Psychiatry Flashcards
What is the definition of ADHD?
Attention Deficit Hyperactivity Disorder
Is a neuro-developmental disorder characterised by persistent patterns of inattention, impulsivity, and hyperactivity that are inappropriate for the individual’s developmental level.
The symptoms significantly affect daily functioning in more than one setting, such as at home and school or work.
What is the epidemiology of ADHD?
It is most common in children, although a significant proportion (50%) continue to have problems with behaviour or attention in adult life.
What is the cause of ADHD?
Exact cause is unknown.
But it is associated with reduced activity in the frontal lobe leading to impaired executive functioning.
What criteria needs to be met for a diagnosis of ADHD to be made? (According to DSM-5)
Inattention:
- Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults
- Symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level
Hyperactivity and impulsivity:
- Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults
- Symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level
Additional criteria:
- Several inattentive or hyperactive-impulsive symptoms present before the age of 12 years
- Several symptoms are present in two or more settings (e.g., at home, school, or work)
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
- The symptoms are not better explained by another mental disorder
What are some differentials for ADHD?
Learning Disabilities:
Characterised by difficulties in reading, writing, mathematics or other learning skills, often with normal attention span.
Conduct Disorder:
Presents with persistent pattern of antisocial behaviour, such as aggression or destructiveness.
Autism Spectrum Disorder:
Mood Disorders:
E.g. depression and bipolar disorder, can cause concentration problems and impulsivity
What investigations are done for ADHD?
Diagnosis is done primarily done using the DSM-5 criteria. But the following can also help:
- Comprehensive history and physical examination
- Observation of the individual’s behaviour
- Teacher and parent reports or rating scales
- Neuropsychological testing
What is the management of ADHD?
Non-Pharmacological
- Behavioural techniques
E.g. cognitive behavioural therapy (CBT), behavioural therapy, psychoeducation, and social skills training. - Extra support at school
Pharmacological
- Stimulant medications:
E.g. methylphenidate or amphetamines. These have some activity in the frontal lobe, thus increasing executive function, attention, and reducing impulsivity.
What is the definition of Depression?
It’s a common mental health disorder typified by low mood, anhedonia, significant weight change, sleep and activity changes, fatigue, feelings of guilt or worthlessness, poor concentration and suicidality.
It is defined by the DSM as the presence of 5 out of these 9 symptoms (almost every day) for at least 2 weeks.
What is the epidemiology of depression?
Increased prevalence in Females
What causes depression?
Depression results from a complex interplay of genetic and environmental factors. The following all contribute:
- Personal or family history of depression
- Personal history of mental health issues
- Physical illnesses
- Social challenges like divorce, poverty, and unemployment
What are the clinical features of depression?
Depressed mood or irritability for most of the day, indicated by either subjective report (feels sad or empty) or observation by others (appears tearful).
Anhedonia: Decreased interest or pleasure in most activities, most of the day.
Significant weight change (5%) or change in appetite.
Sleep alterations: Insomnia or hypersomnia.
Activity changes: Psychomotor agitation or retardation.
Fatigue or loss of energy
Guilt or feelings of worthlessness: Excessive or inappropriate guilt or feelings of worthlessness.
Cognitive issues: Diminished ability to think or concentrate, or increased indecisiveness.
Suicidality: Thoughts of death or suicide, or formulation of a suicide plan.
What are the main differentials for depression?
Bipolar Disorder
Anxiety Disorders
Substance/Medication-Induced Mood Disorder
Mood disturbance associated with intoxication or withdrawal from substances or side effects of medications.
Adjustment Disorders
Development of emotional or behavioural symptoms in response to identifiable stressors.
Various organic causes also need to be considered:
Neurological disorders
E.g. Parkinson’s disease, dementia, and multiple sclerosis.
Endocrine disorders especially thyroid dysfunction and hypo/hyperadrenalism (e.g., Cushing’s and Addison’s disease).
