Psychiatry Flashcards
1
Q
Alogia
A
impoverished speech
2
Q
Avolition
A
lack of desire drive or motivation to pursue meaningful goal
3
Q
Avnhendonia
A
inaility to experience pleasure from normally pleasurable life events
4
Q
Negative schizophrenia symptoms
A
- memory and concentration
- unusual behaviour
- impaired communication
- social withdrawal
- decrease interest w/ daily activity
5
Q
types of schizophrenia
A
Paranoid schiz Hebephrenic schiz catatonic schiz undifferentiated schiz post schiz depressiion residual schiz simple schiz
6
Q
Schneider 1st rank symptoms
A
auditory hallucination
somatic passivity
delusion of passivity
delusion of perception
7
Q
Schneider 2nd rank symptoms
A
2nd hallucionation
2nd delusions
visual tactile olfacory and gestatory hallucination
perplexity (inabilit to deal/ understand something)
emotional blunting
8
Q
type 1 schizophenia
A
- ACUTE
- POSITIVE symptoms
- functioned well before the symptoms
- DUE TO: dopamine transmission problem
- no neuro signs
- good cognition
- response well to antipyschiotics
good prognosis
9
Q
type 2 schizophrenia
A
- CHRONIC
- NEGATIVE symptoms
- hx of poor social and education prior to it
- DUE TO: structural brain abnormalities (CT - Dx)
- neuro signs
- impairment of cognition
- response poor to antipyschiotics
- poor prognosis
10
Q
dopmine abnormalities in schiz
A
INCREASE dopamine release in mesolimbic stratum during lines
- correlates to positive symp and good prognosis
DECREASE in mesocortical system
- correlates with defective cognition
11
Q
DDX of negative schiz symptoms
A
Depression
effects of neuroleptic meds
environmental under stimulation
physical illness (endocrine/ alzeihmers)
substance misuse
Schizoid or schizotypical personality disorder
autism / asperfer’s syndrome
12
Q
Ambivalence
A
simutaneous contradictory thinking (angle and devil)
13
Q
bleuler - four As of schizophrenia
A
Ambivalence
Autism (internal simuli)
inappropiate affect
loosening of association
14
Q
epidemiology of schiz by sex and age
A
Males = 22 years
feamles = 26
MALES > female
15
Q
Susceptibility genes and chromosomal abnormalities
A
Genes
- DAOA - dopamine amino acid oxidase activator
- dysbindin
- neuroregulin
- zinc finger protein 804A
Chromosomes
- DISC1 - disrupted in schizophrenia 1
- microdelition of chrom 22q11 (vela-cranial facial syndrome)
16
Q
what season is schiz more common
A
babies born in spring and winter
NH: january - April
SH: Julyl - september
17
Q
serotonin level in schizophrenia
A
INCREEASED
18
Q
left handedness
A
increase risk of SCHIZOPHRENIA
19
Q
why does cannibis increase schizophrenia
A
COMT gene moderates the influence of cannibis use on developing psychosis
20
Q
brain abnormalities in schizophrenia
A
Ventricles larger >brain tissue
GREY matter loss > white
TEMPORAL lobe - esp. medial temporal lobe
21
Q
why are males at greater risk of schizophrnia
A
Males: - increase obstetric problems - worse premorbid adjustment - more structural brian abnormalities negaitive sympto - worse prognosis
22
Q
risk of suicide in schizophrenic patients
A
2%
23
Q
schizohrenia is ass .w/
A
Smoking
Bipolar disease
24
Q
schizotypical disorder
A
eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia
25
schizoaffective disorder
episiodic disorger in which both affective and schizophrenic symptoms are prominent within the same episode of the illness preferably spontaneously but at least within a few days of each other
26
schizoaffective types with best and worse prognosis
best - schizoaffective type w. mania
| worse - schizoaffective type w/ depression
27
ICD10 criteria - how long for symptoms
1 month or more
28
```
what is the least likely to be a DDX of negative symptoms of schizophrenia
A - cannibis excess
2. enviromental overstimulation
