Psychiatry 3 Flashcards
Describe some of the features seen in mania:
DIGFAST:
D - distractibility
I - Impulsivity - usually dangerously, including sexually
G - grandiosity
F - Flight of idea
A - Activity - usually starting up a business/ spend lots of money usually
S - Sleep - decreased need for sleep, typically not tired though (differentiated from depressive)
T -Talkativeness
> 7 days and significant impact on the persons life
unlike hypomania which is 4 days and doesn’t signicantly impact the persons well being or life
What is the criteria for a diagnosis of type I bipolar Affective disorder?
Symptoms of Mania which last for >7 days which causes impairment of function.
with depressive episode following.
or
Mania severe enough to require admission
or
Psychosis
Mania + depressive (with the mania lasting for at least 7 days)
Highlight the different types of bipolar affective disorders, and list some causes of mania:
Type I
- mania and depressive
Type II:
- hypomania + depressive
Cyclothymia
- subclinical features
Causes:
- Genetics (10x if family member)
- steroids
- illicit substances (cocaine)
- Infection
- stroke
- MS
What drug should you not give to a manic patient?
An SSRI
- this will push them into excessive mania
What is the diagnosis of type II bipolar affective disorder?
Hypomania + depressive episodes
Mania for >4 days <7 days
No evidence of psychosis
Does affect the person to the same degree as manic episode
How should Lithium be monitored?
Weekly - 12 hours after dose until levels stable for at least 4 weeks.
Then monthly for 6 months
Then 3 monthly following this.
Check:
- lithium levels
- TFTs - can induce hypothyroidism
- U&Es - can induce nephrogenic diabetes insipidus
What are the signs of lithium toxicity and how is treated?
Mild:
- Blurred vision
- altered taste
Moderate:
- blackouts
- fasciculations
Severe:
- coma
- seizures
- cerebellar signs (ataxia)
- ECG - AV block
Treatment:
- supportive
- IV fluids
- electrolyte balance +/- dialysis
What are some risks for suicide in those with bipolar disorder?
Previous suicide attempt
Family history of suicide
Rapid cycling
Alcohol/ drug abuse
What are the teratogenic effects of lithium?
Ebsteins anomaly
Floppy baby syndrome
Thyroid dysfunction
- if pregnancy try and avoid.
- if breast try and avoid
It is not absolutely contraindicated
Which drugs should be avoided with SSRIs and why?
Triptans
- due to risk of serotonin syndrome
Which anti-psychotic reduces seizure threshold?
Clozapine
Which of the personality disorders is most likely to transform into a psychotic disorder?
Schizotypal personality disorder
- these people think a lot about magical things, very eccentric, usually dresses weirdly
What is the disorder called which in which the person has the symptoms of schizophrenia but it has only been occurring for less than <6 months but more than 1 month?
Schizophreniform disorder
symptoms from 1-6 months.
How long must someone have psychotic symptoms for them to be diagnosed with schizophrenia?
> 6 months.
What are the different types of schizoaffective disorders and how are they differentiated?
Schizoaffective disorder, depressed type
Schizoaffective disorder, bipolar type
Major depressive disorder with psychotic features
Bipolar with psychotic features
*whatever syndrome came first and was sustained without other symptoms for 2 weeks is the primary condition.
What is it called when an individual with autism has a particularly interest in a subject becoming hyper focused on it, usually far surpassing normal knowledge/ ability in it?
Savants syndrome
Name some genetic conditions associated with autism:
Fragile X syndrome
Tuberous sclerosis
PKU
Highlight some key developmental restrictions in someone with autism:
Delayed speech
Lack of response to name
Reduced eye contact
Delayed and poor play with others
Regression of social milestones - especially language
Name some screening tools for autism:
Gilliam Autism scale rating
- used for pre-school
Social responsiveness scale
- for older children
What are the three main domains of symptoms of autism?
Social communication and reciprocal interaction
Global impairment of speech and language
Restricted behaviour/ interests/ activities
What advice should be given to a breast feeding woman taking lithium?
Do not breast feed
When is ECT indicated?
Life threatening depressive disorder order or Catatonia or Severe mania
What age can a personality disorder be diagnosed?
> 18 years old. when their personality is fully formed
What are the core features of PTSD?
Re-experiencing the ordeal - flashbacks
Avoidance - people, places
Hyperarousal - hypervigilant, sleep disorder
Emotional blunting
What is it called when then there is loss of function or strange sensations felt and no organic feature can be felt:
Conversion disorder
- this is a NEUROLOGICAL sensation of disorders. i.e. things that would mimic MS or a stroke (loss of sensory, motor function)
*this differs to somatisation disorder which multiple PHYSCIAL symptoms for least 2 years
List some specific mental health illnesses which are associated with increased risk of suicide:
Depression Bipolar disorder Borderline personality disorder Substance abuse Anorexia
If clozapine is missed on more than 2 days (48 hours) what is the management:
Restart the titration dose. if you start back at the dose previously on it may cause BP abnormalities
What are the treatment options for OCD?
Mild:
- CBT and exposure therapy
Moderate:
- SSRI
or
- Intense CBT + exposure therpay
Severe:
- SSRI + CBT + exposure therapy
*clomipramine is can be used which is a TCA
What is the most common type of memory loss occurs in ECT?
Retrograde memory loss
- usually improves following months
*they can have both though, retrograde and antegrade
