
and** two or more** of the following symptoms:
-weakened concentration and attention,
-low self-esteem and little self-confidence,
-feeling of guilt and being worth less,
-pessimistic vision of the future,
-thoughts and suicidal acts,
-sleep disorders,
-reduced appetite.
Bipolar disorder
-in the past known as manic depression or cyclophrenia,
-characterized by episodes of depression and mania / hypomania or mixed episodes
The criterion for the diagnosis of a mania:
Diagnosis of Mania persistent, expansive or irritable mood and increased activity or energy, and presence of at least three out of seven symptoms:
Inflated self-esteem
Reduced need for sleep
Being more talkative
Accelerated course of thought
Attention dispersal
Increased social activity, sexual activity or agitation
Involvement in pleasant activities that can cause unpleasant consequences
Duration of symptoms min. 7 days
dysphoric mania
mixed manic episode
Depression - criteria similar as in the diagnosis of depression
Characteristic features of depression in bipolar disorder:
start (before 25 years)
Psychotic depression
Atypical depression (excessive sleepiness and appetite)
Postnatal depression
Resistant to antidepressants
Delirium tremens
- it is a complicated withdrawal syndrome (ie a condition after a sudden cessation of prolonged and intense alcohol consumption)
-can occur after a few hours-days after stopping alcohol consumption
-lasts for several hours-days
-one may have preceding symptoms:
-insomnia
-muscular tremor
-anxiety
-visual, auditory, tactile (cenesthetic) hallucinations
-partial criticism is preserved
-the episode can be preceded and / or ended by seizuresEarly
Criteria according to ICD-10 and symptoms:
Delirium tremens symptoms
-Finding a connection between the cessation of alcohol consumption or a significant reduction of its dose and the occurrence of disorders
finding symptoms:
-disturbances of consciousness
-hallucinations, illusions, so called “white card symptom” (the patient reads from a blank sheet)
-muscular tremors
-delusions of participating in surrounding events
-psychomotor excitement
-difficulties to fall asleep, reversal of the day-night rhythm
stimulation of the sympathetic nervous system:
-tachycardia
-high blood pressure
-mydriasis
In order to recognize delirium tremens, the first three symptoms must be noted.
Other complications co-occurring with delirium:
hypokalaemia
hypomagnesemia
metabolic acidosis
vitamin deficiencies
arrhythmias, heart failure
injuries
Conditions with a course similar to delirium tremens:
intracranial bleeding
psychosis during infection
hyper- and hypoglycemia
hepatic encephalopathy
uraemia
endocrine disorders
poisoning with other substances, e.g. medicines
Depression
- mood disorder consisting in its reduction, manifested by the occurrence of sadness and emotional indifference (the patient does not feel pleasure = anhedonia). These symptoms must persist for at least 14 days.
Mania
- it is a mood disorder in the course of which there is an elevated mood, physical hyperactivity and accelerated thinking. Symptoms must persist for at least 7 days.
hypomania
If it is less severe, then Mania
Generalized anxiety disorders
- disorders in which the patient feels a constant, generalized anxiety that is not associated with real threat, usually are accompanied by symptoms such as: tremors, increased muscle tone, tachycardia, rapid breathing, headaches.
- The patient is deeply affected by the ailments, which further intensify the anxiety.
- To recognize anxiety, generalized symptoms must persist for a minimum of 6 months.
Inhibition of thinking
- a complete retention of the train of thought, that has recently been slowed down
Thought blocking
- the train of thought that has been correct is suddenly stopped
Derailment of thinking
- loss of coherence of speech between trains of thought while maintaining the correct pace of thinking
Word salad
- an incoherence of thinking - loss of coherence of thinking and expression within sentences. The incomprehensibility of the statement results from the fact that no logical statement can be found in the patient’s speech. Individual phrases or words remain without logical connection
Thought inherence
- its other term is word incoherence
Thought disorders can be divided into disorders of:
Thought content:
Delusions
Overvalued ideas
Intrusive thoughts
Thought disorders can be divided into disorders of:
Logic:
Paralogical thinking
Dereistic thinking
Magical thinking
Ambivalence of thinking**
Thought disorders can be divided into disorders of:
Form:
name 2
space:
Slowdown
Acceleration
Inhibition of thinking
Thought blocking
Flight of ideas
quantity
Thought disorders can be divided into disorders of:
Form:
name 3
continuation of form
-Mutism
-Alogia
-Logorrhea
logorrhea: pathologically excessive and often incoherent talkativeness or wordiness that is characteristic especially of the manic phase of bipolar disorder
Thought disorders can be divided into disorders of:
“Form”
Structure (formal)
Derailment of thinking
Minuteness
Perseveration
Verbigerations
Echolalia
Thought disorders can be divided into disorders of:
Name 3 types of
“Form”
Space
Quantity
Structure
Alprazolam
- ** (Xanax)**
- a fast-acting anxiolytic drug with high potential for addiction
- used to relieve symptoms of anxiety, including anxiety caused by depression.
- It is also used to treat panic disorder in some patients
Olanzapine
- an antipsychotic medicine used to treat schizophrenia, bipolar mania
Escitalopram
- is a representative of the SSRI group which is considered thefirst line treatment in depressive episodes
- panic disorder
- social phobia(paroxetine, fluvoxamine, sertraline)
- obsessive-compulsive disorder (all drugs)
Venflaxine
- an antidepressant from the SNRI group
- used in the treatment of** depression**, also with concomitant anxiety, anxiety disorders, and social phobia.
- second most used group of drugs in the treatment of depression
- SE of venlafaxine is an increase in blood pressure, therefore, due to the diagnosis of hypertension in the patient, this drug should not be taken into account.
Treatment
ADHD
psychostimulants:
atomoxetine, methylphenidate
other drugs with proven efficacy:
TCA, bupropion, clonidine, guanfacine
Parasomnia
- abnormal behavior when waking up from sleep or changes in its stages.
- most often affect children.
- Belong to them:
somnambulism
eating disorders related to sleep
behavioral disorders during REM sleep
nightmares
anxiety at night
night moans (catathrenia)
sleep paralysis
Criteria for the diagnosis of schizophrenia ICD:
The presence of at least one of the following (persisting for a minimum of one month):
-Echo of thoughts: sending and receiving thoughts, broadcasting thoughts;
-Delusions of influence of being affected, overpowered;
-Commenting, arguing or other voices;
-Permanent delusions, culturally maladjusted and completely absurd
Criteria for the diagnosis of schizophrenia ICD:
Or the presence of at least two of the following symptoms (lasting at least 2 weeks):
-Persistent hallucinations that occur every day for at least a month, accompanied by delusions or over-valued thoughts;
-Neologisms, interrupting the course of thought or other symptoms leading to distraction or maladjustment of speech;
-Catatonic symptoms: arousal, freezing, waxy flexibility, negativism, mutism, stupor;
-Negative symptoms: apathy, impoverishment of speech, stiffness or non-adaptation of emotional reactions (not caused by depression or medication)
****Characteristic symptoms of schizophrenia = axial symptoms according to Bleuer = so-called 4A:
-Symptoms of “Ambi”,
i.e. ambivalence, ambisentency, ambitendency
-Autism
-Blunt affect (emotional stiffness)
-Associative association - derailment of thoughts
Nihilistically delusional:
Otherwise Cotard’s syndrome
-The patient’s belief that certain parts of his body do not exist or that he is already dead
-They most often accompany severe depression with psychotic symptoms
-Their occurrence is associated with an increased risk of suicide attempt
Hallucinosis
-there are poorly systematized delusions, bizarre, devoid of logic (eg thought revealing, overpowering, persecutory)
-hallucinations appear or pseudohallucinations
-they accompany disorders of thought form from paralogical thinking to derailment
Paranoid syndrome
-delusions are systematized, logical (eg grandiose, persecutory)
-the patient may take actions resulting from delusions
Ganser syndrome
-belongs to dissociative disorders, it may be related to the appearance of severe stress
-the patient provides approximate but incorrect answers to simple questions, he may not have a problem with answering complex questions
-it should be differentiated with simulation (it often concerns people who are in danger of being imprisoned)
Ekbom syndrome
-otherwise known as parasitic hallucinosis
-the patient experiences tactile hallucinations (stings, tingling) and interprets them as creeping of worms in the body (he is conviced that he is infected with parasites)
-lack of insight
-it may be associated with organic CNS damage
Liepmann’s sign
symptom characteristic in alcohol delirium
visual hallucination is induced by eye pressure
Bell’s symptom
symptom occurring in the facial nerve paralysis
turning the eyeball upwards when trying to close the eyelid
Reichardt’s sign
the symptom of a blank page
following the suggestion of the doctor, the patient reads from a blank page
Aschaffenburg’s sign
following the suggestion of the doctor, the patient talks on the phone that is turned off
Cullen’s sign
bloody lesions around the navel that may occur in severe acute pancreatitis
Nyctophobia
- fear of darkness
Musophobia
- fear of mice and rats
Ophophobia
- fear of snakes
Myzophobia
- fear of dirt
Neophobia
- fear of new situations, before changes
Claustrophobia
- fear of closed rooms
Acrophobia
- fear of heights
Arachnophobia
- fear of spiders
Pirophobia
- fear of fire
Photophobia
- fear of light
Xenophobia
- fear of strangers
There are two basic types of bipolar disorder:
Bipolar I
-mania and depression
-this type is considered a classic form of bipolar disorder
-the mania phase lasts min. 7 days
There are two basic types of bipolar disorder:
Bipolar II
-depression and hypomanic states occur
-periods of depression are significantly longer than periods of hypomania
-does not transform into Bipolar type I
-the hypomania phase lasts 4 days or longer
- Synthymia
-behaviors, experienced emotions, formulated content
commensurate with experienced experiences
Hypothymia
limiting the expression of feelings
Catathymia
transforming feelings in a wishful way under the influence of emotions that do not reflect the real situation
Athymia
loss of expressing feelings
hyperthymia
excessive emotional reaction to existing situations
medications registered in Poland for the treatment of ADHD in children?