Substance use or medication side effects
e.g. steroids, isotretinoin, alcohol, beta-blockers, benzodiazepines, and methyldopa.
Chronic conditions
like diabetes and obstructive sleep apnea.
Long-standing infections
Neoplasms and cancers
low mood can theoretically be a presenting complaint in any cancer, with pancreatic cancer being a notable example.
What investigations are done for Depression?
Depression is primarily a clinical diagnosis, with patients fulfilling the diagnostic criteria outlined above. Other investigations that are done can be:
- Patient Health Questionaire - 9 (PHQ-9)
- FBC
- TFTs
- U+Es
- LFTs
- Blood glucose
- B12/Folate Levels
- Cortisol levels
- Toxicology Screen
- CNS Imaging
What is the Non-Pharmacological Management of Depression?
Initial treatment Involves low-intensity psychological interventions or group-based Cognitive Behavioral Therapy (CBT).
For moderate to severe depression, higher-intensity CBT/interpersonal therapy combined with pharmacological therapy is typically employed.
Mild cases may respond to CBT alone.
What is the Pharmacological management of depression?
First-line pharmacological treatment:
Selective Serotonin Reuptake Inhibitor (SSRI) such as sertraline.
Continuation of antidepressants for at least six months post-remission is recommended to mitigate relapse risk.
Tapering should be done gradually over a four-week period when discontinuing antidepressants.
2nd line pharmacological treatment
Tricyclic Antidepressants (TCAs) e.g. amitriptyline
What is the definition of Refractory Depression?
Its defined as a failure to demonstrate an adequate response to an adequate treatment trial
How is Refractory Depression Managed?
Lithium or Electroconvulsive Therapy (ECT) (After all other approaches have been tried).
Short-term side effects of ECT include headache, muscle aches, nausea, temporary memory loss, and confusion, while long-term side effects can include persistent memory loss.
What is the definition of Austistic Spectrum Disorders (ASDs)?
ASDs are a set of complex neuro-developmental disorders, characterised by a spectrum of social, language, and behavioural deficits.
They span a wide range of symptoms, skills, and levels of disability. ASDs are persistent and impact everyday living.
What is the epidemiology of Autistic Spectrum Disorders?
Higher prevalence in Males
What are some risk factors for developing an ASD?
- Male Sex
- Advanced parental age at the time of conception
- Certain genetic mutations
- Maternal exposure to specific drugs or infections during pregnancy
What deficits in social interaction might someone with Autism show?
- Lack of eye contact
- Delay in smiling
- Avoids physical contact
- Unable to read non-verbal cues
- Difficulty establishing friendships
- Not displaying a desire to share attention (i.e. not playing with others)
What deficits in communication might someone with Autism show?
- Delay, absence or regression in language development
- Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interest
- Difficulty with imaginative or imitative behaviour
- Repetitive use of words or phrases
What behavioural traits may someone with Autism show?
- Greater interest in objects, numbers or patterns than people
- Stereotypical repetitive movements. There may be self-stimulating movements that are used to comfort
themselves, such as hand-flapping or rocking. - Intensive and deep interests that are persistent and rigid
- Repetitive behaviour and fixed routines
- Anxiety and distress with experiences outside their normal routine
- Extremely restricted food preferences
What are some differentials for ASDs?
Intellectual Disability
Characterised by generalised deficits in intellectual functioning and adaptive behaviour, typically lacking the social deficits seen in ASD.
Attention Deficit Hyperactivity Disorder (ADHD)
Exhibits symptoms of inattention, hyperactivity, and impulsivity, but does not exhibit significant social or language communication deficits as seen in ASD.
Specific Language Impairment
Characterised by difficulties in language acquisition in the absence of cognitive impairment. Unlike ASD, social interaction is not typically affected.
Childhood Schizophrenia
Characterised by hallucinations, delusions, and disorganised speech or behaviour, which are not typical in ASD.
How is an ASD diagnosed?
