Psychiatry Flashcards
where is post stroke psychosis commonly seen
right side middle cerebral artery lesions
affect frontal and temporal region
what is the most common psychotic symptom
delusion
definition of delusion
false fixed belief not understandable within the person’s sociocultural setting
what are the most common perceptual abnormalities of post stroke psychosis
auditory hallucination followed by visual
what are the risk of antipsychotic use with those with dementia
increased risk of stroke
what long term medical conditions are risk factors for development of mental disorders
CVD
MSK disorders
diabetes
COPD
how is delirium classified
hyperactive
hypoactive
mixed
Risk factors of delirium (5)
advancing age
cognitive impairment
poor nutrition
polypharmacy/alcohol misuse
frailty
common causes/ precipitating factors of delirium
physical illness
injury
infection
constipation
… (multi factorial)
management of delirium
anticipate and address modifiable risk factors
optimise treatment of underlying comorbidities
treat underlying causes
re-orientation strategies
normalise sleep-wake cycles
avoid falls
in extremis, short term pharmacological interventions
what is psychosis
difficulty perceiving and interpreting reality (failure of reality testing)
what are positive symptoms of psychosis
hallucinations
delusions
what are negative symptoms of psychosis
alogia (poverty of speech, slow to respond to questioning)
anhedonia
avolition/apathy (lack motivation and poor self care)
affective flattening (unchanged facial expressions, poor eye contact, limited emotional range and lack focal intonations)
what are disorgansation symptoms of psychosis
Bizarre behavior (inappropriate social behavior, aggression, repetitive stereotyped behavior)
formal thought disorder (lack of logical connection between thoughts)
onset of psychosis
can occur at any age
peak in adolescence /early 20s
peak later in women
is schizophrenia inheritable
yes, ~46% concordance in MZ twins
what are environmental risk factors of psychosis
drug use (esp cannabis)
prenatal / birth complications
maternal infections
migrant status
childhood trauma
socioeconomic deprivation
what to look for when someone with psychosis
bizarre or inappropriate clothing
psychomotor retardation/agitation
abnormal movements
self neglect
self harm injuries
echophenomena
stupor and mutism
difficulties with treating someone with poor insight into their psychosis
concordance with treatment
attendance to follow up
willingness to be admitted to hospital
impact on ability to have capacity to consent treatmentw
which NT system is most implicated in antipsychotics mechanisms
dopamine
but antipsychotics act on diff NT eg serotonin, Ach, hhistamine
which drug actions on dopamine receptors would most likely improve psychotic symptoms
antagonist/ partial agonist/agonist
antagonist
most antipsychotics are what
Dopamine antagonsits
newer agents are partial agonists
what are side effects of antipsychotics
EPSEs (extrapyramidal side effects) (eg parkinsonism acute
dystonic reactions
tardive dyskinesia
akathisia)
increased appetite, weight gain, diabetes, dysrhthymia, increase prolactin, constipation, agranulocytosis, sedation, neutropenia
what is DSM-5 criteria
2 weeks or more of depressed mood and presence of 4/8 symptoms
sleep alterations
appetite alteratios
anhedonia
decreased concentration
low energy
guilt
psychomotor changes
suicidal thoughts
subtypes of DSM-5 for MDD
atypical features (increase slp n appetite with heightened modo reactivity)
melancholic features (no mood reactivity with retardation and anhedonia)
psychotic features (delusions or hallucination)
maniac criteria
irritable mood/euphoric with 3/7
decreased need for sleep with increased energy
distractibility
grandiosity or inflated self esteem
fight of ideas or racing thoughts
increased talkativeness or pressured speech
increased goal directed activities or agitation
impulsive behaviour
how to diagnose type 1 bipolar
symptoms present for minimum 1 week with notable functional impairment
how to diagnose hypomanic episode
symptoms present for min 4 days without notable functional impairment
how to diagnose type 2 nipolar
no single manic episode occurr, only hypomanic episodes present with at least on MDD episode
how to diagnose uispecified bipolar
manic symptoms less than 4 days and other thredsholds not met
what happens if patient hospitalised, irresepctive of duration of manic symptoms
manic episode diagnosed
what happens if psychotic features present
hypomanic cannot be diagnosed
what happens in majority first episodes in bipolar 1
majority of first episodes are depressive
what are some scans that measure receptors and transmitters in human brain
PET imaging (positron emission tomography)
what are the components of mental state examination (MSE)
appearance and behaviour
speech
mood/affect
thought (content and form)
perceptions
cognition
insight
what are some organic or iatrogenic causes of mood disorder
endocrine (thyroid related, hypoglycaemia, cushing’s syndrome, addison’s)
systemic (viral bacterial infection)
deficiencies (V B12, folic acid)
neurological (MS, AD, parkinson’s)
medications (B blockers, steroids, AB)
what are vascular depressions associated with
white matter hyperintensities
can impact cognitive function causing pt more vulnerable to stressors
what is the main symptom of poststroke depression
retardation in thinking and behaviour
poststroke depression pathology
lesions in left frontal lobe or basal ganglia
differentials between BPAD and BPD
BPAD: episodic, inheritable, mood less affect by environment
BPD: mood changes over hrs or days rather than days/weeks
poor self image, fear of abandonment, feel empty, Hx of self harm and trauma
similarities in BPAD and BPD
rapid mood change
unstable interpersonal relationships
impulsive sexual behavior
suicidality
differentials between BPAD and Schizoaffective disorder
BPAD: episodic, hallucinations (rarely chronic)
Schizoaffective disorder : episodic delusion / hallucinations (residual symptoms more likely)
more prominent disorganisation of thought, paranoid delusional beliefs and auditory hallucinations
similarities in BPAD and Schizoaffective disorder
both can present with psychosis and mood symptoms (depression and mania)
differentials between BPAD and ADHD
BPAD: not necessarily present in childhood, episodic, fam hx, amphetamines worsen mania, recurrent depressive episodes