Psychiatry Flashcards
1
Q
What components are in a formulation?
A
- predisposing
- precipitating
- presenting
- perpetuating
- protective
2
Q
What is included in an MSE?
A
A - appearance and behaviour
S - speech
E - emotion
P - perception
T - thought
I - insight
C - cognition
3
Q
What is the definition of mental health disorder?
A
Disorder of mind excluding alcohol and drugs
4
Q
What is the definition of psychosis?
A
Loss of touch with reality + impaired function
5
Q
What is the definition of a hallucination?
A
An unreal interpretation of an unreal stimulus (e.g. hearing voices)
6
Q
What is the definition of an illusion?
A
An unreal interpretation of a real stimulus (e.g. leaves rustling mistaken for footsteps)
7
Q
What is a delusion?
A
A fixed false unshakeable belief out of keeping with social norms
8
Q
What is the definition of delusional perception?
A
‘If A happens, B will happen’ (pathognomonic for schizophrenia)
9
Q
What is the definition of flight of ideas?
A
Rapid stream of consciousness - jump between topics
10
Q
What is the definition of formal thought disorder?
A
Disordered pattern of speech as a result of disordered thought
11
Q
What is the definition of knight move?
A
Illogical jumps from a point and not returning
12
Q
What is the definition of tangeniality?
A
Deviating from a point and not returning
13
Q
What is the definition of circumstantiality?
A
Deviating from a point but returns
14
Q
What is the definition of depersonalisation?
A
When someone thinks there not real
15
Q
What is the definition of derealisation?
A
When someone thinks the world around them isn’t real
16
Q
What is the definition of obsession?
A
Mental preoccupation, pervasive and recurrent
17
Q
What is the definition of compulsion?
A
Urge + action or obsession to obtain relief
18
Q
What are some of the thought problems patients experience?
A
- Insertion
- withdrawal
- broadcast
- passivity
19
Q
What is somatoform disorder?
A
Medically unexplained symptoms
20
Q
What is hypochondriasis?
A
Mental preoccupation that a patient has a life threatening illness despite a lack of symptoms and negative tests
21
Q
What is conversion disorder?
A
Neuro symptoms (e.g. weakness) in absence of pathology therefore put down to psych
22
Q
What are some of the types of delusion?
A
- persecutory - mc
- grandiose
- guilt + worthlessness
- nihilistic
23
Q
What is Capgras delusion?
A
The belief that a close relative has been replaced with an imposter
24
Q
What is Fregoli delusion?
A
The belief that everyone is one person with masks
25
What is Othello delusion?
The belief that their partner is unfaithful (extreme jealousy)
26
What is de clerambault delusion?
The belief that a exalted yet inaccessible person is in love with the patient
27
What is Ekbom delusion?
Restless leg syndrome, painful calf cramping, "creepy crawly"
28
What is Cotard delusion?
The belief that the patient is dead and rotting
29
How long do antidepressants take to start working?
4-6 weeks
30
What is there an increased risk of in under 30s starting antidepressants?
Increased suicide risk
31
How long do antidepressants need to be taken after symptoms improve?
Keep taking for 6 months after symptoms improve and then wean over 4 weeks - prevents serotonin discontinuation syndrome
32
What are the symptoms of serotonin discontinuation syndrome?
- nausea + vomiting
- agitation
- insomnia
- paraesthesia
- flu like symptoms
33
According to the MHA 1983 what do you need to be able to detain a patient?
- Evidence of a mental health illness
- They're going to be a risk to society
- They will benefit from admission
- There is treatment available for them
34
What are the principles of the MHA 1983?
- need to pick the least restrictive option available
- patient needs to be safe
- improve patient wellbeing '
- give effective treatment
35
True or false: the MHA can override the MCA?
True
36
What is the most commonly used SSRI?
Sertraline
37
What are some available SSRIs?
- Sertraline
- Paroxetine
- Fluoxetine
- Citalopram
38
Which SSRIs can be used when breastfeeding?
Paroxetine and fluoxetine
39
Which SSRI is most likely to cause QTc prolongation on an ECG?
Citalopram
40
What are some of the side effects of SSRIs?
- GI - n+v, pain, increased GI bleed risk
- Impotence and decrease libido
- Serotonin syndrome
- QTC prolongation
- Hyponatremia
41
What medications can SSRIs interact with?