*Psychostimulants: *
Atomoxetine
Methylphenidate
*other drugs with proven efficacy: *
TCA, bupropion, clonidine, guanfacine
Manitism
-a sense of arduous excess of spontaneously emerging topics and lines of thought, usually interfering with each other and expressing themselves in limiting fluency, clarity, content of expression.
Manitism
-a sense of arduous excess of spontaneously emerging topics and lines of thought, usually interfering with each other and expressing themselves in limiting fluency, clarity, content of expression.
slowed / inhibited thinking
-total inhibition of the thought process, which so far was slowed down
often in catatonia
mutism
-lack of verbal response, despite requests and incentives addressed to the patient
perseverations
persistent repetition of the same activity
clang associations
- verbal stereotypes
- repeating words due to the similarity of sound
- answering the same thing to different questions
Fregoli’s syndrome
-like Capgars syndrome, intermetamorphosis syndrome, and double syndrome, belong to the delusional misidentification syndrome group.
- -the belief that people known to the patient constantly change their appearance, but retain their current psychological features
- -persecutory delusions e.g. of poisoning attempts
- -anxiety, suspicion
Capgras syndrome
- The patient is convinced that the family member has been swapped for a double
- may appear in schizophrenia, dementia, head injury
Cotard syndrome
- nihilistic delusions
- patient thinks that his internal organs are broken, decomposing, or that he does not have them
- he can believe he is dead
- most often accompanied by severe depression with psychotic symptoms
Othello syndrom (pathological jealousy)
- morbid jealousy
- in its course there are delusions of jealousy, often with absurd content
- person even suspects the closest family of being partner’s lovers
- the patient is often aggressive towards his partner and alleged lovers, he follows them, sometimes he tries to kill them
- most often occurs in men addicted to alcohol as a result of brain damage
- often in addicts with prior tendencies to feelings of suspicion and jelousy
- treatment is hard and involves the use of antipsychotics
Ganser’s syndrome
- the patient simulates the occurrence of mental disorders, psychosis, dementia
- the patient provides approximate but incorrect answers to simpler questions, he may not have a problem with answering complex questions
vortioxetine
- inhibits serotonin and 5-HT3, 5-HT7 receptors, stimulates 5-HT1
- causes less intense sexual dysfunction than SSRI
- indicated for the treatment of major depressive episodes
SSRIs
- selective serotonin reuptake inhibitors
- first line in the treatment of depression
- their estimated effectiveness is approx. 70%
name 7
SSRIs
- sertraline
- paroxetine
- fluoxetine
- fluvoxamine
- citalopram
- escitalopram
- vortioxetine (according to Gałecki and Szulc)
Hypnopompic hallucinations
- it is a physiological condition
- occurs during awakening from a nightmare
- they are accompanied by confusion
- person experiencing hallucinations is not able to determine if the nightmare really happened or if it was a dream
Hypnagnogic hallucinations
- it is a physiological condition
- occur while falling asleep
- the images appearing in them are expressive and may be:
auditory
kinesthetic
visual - they are often associated with situations from the previous day
may transform into dreams
Dyssomnias
- disturbances in quality, quantity, and time of sleep
- primary insomnia
- hypersomnia - excessive sleepiness
- narcolepsy
- sleep disorders associated with nocturnal respiratory
dysfunction:
-Obstructive sleep apnea
-Central / mixed sleep apnea
-Central hypoventilation syndrome of alveoli - circadian rhythm sleep-wake disorders
other:
-periodic limb movement disorder
-RLS - restless legs syndrome
-Kleine-Levin syndrome
-sleep disorder associated with menstruation
-exogenous sleep deprivation syndrome
-intoxication
-high-altitude insomnia
Parasomnias
- disorders related to sleep phases
- nightmares-night fears
- somnambulism - sleepwalking
other:
-nocturnal bruxism - grinding of teeth
-REM sleep behavior disorder
-sleep talking
-rhythmic movement disorder
-sleep paralysis
define
Alzheimer’s disease
-the etiology of the disease is unknown
-the course of the disease is slow,progressive
-the disease *develops as a result of deposition in the brain *of
-beta-amyloid
-tau proteins
-α-synuclein
Alzheimer’s disease
genes responsible for AD development can be found on:
chromosome 21
chromosome 19 - gene coding for apo-E4
Alzheiner’s diesase
risk factors:
age
carrier of mutations in the βαAPP / presenilin 1 and 2 genes
polymorphism of the apo-E gene
low education
loneliness
lack of social relationships
Alzheimers disease
symptoms of the disease include:
memory problems
behavioral disorders
disturbances of general functioning
cause of 30-70% dementia
Alzheimers disease
Treatment in AD
*NMDA * antagonists rec. N-methyl-D-aspartate
-memantine
-used in moderate to severe AD
-leads to stabilization of the patient’s condition or to its improvement
* selective and reversible inh. of acetylcholinesterase
-donepezil
-used in all forms of AD
* tertiary selective alkaloids, reversible, competitive inh. of Ach and allosteric modulator of nicotinic receptors
-galantamine - not available in Pl
-intensifies the activity of the cholinergic system.
* Ach and butyrylcholinesterases inhibitors
-rivastigmine
-used in all forms of AD
CATAPLEXY
- a sudden drop in muscle tone without loss of consciousness, often caused by emotional factors, occurring in narcolepsy
CATATONIA
- a psychomotor disorder, it includes an increase in resting muscle tone, which disappears during movement, catatonia occurs in schizoaffective psychoses (characteristic of the catatonic form of schizophrenia), organic brain diseases, affective diseases, intellectual disabilities and somatic or metabolic diseases.
Catatonia
CATATONIC SYNDROME - subtypes:
hypokinetic - significant slowdown, complete immobility may occur, coexisting deterioration of verbal contact .
hyperkinetic - significant psychomotor agitation, with bizarre and incomprehensible behaviors, up to complete disorder. Patients are loud, talkative, destroy objects.
Qualitative disorder of activity is accompanied by other irregularities:
CATALEPSY
- a generalized state, an unnatural increase in muscle tone of a plastic nature (leads to solidification or waxiness - maintaining posture given by another person) or stiff ( board-like stiffening of the torso and limbs ), relates to disease states, but may appear in healthy people under the influence hypnosis
Qualitative disorder of activity is accompanied by other irregularities:
catatonic stupor
- a significant slowdown up to complete immobility
Qualitative disorder of activity is accompanied by other irregularities:
motor stereotypes
- mechanically repeated, non-functional, seemingly deliberate movements or activities e.g. shaking head, hands, rocking the body, hitting hands
Qualitative disorder of activity is accompanied by other irregularities:
movement mannerisms
- bizarre, inadequate to the situation and incomprehensible gestures or motor activities
BECK DEPRESSION TRIAD (Cognitive TRIAD)
- the concept introduced by Aaron Beck, derived from the cognitive model of depression, includes the occurrence of negative thoughts in three areas :
Negative view of oneself.
Negative assessment of the present and surrounding world.
Pessimistic prediction of the future.
“I am a loser, the world is hostile and the future is hopeless”
Diagnosis is made upon the following
DEPRESSION
-Occurrence for at least 2 weeks for at least 2 of 3 symptoms: depressed mood, loss of interest and ability to be happy (anhedonia), decreased energy leading to increased fatigue and reduced activity.
Additionally:
-2 or more of the following: poor concentration and attention, low self-esteem and low self-confidence, guilt and low self-value, pessimism, dark vision of the future, suicidal thoughts and acts, sleep disturbance, decreased appetite.
TO REMEMBER!
E. Bleuler described the so-called the axial symptoms of schizophrenia, which are the basis for the diagnosis of this disease, include the characteristic “4A”:
AMBIVALENCE, AMBISENTENCE, AMBITENDENCE - dual, contradictory, mutually exclusive feelings, judgments, and actions.
**AUTISM **- cutting off from reality, immersion in the inner world.
AFFECT - disturbed affect, flatness, maladjustment, lack of emotional reactions, poor facial expressions, the patient seems indifferent to everything,
**ASSOCIATIONS **- disorder, distraction, lack of connection between spoken words, lack of consistency of expression, which is a manifestation of thinking disorders.
SYMPTOMS OF SCHIZOPHRENIA
NIHILISTIC DELUSIONS
- a disorder of the content of thinking in which the patient is convinced that his body is destroyed by disease, body parts disappear or do not exist at all.
- It occurs in depression, schizophrenia, and organic disorders
Hallucinations
- a perception disorder consisting of the realistic conviction of sensory sensation (hearing, sight, smell, touch, taste) despite the lack of a stimulus that could trigger it. It belongs to the positive symptoms of schizophrenia.
PSEUDOHALUCINATIONS
- they meet the hallucinations criteria, differ in the location of their reception - they do not come from outside, but are received by the wrong receptors inside the patient - the patient’s head, abdomen
normal range of
Potassium:
3.5-5 mmol/L.
Normal range of
Pyruvate:
300-900 µg/dL.
Normal range
Sodium:
135-145 mmol/L.
Normal range
Total calcium:
2-2.6 mmol/L (8.5-10.2 mg/dL)
define
Vascular dementia
This is the result of ischemic or haemorrhagic changes related to vascular disease. It is necessary to demonstrate the temporal relationship between vascular brain damage and the onset of dementia to be established.
Typical features: moderate memory problems, impaired executive functions, problems with daily activities, changes in behavior, emotions, personality.
Survival approx. 5 years.
define- expected life span
Frontotemporal dementia
It occurs earlier, has a progressive course (approx. 10 years).
-Typical features: early personality changes and disturbances in social functioning, relatively long-lasting: memory, perception, visual-spatial analysis, praxia (long-term, apparent professional and social efficiency), also disinhibition, lack of insight, impulsiveness, distraction, apathy, abulia, antisocial behavior, vocabulary depletion to the point of anomie.
-The duration of the disease varies from 2 to 20 years. Regardless of the time of diagnosis - these patients may die after 2 years.
Dementia in Parkinson’s disease
It affects 20-40% of Parkinson’s patients.
Type:
subcortical: disturbance of attention, recall, visual-spatial, verbal fluency, limited ability to plan and use acquired information.
*Typical features: *apathy, impoverished initiative, slowing down of thought processes, depression, sleep disturbances, aggression, anxiety, hallucinations, delusions.
