Psychiatry Flashcards
SSRI
Fluoxetine
Paroxetine
Sertraline
Citalopram/escitalopram
Which SSRI is contraindicated in pregnancy
Paroxetine
Which SSRI is safe for MI
Fluoxetine
SNRI
Venaflaxine
Desvenaflexine
Duloxetine
Indications for SNRI
For treating depression AS WELL AS anxiety (75% depression 25% anxiety)
Venlafaxine contraindication
- Diastolic Hypertension
- Breast feeding
Antipsychotics
Order from lowest to highest potency
Aripiprazole
Quetiapine
Olanzapine
Risperidone
Clozapine
Amisulpride??
Common adverse effect of Antipsychotics
Hyperprolactinemia (>2000 mIU/L)
galactorrhea
gynaecomastia
sexual dysfunction
infertility
amenorrhoea
Examples of Overvalued Ideas
Body dysmorphic disorder
Anorexia Nervosa
Hypochondriasis
Features of Schizophrenia
Positive symptoms
Negative symptoms
Disorganised thought
Hallucinations
Negative symptoms of Schizophrenia
flat affect
poverty of thought
lack of motivation
social withdrawal
reduced speech output
Positive symptoms of Schizophrenia
delusions
hallucinations
thought disorder
disorganized speech and behavior
Drug of choice for Bipolar disorder
Lithium
Haloperidol (Emergency, if uncooperative)
Eating disorders are commonly associated with what patient profiles (history)
– Female Adolescent
– Low self-esteem
– Personal or family history of depression
– Family history of obesity
– High personal expectations
– Family history of eating disorders
– Disturbed family interactions
- Social factors
- Childhood sexual abuse
- Perfectionism and obssessionality
Common clinical features of Anorexia Nervosa
- < 16 BMI
- Significant electrolyte disturbance (K < 3.0 or Na < 130)
– Amenorrhoea
– Constipation.
– Cold intolerance.
– Cachexia.
– Hypothermia.
– Bradycardia. (< 40bpm)
– Hypotension (< 90mmHg) - Raised liver enzymes and Albumin < 35g/L
Complications of Anorexia Nervosa
– low level of LH, FSH and TSH
- secondary amenorrhoea due to low levels of LH and FSH
-Depression
-Obsessive-compulsive disorder
- increased risk of developing bone fractures in later life due to osteoporosis
Causes of Serotonin Syndrome
Serotonin antagonist
SSRI
MAOi
TCA (perhaps)
Symptoms of Serotonin Syndrome
features that differ from NMS
– Muscle weakness, clonus and hyperreflexia
- Rapid Onset (<24hrs)
- Dose dependant
- Nausea and vomiting
- Increased bowel sounds
- Dilated pupils
features shared with NMS
- High grade fever (>40 degrees)
– Autonomic instability (hypertension, tachycardia, diarrhoea, muscle spasms & red skin, sweating).
– Mental state change (agitation, confusion, hypomania, seizure).
- Hypersalivation
-Use of benzodiazepines
Treatment of Serotonin Syndrome
- Cyproheptadine
- Chlorpromazine
St John’s Wort with antidepressant causes
Serotonin syndrome
Causes of Neuroleptic Malignant Syndrome (NMS)
- anti-emetics
- anti-psychotics
- Dopamine antagonists
- cessation of a dopamine agonist
Medications that cause Neuroleptic Malignant Syndrome (NMS)
- quetiapine
- olanzapine
- risperidone
- paliperidone
- domperidone
- metoclopramide
-promethazine
Symptoms of Neuroleptic Malignant Syndrome (NMS)
Features that differ from SS
-Slow onset
- Not dose dependant
- pupils are normal
- No nausea and vomiting
-severe muscle rigidity with hyporeflexia
Features share with SS
- High grade fever (>40 degrees)
– Autonomic instability (hypertension, tachycardia, diarrhoea, muscle spasms & red skin, sweating).
– Mental state change (agitation, confusion, hypomania, seizure).
- Hypersalivation
- Use of benzodiazepines
Treatment of NMS
Bromocriptine
Difference between dementia & pseudodementia?
Cognitive impairment due to the presence of a mood-related mental health concern, most often depression (giving up).