- Triptans - decrease the efficiency
- NSAIDs - GI bleeds, co-prescribe a PPI
42
What congenital defects can paroxetine cause in the first trimester?
- Congenital heart defects
- Cleft palate
43
What congenital defects can paroxetine cause in the third trimester?
Persistent pulmonary hypertension of the newborn
44
What are some examples of SNRIs (antidepressants)?
- Venlafaxine
- Duloxetine
45
What are some side effects of of SNRIs?
- Nausea and vomiting
- dry mouth
- rhabdomyolysis
- SIADH
46
What are some examples of tricyclic antidepressants?
- amitriptyline (sedating)
- imipramine (non sedating)
47
What are the side effects of tricyclic antidepressants?
- Dry eyes, mouth, dehydrated, constipation
- impotence
- sedation
48
What are the side effects for overdosing on tricyclic antidepressants?
- Dry hot skin
- confusion
- Increased acetylcholine symptoms
49
How is a tricyclic antidepressant overdose diagnosed?
ECG - Wide QRS + QTC prolongation
50
How is a tricyclic antidepressant overdose treated?
IV Bicarb
51
What are the side effects of mirtazapine?
- weight gain
- sedation
52
What is first line for depression if a patient is on warfarin or LMWH?
mirtazapine
53
What are the symptoms of major serotonin syndrome?
- Hyperreflexia
- ankle clonus
- dilated pupils
- autonomic symptoms
- maybe increased creatinine kinase
54
What is the treatment for serotonin syndrome?
Stop SSRI and give chlorpromazine
55
How should antipsychotic medications be stopped?
Gradual reduction when stopping (over 3 months) to prevent relapse
56
What is checked at the 12 monthly review for a pt on antipsychotics?
FBC, U+E, HbA1C, LFT, prolactin, BMI
57
What are typical antipsychotics?
Haloperidol and chlorpromazine
58
What are the side effects of typical antipsychotics?
- Acute dystonic reaction
- Akathisia - Lower leg motor restlessness
- Parkinsonism
- Tardive dyskinesia - years after
- lactation
- decreased libido
- infertility
59
What are atypical antipsychotics?
Risperidone, olanzapine, quetiapine, aripiprazole, clozapine
60
What are atypical antipsychotics associated with?
- Weight gain
- Metabolic syndromes - T2DM, Cushings
61
When will clozapine be used on a patient?
When 2 different antipsychotics have been tried
62
When are patients on clozapine monitored?
- First 18 wk - weekly
- Then fortnightly for 16 wk
- Then monthly
- Monitor - FBC, BP, BMI, SE
63
Which antipsychotic is proven to work on the mesocortical pathway and the mesolimbic pathway?
Clozapine
64
What are the main side effects of clozapine?
- Agranulocytosis
- Hypersalivation
- Weight gain
- Constipation
65
What needs to happen if a patient on clozapine misses a dose for more than 48hr?
Need to retitrate their dose - start on lower and work way back up
66
What needs to happen if a patient on clozapine's smoking status changes?
Need to retitrate their dose - smoking decreases bioavailability of clozapine
67
What causes major neuroleptic malignant syndrome?
Overuse of antipsychotic or hypersensitivity reaction to antipsychotic
68
What are the symptoms of major neuroleptic malignant syndrome?
- Hyporeflexia
- Rigidity
- Normal pupils
- Raised creatine kinase +/- raised WCC
69
What is the treatment for major neuroleptic malignant syndrome?
Stop the antipsychotic, give dantrolene IM and bromocriptine
70
What are the complications of major neuroleptic malignant syndrome?
- Rhabdomyolysis
- AKI due to acute tubular necrosis
71
What is lithium used for?
Mood stabiliser - acts on cAMP
72
What medication does lithium interact with?
- NSAIDs
- diuretics
- ACE inhibitors
73
What side effects can lithium cause?
- Dehydration
- renal failure
- lithium toxicity
74
What level of serum lithium in the blood is classed as lithium toxicity?
>1.5mmol/l
75
What are the symptoms of lithium toxicity?
- Leucocytosis
- diabetes insipidus
- tremor - coarse
- dehydration
- hypothyroidism
76
True or false: lithium is teratogenic?
True
77
When are you going to measure lithium levels in a pt?
- 12hr post first dose
- weekly till stable
- 3 monthly
78
What are you going to monitor on patients on lithium?
