Psychiatry Flashcards
What is ADHD?
Attention deficit hyperactivity disorder= a triad of impaired attention, impulsivity & hyperactivity causing significant functional impairment in at least 2 domains (eg, home & school) for a period of >6 months.
- ADHD is a neurodevelopmental condition
- Features must have been present since <7 years old
How does ADHD present?
All of the features of ADHD are common in all children to varying severities. A diagnosis of ADHD should only be considered when a child has many of these features & they are adversely affecting the child’s life. Features must be present from <7 years old & present across at least 2 settings.
Typical features:
- Impaired attention
- Poor/limited concentration on tasks
- Highly distractible → quickly loses interest in tasks
- Difficulty listening
- Losing things often, poor organisational skills
- Quickly losing interest in tasks
- Impulsivity
- Inability to suppress impulses → acting on them all & not thinking about consequences
- Difficulty waiting their turn
- Hyperactivity
- Restlessness
- Excessive fidgeting, talkativeness, noisiness → often described as disruptive
How is ADHD managed?
ADHD tends to improve in adolescence (particularly hyperactivity), however 2/3 will have symptoms that persist into adulthood.
- Worse prognosis is associated with unstable family dynamics.
- Healthy diet → keeping a food diary can help show if there are any food triggers
- Exercise
Psychosocial:
- Recommended first line in mild-moderate
- Parental education, CBT, social skills training
Pharmacological:
- For school-aged children with severe ADHD & adults with moderate-sever symptoms
- Methylphenidate → first line
- Children must have their height & weight monitored for signs of growth suppression.
How is OCD managed?
Mild-Moderate (minimal functional impairment):
- Self-help
- Individual or group CBT with exposure response prevention (ERP)
- Education
Moderate-Severe (mild-marked functional impairment):
- Individual CBT with ERP (exposure & response prevention)
- Medication:
- 1st line - SSRI (fluoxetine, sertraline). 12 weeks before response. Can try a couple before moving on.
- 2nd line - Clomipramine (tricyclic antidepressant)
- Referral to secondary care if severe and/or initial therapies have not worked.
What are the 2 different types of BPAD?
- Bipolar 1 → the person has experienced at least one episode of mania.
- Bipolar 2 → the person has experienced at least 1 episode of hypomania, but never mania. They must have experience at least one episode of major depression.
How does mania present?
- Elevated, irritable, or expansive mood → out of keeping with the patient’s circumstances
- Excessive activity or feelings of energy → overactivity, pressure of speech, decreased need for sleep.
- Inability to maintain attention
- Grandiosity & increased self-esteem
- Accelerated thinking & speech
- Loss of normal social inhibitions
- Mood-congruent psychotic symptoms
^^present for >7 days and functional effects.
What are the differences between mania & hypomania?
Hypomania has no (or very little) functional effect & does not present with psychotic symptoms.
Hypomania is diagnosed after 4 days, where as mania is diagnosed after 7 days.
How is an acute episode of mania/hypomania managed?
- Admit to hospital if required
- Taper down antidepressants
- Trial of antipsychotic → haloperidol, olanzapine, quetiapine, risperidone
- Benzodiazepine → to acute manage symptoms of increased activity & allow for better sleep.
How is acute depression managed in BPAD?
- Difficult, as using an antidepressant can induce mania → therefore co-prescribe with an antimanic agent.
- Choices:
- Quetiapine
- Fluoxetine + olanzapine
What are the side-effects of lithium?
- Thirst, polydipsia, polyuria → if severe, nephrogenic DI.
- Impaired renal function
- Hypothyroidism
- Worsens skin problems
- Weight gain
- Oedema
- Concentration & memory problems.
- Fine tremor
What are the symptoms of lithium toxicity?
- Nausea, vomiting
- Coarse tremor
- Ataxia
- Muscle weakness
- Nystagmus
- Hyperreflexia
- Impaired consciousness
What is schizophrenia & what causes this?
= a long-term mental health condition which affects thinking, perception, and affect (psychosis), causing a deterioration in the person’s functioning.
Aetiology:
- Multifactorial
- Genetic/biological factors:
- Neurodevelopmental → people with hypoxic brain injury at birth, or who were exposed to viral infections in utero are at greater risk.
- Excess of dopamine is believed to cause the positive symptoms
- Family history → 10% risk if 1st degree relative is affected
- Environmental risk factors:
- Cannabis-use → risk doubled for smoking on 10 occasions. Can be the tipping point for those pre-disposed
- PTSD, adverse life events
- Malnutrition during pregnancy
Define delusions
fixed beliefs, arrived at illogically, not amenable to reason, and not accepted in the patient’s cultural background.
How does schizophrenia present?
Positive Symptoms:
- A change in behaviour or thought
- Auditory hallucinations → thought echo, running commentary
-
Delusions:
- Thought control → insertion, withdrawal, broadcast
- Passivity (control) → mood, impulse, actions, bodily sensations under control of an external force.
- Perception → a true perception of an external stimulus is interpreted in a delusional way, can be persecutory
- Lack of insight
Negative Symptoms:
- Usually involve a decline in normal functioning.
- Blunted affect
- Apathy
- Social isolation
- Poverty of speech
- Poor self-care
What are the differentials of schizophrenia?
- Schizophrenia-like disorder → where symptoms have resolved or not lasted long enough for diagnosis.
- Schizoaffective disorder → psychotic symptoms, as well as prominent mood symptoms within the same episode of illness.
- Delusional disorder → where the primary psychotic symptom is delusions.
- Psychosis secondary to medical condition or substance misuse
- Dementia
- Delirium
- EUPD → may present with unusual beliefs or hallucinations
