PSYCHIATRY Flashcards
BIPOLAR DISORDER
- MANIA OR HYPOMANIA AND DEPRESSION is called BPD
- Only elevated mood : Hypomania
- Elevated mood + depression : BPD
- Elevated mood + psychotic symptoms ( delusion or halucination ) : Mania
T/t : GP setting - refer to psychiatry
Psychiatry setting - Lithium - first line
Anorexia Nervosa
Management :
1) Immediate referral to medicine unit
any BMI with features of medical complications ( Hypotension ( <90/60 mmHg ) , Bradycardia , Hypoglycemia , Electrolyte imbalance
2) Immediate referral to Psychiatric unit
if there are any signs of suicidal tendancies
3) Eating disorder unit
if there are only signs of eating disorder
BULLIMIA NERVOSA
Managment : CBT and SSRI
RUMINATION SYNDROME
Regurgitation
t/t : Diaphragmatic breathing
ADHD
Disorder of executive functioning
below symptoms in more than 2 settings
Hyperactivity + impulsitivity + Attention disorder
t/t : Methylphenidate
Autism Spectrum Disorder
Language difficulty + Anti social + repetitive behaviour
t/t : multidisciplinary approach
MANIA
Elevated mood ( sleeplessness, overspending etc ) with delusion / hallucinations +
Hypomania - Milder version of mania without delusions or hallucinations
t/t of mania : Lithium - first line
2nd line - psychotherapy
CLINCHERS FOR Bipolar disorder
1) Only elevated mood : Hypomania
2) Elevated mood + depression : BPD
3) Elevated mood + Psychotic symptoms ( delusions/ hallucinations) : Mania
T/T for mania , hypomania or BPD
Psychiatry setting or if not mentioned : Lithium
GP setting : refer to psy
Lithium toxicity
Tremor, nausea , vomititng, hyperreflexia, seizures , coma , polyuria , polydipsia
In pregnancy : Ebstein anomaly
t.t:
mild to moderate : IV FLUIDS and stop the drugs ASAP
Severe toxicity : Haemodialysis
Investigations for lithium toxicity
BEFORE STARTING : TFT AND ECGs
AFTER STARTING : after 12 hours - lithium levels check
then after 1 week , then 3 montly
check RFT , TSH - 6 monthly
Depression Management
mild to moderate - CBT , Psychotherapy
More severe : CBT + SSRI
SSRI vs CBT : SSRI first line »_space;»CBT
Antidepressants of choice
Sertaline - safest for MI and bleeding and with patient on aspirin
Patient on warfarin - Mirtazapine
For young teenagers : Fluoxetine
For breast feeding : Sertaline
Timing of SSRI
2-4 weeks - improvement expected , full efect 6 weeks
tried for at least 6 months - if not effective , change to another antidepressant
DEPRESSION IN ADOLESCENTS
FIRST LINE - PSYCHOTHERAPY
SECOND LINE - FLUOXETINE
DELUSION
- EKBOMS SYNDROME
infested by parasites
2.Delusion of reference
3.Delusional perception
4.Folie a deux : same delusional belief and hallucinations shared by 2 ppl
5.OTHELLO Syndrome: unfaithful partner
6.Erotomania : Delusional belief that a person of higher social status falls in love with him/her
7.Capgras syndrome : Fixed belief that someone they know has been replaced by an imposter
8.Fregoli delusion : Delusional belief that diff ppl are in fact a single person who changes apperance
HALLUCINATION
No stimulus present
Auditory hallucinations:
1) 1 st person : “I am walking “
2) 2nd person :”You are walking”
3) 3 rd person :” He is walking “
SCHIZOPHRENIA
More than 2 of the following symptoms to be present for at least 1 month to be termed as SCHIZOPHRENIA
1) Dellusion
2) Hallucination
3) Disorganised speech
4) Disorganized behaviour
5) Negative symptoms : FLAT AFFECT , SOCIAL WITHDRAWAL
Management of schizophrenia
1) Atypical antipsychotics: Risperidone , olanzapine
Subtypes of Schizophrenia
Paranoid : fearful schizophrenia
Hebephrenic : Disorganized speech or silly responses and foolish or bizzare behaviour, delusions and hallucinations.
Catatonic: Reduction in moving, rigid posture , not talking , sluggish response
Simple : schizophrenia without delusion or hallucinations
SCHIZOAFFECTIVE DISORDER
Psychotic symptoms ( delusion and hallucination ) + Mood disorders ( mania or depression)
How to differentiate between BPD and Schizoaffective disorder ?