Diagnosis should be made through a multidisciplinary assessment completed by a specialist in autism.
This can involve:
* Psychological evaluation
* Speech and language assessment
* Cognitive assessment
* Thorough review of the child’s behaviour in different settings (home, school, etc.).
How are Autistic Spectrum Disorders Managed?
Autism cannot be cured
Management requires a multidisciplinary approach:
Behavioural Management
Applied Behavioural Analysis is a widely used technique, whereby positive behaviours are encouraged and negative behaviours are largely ignored.
Family Support
Due to the chronic nature of the disorder and its pervasive impact on family life, significant extra support for the family is often required.
What is the definition of Bipolar Affective Disorder?
Bipolar disorder is a mental health disorder marked by alternating periods of:
Depression
Characterised by low mood, feelings of worthlessness, decreased energy, and potential suicidality.
Elevated mood (mania or hypomania)
Characterised by persistently elevated, expansive, or irritable mood, inflated self-esteem, decreased need for sleep, and potential for reckless behaviour.
What are the risk factors for developing Bipolar Disorder?
- Having a first-degree relative, such as a parent or sibling, with bipolar disorder.
- Periods of high stress, such as the death of a loved one or other traumatic event.
- Drug or alcohol abuse.
What is the clinical presentation of Bipolar Disorder?
It depends on the phase of the disorder:
Depressive Phase
- Withdrawal
- Tearfulness
- Low mood
- Poor sleep
- Anhedonia
- Potential suicidal ideation or attempts.
Manic Phase
- Elevated mood
- Irritability
- Impulsivity
- Reduced need for sleep
- Mood congruent delusions
- Pressured speech
- Flight of ideas.
What are some differentials for Bipolar Disorder?
Major Depressive Disorder
Characterised by low mood, loss of interest or pleasure, feelings of worthlessness, impaired concentration, and possible suicidality.
Schizoaffective Disorder
Presents with hallucinations, delusions, disorganised speech, disorganised behaviour, and symptoms of depression or mania.
Generalised Anxiety Disorder
Chronic and excessive worry, restlessness, fatigue, impaired concentration, and sleep disturbance.
Substance-Induced Mood Disorder
Mood disturbances caused by substance misuse or withdrawal.
How is Bipolar Disorder diagnosed?
Diagnosis is based on the DSM-5 criteria:
Mania: Requires at least one episode lasting at least a week with at least three associated symptoms (e.g. inflated self-esteem, decreased need for sleep).
Hypomania: Similar to mania but less severe, not causing marked impairment in social or occupational functioning, and lacking psychotic features.
Depression: Requires at least one major depressive episode lasting at least two weeks with at least four associated symptoms (e.g. changes in appetite or sleep, feelings of worthlessness).
What is the acute management for Bipolar Disorder?
Acute Mania with Agitation
IM therapy (neuroleptic or benzodiazepine) and potential secure unit admission.
Acute Mania without Agitation
Oral antipsychotic monotherapy, potential addition of sedatives or mood stabilisers.
Acute Depression
Mood stabiliser, atypical antipsychotic, or antidepressant with psychosocial support.
What is the chronic management for Bipolar Disorder?
Long-term maintenance therapy is crucial due to high relapse risk:
Mood stabilisers
(e.g., Lithium or Valproate) are the cornerstone of treatment.
Atypical antipsychotics and anticonvulsants
May be used in treatment-resistant cases.
High-intensity psychological therapies
e.g. CBT, interpersonal therapy, or couples/family therapy
What is the definition of a Generalised Anxiety Disorder (GAD)?
Generalised anxiety disorder (GAD) is defined as at least 6 months of excessive worry about everyday issues that is disproportionate to any inherent risk, causing distress or impairment.
What is the epidemiology of GAD?
Higher prevalence in Females
Higher prevalence in younger age groups (age of onset after 35 is more indicative of depressive disorder or organic disease).
What are some risk factors for GAD?