HEBEPHILIA
- a type of paraphilia, classified as PEDOPHILIA, in which adults prefer sexual contact with children in early puberty (11-14 years).
EPHEBOPHILIA
- adults preferring sexual contact with children in late puberty (15-19 years).
- In both disorders, the need for sexual contact with the immature is stronger than with adults.
PEDOPHILIA
- a type of sexual preference disorder in which the erotic stimulus necessary to achieve sexual arousal, its maintenance and to obtain sexual satisfaction is a child’s body which does not show signs of puberty or is in the early stages of puberty.
- It is characteristic to undertake various sexual practices with children.
FETISHISM
- port. feitico - “charm, magic,”, a type of sexual deviation, in which the source of obtaining sexual satisfaction is the need for sexual contact with a specific object, part of the human body or animal (fetish).
- This deviation is fixed and habitually repeated.
Examples of deviation and fetish:
agoraphilia - public places
necrophilia - sexual intercourse with a deceased person
coprophilia - feces and activities related to it
podoophilia - feet
urophilia - urine
EXHIBITIONISM
- Latin. exhibere - “exposing to view”, a kind of sexual deviation.
- A repetitive or persistent tendency to unexpectedly expose your genitals to a stranger and masturbate to achieve sexual satisfaction.
- This practice does not involve the desire to have a relationship with another person.
SADOMASOCHISM
- the coexistence of sadistic and masochistic needs, fantasies and desires necessary to obtain a state of sexual excitement and sexual satisfaction / Means preferring sexual activity including experiencing (masochism) and / or creating (sadism) at least one of the following sensations: pain, humiliation, restraint .
TRANSVESTITISM
- a disorder of gender identification, consisting in becoming similar to a person of the opposite sex through dress and behavior in order to achieve emotional satisfaction (dual role transvestism) or sexual (fetishistic transvestism)
agoraphilia
- public places
necrophilia
- sexual intercourse with a deceased person
coprophilia
- feces and activities related to it
podoophilia
- feet
urophilia
- urine
RECOMMENDATIONS FOR TREATMENT OF PREMATURE EJACULATION:
Pharmacological treatment:
DAPOXETINE WHEN NEEDED (short-acting SSRI, the only drug registered for the treatment of premature ejaculation
other antidepressants (not registered in this diagnosis): CLOMIPRAMINE (a tricyclic antidepressant), selective serotonin reuptake inhibitors (SSRIs) - e.g. CITALOPRAM, FLUOXETINE, FLUVOXAMINE, PAROXETINE, SERTRALINE
Mechanism of SSRI action for ejaculation:
-The ejaculation center in the medulla oblongata is regulated by the central and peripheral nervous system.
-*Inhibition of ejaculation *is most likely caused by 5-HT1B and 5-HT2C receptor activation in spinal and supranuclear centers.
-In contrast, stimulation of 5-HT1A receptors causes ejaculation.
-SSRIs delay ejaculation and are therefore used to treat premature ejaculation.
-The therapeutic effect is evident after 1-2 weeks of taking the drug.
Rysperidone has the greatest potential to cause what complication
- undesirable effect of NEUROLEPTIC MEDICINES used in the treatment of schizophrenia
- Among the aforementioned atypical neuroleptics
- HIPERPROLECTINEMIA- causes arrest of menstruation
MOA of NEUROLEPTICS on D2 receptors
Dopamine binds to the D2 receptor, which reduces the secretion of prolactin. -> Drugs blocking D2 receptors, especially antipsychotics, block the mechanisms that inhibit PRL secretion, leading to hyperprolactinaemia.
Symptoms of hyperprolactinemia
hypogonadism,
gynecomastia,
galactorrhea,
menstrual cycle disorders,
lowering libido,
fertility problems.
Classic antisychotic drugs (first generation) act mainly on?
dopaminergic receptors, which is why they often cause hyperprolactinaemia
Name SE on 5 systems
SIDE EFFECTS OF ANTIPSYCHOTIC DRUGS:
NEUROLOGICAL
Parkinson’s (extrapyramidal) symptoms: stiffness, tremor, early and late dyskinesia, akathisia, neuroleptic malignant syndrome
THE CIRCULATORY SYSTEM
arrhythmias
QTc section extension
cardiomyopathy
orthostatic pressure drops
CIRCULATORY SYSTEM
leukopenia, agranulocytosis
thrombotic states
DIGESTIVE SYSTEM
constipation
bowel obstruction
ENDOCRINE SYSTEM
hyperprolactinemia
sexual dysfunction
type II diabetes
GENERAL SYMPTOMS
weight gain
metabolic syndrome
clozapine SE
- agranulocytosis, weight gain, cardiac complications
olanzapine SE
- weight gain
risperidone, amisulpiride SE
- hormonal disorders
- Parkinson’s (extrapyramidal) symptoms: stiffness, tremor, early and late dyskinesia, akathisia, neuroleptic malignant syndrome
ziprasidone SE
-* akathisia*
- an inability to remain still.
- It is a neuropsychiatric syndrome that is associated with psychomotor restlessness.
- The individual with this conditions will generally experience an intense sensation of unease or an inner restlessness that usually involves the lower extremities.
Bipolar affective disorder (bipolar II disorder)
- is an incurable mental disorder manifested by recurrent episodes of depressed mood (depression of varying severity), elevated mood in the form of mania or hypomania, and asymptomatic periods (euthymia).
- Prevalence in the population 0.4 - 1.5%.
- It usually starts in the third decade of life, affecting both men and women equally often.
- It is associated with a significant risk of suicide (10-15% (Unipolar depression), 15-20% (bipolar disorder)).
- Mood stabilizing (normothymic) drugs are the basis of treatment.
The basic classification includes:
type 1 (BAD I, BP I)
Bipolar affective disorder
- depression + MANIA +/- euthymia
The basic classification includes:
type 2 (BD II, BP II)
- depression + HyPOMANIA +/- euthymia
(hypomanic states alternating with depression)
PSYCHOTIC MANIA
is a state of significantly elevated mood accompanied by psychotic symptoms and can only occur in BP1.
Classification and criteria - what to remember:
Diagnosis of BD requires the occurrence of at least
- 2 affective episodes: depression, hypomania, mania or mixed (simultaneous occurrence of mania and depression symptoms),
- and at least 1 of these episodes was not a depressive episode (repeated affective disorders only in the form of depressed mood are referred to as unipolar affective disorder.
Due to the frequency of relapses, the following subtypes were introduced:
rapid cycling - at least 4 episodes of affective disorders per year
ultra rapid cycling - even higher recurrence rates
cyclothymia
-constant episodes of hypomania and subdepression
- a rare chronic mental disorder.
-Minimal duration - 2 YEARS.
-The disease is characterized by persistent instability of mood involving periods of* hypomania and depression of low intensity* with possible periods of euthymia (normal mood).
-Symptoms are not sufficient to diagnose depression or mania/ hypomania.
HYPOMANIA
- mild mood increase, increase of activity and energy, well-being, reduced need for sleep, increased sexual desire, not reaching the level of severity to qualify as mania, time criterion - minimum 4 days (for mania 7 days)
DEPRESSION
– at least 2 of the 3 symptoms appear for a minimum of 2 weeks:
a) depressed mood,
b) loss of interest and ability to be happu (anhedonia)
c) reduction of energy leading to increased fatigue and reduced activity
SUBDEPRESSION
- depressed mood that is less severe than depression
EUTHYMIA
- balanced mood
MANIA
-in psychiatry means abnormal, for a given person, state of high mood, irritability, adversely affecting their daily functioning and relationships with others, which** lasts for at least 4 consecutive days **
-(an episode of hypomania can be diagnosed after 4 days
-time criterion for mania is 7 days
COMPULSIVE BEHAVIORS
- intrusive activities, repetitive actions that co-occur with obsessions (intrusive thoughts), which are a manifestation of an attempt to relieve anxiety associated with unwanted, unpleasant thoughts.
-These are the symptoms of obsessive-compulsive disorder.
POSTPARTUM DEPRESSION
- affecting up to 20% of women, differs from “baby blues” by its more severe course, chronic duration (several months), manifestation during pregnancy (DEPRESSION DURING PREGNANCY) or up to 3 months after delivery.
- This disorder meets the general criteria of depression such as loss of interest and reduction of energy, depressed mood, sleep and appetite disorders, passivity, reduced intellectual ability and concentration of attention, sense of worthlessness and recurrent suicidal thoughts lasting at least 2 weeks and includes symptoms associated with the woman’s condition such as feeling of being a bad mother, lack of interest in the child, excessive fear about the baby.
The most severe mental disorder of the postpartum period is
postpartum psychosis, which requires hospitalization.
THE DEPENDENCE SYNDROME
includes behavioral, cognitive and physiological symptoms resulting from long-term intake of a given substance
aphthous stomatitis
(canker sores) is the most common ulcerative condition of the oral cavity
INORGANIC SLEEP DISORDERS (F51)
- is a group of sleep disorders that are not associated with another disease of the nervous or somatic system.
Include:
inorganic insomnia
inorganic hypersomnia
inorganic disorders of sleep and wakefulness rhythm
somnambulism
night terrors
nightmares
other inorganic sleep disorders
inorganic sleep disorder, unspecified
EPISODE OF MODERATE DEPRESSION
- a disorder with symptoms of low mood, reduced activity and energy, lack of feeling of joy from previous interests, of moderate severity. Duration: minimum 2 weeks
Duration cryteria
DEMENTIA
- 6 MONTHS
Duration Cryteria
SCHIZOPHRENIA
- 1 MONTHS
Duration
SCHIZOPHRENIFORM DISORDER
- at least 1 MONTH, but no more than 6 MONTHS
Duration
SCHIZOPHRENIC DISORDERS
- 2 YEARS
Duration
SCHIZOAFFECTIVE DISORDERS
- delusions or hallucinations last at least 2 WEEKS
Duration
PERSISTENT DELUSIONAL DISORDER
- 3 months
Duration
DELUSIONAL (previously paranoid) DISORDERS
- 1 MONTH
duration
ACUTE AND TRANSIENT PSYCHOTIC DISORDER
- develop within 2 weeks
duration
BRIEF PSYCHOTIC DISORDERS
- at least 1 DAY, but less than 1 MONTH
duration
HYPOMANIA
- 4 DAYS
duration
MANIA
- 7 DAYS
duration
DEPRESSION
- 14 DAYS
drugs used to treat depression can also relieve pain
-venlafaxine and duloxetine from the SNRI group and milnacipran.