3. Alzehimers disease
4. Depression
4. Aspergers syndrome
```
2. enviromental overstimulation
29
the prevalence of schizophrenia
1%
30
tx of tardive dyskinesia
1. stop anticholinergic and decrease antipsychotic dose
| CHANGE to CLozapine
31
Tx for dystonia
Anticholinergics
| - Procyclidine and biperiden
32
parkinsonism / psurdoparkinsonism tx
dose reduction
change to atypical
Anticholinergics
- Procyclidine and biperiden
33
akathisia treatment
decrease dose
switch to atypical
NO effect with Anticholinergics
34
response to clozapine in resistant tx schizophrenia
30-60%
35
indications for clozapine
```
treatment resistant schiz
tardive dyskinesia
pyschosis in PArkinson
Huntington disease
resistent mania
```
36
Capgras syndrome
illusion of doubles - thinks they are placed by an exact double
- FAMALES >males
37
Fregoli syndrome
believer person/ object changes their identity and follows patient
38
Intermetamorphosis
belief that a person swaps identity BUT same apperance
39
syndrome of sugestive double
Doopelgnager or double of himself carrying out independent task
40
Dilusion misidentity syndrome names 4
Capgras syndrome
Fregoli syndrome
Intermetamorphosis
Syndrome of subjective double
41
lycanthropy
a man who believes he is transferred into an animal
42
Cotard syndrome
nihilistic delusion in which the person holds the delusion that they are DEAD, do not exist , are putrefying or lost blood and internal organs
43
Folie a deux
delusion believe transferred from one sister to another
44
Ekbom syndrome
delusion parasitosis . delusion of infestation
45
Erotomania
the person believes someone high social or professional status is in love with them
46
Morbid jealously
believes that there partner is or will be unfaithful
47
Othello syndrome
MORBID jealousy
| more common in MEN
48
Couvade syndrome
non psychotic syndrome
- experiencing symptoms resmbling pregnnacy 9minor weight gain, monitoring nausea, abdo swelling) in MALE when female is pregnate
49
Charles bonnnet syndrome
non psychotic syndrome
core fearues occurrence of well formed vivid and elaborate visual hallucination in a newly sighted person - ARMD , glaucoma or cataracts
GOES away in 18 months once brain adapts to lost of vision
50
Ganser syndrome
giving approximate answers "five legs on table"
clouding cousiouness
true hallucinations or peudohalucination
Conversion symptoms
MALE , aka prison psychosis, resolves
51
Diogenes syndrome
aka senile sqalor syndrome
EXTREME slef neglet
hoarding of rubbish or objects
52
indication ECT
```
severe depression
catatonia
tx resistent mania
postnatal psycosis
NMS
intractable seizure disorder
```
53
Contraindications to ECT
- NO ABSOLUTE CONTRAINDICATIONS
```
Relative contraindications
- Post MI in last 3 months
Cardiac arrythmia
INCREASe ICP
Intercranial heamorrage
brain/ vascular anneyursm
brain tumour
retinal detachment
phaochromocytoma
high anesthetic risk
```
54
Things that increase seizure threshold
```
MALES
OLDER AGE
Cilateral
POOR scalp contact with electrodes
Low oxygen saturation in blood
Baldness , thickness in the bones, dehydration,
```
55
Things that decrease seizure threshold
```
Younger
fEmales
Unilateral
good scalp contact
low CO2 in blood
caffine and hyperventilation
```
56
Drugs that increase ECT threshold
```
BA BMP
- barbituates
- anticonvulsants
Benzodiazepam
Methohexitone dose - > 1.2mg/kg
Profolol
```
57
Drugs that decrease ECT threshold
```
TALA
- theophyline
antidepressants
lithium
antipsychotics
```
58
Bilateral placement of ECT probes
From external ear to angle of the eye - 4cm perpendicular tot that line
59
Lanster position for ECT
frontotemporal position and vertically to the vertex
60
Unilateral electrode placement - right UL (want to put it on non dominant hemisphere
b/w frontotempral region and the mastoid