- Female sex
- Comorbid anxiety disorder e.g. panic disorder or social phobia.
- Family history of anxiety disorders, depression, or other psychiatric disorders.
-
Childhood adversity such as:
Maltreatment (e.g. sexual or physical abuse), neglect.
Maternal depression, family disruption (e.g. divorce).
Domestic violence, parental alcoholism, or drug use. - History of physical, sexual, or emotional trauma , such as:
Physical or sexual abuse or assault.
Motor vehicle accident.
Sudden bereavement. -
Sociodemographic factors, such as:
Separated, widowed, divorced.
Unemployment.
Low socioeconomic status.
Low education levels.
Substance dependence or exposure to organic solvents - Chronic physical condition e.g. cardiovascular disease, cancer, etc…
How is a GAD disorder diagnosed?
According to the DSM-5-TR criteria, 3 of the following 6 key symptoms are required for a diagnosis (only 1 in kids):
- Restlessness or nervousness
- Being easily fatigued
- Poor concentration
- Irritability
- Muscle tension
- Sleep disturbance
Its partly a diagnosis of exclusion, with physical health conditions, other mental health disorders, and medications or other substances being ruled out as a primary cause
What is the clinical presentation of GAD?
At least 3 of the 6 key symptoms:
- Restlessness or nervousness
- Being easily fatigued
- Poor concentration
- Irritability
- Muscle tension
- Sleep disturbance
Other features:
* Apprehension (worries about future misfortunes, feeling on edge, difficulty in concentrating)
* Motor tension (restless fidgeting, tension headaches, trembling, inability to relax)
* Autonomic overactivity (light-headedness, sweating, tachycardia, epigastric discomfort, dizziness, etc.)
* Depersonalization (altered or lost sense of personal reality or identity) and derealization (surroundings feel unreal).
What are some differentials for GAD?
Hyperthyroidism
Substance misuse (intoxication – amphetamines; withdrawal – benzodiazepines, alcohol)
Excessive caffeine intake
Depression
Anxiety is a common feature of depression and vice versa. Identifying which condition appeared first and which is currently more prominent provides useful diagnostic cues. If both conditions are present, a diagnosis of mixed anxiety and depressive disorder is made.
Anxious (avoidant) personality disorder
The patient describes themselves as an anxious person without a recent significant increase in anxiety levels. (Note, this disorder can predispose the individual to anxiety disorders.)
Early-stage dementia
Early-stage schizophrenia
How is GAD managed?
Mild anxiety can be managed with watchful waiting and advice about self-help strategies (e.g. meditation), diet, exercise and avoiding alcohol, caffeine and drugs.
Moderate to severe anxiety can be referred to CAMHS services to initiate:
* Counselling
* Cognitive behavioural therapy
* Medical management. Usually an SSRI such as sertraline is considered.
What is the definition of Obsessive Compulsive Disorder (OCD)?
Obsessive-compulsive disorder (OCD) is a mental health disorder characterised by the presence of persistent obsessions and/or compulsions.
These are time consuming (i.e. take more than 1 hour per day) and/or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
What are Obsessions?
Obsessions are unwanted and uncontrolled thoughts and intrusive images that the person finds it very difficult to ignore.
E.g. an overwhelming fear of contamination with dirt or germs; or violent or explicit images that keep appearing in their mind.
What are Compulsions?
Compulsions are repetitive actions the person feels they must do, generating anxiety if they are not done. Often these compulsions are a way for the person to handle the obsessions.
E.g. checking that all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down.
Describe the cycle of anxiety seen in OCD?
Obsessions lead to anxiety, which leads to the compulsive behaviour, which leads to a temporary improvement in the anxiety.
Shortly after the temporary improvement in anxiety the obsession reappears, leading to further anxiety, further compulsive behaviour with a temporary relief.
This cycle continues and each time gets more engrained in the person’s behaviour. Without doing the compulsions, the person feels they cannot get relief from their anxiety.