FBC, U+E, TFT, eGRF, BMI, ECG
79
What are the symptoms of syndrome of irreversible lithium effectuated neurotoxicity?
- cerebellar symptoms
- dementia
- parkinsonism
- dystonia
- akathisia
80
If lithium cannot be used as a mood stabiliser what else can be?
- carbamazepine
- valporate
81
What are benzodiazepines used for?
sedation, alcohol withdrawal, anxiety
82
What are some examples of benzodiazepines?
chlordiazepoxide, diazepam, lorazepam
83
When would ECT (electroconvulsive therapy) be used?
In severe refractory depression and severe mania and sometimes catatonic schizophrenia
84
What are the complications of ECT?
- Amnesia (short term)
- Confusion (long term)
85
What is ECT contraindicated in?
- <12yr old
- HTN
- MI <3m ago
86
What is the most widely used talking therapy that can be used for most conditions?
CBT
87
What are the principles of couples therapy?
- Promote communication
- Reduce emotional avoidance
- Modify dysfunctional behaviour
88
What is depression classified as?
>2 weeks of anhedonia, low mood and low energy most days
89
What are the risk factors for depression?
Bio - chronic pain, post partum, chronic steroid use, low T4 (hypothyroidism)
Psych - trauma, low self esteem, abuse
Social - bereavement, stressed, significant life event
90
What are the main biological theories that have been implicated in depression?
- Stress-vulnerability (different people different thresholds)
- Monoamine hypothesis (reduced monoamine neurotransmitters (dopamine, serotonin, norepinephrine) causes depression)
91
What are the symptoms of depression?
S - suicidality/ self harm
I - low interest
G - guilt or worthlessness
E - low energy
C - low concentration
A - low appetite
P - psychomotor retardation
s - decreased sleep
92
What are the symptoms of atypical depression?
- increased appetite
- increased sleep
- mood fluctuation
93
How is depression diagnosed?
Bloods - FBC, U+E, TFT, prolactin, syphilis serology, B12, folate
Questionnaires - PHQ-9 (community), HADS (hospital), Edinburgh (postnatal)
94
What is the treatment for depression?
Mild - 1.CBT, 2.SSRI
Moderate-Severe - SSRI + intense CBT
Last line - ECT
95
What is the treatment for seasonal affective disorder?
Light therapy, SSRI
96
What is the treatment for dysthymia?
Low intensity CBT
97
What are some differentials for depression?
- Seasonal affective disorder
- dysthymia
- other mental health conditions
- Alzheimer's
- substance misuse
98
What are the risk factors for self harm?
- LGBTQ
- Female
- Emotionally unstable personality disorder
- depression
- bereavement
- trauma/abuse
99
What are risk factors for suicide?
- Male
- Old age and teens
- depressed
- PHx parasuicide
- alcohol
- psychotic
- low social support
- organised plan
- not married
- chronic illness
100
Which patients have an increased risk of recurrent suicide?
- Made a conscious effort not to be found
- If they leave a note
- If they plan their death
- No regret afterwards
101
What is bipolar type 1?
When a pt has alternating bouts of mania (psychotic symptoms) and depression
102
What is bipolar type 2?
When a pt has bouts of hypomania (no psychotic symptoms) and depression
103
What is cyclothymia?
When a pt has bouts of hypomania and subclinical depression
104
What can precipitate a manic episode?
- Benzodiazepine use
- SSRI use
- Alcohol
- LSD
105
What are the risk factors for bipolar?
- Family history
- stress
- abuse/trauma
- substance abuse
Mean age - 24/25
106
What are the symptoms of mania?
>7 days of symptoms
- irritability
- distractable
- insomnia
- grandiose delusions
- flight of ideas
- activities increased
- speech increased
- thoughtless - increased risk taking behaviours
107
What are the symptoms of hypomania?
4-7 days
- increased mood
- mildly distractable
- decreased sleep and food need
- no grandiose delusions
- talkative
- mildly reckless
- no hallucinations
108
What GP referrals are made for mania and hypomania?
Mania - urgent CMHT referral
Hypomania - routine CMHT referral
109
How is bipolar diagnosed?
- clinical diagnosis
- depression bloods
110
What are the treatments for bipolar?
Acute - Antipsychotics (and stop taking SSRI for depression)
Long term - Lithium
111
What is schizophrenia?
Disassociation from reality >28 days and not as a result of substance abuse
112
Who is most affected by schizophrenia?