-Amitriptyline from the* tricyclic antidepressant group* is another antidepressant that is also used to treat depression with pain symptoms.
agomelatine
-works by regulating circadian rhythms
-is particularly recommended for depressive disorders accompanied by sleep disorders
-side effects include anxiety and headache
trazodone
-its action is based primarily on action through serotonin receptors
-It can be used in depression with sleep disorders
like agomelatine,
-it does not have an analgesic effect
-side effects, as in the case of agomelatine include headache
Lithium, which belongs to:
used in the prevention of
- the first-generation normothymic drugs,
-is used in the prevention of relapses in bipolar disorder.
Side effects and symptoms of overdose of lithium include:
Hypothyroidism
shaking hands
dry mouth
↑ thirst
irritability or drowsiness that can lead to coma
ataxia
renal failure
which may manifest with polyuria
Lithium carbonate is used in a dose of
- 750 to 1250 mg.
- Serum lithium levels must be monitored during treatment.
- Initially, when determining the dose, tests should be done once a week, then once a month.
- The recommended serum lithium level is 0.6 to 0.9 mEq / l. -It is not recommended to exceed 1.2 mEq / l.
mood-stabilizing drugs, and their side effects include:
SE of quetiapine & olanzapine
excessive sleepiness
↑ weight
mood-stabilizing drugs, and their side effects include:
SE of lamotrigine
leucopenia
skin changes
mood-stabilizing drugs, and their side effects include:
SE of valproic acid
↑ body weight
Polycystic ovaries syndrome
leucopenia
mood-stabilizing drugs, and their side effects include:
SE of valproic acid
↑ body weight
Polycystic ovaries syndrome
leucopenia
Symptoms
Anxiety is accompanied by
- somatic symptoms typical of phobias, associated with the activation of the sympathetic nervous system: **tachycardia, tachypnoe, dry mouth and sweating. **
Masochism
belongs to/define
paraphilias, or sexual preference disorders.
-It involves a disorder in the preferred manner of sexual practices.
-The source of sexual satisfaction is total submission to the sexual partner.
-This is associated with causing pain, restraint, choking, which is a source of sexual satisfaction.
-This is the only paraphilia that occurs with the same frequency in both men and women
Fetishism
-the source of sexual satisfaction is contact with an thing that is not a human, these can be body parts,
e.g. feet, but also objects such as shoes
Sadism
the source of sexual satisfaction is inflicting pain or humiliating a sexual partner
Exhibitionism
-is about satisfying sexual needs by exposing yourself, sometimes combined with masturbation, to strangers.
-The person affected by this disorder does not expect his witnesses to have sexual intercourse with him.
-The onset of disorder most often begins during puberty.
Voyeurism
-is about peeping at people who are naked or have intercourse.
-Observed people are not aware that someone is watching them.
-This conditiona can be diagnosed when peeping becomes the main form of achieving sexual satisfaction.
Hemophobia
- fear of seeing blood.
- This is the only phobia in which the parasympathetic nervous system is stimulated and consequently faints
Homichlophobia
- fear of fog
Erythrophobia
- fear of turning red
Erythrophobia
- fear of turning red
Ergophobia
- fear of work
Coitophobia
- fear of having sexual intercourse
confabulation
- is a memory error defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world.
- It is generally associated with certain types of brain damage (especially aneurysm in the anterior communicating artery) or a specific subset of dementias
Define -2 examples
Paramnesia
-is memory-based delusion or confabulation, or an inability to distinguish between real and fantasy memories.
It may refer more specifically to:
Déjà vu, the delusion that a current event has already been experienced before
Reduplicative paramnesia, the delusion that a location exists in more than one place simultaneously
ecmnesia (uncountable)
-A form of amnesia in which the patient can recall older events but not recent ones
- memory disorder, consisting in experiencing stored events from the past as present.
- They occur in* dissociative disorders*, disturbances of consciousness, amnestic and dementia syndromes.
- They belong to quantitative memory disorders.
Scoptophilia
- watching - characterized by a tendency to watch other people during sexual behavior
Frotteurism
- rubbing - here a way of achieving sexual satisfaction is rubbing against the body of a stranger, e.g. in crowded public places (trams, buses.)
Transsexualism
- belongs to gender identity disorders.
- A transsexual person wants to live and be accepted as a person of a gender different from their biological sex.
- These feelings lead to hormonal or surgical treatment, as they do not accept their own anatomical sexual characteristics. In order to diagnose transsexualism, the sense of gender identity must be constant and persist for at least two years and not result from mental disorders and somatic abnormalities.
normal sodium concentration
= 135-145 mmol/l
normal potassium concentration
= 3.5-5.5 mmol/l
The primary medications used in the treatment of bipolar disorder includ
First-generation mood stabilizers include:
lithium salts → the drug of first choice in the prophylaxis of recurrences in bipolar disorder of a classic course.
-During treatment, it is necessary to control serum lithium concentration - for prophylactic purposes it should be 0.5-0.8 mmol/l.
-You should also remember to check TSH regularly - hypothyroidism is a common side effect of lithium use.
valproate
**carbamazepine **→ especially recommended in the atypical form of the disease and in patients with the rapid cycling type in combination with lithium salts.
The primary medications used in the treatment of bipolar disorder includ
Second generation mood stabilizers are mainly atypical neuroleptics:
*name 6
clozapine (used in case of drug resistance!)
olanzapine
quetiapine
aripiprazole
risperidone
lamotrigine → a new generation antiepileptic drug, effective especially in bipolar disorder with a predominance of depressive episodes
Topiramate
is an anti-epileptic drug with limited evidence of efficacy in bipolar disorder
name 8
In the treatment of manic episode in the course of bipolar disorder, a *combination of a mood stabilizing drug *and a second-generation antipsychotic is used.
lithium carbonate
valproic acid
carbamazepine
aripiprazole
olanzapine
risperidone
lamotrigine
quetiapine
Class of drugs + indications
Venlaflaxine
is a ?
** is a norepinephrine-serotonin reuptake inhibitor (SNRI).
The indications for its use are as follows:
Treatment of major depressive episodes
To prevent recurrence of major depressive episodes
Treatment of generalized anxiety disorders
Treatment of social phobia
Treatment of* panic attacks with or without agoraphobia*
The drug that can be administered as a long-acting injection to treat schizophrenia is:
Haloperidol
There are two generations of antipsychotic drugs (neuroleptic):
I - classic/typical,
chlorpromazine, haloperidol, sulpiride
There are two generations of antipsychotic drugs (neuroleptic):
II - atypical,
clozapine, quetiapine, olanzapine
.-mechanism of action of classic neuroleptics is mainly blockade of dopaminergic receptors.
-Atypical neuroleptics also block dopaminergic receptors, but also act on other neurotransmitters, such as serotonin.
-side effects of using classic neuroleptics are extrapyramidal symptoms, e.g. stiffness, tremors or dyskinesias.
The use of second-generation antipsychotics is associated with?
-a lower risk of extrapyramidal symptoms
-may result in significant weight gain and metabolic syndrome.
Criteria for the diagnosis of Metabolic Syndrome:
For the diagnosis of the syndrome, 3 of the 5 criteria should be met.
- **waist circumference ≥80cm **for women and ≥94 in men in the European white race (Gałecki’s textbook mentions 88 cm in women and 102 cm in men);
- fasting triglycerides >1.7 mmol/l (150 mg/dl) or therapy for hypertriglyceridemia;
- **fasting HDL <1.0 mmol/l (40 mg/dl) **in men and <1.3 mmol/l (50 mg/dl) in women or treatment for this lipid disorder;
- **systolic blood pressure ≥130 mm Hg or diastolic ≥85 mm Hg, **or treatment of hypertension;
-** fasting plasma glucose ≥5.6 mmol/L (100 mg/dL),** or to treat type II diabetes.
Anankastic personality disorder
- the dominant traits in this personality disorder are excessive perfectionism, which makes it difficult to implement the plans, special attention to good organization and order, the need for strong mental control in interpersonal relations and rigid behavioral mechanisms.
- People with this disorder feel a strong need to adapt to social expectations and norms. It is common in people suffering from anorexia.
- It occurs in 1% of the population
Avoidant personality disorder
- the patient is shy and constantly feels a sense of tension, anxiety and anxiety associated with excessive analysis of one’s own behavior in social contacts.
- The most important features of this disorder are social isolation resulting from the disorders described above, a sense of maladaptation and sensitivity to negative assessments.
- It occurs in approximately 0.5-1% of the population.
Histrionic personality disorder
- people with this personality disorder have a constant need for social interest, theatrical way of expressing emotions and are easily influenced.
- They put a lot of effort into attracting attention and look for confirmation of being important in the environment.
- They over-focus on physical attractiveness.
- It occurs in 2-3% of the population.
Emotionally unstable personality disorder
- this disorder is characterized by: emotional instability, relationships and self-image, a strong sense of emptiness, the desire to avoid rejection, and a tendency to be impulsive, self-aggressive and risky.
- It is a personality disorder common in people with bulimia.
- It occurs in 2% of the population.
Bupropion should not be used in?
is associated with a risk of?
-used in a** depressed patient with epilepsy**, as it is a “stimulant” drug
-is associated with a risk of seizures.
In order to determine the presence of a depressive episode, the presence of specific symptoms should be found for 2 weeks. They are at least 2 out of 3:
depressed mood;
anhedonia;
energy decline with decreased activity;
and at least 2 of the following:
deterioration of concentration;
low self-esteem;
feeling guilty;
negative thoughts about the future;
thoughts of or attempted suicide;
problems with sleeping;
decrease in appetite
SSRIs are drugs that act as
-antidepressants.
-MOA is based on the inhibition of serotonin reuptake.