What is the epidemiology of OCD?
It affects Males and Females equally (although presents earlier and more severely in males)
More common in pregnant and post-partum women
Bimodal age of onset, peaking at 10 and 21 years
What are the risk factors for developing OCD?
- Family history of OCD
- Personal history of co-morbid psychiatric conditions e.g. anxiety disorders, depression and other mood disorders, eating disorders, etc…)
- Pregnant/Post-Partum women
What is the diagnostic criteria for OCD?
OCD is a clinical diagnosis and according to ICD-11:
- Either obsessions or compulsions (or both) are time-consuming and must be present for at least one hour per day.
- They are acknowledged as originating in the mind of the patient and are not imposed by outside persons or influences.
- They are repetitive and unpleasant and at least one obsession or compulsion must
be present that is acknowledged as excessive or unreasonable. - The subject tries to resist them (but if very long-standing, resistance to some obsessions or compulsions may be minimal). At least one obsession or compulsion must be present which is unsuccessfully resisted.
- Carrying out the obsessive thought or compulsive act is not in itself pleasurable.
- The obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time.
What scale is used to assess the severity of OCD symptoms?
Yale-Brown Obsessive Compulsive Scale
What is the management for OCD?
Mild OCD may be managed with education and self help resources.
More significant OCD may require:
- Referral to CAMHS
- Patient and carer education
- Cognitive behavioural therapy
- SSRIs medications
What is the definition of Postpartum depression?
It’s a significant mood disorder that can develop at any time up to one year after the birth of a baby.
This condition represents a considerable aspect of maternal mental health and extends beyond the common “baby blues”.
Typically presenting with persistent depressive symptoms that may interfere with daily functioning and parenting.
What causes Postpartum depression?
Development of postpartum depression is multifactorial with a combination of Biological, Psychological, and Social factors all contributing.
What biological factors contribute to the development of postpartum Depression?
- Hormonal fluctuations post-delivery, including sudden drops in progesterone, estrogen, and thyroid hormones.
- Alterations in melatonin and cortisol rhythms and immune-inflammatory processes
- Genetic predispositions
What Psychological factors contribute to the development of postpartum Depression?
- A history of mood or anxiety disorders
- Previous episodes of postpartum depression
- Certain personality traits such as neuroticism
- Psychological stress from the transition to parenthood
- Unrealistic expectations of motherhood
What Social Factors contribute to the development of postpartum depression?
- Lack of social support
- Relationship issues,
- Life stressors
- Low socioeconomic status
What are the signs and symptoms of postpartum depression?
- Persistent lowering of mood and reduced enjoyment or interest in activities.
- Lowering of energy levels.
- Biological symptoms of depression like poor appetite and disturbed sleep patterns (not associated with normal disturbed sleep patterns with a baby)
- Concerns related to bonding with the baby, caring for the baby, and in extreme circumstances, thoughts about harming oneself or the baby.
What are some differentials for postpartum depression?
Baby blues
Characterised by mild mood swings, irritability, anxiety, and tearfulness. However, these symptoms usually present within the first two weeks after birth and resolve spontaneously.
Postpartum Psychosis
Adjustment disorders
These disorders may develop in response to a major life change or stressor, such as having a baby, but the emotional or behavioural symptoms are less severe than in depression.
Generalized Anxiety Disorder (GAD)
What is the main screening tool for Postpartum depression?
Edinburgh Postnatal Depression Scale (EPDS)
A cutoff score of over 10 is used as a positive result.
What is the management of postpartum depression?
First-line treatments:
- Self-help strategies and psychological therapies e.g. Cognitive Behavioural Therapy (CBT) or Interpersonal Therapy (IPT).
Pharmacological treatments
- Antidepressants considered in high risk cases
In severe cases admission to a mother and baby inpatient mental health unit might also be necessary.
What is the definition of Postpartum Psychosis?
It’s a serious psychiatric disorder that typically develops within the first two weeks following childbirth.