Median age - 25
M=F
113
What lobe is most commonly affected in schizophrenia?
Temporal
114
What are the main theories for schizophrenia?
- Neurodevelopmental hypothesis - hypoxic ischaemic injury or any other birth complication can impair brain development, therefore increase risk
- Neurotransmitter hypothesis - increased neurotransmitter in mesolimbic pathway = positive symptoms. Reduced neurotransmitter in mesocortical pathway = neg symptoms
115
What are the risk factors for schizophrenia?
- Family history !!!!!!!
- Smoking cannabis in youth
- Traumatic birth
- Trauma + abuse
116
What is the most common type of schizophrenia?
Paranoid schizophrenia
117
What are the types of schizophrenia?
- Paranoid
- hebephrenic (young people)
- catatonic
118
What are the 1st rank symptoms of schizophrenia (Schniders symptoms)?
- delusional perceptions
- thought alienation - insertion, withdrawal, broadcast
- third person auditory hallucinations
- passivity
119
What are the 2nd ranked symptoms of schizophrenia?
- non-auditory hallucinations
- catatonia
- delusions
- decreased insight
120
Can you drive after a diagnosis of schizophrenia?
Can't drive until 3 months on treatment and well or you have a good psychiatry report
121
What are the differentials for psychosis?
- drug induced schizophrenia
- depression
- post partum psychosis
- schizoaffective
- syphilis
- Huntington's
122
How is schizophrenia diagnosed?
Bloods - Toxicology, FBC, U+E, TFT, B12+folate, syphilis
Diagnosis needs either 1 1st rank symptom or 2 2nd rank symptoms for >28 days
123
How is schizophrenia treated?
- Antipsychotic for at least 6-8 weeks, then another if unsuccessful, last line = clozapine
- Consider MHA 2 or 3 section
- CBT, CMHT
- Consider social worker
124
What is delusional disorder?
Pt has an isolated delusion >3m, no psychosis or loss of function
125
What is schizoaffective disorder?
Schizophrenia + at least 1 mood disorder
126
How is schizoaffective disorder treated?
- Antipsychotics
- Mood treatments
127
What are the types of anxiety disorder?
- GAD
- Panic disorder
- Simple/specific phobias
- OCD
- PTSD
128
Which model explains the rational behind developing an anxiety disorder?
Triple vulnerability model : Genetic predisposition + life factor (loss of control) + life stress
129
What are the risk factors for an anxiety disorder?
Bio- genetics, stimulant drugs, palpitations, increased T4, withdrawal
Psych- MHx, trauma, abuse
Social- stress, life event
130
What is generalised anxiety disorder?
Pervasive, persistent non specific anxiety >6m
131
Who is most commonly affected by GAD?
Females, 40-65yrs
132
What are the symptoms of GAD?
I'm MISERAble
M - muscle tension
I - irritable and insomnia
S - sweaty
E - low energy
R - restlessness
A - autonomic - palpitations, SOB, tremor
133
How is GAD diagnosed?
Bloods - FBC, U+E, TFT, Glucose, urine toxicity
Q = GAD-7 (5-9 mild, 10-14 mod, 15+ severe /21)
134
What is the treatment for GAD?
1. Patient education
2. low intensity CBT
3. high intensity CBT + SSRI + CMHT referral
4. Propranolol for muscle tension
135
What is panic disorder?
A pervasive disorder, lasting > 1 month with at least 4x week spells of 10-30min panic attacks
136
Who is most affected by panic disorders?
F
20-30yrs
137
What are the symptoms of panic disorder?
3cs - chest pain, choking, chills
MISERABLE - muscle tension, irritable+insomnia, sweaty, low energy, restlessness, autonomic,
138
How is panic disorder diagnosed?
- Panic disorder severity scale (PDSS)
- PHQ-PD
139
How is panic disorder treated?
Self help CBT + education -> higher intensity CBT + SSRI (CMHT referral)
140
What are simple/specific phobias?
An irrational extreme fear leading to avoidance and catastrophising
141
How are simple/specific phobias treated?
Exposure re-exposure and prevention therapy (ERP) and then consider SSRI
142
What is OCD?
>2 weeks of >4 days a week of recurrent pervasive obsessions, resulting in compulsions for relief.
Pt recognises actions are unnecessary but is obsessed.
143
What are the symptoms of OCD?