- first choice for the treatment of depression.
- individual of them are also used, for example, in:
obsessive-compulsive disorder;
anxiety disorders;
PTSD
social phobias.
Name 4
SSRIs include
paroxetine
sertraline
fluvoxamine
escitalopram
Catalepsy
- is a specific muscular rigidity, combined with the stiffening of the body posture and limb position, and bending the neck, also in unnatural positions.
- It is one of the** disorders of physical activity.**
drugs that are considered cholinesterase inhibitors
-Donepezil and rivastigmine are acetylcholinesterase inhibitors, which are included in the group of pro-cognitive drugs.
-These drugs are used in Alzheimer’s disease, and their task is to extend the period of better functioning and independence, and to reduce behavioral disorders.
are used to treat manic phase of bipolar disorder
Valproic acid and haloperidol
first-line drugs in the therapy of depression in the course of bipolar disorder
“LLQ”
The mood stabilizers with an antidepressant effect, which should be the first-line drugs in the therapy of depression in the course of bipolar disorder, include:
-lithium
-quetiapine
-lamotrigine (the last one additionally intensifies effects of antidepressants).
REMEMBER!
Antidepressants, especially TCAs (e.g. doxepin) and venlafaxine, rarely SSRI (fluoxetine) and bupropion, may cause the transition from depressive phase to a manic or hypomanic phase! Therefore, especially in the treatment of depression in the course of BD I, antidepressants should be used along with normotymics! In BD II antidepressants can be used as a monotherapy, while in the mixed affective state you should rather not use antidepressants.
REMEMBER! Antidepressants, especially TCAs (e.g. doxepin) and venlafaxine, rarely SSRI (fluoxetine) and bupropion, may cause the transition from depressive phase to a manic or hypomanic phase! Therefore, especially in the treatment of depression in the course of BD I, antidepressants should be used along with normotymics! In BD II antidepressants can be used as a monotherapy, while in the mixed affective state you should rather not use antidepressants.
Clozapine SE
- is the most effective antipsychotic drug, unfortunately, it has serious side effects, including leukopenia, convulsions, and other very common side effects: tachycardia, drowsiness, sedation, dizziness, constipation, excessive production of saliva.
-The most serious complication of clozapine treatment is agranulocytosis (neutrophil count <500 / mm3).
-For this reason, the complete blood count is monitored in patients during pharmacotherapy.
necessary to monitor the patient’s?
Olanzapine therapy
-During* olanzapine therapy* it is necessary to monitor the patient’s lipid profile, blood glucose level and blood pressure due to the possibility of developing metabolic syndrome.
-This medicine is administered at a dose of 5-20 mg.
The symptomatic treatment of choice in the case of panic disorder is the administration of:
Short-acting Alprazolam (orally)
The benzodiazepines are definitely the best medication in an ad hoc treatment.
They relieve symptoms immediately and interrupt the panic attack.
An attempt to obtain an intravenous access to administer diazepam may be difficult during an attack of anxiety, therefore the best solution is to administer alprazolam orally.
Ad hoc is a Latin phrase meaning literally ‘to this’.
Remember
What antidpressants can be uised treatment of depression in the course of BD I
Antidepressants, especially TCAs (e.g. doxepin) and venlafaxine, rarely SSRI (fluoxetine) and bupropion, may cause the transition from depressive phase to a manic or hypomanic phase! Therefore, especially in the treatment of depression in the course of BD I, antidepressants should be used along with normotymics! I
Meds used to treat manic phase of bipolar disorder.
Valproic acid and haloperidol
parahallucinations (hallucinoids)
-perception disorder, the patient realizes his perceptions are not real
-characteristic for CNS disorders of an organic nature
-may accompany epilepsy or brain tumors
Synthymic delusions (mood-congruent) are
delusions that are consistent with the patient’s mood
Medications used ad hoc in a panic attack include:
-Alprazolam
-emergency treatment - short-acting benzodiazepines: alprazolam ,lorazepam
-applied up to 6-8 weeks
-chronic treatment includes the use of SSRIs and SNRIs (paroxetine, venlafaxine)
-psychotherapy
symptoms
neuroleptic malignant syndrome:
-disturbances of consciousness
-increase in muscle tone (muscle stiffness)
-increasing body temperature
-disorders of autonomic nervous system balance (sweating, tachycardia, salivating)
-increase in creatinine phosphatase
Muscle necrosis may lead to the emergence of myoglobinuria. The syndrome occurs in about 0.2% of patients treated, more often in younger men (before the age of 40)
Late dyskinesias
- are one of the more frequent complications of antipsychotic treatment (treatment with high doses of drugs with a strong affinity to DA rec.).
- They occur more often in the elderly and in women.
Clinical picture: involuntary movements of the face, tongue and involuntary movements in the form of sudden spasms or dystonia in the limbs.
Distinctive feature: involuntary movements intensify under the influence of emotions and do not occur during sleep
Drugs for the symptomatic treatment of cognitive impairment in Alzheimer’s disease
cholinesterase inhibitors - light and moderate form
donepezil
rivastigmine
galantamine
partial NMDA antagonist - moderate and severe form
memantine
Delirium tremens (DTs)
- is a rapid onset of confusion usually caused by withdrawal from alcohol.
- When it occurs, it is often three days into the withdrawal symptoms and lasts for two to three days.
- Physical effects may include shaking, shivering, irregular heart rate, and sweating.
- People may also hallucinate.
- insomnia
muscular tremor
anxiety
visual, auditory, tactile (cenesthetic) hallucinations
partial criticism is preserved
the episode can be preceded and / or ended by seizures
stimulation of the sympathetic nervous system: tachycardia (Answer D), high blood pressure (Answer E), mydriasis
Olanzapine
- an antipsychotic medicine used to treat schizophrenia, bipolar mania
Venflaxine
- an antidepressant from the SNRI group, used in the treatment of depression, also with concomitant anxiety, anxiety disorders, and social phobia.
- They are the second most used group of drugs in the treatment of depression, but a side effect of venlafaxine is an increase in blood pressure, therefore, due to the diagnosis of hypertension in the patient, this drug should not be taken into account.
Narcolepsy
- hypersomnia involving the emergence of sudden excessive drowsiness, may occur both during the performance of motor activities and in a static situation. The sleep lasts a few dozen minutes, the patient wakes up rested.
define-belongs to them
Parasomnia
- abnormal behavior when waking up from sleep or changes in its stages. They most often affect children. Belong to them:
somnambulism
eating disorders related to sleep
behavioral disorders during REM sleep
nightmares
anxiety at night
night moans (catathrenia)
sleep paralysis
Somnambulism
- (sleepwalking)
- typical for children 4-10 years old.
appears during a deep sleep phase
more often appears in situations that are accompanied by a reduced amount of sleep, eg intensive learning and stress
usually appears about 60-120 minutes after falling asleep
the patient performs complex motor activities, e.g. walking, usually opens the eyes and a superficial contact is possible
usually the treatment consists in the recommendation of an afternoon nap and care for the patient’s safety by removing dangerous objects from the area of his bed and closing the windows and doors
if the above methods do not help, a small dose of** clonazepam** is used
Classification of thinking disorders:
Disturbance of the content of thinking
-overvalued thoughts (beliefs inconsistent with reality, generally unacceptable views, to which the patient submits to, often neglecting other areas of life. These thoughts are not maintained with delusional certainty by the patient)
-delusions (incorrect content accompanied by a strong feeling of obviousness cannot be corrected even though there is evidence that it is false. Remember that it is always associated with severe mental disorders)
-mental automatisms (the belief that you have lost influence on your behavior, thought process and body movements. Memories and experiences give the impression of strangers. They are independent of the patient’s will and directed, for example, by a higher force.)
-intrusive thoughts (recurring thoughts, fantasies, impulses that are unwanted, unnecessary or distressing and meaningless. Remember that they are always considered your own!
Classification of thinking disorders:
Disorders of the form of thinking
****disturbance of the way of thinking
racing thoughts
slowing down / inhibition of thinking
inhibition of thinking
mutism
logorrhea
perseveration
fight of ideas (mantism)
meticulousness / verbosity
****impaired thinking function
impoverishment of thinking
paralogical thinking
disjointed thinking
non-communicative thinking
dissociation
entanglement
aphasia
Manic syndrome is characterized by
- an intense, expansive or irritable mood and increased activity or energy, and the presence of min. 3 out of 7 symptoms:
grandiose delusions
Reduced need for sleep
Excessive verbosity
Acceleration of the course of thinking (racing of thoughts - answer A, flight of ideas - answer B)
Distractibility of attention
Increasing social and sexual activity or motor stimulation
Engagement in pleasurable activities that may result in unpleasant repercussions
Duration of symptoms min. 7 days
Ekbom syndrome
-otherwise known as parasitic hallucinosis
- patient experiences tactile hallucinations (stings, tingling) and interprets them as creeping of worms in the body (he is conviced that he is infected with parasites)
-lack of insight
-may be associated with organic CNS damage
Ganser syndrome
-belongs to dissociative disorders, it may be related to the appearance of severe stress
the patient provides approximate but incorrect answers to simple questions, he may not have a problem with answering complex questions
-it should be differentiated with simulation (it often concerns people who are in danger of being imprisoned)
Paranoid syndrome
-delusions are systematized, logical (eg grandiose, persecutory)
-the patient may take actions resulting from delusions
Hallucinosis
-there are poorly systematized delusions, bizarre, devoid of logic (eg thought revealing, overpowering, persecutory)
-hallucinations appear or pseudohallucinations
they accompany disorders of thought form from paralogical thinking to derailment
Catathymia
transforming feelings in a wishful way under the influence of emotions that do not reflect the real situation
Hypothymia
limiting the expression of feelings
Hypothymia
limiting the expression of feelings
Athymia
loss of expressing feelings
hyperthymia
excessive emotional reaction to existing situations
perseverations
persistent repetition of the same activity
clang associations
verbal stereotypes
repeating words due to the similarity of sound
answering the same thing to different questions
SSRIs
-selective serotonin reuptake inhibitors
-first line in the treatment of depression
-their estimated effectiveness is approx. 70%
“wait a* SEC PFF*”
sertraline
escitalopram
citalopram
paroxetine
fluoxetine
fluvoxamine
vortioxetine
vortioxetine
-inhibits serotonin and 5-HT3, 5-HT7 receptors, stimulates 5-HT1
-causes less intense sexual dysfunction than SSRI
-indicated for the treatment of major depressive episodes
name
E. Bleuler described the so-called the axial symptoms of schizophrenia, which are the basis for the diagnosis of this disease, include the characteristic* “4A”:*
-“AMBI”* AMBIVALENCE, AMBISENTENCE, AMBITENDENCE - dual, contradictory, mutually exclusive feelings, judgments, and actions.