It is characterised by a range of psychological symptoms, including paranoia, delusions, hallucinations, mania, depression, and confusion.
What are the risk factors for Postpartum Psychosis?
- Prior history of severe mental illnesses such as schizophrenia or bipolar affective disorder
- Family history of postpartum psychosis
- Previous episode of postpartum psychosis
What is the clinical presentation of Postpartum Psychosis?
Paranoia
Delusions
Hallucinations
Manic episodes
Depressive episodes
Confusion
What is the main differential for Postpartum Psychosis?
Postpartum depression with psychotic features
How is Postpartum depression diagnosed?
Diagnosis is predominantly clinical, based on the presenting signs and symptoms.
It requires a thorough psychiatric evaluation.
Consideration should be given to other medical conditions that may cause similar symptoms, such as thyroid disorders or sepsis.
How is Postpartum psychosis managed?
Pharmacotherapy with:
- Antipsychotic medications
- Mood stabilisers in some instances
Potential referral to a specialist mother and baby inpatient mental health unit in very severe cases (when the mother experiences command hallucinations, thoughts of self-harm or suicide, or delusional beliefs regarding the baby’s role or identity).
What needs to be considered when prescribing medications for Postpartum Psychosis?
The mother’s breastfeeding status and the potential for the transfer of drugs to the nursing infant.
What is the definition of Post Traumatic Stress Disorder (PTSD)?
It’s a condition that may develop following exposure to 1 or more traumatic events involving actual or threatened death, serious injury, or sexual violence.
Exposure can be through directly experiencing the traumatic event, witnessing the event as it occurred to others or learning that the event occurred to a family member or a close friend.
What does the ICD-11 state PTSD is characterised by?
- Re-experiencing the traumatic event in the present in the form of vivid intrusive memories, flashbacks, or nightmares. This is typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations.
- Avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event.
- Persistent perceptions of heightened current threat E.g. hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises.
What is the definition of Complex PTSD?
A disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, etc…)
In addition to all the diagnostic criteria being met for PTSD; complex PTSD is characterised by severe and persistent:
- Problems in affect regulation.
- Beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event.
- Difficulties in sustaining relationships and in feeling close to others.
What are some Risk Factors for PTSD?
- Refugees and Asylum Seekers
- First Responders
- Combat Exposure
- Poor Social Support
- History of previous psychiatric disorders
- Giving birth
What is the clinical presentation of PTSD?
- Re-experiencing.
- Avoidance.
- Hyperarousal (including hypervigilance, anger and irritability).
- Negative alterations in mood and thinking.
- Emotional numbing.
- Dissociation.
- Emotional dysregulation.
- Interpersonal difficulties or problems in relationships.
- Negative self-perception
When is usually the time of onset for PTSD?
PTSD tends to develop soon after the event. It may be delayed, but delayed onset greater than a year post-trauma is very rare.
What are some differentials for PTSD?
Prolonged grief disorder
A disturbance in which, following the death of a person close to the bereaved, there is persistent and pervasive grief response characterised by longing for (or a persistent preoccupation with) the deceased, accompanied by intense emotional pain.
Depression
Adjustment disorders
Enduring personality change after catastrophic experience
What screening questionnaires are there for PTSD (1st line investigations)
DSM-5 PTSD Checklist
A 20 item checklist assessing the symptoms of PTSD according to DSM-5.
Trauma Screening Questionnaire (TSQ)
A set of 10 items covering re-experiencing and arousal symptoms.
Post traumatic Diagnostic Scale (PDS-5)
A 24-item self report measure assessing PTSD symptom severity in the last month.
- International Trauma Questionnaire (ITQ)
What are the Non-Pharmacological managements of PTSD?
Cognitive Behavioural therapy
Narrative/Prolonged exposure therapy
In patients who have been diagnosed with PTSD, or in patients who present with symptoms of PTSD one or more months after a traumatic event.