4d/week for >2 weeks where obsessions need compulsions for anxiety relief
No action = no relief
MISERABLE symptoms
144
How is OCD diagnosed?
Yale Brown OCD scale
145
How is OCD treated?
-ERP + CBT -> SSRI (2nd line clomipramine)
146
How long does a patient with OCD need to keep taking their SSRI?
Takes up to 12 weeks to start working, then needs to take for up to a year before being weaned off
147
What is PTSD?
>28d prolonged stress reaction to a previous traumatic event
148
What are the symptoms of PTSD?
H - hyperarousal
E - emotional blunting
A - avoidance
R - reliving experiences
149
How is PTSD diagnosed?
Trauma screening Q
150
How is PTSD treated?
- Eye movement desensitisation and reprocessing therapy (EMDR)
- For combat related use trauma related CBT
- Consider SSRI in severe cases
151
What is an acute stress reaction?
<28 days, self resolving
152
What pathway do addictive behaviours work on?
Mesolimbic reward pathway
153
What are symptoms of dependence?
- withdrawal - taking substance to avoid withdrawal
- tolerance
- narrowed repertoire
- craving
- loss of control
- rapid reinforcement - quick return to old level after stopping
- primacy - takes precedence over physiological needs
- continued use despite harm
154
How does alcohol affect the body?
- GABAergic CNS retardant
- increases adipose mass
- increased cortisol
- decreased co-ordination
155
What are the symptoms of alcohol intoxication?
- increased sexual arousal
- increased risk taking behaviours and confidence
- ataxic gait
- slurred speech
- vomiting
- altered GCS scale
156
What are the symptoms of alcohol withdrawal?
6-12hr - anxiety + fine tremor
36hr - seizures (typically tonic-clonic)
72hr - delirium tremens
157
What may been seen on bloods of a pt who is alcohol dependent?
- macrocytic anaemia
- raised GGT
- raised CDT
- raised ALP
158
How can alcohol dependence be diagnosed?
- Bloods
- Cage + audit questionnaires
- Once stable use the CLWA-Ar (clinical withdrawal assessment - alcohol related)
159
What level of alcohol concentration needs to be in your blood for it to be illegal to drive?
>0.08%
160
What is the treatment for acute alcohol withdrawal?
IV Chlordiazepoxide
161
What is the treatment for long term alcohol withdrawal?
Naltrexone - opioid inhibitor - decreases pleasure
Acamprosate - NDMA inhibitor - reduces craving
Disulfiram - AAD inhibitor - induces hangover symptoms when alcohol is consumed - contraindicated in pregnancy
162
What are the symptoms of taking opioids?
- Pain relief
- constipation
- pin-point pupils
- euphoric
163
What is the main side effect of taking opioids?
Respiratory depression
164
What is the treatment for opioid dependency?
Acute= IV 400mg naloxone
Long = methadone/buprenorphine + naltrexone
165
What are the withdrawal symptoms of opioids?
- yawning
- dilated pupils
- lacrimation
- rhinorhea
166
What symptoms can NDMA dependency cause?
- agitation
- HTN
- tachycardia
- hyperthermia
- hyponatremia
- decrease appetite
167
What are the symptoms of amphetamine dependency?
- agitation
- hyperthermia
- hallucinations
- dilated pupils
168
What are the symptoms of cocaine dependency?
- coronary artery vasospasm
- angina
- seizures
- ischaemic colitis
- hyperthermia
169
What are the symptoms of LSD dependency?
- hallucinations
- psychosis
- impaired judgement
- dilated pupils
- hyperreflexia
170
How is anorexia defined?
BMI <17.5, with body dysmorphia, purging, compensation and physical symptoms
171
What are the risk factors for anorexia?
- family history
- personal history of being overweight
- EUPD
- depression
- trauma + abuse
- Female 20-40
- bodybuilding/social media
172
What are the symptoms of anorexia?
- Low BMI, Purging (laxatives, vomiting), compensation (e.g. increased exercise when overeating), deliberate weight loss and body dysmorphia for >3months
- Dry thin skin + lanugo hair + dental caries + gum retraction
- CV - arrhythmias, bradycardias + hypotension
- Endo - impaired glucose tolerance, amenorrhoea
- Osteopenia + muscle wasting
173
How is anorexia diagnosed?
