Psychiatry Flashcards
third person hallucinations
schizophrenia
mesocortical dopamine hypoactivity
negative and cognitive symptoms in schizophrenia
subcorticol dopamine hyperactivity
psychosis
dopamine pathways in the brain
tuberoinfundibular (concerned with prolactin release), nigrostriatal (extra pyramidal motor movements), subcortical and mesocortical (sometimes known as mesolimbic system) (motivation and reward). The latter is dysregulated in schizophrenia
Mesolimbic
Da Blockage
Da angonism
depression
psychosis
Clozapine side effect
clozapine does cause agranulocytosis, cardiomyocitis but it also causes a lot of weight gain (second to olanzapine, which causes the most weight gain of the atypical anti-psychotics)
When is someone put on clozapine?
need to try 2 other anti-psychotics and be a consultant to prescribe. Lots of monitoring once a week for the first 6/12, then once every 2 weeks for the next 6/12 then every four weeks thereafter and one month after discontinuation.
Limbic system functions
M2OVE - Motivation, memory, olfaction, visceral afferents and Emotion
Brain changes in schizophrenia
reduced frontal lobe volume (and grey matter), enlarged lateral ventricles, reduced grey matter in the temporal cortex.
What is pressure of thought?
varied ideas in abundance (characteristic of mania but can also be seen in schizophrenia
What is poverty of thought?
patient reports lack/absence of thoughts
What is thought blocking?
abrupt and complete interruption of stream (strong associated with schizophrenia)
What is flight of ideas?
Quickly moving from one topic to another but there is a link unlike in knight’s move thinking where there does not appear to be a link between point A and point B - seen in bipolar during manic phase
What do you treat EPSE with?
Procyclidine
What is the amygdala?
Part of the brain involved in normal response to threat
What is the PFC (pre frontal lobe) involved in?
Dampens down amygdala response to threat (fewer connections, less effective)
Management of OCD
- SSRI
- SSRI
- TCA or SSRI
- SSRI or TCA - (TCA used is clomipramine) so essentially an SSRI and if there is a partial response at any of those points, consider CBT as an adjunct
What is the IQ for a borderline learning disability?
70-80 ish
What is the IQ for mild learning disability?
50-69
What is the IQ for moderate learning disability?
35-49
What is the IQ for severe learning disability?
20-34
What is the IQ for profound learning disability?
<20
What is Beck’s triad?
-ve feelings about self, world and future
What medications characteristically cause psychotic symptoms?
NMDA Antagonists
What medication should be used for alcohol withdrawal?
chlordiazepoxide ( 30mg QDS, 25mg QDS, 20 mg QDS, 15mg QDS, 10mg QDS, 10mg TDS, 10mg BD, 10mg OD - nocte)
With alcohol withdrawal, what is the time frame for seizures to occur?
48 hours
What is Delirium Tremens and in what time frame does it occur in alcohol withdrawal?
A psychotic condition typical of withdrawal in chronic alcoholics, involving tremors, hallucinations, anxiety and disorientation. Occurs within 48-72 hours
There is a risk of hypertensive crisis with MAOIs, (interactions with tyramine containing foods, ephidrine, nasal decongestants, TCAs, pethidine) how is this treated?
Phenotlamine
When should TCAs be avoided?
In patients with cardiac problems or patients with suicidal intent
