Psychiatry Flashcards
What are the differences between Munchausen’s and hypochondriasis?
Hypochondriasis (NOT BELIEVING DOCTORS) is the persistent belief in the presence of an underlying serious disease, like cancer or HIV. The patient refuses to accept reassurance or negative test results.
Munchausen’s (FAKING SYMPTOMS) patients intentionally falsify their symptoms and past history and fabricate signs of physical or mental disorder with the primary aim of obtaining medical attention and treatment. There are no secondary gains.
Malingering is deliberately falsifying the symptoms of illness for a secondary gain.
What are the different effects of ecstasy and LSD?
ECSTASY
- uncontrolled body movements
- hyperthermia
- increased BP, HR, RR
LSD
- mydriasis
- flushing and sweating
- diarrhoea
- delusions and hallucinations (smelling colours and seing sounds)
What are features and treatment for schizophrenia?
Features
- thought blocking: speeches that are interrupted with silence followed by unrelated topic
- passivity phenomenon: patient loses control of their body and thoughts
- delusional perception: when a normal fact or action is followed by a bizarre delusion of unrelated context
Treatment: antiphychotics like quetiapine, risperidone, olanzapine.
Benzodiazepines are only used if rapid tranquilisation is needed, in case of a violent, agressive patient
How to manage anorexia nervosa?
ADMIT TO ACUTE MEDICAL WARD
- severe electrolyte disturbance
- bradycardia < 45 bpm
- hypoglycaemia
ADMIT TO ACUTE PSYCHIATRIC WARD
- very high risk of suicide or severe self-harm and no medical complications
REFER URGENTLY TO EATING DISORDER UNIT OR PSYCHIATRY
- BMI less than 15 and no medical complications
REFER ROUTINELY TO AN EATING DISORDER
- suspect eating disorder and no medical complications
What are the different indications for disulfiram, acamprosate and chlordiazepoxide in alcohol withdrawal management?
Disulfiram promotes abstinence by causing a bad reactions to drinking alcohol, serving as a deterrent. Acamprosate reduces craving and improves abstinence. Both are used in the management of alcohol dependency in those who have undergone a detoxification programme.
Chlordiazepoxide is a benzodiazepine used as a sedative and for controlling symptoms related to alcohol withdrawal; it can be prescribed in advance in anticipation of the patient’s withdrawal symptoms.
Lorazepam is reserved for patients with delirium tremens.
What is Capgras syndrome?
Patient believes that a person known to them has been replaced by a ‘double’ who is identical, but not the real person
What is Ganser syndrome?
Person that deliberately and counsciously acts as if they had a mental illness, usually as a form of malingering in those attempting to feign mental illness, usually prisoners awaiting trial
What is Todd’s syndrome?
Also known as “Alice in wonderland syndrome”, it involves perceptual distortions of the size or shape of objects and altered body images. Patients may fell as though their body is expanding or getting smaller.
What is Fregoli delusion?
When a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise.
What is Cotard syndrome? How is it different from nihilistic delusions?
Presentation of psychotic depressive illness characterised by a combination of severely depressed mood with nihilistic delusions. The patient may state that he is already dead and should be buried. He may state that his insides have stopped working and are rotting away, or that he has stopped existing altogether.
Nihilist delusion is the delusional belief that the patient has died or no longer exists or that the world has ended or is no longer real. Nothing matters any longer and continued effert is pointless. It is a feature of psychotic depressive illness. Patient may believe that he/she is dead and may ask people to bury them.
What characterises a patient with insight?
A patient who knows that their symptoms aren’t normal and seek diagnosis and treatment.
After starting therapy with lithium, when should blood levels be ordered, and after how many hours of the regular dose should the patient have the tests collected?
Lithium levels are checked 1 weeks after initiating; following that, they are checked every 3 months.
Blood test should be taken 10 to 14 hours (ideally, 12 hours) after taking the last dose of lithium.
What is the treatment for bipolar disorder, which professional should prescribe it, and which medication should never be given?