Eye movement desensitisation and reprocessing (EMDR) should be offered to patients who have presented more than three months after a non-combat-related trauma
What is the Pharmacological management of PTSD?
First line:
- Venlafaxine
- Or an SSRI (e.g. sertraline)
In serious cases that haven’t responded to previous drug or psychological therapies:
- Antipsychotics (like risperidone) in addition to psychological therapies
Define the term Learning Disability
It’s a general umbrella term encompassing a range of different conditions that affect the ability of the child to develop new skills.
Examples include:
- Dyslexia
- Dysgraphia refers to a specific difficulty in writing.
- Dyspraxia
- Auditory processing disorder
- Non-verbal learning disability
- Profound and multiple learning disability
They can vary from very mild to severe
What is the definition of Dyslexia?
It refers to a specific difficulty in reading, writing and spelling.
What is the definition of Dysgraphia?
It refers to a specific difficulty in writing.
What is the definition of Dyspraxia?
Also known as developmental co-ordination disorder.
It refers to a specific type of difficulty in physical co-ordination.
More common in boys.
It presents with delayed gross and fine motor skills and a child that appears clumsy.
What is the definition of Auditory processing disorder?
It refers to a specific difficulty in processing auditory information.
What is the definition of a Non-verbal learning disability?
It refers to a specific difficulty in processing non-verbal information, such as body language and facial expressions.
What is the definition of a Profound and multiple learning disability?
It refers to severe difficulties across multiple areas, often requiring help with all aspects of daily life.
How are Learning disabilities classified?
The severity of the learning disability is based on the IQ (intelligence quotient):
55 – 70: Mild
40 – 55: Moderate
25 – 40: Severe
Under 25: Profound
What are the risk factors for Learning Disabilities?
- Family history of learning disability
- Abuse
- Neglect
- Psychological trauma
- Toxins
- Certain conditions
What conditions are associated with learning disabilities?
- Genetic disorders such as Downs syndrome
- Antenatal problems, such as foetal alcohol syndrome and maternal chickenpox
- Problems at birth, such as prematurity and hypoxic
- ischaemic encephalopathy
- Problems in early childhood, such as meningitis
- Autism
- Epilepsy
What does the management of learning disabilities involve?
The key is a multidisciplinary approach to support the parents and child:
Health visitors
Social workers
Schools
Educational psychologists
Paediatricians, GPs and nurses
Occupational therapists
Speech and language therapists
Define Psychosis
Its a syndrome associated with dysregulation of the neurotransmitters dopamine and serotonin, and abnormal functioning of key brain circuits (particularly involving frontal, temporal, and mesostriatal brain regions.)
What are the 2 main causes of Phychosis?
Psychosis can be due to:
- Primary (“non-organic”) psychiatric disorders
- Secondary to substance use or specific medical (“organic”) aetiologies
Give some examples of primary psychotic disorders
Schizophrenia
Delusional disorder
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder
They may also accompany other psychiatric conditions like major depressive disorder and bipolar disorder.
How does psychosis associated with primary psychotic disorders present?
- Hallucinations (mostly auditory)
- Delusions
- Disorganised thought process
- But are usually oriented and have minimal overt cognitive deficits.
- Have normal Vital Signs
How does psychosis secondary to drug use or medical causes present?
- Altered vital signs
- Visual hallucinations
- Severe cognitive impairment, including confusion or disorientation.
How is Psychosis investigated?
- Physical examination
(detailed neurological examination and a complete mental status examination) - Complete psychiatric and medical history
(review of head injury, seizures, cerebrovascular disease, sexually transmitted infections, and new or worsening headaches) - Laboratory work-up
What lab work should be done for a Psychosis investigation?
FBC
Comprehensive metabolic profile
TFTs
Urine toxicology
Parathyroid hormone
calcium
vitamin B12
folate
niacin
Based on clinical suspicion, testing for HIV infection and hepatitis C,