Pseudodementia have INSIGHT
Long-term use of haloperidol
Tardive Dykinesia
Clinical features of Obsessive Compulsive Disorder
- obsessive thoughts and compulsive rituals
- Compulsions are repetitive purposeful, intentional behaviours conducted to prevent an adverse outcome
- Mild obsessional or compulsive behaviour can be considered as a reasonable response to stress
- SSRIs are the treatment of choice
Patients suffering from BPD are at high risk of
Suicide
Capgras syndrome
- Also called delusional misidentification syndrome
- Disorder in which a person believes that an identical-looking has replaced a friend, spouse, parent, or other close family member impostor
- commonly occurs in patients with paranoid schizophrenia,
dementia and brain injury
CAGE questionnaire:
C- Have you ever felt you should Cut down on your drinking?
A- Have people Annoyed you by criticizing your drinking?
G- Have you ever felt bad or Guilty about your drinking?
E- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? (Eye-opener)
How much time needs to progress until regular grief becomes pathological?
Complicated: > 6 months in stage 2
Complex: < 6 months with stages alternation
Difference between Complicated Grief Disorder & Avoidant personality disorder?
Complicated grief:
- symptoms persist longer than six months
- Avoidance of situations that serve as reminders of the loss is also common
Avoidant Personality Disorder:
Initial treatment for Hoarding personality disorder?
CBT and SSRI
Which of the following disorders warrant CBT PLUS medication
Obsessive Compulsive Disorder (CBT in the form of exposure & response prevention)
Prolonged excessive cannabis abuse initial treatment
CBT
Most common side-effect of Clozapine?
- Low WBC (agranulocytosis)
- recurrent infections
- metabolic syndrome
- hypersalivation
- sedation
OCD patients are egosyntonic or egodystonic with how they view their disorder?
Egodystonic
1st line treat for malignant catatonia?
ECT
Hypochondriacs come for cause in relation to their…?
Diagnosis
Criteria for Somatic Symptom Disorder
-1 or more somatic symptoms that are distressing or result in significant disruption of daily life
- Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)
Difference between hypochondriasis & Illness anxiety disorder
hypochondriasis: already have a diagnosis failure to respond to reassurance is an explicit criterion
illness anxiety disorder: has as its primary focus preoccupation with having or acquiring a serious (and undiagnosed) medical illness (think general overall health)
Diagnostic criteria for Conversion Disorder
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical
evaluation.
Individuals with conversion disorder conversion disorder have symptoms that simulate or mimic
neurological illness. Typical symptoms include paralysis, abnormal movements, inability to speak (aphonia), blindness, and deafness. Pseudoseizures are also
common and may occur in individuals with genuine epileptic seizures. Individuals with conversion disorders are commonly seen on neurology wards and on psychiatry consultation-liaison services at general hospitals
Methamphetamine antidote
Wait it out?
Activated charcoal of option is given history of patient ingesting within 2 hours
Methamphetamine withdrawal treatment of choice?
No proper medication to treat withdrawal. but to treat symptoms that arise such as mood disorders in which case : TCA
Methamphetamine overdose can cause what fatal symptoms?
- Stroke
-seizures
-hyperthermia
how to treat sympathomimetic symptoms?
Agitation: benzodiazepines (lorazepam IV if not cooperative, diazepam oral if patient cooperative)
Hypertension: nitrates (nitroprusside), beta blockers (metoprolol 2-5mg IV)
Hyperthermia: evaporative cooling, icepacks and maintenance of intravascular volume and urine flow with IV normal saline solution.
Seizures: Phenothiazines as last resort
Drug-induced extra-pyramidal disease features
- common in the elderly
- due diminished brain dopamine stores
- caused by neuroleptic drugs
- Tardive dyskinesia is the primary symptom
- Treatment is to cease offending neuroleptic
Tardive dyskinesia vs Parkinsons disease
identical symptoms:
- rigidity
- bradykinesia
- postural instability
Differentiating symptoms:
- involuntary movements of face and tongue (tardive)
- Stiffness
Projection
attribution of one’s feelings or beliefs to another
Idealization
the exaggeration of an individual’s qualities by an admirer
Conversion
transformation of psychologic stressors into physical complaints
Symbolization
the selection of a particular object or event to represent other meanings
Splitting
psychologic separation of all good qualities into one
individual and all bad qualities into another
Sertraline and ecstasy drug interaction
They are synergistic
(increase concentration of serotonin in the
body)
Main characteristic of BPD
Difficulty/Inability to main personal relationships (close friend or romantic partner)
Difference between BPD and Cyclothymic disorder?
