Psychiatry Flashcards
Positive & Negative Schizophrenia
**Positive **
A = Auditory hallucinations-
○ Second or third person
○ Thought Echo (écho de la pensée) = hearing own thoughts out loud
• B = Broadcasting, insertion/withdrawal of thoughts
○ Insertion/withdrawal = experiencing thoughts being inserted or removed from one’s brain
○ Broadcasting = believing one’s thoughts are open to everyone
• C = Controlled feelings, impulses or acts (‘passivity’ experiences/phenomena)
○ Somatic passivity = people are in control of your body
• D = Delusional perception (attributing delusional meaning to real perception)
“When I saw a bunch of flowers by the side of the road, I knew the terrorists were after me)
Negative
- Flattened (blunted) affect - lack of emotional reactivity
- Apathy and loss of drive (avolition)
- Social isolation
- Poverty of speech
- Poor self-care
3 domains of Depression
1) Somatic (sleep, appetite, tiredness, general aches and pains)
2) Mood and affect
3) Cognitive Distortions/Self-harm/Suicide
Classification Depression (ICD)
Mild (key: interest, decreased mood, tirdness) -
2 AND 2 (2 key and 2 common symptoms)
Moderate (sleep, concentration,
2 AND 3 (2 key and 3 common symptoms)
Severe
3 and 4 (3 key and 4 common)
Risk Factors Suicide
1) Previous DSH
Organised plan
alone and precautions to avoid discovery
no attempts to be found
Final acts/letter
2) Pychiatric Disorders
3) Socio-cultural factors
Age
FH
Divorce, widowed
Young age (15-44); elderly (75 yrs)
Unemployment
4) Patient’s current mental health
Mental State Exam
Define
1) Panic Attack
2) Panic Disorder
3) Phobia
4) Generalized Anxiety Disorder
1) Panic Attack: a period of intense fear that develops rapidly, peaks in approx 10 minutes and generally does not last longer than 20-30 minutes
2) Panic Disorder: If 3 attacks in a 3 week period then it is deemed a panic disorder
3) Phobia: marked and persistent fear that is excessive or unreasonable, cued by presence or
* *anticipation** of a specific object or situation
4) GAD: excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). the person finds it difficult to control the worry
Drug monitoring for
Lithium
Phenytoin
Ciclosporin
Digoxin
Lithium
range = 0.4 - 1.0 mmol/l
take 12 hrs post-dose
Ciclosporin
trough levels immediately before dose
Digoxin
at least 6 hrs post-dose
Phenytoin
trough levels immediately before dose
DSM Anorexia Nervosa
Diagnosis (based on the DSM-IV criteria)
person chooses not to eat - BMI < 17.5 kg/m^2, or < 85% of that expected
intense fear of being obese
disturbance of weight perception
amenorrhoea = 3 consecutive cycles
Associations of OCD
Associations
depression (30%)
schizophrenia (3%)
Sydenham’s chorea
Tourette’s syndrome
anorexia nervosa
Screening Qs Depression
‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’
A ‘yes’ answer to either of the above should prompt a more in depth assessment.
DSM Classification of Depression
Subthreshold depressive symptoms Fewer than 5 symptoms
- *Mild** depression Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment
- *Moderate** depression Symptoms or functional impairment are between ‘mild’ and ‘severe’
- *Severe** depression Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms
NICE use the DSM-IV criteria to grade depression:
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss or weight gain when not dieting or decrease or increase in appetite nearly every day
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Management of neuroleptic malignant syndrome
Management
stop antipsychotic
IV fluids to prevent renal failure
dantrolene* may be useful in selected cases
bromocriptine, dopamine agonist, may also be used
*thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
Neuroleptic malignant syndrome is typically seen in patients who have just commenced treatment. Renal failure may occur secondary to rhabdomyolysis. It carries a mortality of up to 10% and can also occur with atypical antipsychotics
EPS of Typical antipsychotics
Extrapyramidal side-effects
Parkinsonism
acute dystonia (e.g. torticollis, oculogyric crisis)
akathisia (severe restlessness)
tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
Categories of MMSE
Orientation to place, time
Registration
Attention and calculation
Recall
Language
Repitition
Complex commands
DDx of Elation
- Normal Happiness/hyperthermia
- Acute stress rxn/manic defense
- Anxiety disorder
- Schizophrenia/schizoaffective disorder
- Hypomania/mania
- Organic (including substance misuse and medications)
Qs to ask for Mania
How has your mood been lately?
