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
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**