61
Mental Health Act - form 1
spouse or family
62
Mental Health Act - form 2
Authorized officer (designated officer of HSE
63
Mental Health Act - form 3
Gardai
64
Mental Health Act - form 4
Stranger
65
Mental Health Act - form 5
```
GP , in 24 hours, expiries 1 week
GP CANNOT BE
- spouse
Gardai
- money value
- work in the centre in which they are being detained
```
66
Who cannot fill out STEP 1 of Mental Health Act
67
How long do you have for step 1
48 hours
68
Step 3 - what form
Form 6 - by consultant psychiatrist - within 24 hours
| Expiry 21 days
69
Form 7
renewal order
| 1st renal
70
form 14
discharge from approved centre - when the patient no longer suffers from mental illness
71
comments of mental health tribunal
chairperson
consultant psychiatrist
3rd person - not a registered medical practitioner - usually a lay person
72
Age of anorexia va. bulimia
anoreexia - 16-17 (female), 12 (male)
Bulemia - adolescent 20 years old
73
criteria for admission
```
Medical
- BMI 5 years
co morbid with impulsive type
intolerable family
social situation
personality disorder
```
74
poor prognosis of anorexia
```
male
chronicity for 6 or more years
bulimic behaviour
excessive weight loss
premorbid heavy weight
personality disorder
```
75
obsetiy - leptin and grelin
increase leptin - due to increase fat mass
| decrease grelin = slows body ability to burn fat
76
early menarche is a risk factor for
anorexia narvosa
77
least likely sign of anorexia nervosa
gastric contrsictors
78
kleine levin syndrome
hypersomnea, hyperphagia and hypersexuality
79
kluver bucy syndrome
hyperorality (objects in moth9 , hyperphagia, hyperseculatiy
80
risk factor for baby blues
BIOLOGICAL
- postpartum decrease in level of estrogen, progesterone and prolactin
- premenstrual tension
- primigravida status
- increase degradation of tryptophan to kyneurenine (often occurring after the immunity
PSYCHSOCIAL (SASP)
- poor relation with partner
Physical and emotional stress of birthing
awareness and stress about increase responsibility
fatigue and sleep deprivation
81
biological factors of postnatal drepression
```
older age
severe baby blues
past history of depresson during pregnancy or postpartum
fam history of depression
sensative to hormonal milieu
```
82
physiological rf for postnatal depression
```
single mom
marital instability
adverse life event
ambivalence towards pregnancy
bonding difficulties
sleep disturbances in LATE pregnancy
```
83
symptoms of postnatal psychosis
```
RRIID
Restless
refusal for food
irritablity
insomnia
depression
```
84
risk factor for postnatal psychosis -- biological
```
Dx BPD (25-50%) , schizophrenia,
fam history of major psychiatry disorder
decreae in P E C
postnatal thryoiditis
Primigravid status
older age
c-section
HIGH SES
HX POSTNATAL PSYCHOSIS - 74$
```
85
pyschosocial RF postnatal psychosis
perinatal death of the baby
lack of social supper
psychodynamic factors - motherhood conflict, unwanted , trapped unhappy relationship
86
risk of developing non puerperal BPA after having postnatal psychosis
20%
87
risk of developing another pschosis episode having postnatal psychosis
57%
88
sings of poor prognosis for post natal psychosis
family historyy physicatric disorder
schizophrenia
neurotic personality
presence of serve marital problems
89
which antipsychotic is represented during pregnancy
trifluroperazine
ALSO:
- chlorpromazine, haloperiodol, olanzapine and clozapine
90
high or low SES is a risk factor for postpartum depression
HIGH
91
antipsychotic safe in breastfeeding
Olanzapine
92
Antidepressant safe in breastfeeding
paroxetine and reboxetine
93
antidepressant safe in pregnancy
fluoxetine
amitryptyline
imipramine
fluoxetine
94
sedatives in pregnancy
chlorpromazine and amitriptyline