How good has it been?
Has your mood been changeable?
How are your levels of confidence?
Have you been feeling special / talented / empowered?
Does anything upset you?
How have your energy levels been?
How have you been sleeping? Have you been needing less sleep?
How do you feel in the morning?
How has your concentration been?
Do other people irritate you because they aren’t thinking quickly enough
Indications for ECT
- Severe depression
- Depression in pregnancy
- Refractory mania
- Neuroleptic malignant syndrome
- Catatonic schizophrenia
Define Delusion
“fixed, firm, false belief” out of keeping with a person’s cultural of religious background and is firmly held despite incontrovertible proof to the contrary
Obsessions vs Ruminations
Obsessions: re-curring, intrusive, disruptive, egodystonic (out of keeping with self - these thoughts are not their own as not part of their character), resisted (anxiogenic- cause anxiety). Often have themes of sex and violence, contamination
Note: obsessions are thoughts/feelings, compulsions are actions
Ruminations: are low level thoughts
Qs one can ask to assess thought form
General interview / Proverb interpretation
Use: ‘A rolling stone gathers no moss’
‘One man’s meat is another man’s poison’
‘A stitch in time saves nine’
Assessing Insight
Does the patient recognise their problems / experiences as symptoms?
Do they attribute these symptoms to illness? (some / all symptoms)
Do they believe that the illness is psychological / mental illness?
Do they recognise the need for treatment?
Are they willing to accept treatment (?! The advice of the psychiatrist)
Assessing one’s personality
Introvert vs extrovert?
Optimistic / pessimistic….Moodiness
Prone to anxiety?
What are you like under pressure?
Obsessionality / perfectionism
Impulsivity (shopping / trouble!)
What are your main hobbies / interests
Spirituality / moral code
Define Felicide
Killing of ones own child
Define Obsessions
Recurrent, intrusive and distressing thoughts, images or impulses. Obsessional thoughts differ from pre-occupations by virtue of their intrusivness, distressing effect, ego-dystonic nature
+
,-
Define Compulsions
Repititive actions that are seemingly with purpose that the person feels a compulsion to perform. Resisting carrying out these acts is anxiety provoking
Define Personality Disorder
Lifelong, pervasive inflexibility and inability to adapt to all areas of life.
Define Borderline Personality Disorder
Instability of:
1) behaviour
2) self-image
3) relationships
Medical Complications of Eating Disorders
CVS: arrthymia, sudden death, hypotension, bradycardia, prolonged QT
Gastrointestinal: Delayed gastric emptying, gastric atrophy,
constipation.
– Metabolic: Hypokalaemia, hyponatraemia, hypoglycaemia, hypocalcaemia,
hypomagnesaemia, hypercholesterolaemia, deranged
thyroid function.
– Haematological: Anaemia, leucopaenia, thrombocytopaenia.
– Neurological: Peripheral neuropathy, cerebral pseudoatrophy,
ventricular enlargement.
– Physical signs: Lanugo (thin, fine) body hair, brittle nails,
hypothermia.
– Musculoskeletal: Osteoporosis, proximal myopathy.
What are the 2 core physical characteristics of Anorexia Nervosa
Osteoporosis
Secondary Ammenorrhea (no period > 3 months)
Reversible causes of Dementia
Hypothyroidism
Chronic subdural haematoma
Normal Pressure hydrocephalus
CNS tumour
CNS infection
Meningioma
Metabolic (e.g. Wilson’s)
Toxic (e.g. meds)
Diagnosis of Autism
Impairment of the following:
1) Social interaction - social gaze, social reciprocity, peer relationships
2) social communication - delay in language and abnormalities in speech
3) Restricted and stereotyped pattern of interests, behaviours, and activities (e.g. rituals, routines)
Prevalence of panic attack, panic disorder, GAD, social phobias
Panic attack 8%
Panic disorder 4%
GAD 3-4%
Specifc phobias 10%
Social anxeity disorders 2-13%
