Psychiatry

Question 1

Name 2 psychotic disorders, some basic characteristics and some common presentations

Answer 1

Schizophrenia + bipolar
Delusuions, hallucinations,
Bizzarre ideas, odd behaviours

Question 2

Whats neurosis? Basic characteristics?

Answer 2

Anxiety disorders and hypochondriasis

Emotional disturbance

Worried, tired, physical complaints

Question 3

Some mood disorders? Characteristics? PCs?

Answer 3

Depression
Low mood, loos of pleasure

Tearful, fed up, physical complaints

Question 4

Substance misuse? What happens?

Answer 4

Alcohol, opiates,
Psych or physical withdrawal

Addiction, withdrawal, depression: PCs

Question 5

Name some personality disorders and their characteristics

Answer 5

Dissocial, paranoid

Dysfunctional personality disorders

Exacerbation of traits when stressed

Question 6

Mental retardation? Commonest example?

Answer 6

Downs, autism, congenitally low IQ,

PC: developmental delay, physical features

Question 7

Name 2 organic disorsers, some basic characteristics and some common presentations

Answer 7

Dementia
Delirium
BC: impaired memory- organic cause
Delusions, hallucinations

PCs: forgetfullnes,
Confusion

Question 8

What are some organic causes of depression?

Answer 8

Cushings
Addisons
Hypothyroidism
Hypercalaemia
Folate deficiency 

Beta blockers
Digoxin
Anti-epileptics
Barbiturates

Question 9

What organic causes precipitate Mania?

Answer 9

Hyperthytoidism

Amphetamines
Steroids

L-Dopa
Antidepressants

Question 10

What organic causes can precipitate either mania or depression?

Answer 10

Endocrine and metabolic 
Neurological 
Cerebrovascular disease
Epilepsy
MS
Brain tumour
Head injury 
SLE
Parkinsons

Question 11

Whats maternity blues?

Answer 11

3-4 post natal day, tearful,

Less sex steroids and concerns about mothering. No assc bw mood disorders

Question 12

What happens in postnatal depression?

Answer 12

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.

Question 13

When is postnatal D commoner?

Answer 13

Women with past psychiatric illnesses and lack of seeking help

Question 14

Whats premenstrual syndrome?

Answer 14

Not a validation to be included as psychiatric.

Pain, irritability, depression, abdo bloating, breast tendreness.

Question 15

What are some forms of adjustments to grief?

Answer 15

1. Shock and disbelief: stress reaction. Numb for 1-2 days.
2. Preocupation and depression- Central phase- anger at doctors common, God, blame targets.
3. Acceptance and resolution
   Time.. Months sometimes. Reocurance around anniversaries.

Any abnormal grief? Uncomplicated? Natural or?

Question 16

What is a pathological grief? Give examples

Answer 16

1. Absent or delayed grief. (Delayed a few weeks)
2. Prolonged grief: more than 6-12M comdiser depressive disorder.
3. 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.

Question 17

What happens in Delirium?

Answer 17

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

Question 18

Some causes of delirium?

Answer 18

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

Question 19

Tx of delirium?

Answer 19

Olanzapine and benzos for sedation and relaxation

Question 20

What are the 2 somatoform disorders?

Answer 20

Somatizing disorder and hypochondriasis

Question 21

What hapoens in somatising disorder?

Answer 21

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.

Question 22

What happens in hypochondriasis?

Answer 22

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.

Question 23

What is a dissociative disorder?

Answer 23

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

Question 24

What are the types of dissociative disorders?

Answer 24

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.

Question 25

Ddx of dissociative fugue?

Answer 25

Alcohol misuese
Depressive illness
Post epileptic automatism

Question 26

What are personality disorders?

Answer 26

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 !

Question 27

How would u manage personality disorders?

Answer 27

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

Question 28

Whats Ekboms syndrome?

Answer 28

Delusion that one ifected with oarasites- formication! Running under skin.

Cocaine use

Question 29

Cotard syndrome?

Answer 29

Delusion that one is dead.
Lost all possesions, doesnt exist, decaying…

Clincal,severe depression

Question 30

Da Clerambaults syndrome?

Answer 30

Erotomania ❗️😍

Delusional belief that someone in a higher social status is in love with them. F>M

Question 31

Gilles de la Tourrettes?

Answer 31

Inherited, onset in kids, motor actions and multiole inappropriate vocal acts.