-AUTISM - cutting off from reality, immersion in the inner world.
-AFFECT - disturbed affect, flatness, maladjustment, lack of emotional reactions, poor facial expressions, the patient seems indifferent to everything,
-ASSOCIATIONS - disorder, distraction, lack of connection between spoken words, lack of consistency of expression, which is a manifestation of thinking disorders.
Hallucinations
- a perception disorder consisting of the realistic conviction of sensory sensation (hearing, sight, smell, touch, taste) despite the lack of a stimulus that could trigger it. It belongs to the positive symptoms of schizophrenia.
PSEUDOHALUCINATIONS
- they meet the hallucinations criteria, differ in the location of their reception - they do not come from outside, but are received by the wrong receptors inside the patient - the patient’s head, abdomen.
FORMAL THINKING DISORDERS - include:
disorder of thought form, e.g
- flood of thoughts, word flooding, slowdown, inhibition, mutism, distraction, stereotype, perseverations, iterations, verbigerations, lengthiness
FORMAL THINKING DISORDERS - include:
structure and function disorders, e.g.
-distraction, schizophasia, incoherence, paralogical thinking, dereism, distraction, grammatical inaccuracy, impoverished thinking.
HEBEPHILIA
- a type of paraphilia, classified as PEDOPHILIA, in which adults prefer sexual contact with children in early puberty (11-14 years).
EPHEBOPHILIA
-adults preferring sexual contact with children in late puberty (15-19 years). In both disorders, the need for sexual contact with the immature is stronger than with adults.
EPHEBOPHILIA
-adults preferring sexual contact with children in late puberty (15-19 years). In both disorders, the need for sexual contact with the immature is stronger than with adults.
PEDOPHILIA
- a type of sexual preference disorder in which the erotic stimulus necessary to achieve sexual arousal, its maintenance and to obtain sexual satisfaction is a child’s body which does not show signs of puberty or is in the early stages of puberty. It is characteristic to undertake various sexual practices with children.
PEDOPHILIA
- a type of sexual preference disorder in which the erotic stimulus necessary to achieve sexual arousal, its maintenance and to obtain sexual satisfaction is a child’s body which does not show signs of puberty or is in the early stages of puberty. It is characteristic to undertake various sexual practices with children.
name drug - reason for amenorrhea
Amenorrhea occurred in a 25-year-old patient with schizophrenia when the pharmacotherapy was started. She was probably treated with:
-Rysperidone
-The arrest of menstruation in this case is most likely caused by HIPERPROLECTINEMIA, which is an undesirable effect of NEUROLEPTIC MEDICINES used in the treatment of schizophrenia. -Among the aforementioned atypical neuroleptics, Rysperidone has the greatest potential to cause this complication.
duration criteria
DEMENTIA
- 6 MONTHS
duration criteria
SCHIZOPHRENIA
- 1 MONTHS
duration criteria
SCHIZOPHRENIFORM DISORDER
- at least 1 MONTH, but no more than 6 MONTHS
duration criteria
SCHIZOPHRENIC DISORDERS
- 2 YEARS
duration criteria
SCHIZOAFFECTIVE DISORDERS
- delusions or hallucinations last at least 2 WEEKS
duration criteria
PERSISTENT DELUSIONAL DISORDER
- 3 months
duration criteria
DELUSIONAL (previously paranoid) DISORDERS
- 1 MONTH
duration criteria
ACUTE AND TRANSIENT PSYCHOTIC DISORDER
- develop within 2 weeks
duration criteria
ACUTE AND TRANSIENT PSYCHOTIC DISORDER
- develop within 2 weeks
duration criteria
BRIEF PSYCHOTIC DISORDERS
- at least 1 DAY, but less than 1 MONTH
duration criteria
HYPOMANIA
- 4 DAYS
duration criteria
MANIA
- 7 DAYS
duration criteria
DEPRESSION
- 14 DAYS
define / duration
CYCLOTHYMIA
- a rare chronic mental disorder.
-Minimal duration - 2 YEARS.
-The disease is* characterized by persistent instability of mood involving periods of hypomania and depression of low intensity with possible periods of euthymia (normal mood). *
-Symptoms are not sufficient to diagnose depression or mania/ hypomania.v**
agomelatine
-it works by** regulating circadian rhythms**
-is particularly recommended for depressive disorders accompanied by sleep disorders
-side effects include anxiety and headache
define/moa/SE
trazodone
-its action is based primarily on action through serotonin receptors
-It can be used in** depression with sleep disorders**
like agomelatine, it does not have an analgesic effect,
-its side effects, as in the case of agomelatine include headache
Lithium
- belongs to the** first-generation normothymic drugs**
- used in the** prevention of relapses in bipolar disorder**.
Side effects and symptoms of overdose of lithium include:
Hypothyroidism
shaking hands
dry mouth
↑ thirst
irritability or drowsiness that can lead to coma
ataxia
renal failure- which may manifest with polyuria
Lithium carbonate is used in a dose of
- 750 to 1250 mg.
- Serum lithium levels must be monitored during treatment.
- Initially, when determining the dose, tests should be done once a week, then once a month.
- The recommended serum lithium level is 0.6 to 0.9 mEq / l.
- It is not recommended to exceed 1.2 mEq / l.
mood-stabilizing drugs, and their side effects include
side effects of quetiapine and olanzapine
Quiet Olan is always what?
excessive sleepiness
↑ weight
mood-stabilizing drugs, and their side effects include:
side effects of using** lamotrigine**
poor lam has what?
leucopenia
skin changes
mood-stabilizing drugs, and their side effects include:
side effects of using valproic acid
val has gained what and 2 other conditions
-↑ body weight
-Polycystic ovarien syndrome
-leucopenia
Agoraphobia
-fear of open space or being in places full of people.
-The source of fear is also the lack of the possibility of quickly getting out of the space which is, according to the individual, a threat.
-Somatic symptoms such as tachycardia, shortness of breath, nausea and increased sweating predominate.
-The basic form of treatment is cognitive-behavioral psychotherapy
Generalized anxiety disorder
-Experienced anxiety is chronic, and stressful situations can add to it. The duration of the disorder is a minimum of 6 months.
-Patients tend to be constantly worried, which causes great discomfort. It also results in sleep disorders and sexual disorders.
Panic disorder
-characterised by:
-sudden start
short duration
-accompanying** fear of death, a feeling of derealization or depersonalization,i.e. a feeling of disconnection from the unreal environment or one’s self
-seizures are not associated with any particular situation**, often occur in a spontaneous, unpredictable way
-factors that can provoke an anxiety attack include
* stressful situations
* life-threatening conditions
* acute pain syndromes
Bordeline personality, manifests itself as:
excessive irritability
emotional instability
impulse control disorder
need of social contacts
earnest avoidance of loneliness
creating unstable relationships
undertaking risky behaviors
sense of fear and helplessness:
-which may appear as a tendency to self-destructive behavior, e.g. self-mutilation and the occurrence of addiction
narcissistic personality
the person affected by this disorder tries to be in the center of attention, expects constant praise and accepts criticism with great difficulty
histrionic personality
the behavior of the person affected by this disorder is characterized by excessive theatricality and coquettishness, excessive focus on external appearance
antisocial personality
disregard for social norms , a tendency to aggressive behavior and blaming others for their behavior and difficulty in creating lasting relationships
schizoid personality
feel safer by withdrawing from social life and avoiding entering into relationships, from the outside world, these people prefer to focus on the world of their own imagination,the features of schizoid personality include:
avoiding contact with other people, isolation
abnormal social relations
emotional coldness
Bulimia is also known as
bulimia nervosa,
-it consists of uncontrolled binge eating attacks, and later as a result of remorse, provoking vomiting.
-The disease most often affects women, usually in adolescence. This disorder affects 1 to 4% of young people.
-Bulimia symptoms are often accompanied by alcohol and psychoactive substance addiction.
-Bulimia can lead to somatic complications such as:
electrolyte disturbances
arrythmias
stomach ulcers
gastrointestinal disorders
loss of consciousness
tooth enamel damage
include SE
SSRIs are a group of drugs called selective serotonin reuptake inhibitors that are used to treat ?
** depression as well as anxiety disorders.**
In addition, side effects of treatment include:
**nausea
diarrhea
insomnia **
anxiety, fear
arythmias
but not stenocardial disorders
↑ blood pressure
hyponatraemia
↑ prolactin levels causing, among others, menstrual disorders
excessive sleepiness
extrapyramidal symptoms
weight change
both increase (more often) and decrease
↑ the risk of gastrointestinal bleeding
Serotonin syndrome is the result of
-excessive stimulation of serotonin receptors, mainly 5-HT 2A, and to excessive activation of the noradrenergic system.
It can happen as a result of:
-taking a single dose or long-term treatment with serotonergic drugs
-overdose of SSRI and SNRI antidepressants
-These drugs work through a mechanism of selective blocking of serotonin reuptake, increasing its concentration in the body
- increased muscle tone
Symptoms of serotonin syndrome include:
somnolence
disturbances of consciousness
↑ sweating
↑ muscle tone
hyperthermia
tachycardia
nausea, vomiting
skin redness
trembling
increased tendon reflexes
myoclonus
renal failure
Drugs that increase serotonergic conduction include:
SSRI, SNRI
TCAs
MAO inhibitors
painkillers such as
fentantyl
tramadol
anti-migraine drugs
triptans
ergotamine derivatives
metoclopramide
Id
it is synonymous with impetus and primal instinct
generates following strong needs and emotions
drives the need to meet needs as soon as possible
Ego
it functions in the real world
is responsible for intellect and cognitive processes
decides which needs are to be met and which are not necessary
superego
represents morality
it influences the ego in such a way that the behavior follows moral principles
its mechanisms include:
withdrawal
denial
rationalization
regression
humor
altruism
superego
-represents morality
-it influences the ego in such a way that the behavior follows moral principles
its mechanisms include:
withdrawal
denial
rationalization
regression
humor
altruism
consciousness
-has the ability to receive and* respond to stimuli *and information.