BPD:
- impulsivity in at least two areas that are potentially self-damaging
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Dialectical behaviour therapy
Cyclothymic:
- many periods of depressed mood and many
episodes of hypomanic mood for at least 2 years
- During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time
Saint John’s Wort combined with COCP
- SJW reduces the effectiveness of COCs and increases the risk of unintended pregnancy
- SJW’s extracts have been reported to induce the cytochrome P450 enzymes CYP1A2, CYP2C9 and CYP3A4, and increase intestinal P-glycoprotein expression. stimulating the liver to break down the oestrogen and progestogen constituents of the COC pill more rapidly, making COCs less effective and increasing chance of unintended pregnancy
St John’s Wort and warfarin
SJW reduces the effectiveness of warfarin and increases the risk of stroke, ischaemia, arterial blockage etc.
- SJW’s extracts have been reported to induce the cytochrome P450 enzymes CYP1A2, CYP2C9 and CYP3A4, therefore metabolising warfarin at a faster rate therefore decreasing its effectiveness.
What MMSE score would indicate cognitive decline?
< 25
If patient has scored just below the normal threshold of MMSE due to sight impairment. What should be done?
Correct sight impairment and redo test, or perform other cognitive tests that do not require sight (Six-item Cognitive Impairment Test)
After MMSE is done to determine cognitive decline (<25), what investigation is best indicated?
CT scan (to see if there’s any degeneration of brain tissue, such as atrophy)
Lithium in pregnancy
- Cause of Ebstein anomaly
- in cases of severe bipolar disorder, benefits may outweigh the risks
- Lithium use during the first trimester of pregnancy has been reported to be associated with fetal cardiovascular
anomalies (e.g. Ebstein’s anomaly) and midfacial and other defects.
Risk of developing Ebstein’s anomaly on patients on lithium?
approximately 1 in 1000 to 2000
compared with 1 in 20000 in the general population.
If patient continues to use lithium during pregnancy, what should be investigated?
Ultrasound and echocardiogram at 16-20 weeks gestation to exclude foetal anomalies, especially cardiac anomalies
In relation to lithium dosage during pregnancy, what should be done in each trimester?
1st trimester: keep same dose as before pregnancy but heavily monitor foetus by US at 16-20 weeks.
2nd trimester: continue same lithium dosage.
3rd trimester: decrease lithium dosage by 25% to avoid floppy baby syndrome due to neonatal toxicity.
After delivery immediately increase lithium dosage due to
increased risk of relapse in postpartum period.
Sodium Valproate in pregnancy
1st trimester: decrease dose to prevent neural tube defects
2nd semester: continue decreased dosage through to 3rd semester
3rd trimester: increase the dosage to prevent seizures
If a patient, who has successfully been stable on prophylactic dose of a particular mood stabilizer, develops acute depression, what is the next best step in management?
- Adding an antidepressant to the prophylactic mood stabilizer: the choices of the drug would be the same as for major depression. SSRls first line.
- Increasing the dose of prophylactic mood stabilizer (ONLY if the patient’s psychosis is indicated in coming back, otherwise continue same dose)
List of anxiety disorders
- OCD
- GAD
List of personality disorder
Divided by Clusters:
-A
-B
-C
-Other
Cluster A personality disorder
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
Cluster B personality disorder
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
Cluster C personality disorder
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive-Compulsive Personality Disorder
Other personality disorders
Personality Change:
- Labile type
- Masochistic
- Disinhibited type
- Aggressive type
- Passive Aggressive type
- Apathetic type
- Combined type
- Unspecified type
List of eating disorders
- Anorexia Nervosa
- Bulimia Nervosa
Timeline for Brief psychotic disorder
> 1 day and < 1 month
Timeline for Schizophreniform disorder
> 1 month and < 6 months
Timeline for Schizophrenia
> 6 months
Criteria for Schizoaffective/ psychogenic
disorder
Schizophrenia + major affective disorder
According to Freud’s theory of psychosexual development, how many stages?
six stages between birth and adolescence:
-oral
- anal
- phallic
- oedipal
- latency
- genital
Cognitive behavioural therapy is useful in many psychiatric conditions including
– Psychosis.