In BPD : Psychotic symptoms present only during mania
In schizoaffective disorder : Psychotic symptoms occur irrespective of mood ie occurs both during high mood ( mania ) and depression
Acute Psychosis
IM lorazepam ( safest)- when medical condition is not known
IM Haloperidol - not safe in parkinsons patient
INCONGRUENCE AFFECT
Inappropriate expressions in unsuitable conditions( like smiling and laughing in father s death ) seen usually in schizophrenic disorder
PANIC ATTACK
C/F :tremors , palpitations , SOBs
Respiratory alkalosis
No triggers required
out of blue
DIAGNOSIS OF PANIC ATTACK
> 1 Panic attack for > 1 month with more than 1 of the following
1) Persistent concern of additional attacks
2) Worrying about consequences of attack
3) Behavioural changes
T/T of Panic attack
Immediate management
1)Rebreathing into mask - first line
2) IM/IV lorazepam
Long term management
CBT
SSRI
Prophylactic : Propanalol , diazepam
Generalized anxiety disorder
Triggers+
Anxiety and worry for more than 6 months
they worry about wide range of things / events / activities not anything specific , random anxiety like that of mothers
T/T: CBT , SSRI
Social anxiety disorder
Trigger : Afraid of social embarssement or being judged
Same features as panic attack like tremors , palpitation, shortness of breath , Numbness
t/t: CBT , SSRI
OCD
T/T:
1) CBT - exposure and response prevention
2) SSRIs
PTSD
Presentation :
1) Reexperiencing of events - flashbacks of events
2) Avoidance of memory/ events associated with trauma
3) Hyperarousal - nightmares
T/T:
1) Trauma focussed CBT
2) Eye movement desensitation and reprocessing
3) SSRIs
Acute stressor reaction
vs
Adjustment disorder
vs
PTSD
Acute stressor and PTSD same in all features expect duration
Acute stressor : sudden onset and symptoms last for less than 4 weeks
PTSD : Last for more than 1 month
Adjustment disorder : Like grief for loss of someone
Dissociative Disorder
Dissociative amnesia: inability to recall , related to truma
Dissociative Identity Disorder : multiple personality disorder
Depersonlisation : derealisation disorder
PHOBIA
Agoraphobia
* Fear of travelling to open spaces
* Occurs as a complication of PSTD
* usually due to trauma related
T/t: GRADED EXPOSURE TO REDUCE FEAR RESPONSE
SUICIDE RISK FACTORS
3 biggest risk factors :
1) H/O suicide attempt
2) H/O self harm
3) Divorce
others : Recurrent depression, alcohol . agoraphobia , h/o suicidal attempt
Protective factors:
1) A Strong faith
2) married
3) children
Completed suicide
R/F:
1) Efforts to avoid discovery
2) leaving a suicide note
3) Violent methods
Admission for depression
TO GP : 1) Low suicidal risk patients
2) No active suicidal ideation
3) Good social support
PSY OPD OR ADMISSION
1) High suicidal risk patients
2) Active suicidal ideation
3) Socially isolaled patient
Developmental disorders
Tourettes syndrome : repetitive tics ( motor - eye twitching or blinking and vocal tics - thorat clearing
and retts syndrome : hand wringing
ANTI PSYCHOTICS S/E
HALOPERIDOL , RISPERIDONE, CLOZAPINE
Neuroleptic malignant syndrome
1) Hyperthermia
2) Muscular rigidity
3) autonomic instability
A/C DYSTONIA : Muscle spasm neck stiffness
AKATHESIA : RESTLESSNESS
TARDIVE DYSKINESIA : LIP SMACKING , TONGUE PROTUSION
OTHER S/E
Hyperprolactinoma due to risperidone
Olanzapine and clozapine - GDM in pregnancy
T/T OF ANTIPSYCHOTICS S/E
Procyclidine
Personality disorder
Borderline personality disorder
* Unstable personal relationship
* Mood swings
* Marked impulsitivity
* Self harm
* Dramatic and attention seekers
Antisocial personality disorder
Criminal acts
Impulsiveness
Aggresiveness
Recklessness and irresponsibility
lack of remorse
DELIRIUM TREMENS
Symptoms of alcohol withdrwal like tremors , sweating , palpitations etc AND psychotic symptoms like hallucinations and delusions