-It is also understanding our own internal experiences .
-There are physiological conditions when consciousness can be narrowed - e.g. drowsiness.
pre-consciousness
it is the boundary between consciousness and unconsciousness
it includes content that is not present in the field of consciousness
apathy
- the absence of emotional reactions
abulia
- reducing the willingness to act and think
alogia
- the poverty of the scope or content of speech reflecting the poverty of thinking
-other speech disorders, e.g. neologisms,
flat affect
- lack of emotional expression (motionless face, monotonous voice)
symptoms of disorganization
- formal thinking disorders, maladjusted affect, ambivalence (coexistence of contradictory emotions, attitudes of thoughts and desires towards people, objects, situations)
cognitive disorders
- they include disorders of perception, memory, attention, speech and thinking (the distraction belongs to the disorders of the thinking function - chaotic statements with disturbed syntax, logic and communication function)
cognitive disorders
- they include disorders of perception, memory, attention, speech and thinking (the distraction belongs to the disorders of the thinking function - chaotic statements with disturbed syntax, logic and communication function)
Positive symptoms - typical of psychotic disorders
delusions - typical for schizophrenia are delusions, interactions, referents
auditory hallucinations - mostly commenting, imperative
experiences typical for schizophrenia - echoing thoughts, thought insertion, thought blocking
catatonic behavior - stupor, excitement
Minimum duration to diagnose dysthymia:
Adults-Children
2 years in adults
1 year in children
side effects from the extrapyramidal system include
(drug-induced parkinsonism, paroxysmal dyskinesias, tardive dyskinesia, drug akathisia)
When using neuroleptic drugs, to avoid metabolic syndrome, we check:
-before treatment: waist circumference, fasting blood glucose, BMI, lipid profile, blood pressure
-after 4 weeks: BMI, blood pressure
-after 8 weeks of BMI
-after 12 weeks BMI, blood pressure, blood glucose and lipid profile
-quarterly: BMI and waist circumference
When using neuroleptic drugs, to avoid metabolic syndrome, we check:
-before treatment: waist circumference, fasting blood glucose, BMI, lipid profile, blood pressure
-after 4 weeks: BMI, blood pressure
-after 8 weeks of BMI
-after 12 weeks BMI, blood pressure, blood glucose and lipid profile
-quarterly: BMI and waist circumference
the consolidation of memory is the consolidation of information and its transfer from short-term memory to long-term memory
structure responsible for memory consolidation is the
hippocampus
Prefrontal cortex →
is responsible for coding of information in short-term memory .
Amygdala →
is involved in the processes of emotional memory.
Basal ganglia →
-are related to the processes of non-declarative (procedural) memory.
-Procedural memory holds and automatically retrieves information on how to perform previously learned activities, such as cycling, for example.
Diencephalon →
together with the frontal cortex, is responsible for extracting information from long-term memory
Qualitative disorders (paramnesia)
Allomnesia
Memory illusions
Cryptomnesia
Identity delusions
Qualitative disorders (paramnesia)
pseudomnesia
Memory hallucinations
Confabulations
Quantitative disorders (dysmnesias)
Quantitative disorders
(dysmnesias)
Hyperamnesia
Hypoamnesia
Amnesia
Ecmnesia
name 5
Venlaflaxine is a?
The indications for its use are as follows:
- norepinephrine-serotonin reuptake inhibitor (SNRI).*
Treatment of major depressive episodes
To prevent recurrence of major depressive episodes
Treatment of generalized anxiety disorders
Treatment of social phobia
Treatment of panic attacks with or without agoraphobia
- The treatment of schizophrenia is mainly based on ?
- The ideal solution is therefore?
- Medicines available in Poland are usually administered intramuscularly at intervals of?
- Name the drugs
- pharmacotherapy with neuroleptics.
- long-acting injections- they significantly improve the effectiveness of therapy.
- 2-4 weeks
- 1st generation:
Haloperidol (at a dose of 50mg every 2-4 weeks);
Flupentixol;
Zuklopentiksol.
Ecmnesia
-is memory disorder, consisting in experiencing stored events from the past as present.
-They occur in dissociative disorders, disturbances of consciousness, amnestic and dementia syndromes.
-They belong to quantitative memory disorders.
Olanzapine
-is a second-generation antipsychotic drug used in patients with schizophrenia.
-Taking this neuroleptic is associated with the greatest risk of weight gain and associated symptoms.
-In overweight and obese patients who require antipsychotic treatment, drugs with a lower risk of causing metabolic disorders should be selected.
Anankastic personality disorder
- the dominant traits in this personality disorder are excessive perfectionism, which makes it difficult to implement the plans, special attention to good organization and order, the need for strong mental control in interpersonal relations and rigid behavioral mechanisms.
- -People with this disorder feel a strong need to adapt to social expectations and norms. It is common in people suffering from anorexia. It occurs in 1% of the population.
Anankastic personality disorder
the dominant traits in this personality disorder are
a) Excessive doubt and caution.
b) Absorbing by details, regulations, inventorying, ordering, organizing, diagrams.
c) Perfectionism interfering with completing tasks.
d) Excessive conscientiousness, meticulousness and focus on productivity, neglecting pleasure and interpersonal relationships
e) Excessive pedantry and submission to social conventions.
f) Stiffness and tenacity.
g) The unreasonable presumption that others strictly subordinate their actions to the patient’s actions, or an irrational reluctance to allow others to act.
h) The appearance of intrusive, unwanted thoughts or impulses.
14
Anorexia nervosa - Somatic complications
cachexia with weakness,
dry skin, Italian (lanugo),
electrolyte disturbance (hypokalaemia),
hormonal disorders:
no menstruation
disorders of the thyroid gland and adrenal glands,
osteoporosis,
Heart arythmia,
bradycardia,
low blood pressure
fainting
bloated and painful abdomen,
anemia,
brain atrophy.
5
Anorexia Nervosa - Mental complications
depression
thoughts of suicide
anxiety disorders
concentration disorders
memory impairment
Votrioxetine
-is a drug that belongs to the group of serotonin modulators and stimulators.
-This drug is also used to treat depression.
Akathisia
- It is a subjective feeling of anxiety accompanied by moving the lower limbs, shifting from one foot to the other, moving restlessly, and the inability to stand or sit still.
- Symptoms appear after several weeks of using classic antipsychotic drugs or in connection with increasing or decreasing the doses of drugs used to relieve extrapyramidal symptoms.
Antipsychotics - extrapyramidal symptoms (EPS)
EPS risk factors
In the case of acute dyskinesia
- young age and male gender
Antipsychotics - extrapyramidal symptoms (EPS)
EPS risk factors
In the case of tardive dyskinesia,
- older age and female gender
Tardive dyskinesia
- an undesirable symptom associated with the use of classic antipsychotic drugs, consisting of the occurrence of pathological involuntary movements, usually affecting the muscles of the tongue and face, sometimes also the arms and trunk.
- irregular, involuntary, hyperkinetic movements affecting mainly muscles of the tongue, lips and face ,
- cause mouth pouting, smacking, clearing,
Dystonias are
- contractions of muscle groups, most often affecting the patient’s body axis.
- They are a side effect of antipsychotic drugs.
Paresthesia
- is an abnormal sensory experience described as burning, tingling, stinging or tickling.
dysthymia
- depressed mood most of the time for at least two years,
- along with at least two of the following symptoms: poor appetite or overeating; insomnia or excessive sleep; low energy or fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness.
SSRIs (selective serotonin reuptake inhibitors) 7
Common SSRIs include
- citalopram
- daposetin
- escitalopram
- fluoxetine
- fluvoxamine
- paroxetine
- sertraline
(SNRIs) serotonin and norepinephrine reuptake inhibitors
Common SNRIs include
- venlafaxine
- duloxetine
Haloperidol is used in
bipolar disorder to treat acute mania
Valproic acid is used in
bipolar disorder to treat mania and hypomania
Treatment of depression in the course of bipolar disorder:
treatment of depression without psychotic symptoms:
- amotrigine
- quetiapine
- lithium are recommended as monotherapy or in combination with antidepressants.
Cataplexy is
a sudden loss of muscle tone, leading to falling .
Echopraxia -
- repetitive reproduction of other people’s movements . e.g. the doctor performing the examination.
Motor mannerisms
- strange gestures or motor activities that are inappropriate to the situation and incomprehensible to those around you (e.g. moving only in a whirling motion, shaking hands with every passing person).
Motor stereotypies
- persistently, mechanically repeated, seemingly purposeful, but non-functional movements or activities (rocking the body, banging the head, shaking hands, twisting the arms, picking at body holes).
Posturisms
- adopting unusual, bizarre, often uncomfortable body positions (e.g. bent, bowed, with strangely positioned limbs).
Clozapine SE:
- agranulocytosis is the most serious complication (mandatory blood count control).
- most common complications are tachycardia , drowsiness, sedation and dizziness.
- It also lowers-seizure threshold.
- QT interval prolongation: sertindole, thioridazine (withdrawn from treatment).
- PRL level control - required during treatment with risperidone and amisulpride.
Fregoli syndrome
- is a delusional syndrome of identification disorders and consists in the patient’s belief that various people he meets are actually one and the same person changing his image .
Capgras syndrome is a
- disorder in which the patient believes that his family members have been replaced by identical-looking strangers . It may be acute or chronic.
This disorder occurs in:
- schizophrenia ,
- dementia ,
- complications after head injury.
Nihilistic delusions also known as
- ( Cotard syndrome ) may concern damage, poor functioning, atrophy or even absence of internal organs.
- The patient may believe that some of his body parts do not exist or that he is already dead.