– Phobias.
– Depression.
– Insomnias.
– Eating disorders
symptoms seen in early pre-psychotic Prodrome of schizophrenia/psychosis
Recurrent depressive symptoms over the course of 3-5 years
Symptoms seen in late stage prodrome period of psychosis
Paranoid ideation
odd beliefs
2nd earliest symptoms seen in pre-psychotic prodrome of schizophrenia/psychosis
Loss of motivation and social disability developing within 12 to 18 months of first recurrent depressive symptoms
PTSD characterisation
a set of symptoms which persist for more than four weeks after exposure to traumatic experience
Symptoms of PTSD
- Hypererosal phenomenon:
- poor concentration and memory, irritability, anger, insomnia etc.
– Re-experiencing symptoms-such as intrusive thoughts, dreams, nightmares, flashbacks, lashing out in sleep.
– Avoidance and numbing-loss of interest in activities which previously brought enjoyment, restricted emotional response, detachment from others, deliberate
attempt to keep traumatic experience out of mind.
– Reckless or self-destructive behaviour with loss of occupational and social functioning
Diagnostic criteria for delirium
- disturbance of consciousness (over a short period of time that tends to fluctuate over the course of a day)
- change in cognition
Antidepressants alone are ________ effective in patients with severe depression
50% to 60%
Effect size of most treatments of depression
ECT (0.8) > CBT (0.5) > Anti-depressants (0.4)
At least ______% of patients with major depression will respond to AT LEAST one antidepressant medication
80%
In patients with severe depression or suicidal ideation taking HCV treatment (interferon). Management should be
Stop interferon, start SSRI. deal with depression and once the depression is managed, start interferon again
Pyromania is a one of _______ disorder
Several impulse control disorders
Leukopenia with or without clinical symptoms in a schizophrenic patient with 3000-3500 WBC on clozapine
Continue clozapine
Start twice per week CBCs with differential counts
Agranulocytosis without signs of infection in a schizophrenic patient, next appropriate management?
- discontinue clozapine
- place patient in protective isolation
- bone marrow specimen to see if progenitor cells being suppressed.
- Do not restart Clozapine
Leukopenia with or without clinical symptoms in a schizophrenic patient with 2000-3000 WBC on clozapine
Stop Clozapine
Start daily CBCs
Clozapine can be restarted after leukopenia is addressed and managed
Antidote to benzodiazepine toxicity
LAAM (flumazenil)
Bupropion in contraindicated in patients suffering from seizures
it reduces seizure threshold
Contraindication to venlafaxine
Hypertension
Contraindication to nefazodone
liver disease
hypersomnia
motor retardation
Contraindication to mirtazapine
hypersomnia
motor retardation
Criteria for avoidant personality disorder
- alone but wants connection
- too scared to start and maintain new relationships
Criteria for schizoid personality disorder
Alone and prefers to be alone (the happy loner)
Depression diagnosis
2 core symptoms (depressed mood, low energy, anhedonia) + 2 or more of the other symptoms for at least 2 weeks
Depression symptoms?
Depressed mood (CORE) + SIGECAPS
– S = Sleep
– I = Interest/Enjoyment/
Anhedonia (low) (CORE)
– G = Guilt/Hopelessness
– E = Energy (low) (CORE)
– C = Concentration
– A = Appetite (low)
– P = Psychomotor retardation
– S = Suicidal thoughts
Sleep disturbance type in depression
- early wakening and having trouble going back to sleep (also referred as middle insomnia)
- if successful [in going back to sleep], broken sleep thereafter
- early morning wakening and being unable to get back to sleep at all (also referred as terminal insomnia)
- increased sleep latency (i.e. difficulty falling asleep)
- increased REM stage
- Decreased stage 3 non-REM stage (less stage 3 means less restorative periods => day light tiredness)
Features of major depression with atypical features?
