Psychiatry Flashcards
Name 2 psychotic disorders, some basic characteristics and some common presentations
Schizophrenia + bipolar
Delusuions, hallucinations,
Bizzarre ideas, odd behaviours
Whats neurosis? Basic characteristics?
Anxiety disorders and hypochondriasis
Emotional disturbance
Worried, tired, physical complaints
Some mood disorders? Characteristics? PCs?
Depression
Low mood, loos of pleasure
Tearful, fed up, physical complaints
Substance misuse? What happens?
Alcohol, opiates,
Psych or physical withdrawal
Addiction, withdrawal, depression: PCs
Name some personality disorders and their characteristics
Dissocial, paranoid
Dysfunctional personality disorders
Exacerbation of traits when stressed
Mental retardation? Commonest example?
Downs, autism, congenitally low IQ,
PC: developmental delay, physical features
Name 2 organic disorsers, some basic characteristics and some common presentations
Dementia
Delirium
BC: impaired memory- organic cause
Delusions, hallucinations
PCs: forgetfullnes,
Confusion
What are some organic causes of depression?
Cushings Addisons Hypothyroidism Hypercalaemia Folate deficiency
Beta blockers
Digoxin
Anti-epileptics
Barbiturates
What organic causes precipitate Mania?
Hyperthytoidism
Amphetamines
Steroids
L-Dopa
Antidepressants
What organic causes can precipitate either mania or depression?
Endocrine and metabolic Neurological Cerebrovascular disease Epilepsy MS Brain tumour Head injury SLE Parkinsons
Whats maternity blues?
3-4 post natal day, tearful,
Less sex steroids and concerns about mothering. No assc bw mood disorders
What happens in postnatal depression?
Post natal change in dopaminergic sensitivity
1M post delivery 15%
Failings as mother, fed up of increasing demands,
ASK:
Mother baby relationship ,
Short term risk for baby?
Reassure mother and family. Gp, midwife, social services.
Usually at home.
If moderate- antiD.
If severe, admit to mother and baby unit, to monitor their relationship.
When is postnatal D commoner?
Women with past psychiatric illnesses and lack of seeking help
Whats premenstrual syndrome?
Not a validation to be included as psychiatric.
Pain, irritability, depression, abdo bloating, breast tendreness.
What are some forms of adjustments to grief?
- Shock and disbelief: stress reaction. Numb for 1-2 days.
- Preocupation and depression- Central phase- anger at doctors common, God, blame targets.
- Acceptance and resolution
Time.. Months sometimes. Reocurance around anniversaries.
Any abnormal grief? Uncomplicated? Natural or?
What is a pathological grief? Give examples
- Absent or delayed grief. (Delayed a few weeks)
- Prolonged grief: more than 6-12M comdiser depressive disorder.
- Excessive grief: this may express closeness to deceased, their personality or a depressive disorder.
Depressive disorder occurs in 1/3 of grieving ppl. Not easy to decide on the threshold.
What happens in Delirium?
Toxic confusional state
Only example of psychiatric organic disorder caused by structural abnormality dirtutbing the CNS function.
Acute/subacute brain failure
Impairment of attention accom by impairmen in mood and perception,
Consciousness impairment.
Most common psychosis seen in hospital setting
14-24% of patients
Some causes of delirium?
Systemic infx- septiciamia and makaria Hepatic failure CKD Vit B12 deficieny Thiamine deficieny (B1) Wernkes - Korsakoff ecephalopathy Hypoxia Iatrogenic Neuro- brain tumour, SAH, epilepsy Siroders of electrolyte imbalance Hypothyroidism and Cushings
Tx of delirium?
Olanzapine and benzos for sedation and relaxation
What are the 2 somatoform disorders?
Somatizing disorder and hypochondriasis
What hapoens in somatising disorder?
Functional disorder 1/10 will develop it
Multiple recurrent medically unexplained sx
Early in adulthood
Often multiple medical opinions and negative investigations
Doctor shop- medical reassuarance will fail.
Attention seeking behaviour and dependence on doctors. Reluctant to believe its psychological. Yet they complain about medical care they received.
Usually want sedatives and anlgesics.
Somatic presentation of psychological distress
Although iatrogenics soon complicate picture- drugs they want.
Long standing martial and relationship breaks.
What happens in hypochondriasis?
Preocupation with assumed serious illness and its consequenses. Believe that they suffer from cancer or AIDS.
May be secondary to psychiatric esp depressive or anxiety.
Request lots of investigations.
Occasionally its delusional 2o to schizophrenia or depressive psychosis.
What is a dissociative disorder?
Profound loss of awarness or cognitive ability without medical explanation.
Alters a persons sense of reality and identity. So experiences lack of continuity of thoughts,
Dissociative- disintegratiom of different mental activities- amnesia, fugues, pseudoseizures.
So its a common reaction/defense to stressful or traumatic situations.
Disruptions or bepreakdowns in memory, perception.
Use dissociatiom a defense mechanism pathologically and involuntary.
Caused by psychological trauma
What are the types of dissociative disorders?
Feeling like world isnt real, foggness of identity,.
Dissociative amnesia
Dissociative identity disorder
Depersonalisation/derealisation
In a dissociative fugue usually in amnesia, patients wander around their surroundings, need to be found.
Ddx of dissociative fugue?
Alcohol misuese
Depressive illness
Post epileptic automatism
What are personality disorders?
When personality traits cause the individual problmes.
Persvasive disorders of inner experience and behaviours that cause distress or significant impairment on social functioning.
Aquired- after insult other than brain insult
Organic- brain damage
A. Paranoid, schizoid,
B. Borderline (emotionally unstable), antisocial, narcisstic- dramatic
C. Dependant, ovoidant, obsessive- or anxious or fearful
Very clever‼️‼️ they react to ur reactions ! They judge and read u !
How would u manage personality disorders?
Tailor to individual
Crises intervention
Increase compliance and motivation
Discuss probs eg self harm
Meds: antipsychotics, antidepressants, anti convulsants, lithium in affective instability or impulsivity
Psychodynamic psychotherapy
CBt
Prognosis: may burn out with age
OCD may worsen with age and more likely to develop depresison
Whats Ekboms syndrome?
Delusion that one ifected with oarasites- formication! Running under skin.
Cocaine use
Cotard syndrome?
Delusion that one is dead.
Lost all possesions, doesnt exist, decaying…
Clincal,severe depression
Da Clerambaults syndrome?
Erotomania ❗️😍
Delusional belief that someone in a higher social status is in love with them. F>M
Gilles de la Tourrettes?
Inherited, onset in kids, motor actions and multiole inappropriate vocal acts.