Treatment for bipolar disorder are mood stabilisers, such as lithium.
They should not be initiated in primary care. They can be continued by primary care once the patient is stable on it, but a referral to the psychiatric team initially.
Don’t start SSRI of you suspect current mania or hypomania.
Which tests should be done before and during lithium therapy?
Kidney function - responsible for most of lithium excretion and susceptible to long term damage
Thyroid function - abnormal function can mimic or precipitate mania or depression, also lithium can induce hypothyroidism
After starting therapy,
- check lithium levels every 3 months
- chech TSH and renal function every 6 months
When should Procyclidine, Baclofen, Botox, Diazepam, and Lorazepam be used in the context of muscle spasms?
Procyclidine - parkinsonism, drug-induced extrapyramidal symptoms
Baclofen - muscle spasms associated with conditions such as multiple sclerosis, spinal lesions, cerebral palsy and motor neurone disease
Botox - muscle spasms in chronic migraine, limb spasticity in stroke, severe hyperhidrosis
Diazepam - acute muscle spasms, anxiety, seizures
Lorazepam - anxiety, panic attacks, seizures
How to differentiate and manage postpartum blues, postnatal depression, and postpartum psychosis?
POSTPARTUM BLUES
- mom cares for baby
- mostly crying, anxious, low moods
- tt: reassurance and explanation
POSTNATAL DEPRESSION
- mom cares for baby + occasional thoughts of harming the baby
- symptoms of depression
- tt: antidepressants or CBT
POSTPARTUM PSYCHOSIS
- thoughts of harming baby
- psychotic symptoms (hears voices) + disorientation + thoughts of suicide
- tt: admit to specitalist mother and baby unit + antidepressants + mood stabilizers (carbamazepine) + electroconvulsive therapy (best management)
What are the features and treatment of delirium tremens?
Features: rapid onset of confusion from withdrawal of alcohol, possibly followed by heart rate and blood pressure increase
Treatment: benzodiazepine, such as lorazepam or midazolam
What is delusion of guilt?
Involves feeling guilty or remorseful for no valid reason. An example would be someone that believes they were responsible for a war in another country or hurricane damage in another state. The object of delusion believes that they deserve to be punished for their sins.
What is persecutory delusion?
Delusional belief that one’s life is being interfered with in a harmful way. it refers to false beliefs or perceptions in which a person believes that they are being treated with malicious intent, hostility, or harassment despite significant evidence to suggest otherwise. This may occur in the context of being tormented, followed, or spied on.
What is Clang association?
It’s an abnormality of speech where the connection between words is their sound rather than their meaning. May occur during maniac flight of ideas. Clang associations generally sound a bit like rhyming poetry, except that the poems don’t seem to make any sense. Example, one may say “systematic, sympathetic, quite pathetic”
What is the management of PTSD?
1st - trauma-focused cognitive behavioural therapy
2nd - SSRI (paroxetine, sertraline, fluoxetine)
Eye movement desensitisation and reprocessing (EMDR) are considered for those who do not respond to CBT.
What are the indications for electroconvulsive therapy?
- life-threatening depression, such as catatonia
- severe depression where other treatments were ineffective
- prolongued or severe episode of mania
- postpartum psychosis with intrusing thoughts of harming the baby
What are the features of antisocial personality disorder?
- continuous antisocial or criminal acts
- inability to conform to social rules
- disregard for the rights of others
- aggressiveness
- lack of remorse
Psychopaths are considered to have a severe form of antisocial personality disorder.
What are the symptoms of drug induced parkinsonism, and how to manage it?
Drug-induced parkinsonism results from the blockage of dopamine receptors resulting in a deficiency in dopamine that causes the rigidity of the muscles, caused by antipsychotic medications used to treat schizophrenia, for example.
The symptoms will subside upon stopping the medication or adding an anticholinergic, like procycline, to reduce the effects of the relative central cholinergic excess and hence reduce the symptoms of rigidity from dopamine deficiency.