- In most cases, such delusional content appears in the course of deep depression with psychotic symptoms and is associated with a high risk of suicide attempt .
Alcohol paranoia also known as
- (alcoholic madness of jealousy, alcoholic Othello syndrome ) is a chronic psychosis caused by many years of heavy drinking of alcohol, the psychopathological picture of which is dominated by:
- delusions of marital disbelief (often absurd),
- aggressive behavior associated with these delusions.
Benzodiazepines are used in the acute treatment of anxiety disorders
- Name fast and short-acting BDZ (preferred route after)
- if there are contraindications to BDZ - use?
- Alprazolam has a quick effect and allows you to immediately control severe anxiety.
- np. alprazolam 0,25-1 mg p.o.,
- lorazepam 1-4 mg p.o.,iv.,im.,
- if there are contraindications to BDZ - use hydroxyzine .
**
( somnambulism )
- Sleepwalking
- one of the parasomnias , characterized by recurrent episodes of getting out of bed and walking around while sleeping.
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Primary sleep disorders are divided into:
- dyssomnias - concern the quality, quantity and timing of sleep,
- parasomnias - concern phenomena related to particular stages of sleep.
Some patients with alcoholic delirium develop Reichardt’s symptom.
Reichardt’s sign
- so-called blank paper - the patient reads from a blank piece of paper what the examiner suggests or describes a non-existent picture
Cenesthetic hallucinations
- tactile hallucinations, related to internal sensations (pain, burning, stinging in the area of internal organs).
- There are mainly visual, auditory and tactile illusions or hallucinations .
Aschaffenburg’s symptom
- is that, under the influence of suggestion, the patient talks on a switched off phone
Liepmann’s symptom
- is the induction of visual hallucinations by gentle pressure on the eyeballs.
- It occurs in patients with alcoholic delirium .
Caution should be exercised because inducing this symptom in a patient may result in aggression .
Qualitative disorders of motor activity
Catalepsy, or wax flexibility
- means the ability to hold the body or a part of the body (limb) in a position given by another person for a long time.
- This symptom is associated with increased suggestibility of a given person, it may be present both in disease states and may be induced in healthy people,
- e.g. under the influence of hypnosis
Aripiprazole
- partial agonist of the D2 receptor,
- has an anti-manic effect,
- does not cause weight gain
- has a favorable metabolic profile.
Anhedonia
- loss of interest and cessation of all activities that are usually a source of pleasure
Hemophobia
- fear of seeing blood. It is the only phobia in which the parasympathetic system is mobilized and, consequently, fainting occurs.
Trazodone is an
-antidepressant that:
- works mainly through the serotonergic system,
- in lower doses (up to 150-300 mg/d) recommended as a companion drug in depression with sleep disorders,
- in higher doses in monotherapy for depression,
- side effects: anxiety, headaches.
Psychiatric symptoms resulting from bilateral damage to the temporal lobes are called
temporal syndrome ( Klüver-Bucy syndrome )
Drug-induced akathisia
(restlessness) is one of the side effects of antipsychotic drugs.
- Involuntary movements in the course of late akathisia may take the form of restlessness in the upper limbs, trunk and lower limbs, which occur both in a sitting and standing position, and a compulsion to walk is also observed .
Klüver-Bucy syndrome
define / associated symptoms
Psychiatric symptoms resulting from bilateral damage to the temporal lobes are called temporal syndrom
It includes the following symptoms:
- not recognizing the closest people,
- difficult emotional contact with the environment,
- hypersexuality,
- insecure behavior,
- constantly looking for something
- lack of ability to use previous experience,
- oss of sense of distance,
- taking actions dictated by the need of the moment,
- uttering hypochondriac complaints in a neutral mood,
- symptoms of dementia syndrome.
Neuroleptic malignant syndrome
- is one of the side effects of antipsychotic drugs, but is characterized by a different clinical picture :
- disorders of the autonomic system , including: increased body temperature, blood pressure fluctuations, tachycardia, excessive sweating,
- motor disorders, including: primary arousal, then slowing down to akinesia, waxy catalepsy, urokthotonus, trismus, convulsive seizures,
- disorders of consciousness : from simple blurring to disturbances of consciousness).
Tardive dyskinesia (TD)
is one of the side effects of antipsychotic drugs, but the most common are :
- movements of a dystonic nature (e.g. torticollis: your neck muscles spasm and your neck twists to the side)
- TD is also described in the form of chorea (a neurological disorder characterized by spasmodic involuntary movements of the limbs or facial muscles),
- myoclonus (sudden, brief involuntary twitching or jerking of a muscle or group of muscles. The twitching cannot be stopped or controlled by the person experiencing it)
- tremor
TX for premature ejaculation
Antidepressants are used in the treatment of premature ejaculation, i.e:
- tricyclic antidepressants
- selective serotonin reuptake inhibitors (SSRIs) .
The most commonly used drugs are:
- clomipramine (10-50 mg),
- sertraline (50-100 mg)
- paroxetine (20-40 mg), which is the strongest drug in this group.
- These drugs increase the threshold of penile excitability without affecting the amplitude and latency of triggering responses in the sacral center and potentials of the somatosensory cortex.
- They are effective in restoring control over ejaculation.
Effect on receptors and side effects:
Dopaminergic :
- extrapyramidal, including postneuroleptic malignant syndrome,
- hyperprolactinemia,
- decreased libido,
Effect on receptors and side effects:
Serotoninergic :
- increased appetite,
- weight gain,
- metabolic syndrome,
- libido disorders,
- serotonergic syndrome.
6
obsessive-compulsive disorder
Drugs used to treat OCD:
- fluvoxamine (at a dose of 150-200 mg/d) ,
- escitalopram,
- clomipramine,
- paroxetine,
- sertraline,
- venlafaxine.
OCD medications are used in high doses , so a higher risk of side effects should be taken into account.
Hallucinogens – Mental and behavioral disorders
1) LSD (lysergic acid diethylamide).
2) Ketamine.
3) Psilocybin (hallucinogenic mushrooms).
4) Mescaline.
5) Phencyclidine.
6) MDMA (ecstasy).
7) Ayahuasca.
Psychostimulants include:
- amphetamine,
- MDMA (3,4-methylenedioxy-N-methylamfetamine, ecstasy )
- cocaine,
- mephedrone ,
- buphedrone (synthetic cathinones).
Psilocybin
(psilocybin mushrooms, hallucinogenic) is a hallucinogen .
Codeine is an
opioid (a natural derivative of poppy seeds, like heroin and morphine).
Hashish is
a natural cannabinoid (like marijuana).
Antipsychotic treatment in overweight and obese patients:
Selection of an antipsychotic drug with a low risk of causing metabolic disorders
(aripiprazole, ziprasidone, sertindole, amisulpride).
in diagnosis of alcoholic delirium:
However, it must be assumed that the patient has stopped drinking alcohol.
- Alcoholic delirium is a life-threatening condition!
- It requires treatment in a hospital setting, which involves the use of:
Alcoholic delirium is a life-threatening condition
- Benzodiazepines in maximum doses, usually 30-60 mg diazepam, best orally .
- If this is not possible, intramuscular injections (average 30 mg/day).
- If the treatment applied does not bring results, haloperidol can be used, preferably in intramuscular injections at doses of 5-15 mg/day.
SPA-related disorders Alcohol
– Alcoholic delirium – Treatment
- Alcoholic delirium is an absolute indication for hospitalization !
- In pharmacotherapy:
- benzodiazepines (diazepam) are used in maximum doses.
- (usually 30–60 mg diazepam po ) .
- benzodiazepines (diazepam) are used in maximum doses.
- If there is no improvement, consider adding haloperidol.
- (preferably at a dose of 5–15 mg/d) . - Supplementation with vitamins B1 and B6 is also beneficial
Sexual Dysfunctions – Premature Ejaculation
In the treatment of premature ejaculation:
- antidepressants are used:
- i.e. tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) .
- The most commonly used drugs are
- clomipramine (10-50 mg),
- sertraline (50-100 mg)
- paroxetine (20-40 mg), which is the strongest drug in this group.
Sexual Dysfunctions – Premature Ejaculation
In the treatment of premature ejaculation, antidepressants are used…..these drugs increase ?
- These drugs increase the threshold of penile excitability without affecting the amplitude and latency of eliciting responses in the sacral center and somatosensory cortex potentials.
- They are effective in restoring control over ejaculation.
Anxiety disorders
Obsessive Compulsive Disorder – Treatment
Medications used to treat OCD:
- SPECVF
- SPECVF
- fluvoxamine (at a dose of 150-200 mg/d)
- escitalopram
- clomipramine
- paroxetine
-sertraline - venlafaxine
- Medications for OCD are used in high doses , so a greater risk of side effects must be taken into account.
In the case of OCD, medications are used in high doses (usually much higher than in patients with depression), so the risk of side effects should always be considered .
- What Drug therapy deserves special attention and why?
**Clomipramine therapy **deserves special attention .
- This drug can negatively affect the heart, cause rhythm disturbances, and even ischemic changes.
- In view of the above, in the case of including clomipramine in the treatment of OCD, it is recommended to perform control ECG tests (once every three months).
Stimulants – General Information
Stimulants = SPAs that have a strongstimulating effect on the central nervous system:
- they cause ?
- they incluce ?
(they cause increased activity in many areas of the brain, especially parts of the cerebral cortex and subcortical nuclei) .
In addition to caffeine, the most commonly used stimulants include:
1) amphetamine,
2) methamphetamine,
3) cocaine,
4) MDMA ( ecstasy ),
5) mephedrone.
Benzodiazepines
have five basic areas of action:
_name and act through what receptors
- act through GABA-ergic receptors
- These agents have five basic areas of action:
- anxiolytic
- hypnotic
- sedative
- striated muscle relaxant
- anticonvulsant
Psychopharmacotherapy
Anxiolytic drugs – Benzodiazepines – Indications
name 7
1) Anxiety disorders (immediate anxiety management) .
2) Anxiety-related sleep disorders.
3) Withdrawal syndrome in alcohol addiction.
4) Delirium.
5) Epileptic seizures.
6) Control of muscle contractions.
7) Premedication before surgical procedures.