mental retardation
memory impairment
dementia
Patient on lithium stable for years but recently is not effective, depressed and shows signs of suicidal ideation, what to do
continue lithium and add SSRI (bupropion)
Contraindications to benzodiazepine
severe hepatic insufficiency
alcohol abuse
opioids
old age
COPD
Benzodiazepines are contraindicated or should be used with extreme caution in the following conditions due to increased risks of severe side effects:
- Severe Hepatic Insufficiency: The liver metabolizes benzodiazepines. In severe liver disease, the drug can accumulate, leading to excessive sedation, confusion, and increased risk of overdose.
- Alcohol Abuse: Alcohol and benzodiazepines both depress the central nervous system. When taken together, they can cause severe drowsiness, respiratory depression, and even death. Additionally, people with a history of alcohol abuse are at higher risk of developing dependence on benzodiazepines.
- Opioid Use: Combining benzodiazepines with opioids can lead to profound sedation, respiratory depression, coma, and death because both drugs depress the central nervous system.
- Old Age: Elderly individuals are more sensitive to the effects of benzodiazepines, which can cause excessive sedation, confusion, falls, and fractures. The metabolism of these drugs is often slower in older adults, increasing the risk of side effects.
- Chronic Obstructive Pulmonary Disease (COPD): Benzodiazepines can depress the respiratory system, which is particularly dangerous for people with COPD, as they already have compromised lung function. This can lead to worsening of respiratory symptoms or even respiratory failure.
Eriksonian stage
Adult ADHD main features
Symptoms are more subtle, and are subject to change:
Hyperactivity may be replaced with restlessness, and impulsivity may be replaced with inability to control emotions or social inappropriateness.
60% will continue to exhibit symptoms into
adulthood
Mechanism of action of ADHD medication
Inhibition of dopamine and norepinephrine
reuptake
clinical features of Postpartum Psychosis
Suicide (20%) rule out by psych eval first (notify child services & consult psychiatrist)
-child harm
-Infanticide (4%)
Features of Adjustment Disorder
-occurring within 3 months of the onset of the stressor
- disturbance may not have persisted for longer than 6 months after the termination of the stressor
- Stressor is severe but not life-threatening
- no symptoms when going through the stressor (not re-experiencing the event)
Features of PTSD
Criteria of Diagnosis for Somatoform Disorder
- History of many physical complaints beginning before the age of 30
- Each of the following criteria must be met:
- 4 Pain symptoms:
Headaches, abdominal pains, back and joint pain, pain during
menstruation or sexual intercourse, chest pain.
- 2 GI symptoms:
Nausea, bloating, vomiting other than during pregnancy,
diarrhoea or intolerance to several foods.
- 1 sexual symptom:
Erectile dysfunction, irregular menses, excessive menstrual
bleeding, vomiting throughout the pregnancy.
- 1 Pseudo-neurologic symptoms: Conversion symptoms such as impaired
coordination or balance, paralysis or localized weakness, difficulty in
swallowing, lump in throat, aphonia, hallucinations, loss of sensations, visual problems, urinary retention
Post Natal Depression
- between 6-12 months after the delivery,
with a peak at 12 weeks
Symptoms: - marked mood swings
-anxiety - agitation
- poor memory and concentration
- depressed mood and weight loss
Differential diagnosis of Post Natal Depression
- Hypothyroidism
Depression Disorder risks
– Family history of depression.
- Family history of Autism
– Substance Misuse.
– Unemployment
– Low socioeconomic status.
– Elderly person with cognitive decline or bereavement.
– All family members who have experienced family violence.
– Experience of child abuse
- intellectual development delay
- Perfectionism and obssessionality
clinical symptoms of cannabis abuse disorder
- anger management issues
- depression
- anxiety
- poor sleep
Treatment for positive symptoms of Schizophrenia
first-generation (typical) antipsychotics:
-haloperidol
- chlorpromazine
Treatment for negative symptoms of Schizophrenia
second generation (atypical) antipsychotics:
- olanzapine
- quetiapine
-clozapine,
- amisulpride
- aripiprazole
- risperidone
Risks of developing Obsessive Compulsive Disorder
- Anxiety
-Depression
-Alcohol or substance misuse
-Eating disorders
-Body dysmorphic disorders
-Chronic physical health problems (skin problems due to excessive
hand washing)
Treatment for insomnia
1st line:
-CBT
-Brief behavioural therapy
- Exercise
2nd line:
- sleep onset insomnia: short acting benzodiazepine temazepam
- sleep maintenance: Zolpidem up to 4 weeks
Chronic long term: melatonin
Diagnosis of chronic insomnia
- A self-reported complaint of poor sleep quality
- Sleep difficulties occur despite adequate sleep opportunity.