- SCOFF questionnaire
- SUSS test
- Bloods - FBC, U+E, TFT, Oest, HbA1C (All low)
- Raised Growth hormone and cortisol
- Low BP
- ECG
174
What is the treatment for anorexia?
- Structured eating plan (AdCalD3, vitamins, K+, Na+) + treat in community with CBT
- In severe cases consider inpatient admission + fluoxetine e.g. 15 BMI
175
Why are people with anorexia's electrolytes checked when refeeding?
Risk of refeeding syndrome
176
What are the possible complications of anorexia?
- Refeeding syndrome
- Infertility
- Amenorrhoea
- Osteoporosis
177
What is bulimia nervosa?
Preoccupation with body image causing >2 weekly episodes for >3 months of binge+purge cycles
178
What are the symptoms of bulimia nervosa?
- >2 ep >3 months of binge-purge with normal BMI
- Russel sign - knuckle callouses due to vomiting
- GORD/Reflux
- Parotitis
- Halitosis
- Dental cavities
179
How is bulimia nervosa diagnosed?
- Bloods
- Venous blood gas
- SCOFF Q
180
What would show on a VBG for someone with bulimia nervosa?
Hypokalaemic hypochloremic metabolic alkalosis
181
What is the treatment for bulimia nervosa?
CBT alone
182
What questions are in the SCOFF questionnaire?
- Make yourself sick after food?
- Lost control of food?
- One stone + loss in last 3 months
- Food dominates life?
- Fat perception?
183
What is binge eating disorder?
Planned binge eating eps >3 months with overweight BMI
184
What is the treatment for Binge eating disorder?
CBT
185
How old do you have to be to be diagnosed with a personality disorder?
18
186
What features do people with paranoid personality disorder present with?
- Sensitive
- Unforgiving
- Takes attacks on character seriously
187
What features do people with schizotypal personality disorder present with?
- Inappropriate affect
- Magical thinking
- Ideas of reference
- Odd behaviour
- MADHATTER
188
What features do people with schizoid personality disorder present with?
- Cold
- Solitude
- Decreased libido
- Thinks worlds uncanny
- BATMAN
189
What features do people with narcissistic personality disorder present with?
- Believes life's a competition
- Grandiose
- Entitled
190
What features do people with histrionic personality disorder present with?
- Craves centre of attention
- Flirtatious
- Considers relationships closer than they are
191
What features would someone with Emotionally unstable personality disorder present with?
- Crave sympathy
- Impulsive acts (self harm)
- Poor relationship history
192
What features would someone with antisocial personality disorder present with?
Repeated unlawful violent acts
193
What features would someone with obsessive compulsive personality disorder present with?
- Strict time regulation
- Refuses to delegate
- Perfectionist
194
What features would someone with avoidant personality disorder present with?
Craves companionship + intimacy but fear of rejection
195
What features would someone with dependent personality disorder present with?
- Want others to make big decisions for them
- Submissive
196
How are personality disorders diagnosed?
Minnesota multiple personality inventory
197
What is the treatment for a personality disorder?
- CBT
- Dialectal behavioural therapy for EUPD
198
What can cause a learning difficulty?
>100 normal
- ASD
- ADHD
- Genetic (Down's)
- TORCH
199
What is autistic spectrum disorder?
Spectrum of severity with impaired communication + social interaction <3 years
200
What are the symptoms of autistic spectrum disorder?
- Reduced speech
- Reduced empathy
- Isolation (reduced interest in shared play)
- Concrete thinking
- Specific knowledge
- Tics
- Ritualistic behaviour
- Reduced emotional cues
201
How is autism diagnosed?
M-CHAT screening
202
How is autism treated?
Supportive
203
What is ADHD?
Hyperactivity, impulsivity and attention deficit (mc 6-12yrs)
204
How is ADHD diagnosed?
DIVA-5
205
How is ADHD treated?
- Trial of watch and wait
- Methylphenidate
206
What are tics associated with?
- ASD
- ADHD
- PANDAS
207
What is PANDAS?
Paediatric autoimmune neuropsychiatric disorders associated with strep infection
208
What is sleep disorder?
Insomnia >3d/week
209
How is sleep disorder treated?
Zopiclone
210
What are the symptoms of narcolepsy?
- Cataplexy
- Visual hallucinations
- Excessive daytime sleepy
- Sleep paralysis
- Sleep difficulty
211
How is narcolepsy treated?
Modafinil + sleep hygiene