Impaired sleep produces deficits in daytime function. - Sleep difficulty occurs three nights per week and is present for three months
Antipsychotic increases the risk of
type 2 diabetes
- raises the level of triglycerides in the blood
BUT no effect on serum cholesterol level
- Aripiprazole is a substitute
2 questions that MUST be asked to assess suicidal ideation
- Do you feel hopeless?
- Have you felt that you’ve lost interest in your usual activities?
Treatment of alcohol withdrawal
Benzodiazepine (Diazepam)
Onset of alcohol withdrawal
6 and 24 hours after the last drink
Side effects of Lithium
-Alopecia/hair thinning
-acne
-nephrogenic diabetes insipidus
- weight gain
- hypothyroidism
- difficulty sleeping
Lithium intoxication
Seizures
Tremors
Fever
Hyperreflexia
Criteria for Histrionic Personality Disorder
- Uncomfortable when not the center of attention
- Seductive or provocative behavior
- Shifting and shallow emotions
- Uses appearance to draw attention
- Impressionistic and vague speech
- Dramatic or exaggerated emotions
- Suggestible
- Considers relationships more intimate than they are
Symptoms of Bipolar Disorder
1- Psychomotor retardation.
2- Increased appetite or hyperphagia
3- Increased sleep or hypersomnia.
4- Early onset of first depression before 25 years of age.
5- Delusions and hallucinations.
6- Positive family history of bipolar disorder
Harmful side effects of the cannabis abuse
– Chronic cough
– Increased risk of stroke and heart disease
– Poorer academic achievement
– Increased risk of suicide attempts
– Drug-induced Psychosis
How long to wait before reevaluating if prescribed medication is working in a schizophrenic patient?
3 weeks. Increase dose of the initial medication first, and wait until 4-6 weeks
after 4-6 weeks change to another antipsychotic of the same generation (depending on positive/negative symptoms)
Symptoms of Social Anxiety Disorder
– Excessive perspiration
– Trembling
– Blushing when trying to speak
– Nausea or diarrhoea
– The person fears others will take notice
– The person fears that they would make a mistake, and that would lead to
embarrassment
Treatment for Oppositional Defiant Disorder
Family therapy
Features of Oppositional Defiant Disorder
– Persistent stubbornness and refusal to comply with instructions or unwillingness
to compromise with adults or peers.
– Deliberate and persistent testing of the limits.
– Failing to accept responsibility for one’s own actions and blaming others for one’s
own mistakes.
– Deliberately annoying others.
– Frequently losing one’s temper
How much time should infants exposed to SSRI’s be observed for
3 days (monitoring for serotonin syndrome)
Criteria for Adjustment Disorder
behavioural and emotional symptoms that develop within 3
months of exposure to an identifiable stressor and these rarely last more than 6
months after the stressor has ended.
Difference between Adjustment Disorder & Depression
Presence of an identifiable stressor
Difference between Adjustment Disorder & Regular Grief
Grief usually occurs after loss of something like any close relative or property, however, there are l**ess behavioural symptoms **and it is a self-limiting
condition
Symptoms for opiate withdrawal
– Headaches
– Insomnia
– Muscle aches
– Fever
– Nausea and vomiting
– Sweating
– Stomach pains
– Diarrhoea
– Craving
Opiate intoxication symptoms
pinpoint pupils
respiratory depression
decreased level of consciousness
Treatment of opiate withdrawal
- codeine detoxication and rehabilitation programme
- methadone programme as an outpatient
Opiate withdrawal diagnosis
psychosis lasting at least 1 day but less than 1 month
Drug of choice for alcohol withdrawal syndrome
Diazepam (unless px has severe liver disease)
Aute PTSD range
<3 months
Chronic PTSD
> 3months
Clinical features of PTSD
– Recollections, nightmares, flashbacks about the trigger event.
– Avoiding the event that resembles the traumatic event.
– Insomnia.
– Irritability.
– Hypervigilance.
Difficulty in concentrating
Smoking cessation drug of choice
Bupropion
Types of immature defence mechanism
Passive aggression
Acting out
Dissociation
Projection
Autistic fantasy: Devaluation, Idealization, Splitting
Types of Neurotic defence mechanism
Intellectualization
Isolation
Repression
Reaction formation
Displacement
Somatization
Undoing
Rationalization
Types of Mature defence mechanism
Suppression
Altruism
Humour
Sublimation
Types psychotic defence
Denial (of external reality)
Distortion (of external reality)
Treatment for Acute insomnia
- CBT
- benzodiazepine (temazepam)
Treatment for Chronic insomnia
- CBT (gold standard)
- Melatonin (>55)
-Zolpidem (case dependant)
Criteria for Chronic Insomnia
Insomnia for more than 4 weeks
symptoms of long term use of SSRI is elderly patients
Hyponatremia
muscle aches/cramps lethargy
tiredness
confusion
seizures
Timeline for postpartum blues becoming postpartum depression?
2 weeks
Conduct disorder age range
10-16
Mood - Definition?
mood reflects person’s INTERNAL emotional experience (e.g. good, ok, frustrated, angry)
Affect - Definition
affect reflects the person’s EXTERNAL emotional expression - which can be evaluated by the interviewer. It can be described as:
- EUTHYMIC (normal, well-balanced mood)
- DYSTHYMIC (sullen, flat)
- EUPHORIC (intensely elated mood)
Types of Thought Process
- Circumstantiality
- Tangentiality
- flight of ideas
- poverty of thought
- disorganised (word salad)
Circumstantiality
patient veers off into unrelated topics before eventually answering the question
Tangentiality
patient never answers the original question
Flight of ideas
patient has so many thoughts that they cannot keep track of them (e.g. manic state)
Poverty of thought
patient has complete lack of spontaneous thinking (e.g depression, psychosis)
Disorganised
words said make no sense (word salad)
Thought Content - definition?
specific ideas and beliefs that a patient has in mind. can only be assessed through what patient says
- suicidal ideation
- homicidal ideation
- preoccupations
- delusions
Preoccupations - definition?
thoughts that command the entirety of the person’s attention to the point where they cannot focus on anything else)
Perception - definition?
one’s ability to accurately take in information about the world. Most common:
- illusions
- Hallucinations
Delusions - definition?
false beliefs that are inconsistent with patient’s background and cannot be corrected by reasoning
Illusions
misperceptions of genuine stimuli
Hallucinations
false perceptions in the absence of any external stimuli (e.g. auditory, visual)
Risk Factors for suicide?
- Guns
- Recent suicide attempts
- Ongoing thoughts of suicide
- Self-harm
- Ethanol
- Substances
mnemonic “Guns & ROSES”
Define Diogenes syndrome
- squalor and decline in personal hygiene
- sometimes hoarding useless items
- significant frontal lobe impairment
Define Charles Bonnet syndrome
- formed visual hallucinations in blind or partially sighted elderly who are not delirious
- always ocular or occipital disease not psychiatric
- vivid, colourful, and well-organised hallucinations
- experience may last for seconds or hours at a time
- patient has good insight
- hallucinations are not distressing, but may be quite engaging
Define Ekbom syndrome
2 forms:
1. ‘/restless legs’ syndrome
2. delusional infestation with parasites or worms in schizophrenic patients
Define Cotard syndrome
patient believes they have lost important body parts, blood, internal organs, or even their soul
- prevalent in schizophrenia, bipolar disorder, non-dominant temporoparietal lesions and migraine.
BMI formula
kg/height^2
Healthy BMI
20=25
Underweight BMI
18
Overweight BMI
25-29
Obese BMI
30-39
Morbidly obese BMI
< 40
ECT contraindications
- Benzodiazepines (lower seizure threshold)
- Water (amitriptyline)
