Psychiatry Flashcards
Diagnostic criteria for schizophrenia
DEAD
D - disorders of thought possession (insertion, withdrawal, broadcasting)
E - experiences of passivity (other people are controlling their thoughts or impulses - passivity phenomenon)
A - auditory hallucinations (thought echo, running commentary, being constantly referred to in the third person)
D - delusions that persist (culturally inappropriate)
Negative schizophernia symptoms
LESS
L - loss of volition, underactivity and social withdrawal
E - emotional flatness, lose normal modulation of mood
S - speech is reduced, monosyllabic if at all
S - slowness of movement
Objective signs of opioid withdrawal
Watering eyes Dilated pupils Rhinorrhoea Agitiation Perspiration Respiratory depression Piloerection Tachycardia Vomiting Shivering Yawning
Signs of depression
SLUMP
S - suicidal ideation or plans
L - lack of interest, enjoyment (anhedonia), energy, appetite or libido
U - unworthiness
M - morning wakening - EARLY
P - poor concentration, psychomotor retardation or agitation
First line psychological therapy for PTSD
CBT
Three core features of ADHD
Inattention/distractibility
Hyperactivity
Impulsivity
Diagnostic criteria of depression (not symptoms)
Symptoms present for most of every day for at least 2 weeks. NO MANIC OR HYPOMANIC EPISODES IN LIFETIME. Not attributable to neurological disease or substance use/abuse
Differential diagnosis of depression
9+
Normal response SAD Dysthymia Cyclothymia BPD Stroke/tumour/trauma Endocrine - hypothyroid, addisons, hyperpara Infection Iatrogenic
Three core symptoms of depression
Low mood
Anhedonia
Fatigue
Additional symptoms of depression
Loss of concentration Poor memory Sleep disturbance Suicidal ideation Appetite loss Weight loss Unreasonable guilt Loss of confidence Psychomotor retardation
Criteria for mild, moderate and severe dementia
Mild - 2 core 2 additional
Mod - 2 core 4 additional
Sev - 3 core 4 additional, or any psychotic symptoms
Difference between acute stress disorder and PTSD
PTSD in symptoms persist longer than 1 month
First line treatment for bipolar disorder
Lithium
SSRI of choice in young people and children
Fluoxetine
Drugs which increase VTE and stroke risk in the elderly
Antipsychotics
Psychotic symptoms which differentiate mania from hypomania
Delusions of grandeur
Auditory hallucinations
Side effects of antipsychotics
Parkinsonism Acute dystonia Akathsia Tardive dyskinesia Antimuscarinic - dry mouth, blurred vision, urinary retention, constipation Sedation Weight gain Prolonged QT Neuroleptic malignant syndrome
Common side effects of TCAs
Dry mouth Drowsiness Blurred vision Constipation Urinary retention Long QT in overdose
Common SSRI side effects
GI upset
RIsk of GI blues - give PPI if also on NSAID
Anxiety/agitation
Drug interactions
Four groups of first rank symptoms in schizophrenia (ABCD)
Auditory hallucination
Broadcasting of thought
Controlled thought (passivity phenomena)
Delusional perceptions
Monozygotic concordance for schizophrenia
50%
Define mania
Pathological, inappropriate elevated mood
Does mania generally disrupt work/responsibilities? Does hypomania
Yes and no
Mania treatment
Antipsychotics
Mood stabilisers
Lithium
ECT
Tests before prescribing lithium
U&Es
TSH
Pregnancy test
Creatinine
Lithium side effects
Reduced appetite Nausea Diarrhoea THyroid abnormalities Polyuria/polydypsia
Main danger with lithium and quantify
Toxicity
Mild - 1.5-2.0 - vomiting, diarrhoea, ataxia, diziness
Mod - 2.0-2.5 - blurred vision, delirium, convulsion, syncope
Sev - >2.5 - generalised convulsions, oliguria, renal failure
3 anticonvulsants used
Valproic acid
Carbamazepine
Lamotrigine
Side effects of valproate
Thrombocytopaenia Platelet dysfunction Nausea Vomiting Weight loss
3 general drugs/classes which lengthen QT interval
Amiodarone
Ciprofloxacin
Antipsychotics
3 general drugs/classes which cause parkinsonism
Metaclopramide
Antipsychotics
Order for long term treatment
Compulsory treatment order
Who can grant a compulsory treatment order
Mental health tribunal
Length of short term detention order
Up to 28 days
Required grounds for compulsory treatment order
Disorder significantly impairs decision making
Lack of long term treatment would cause serious deterioration
Grounds for short term detention order
Significant risk to own or others health if not detained in hospital
Who can grant a short term detention order
Approved medical practitioner
Length of emergency detention order
Up to 72 hours
Grounds for emergency detention order
Mental disorder demonstrably present
Decision making impaired
Who can grant an emergency detention order
Any medical practitioner
Treatment for alcohol withdrawal state and two key risks
Benzodiazapines - addiction and respiratory depression when used with alcohol
Act under which detention/treatment orders can be granted
Mental Health, Care and Treatment (Scotland) Act 2003
Define psychosis
Severe forms of mental illness which are characterised by a lack of insight. Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
Psychotic manifestations
Hallucinations
Delusional beliefs
Most common cause of psychosis
Schizophrenia
Positive symptoms in schizophrenia
Delusions
Hallucinations
Disordered thinking
- those symptoms which appear to represent an excess or distortion of normal functions
Diagnostic criteria for schizophrenia
Two or more of the following: Delusions Hallucinations Disordered speech Disorganised/catatonic behaviour Negative symptoms
Occurring for at least 1 month and with a functional decline of 6 months or more
Do not occur concurrently with substance abuse or a mood disorder episode
What are the two major affective psychoses
Depressive episode with psychotic symptoms
- delusions of guilt, worthlessness and persecution
- derogatory auditory hallucinations
Manic episode with psychotic symptoms
- delusions of grandeur, super powers etc
- gross over-activity, irritability and behavioural disturbance, manic excitement
Percentage recovery after first episode of psychosis
80
Good prognostic factors in schizophrenia
Absence of family history Clear precipitating event Sudden onset Mood disturbance Prompt treatment
Poor prognostic factors in schizophrenia
Slow, insidious onset Persistence of negative symptoms Family history Parental substance abuse Onset in childhood
How to remember the personality clusters
A- weird
B- wild
C- worried
Cluster A PDs
Paranoid
Schizoid
Schizoidal
Cluster B PDs
Borderline
Antisocial
Narcissistic
Histrionic
Cluster C PDs
Avoidant
Dependent
Obsessive-compulsive
Key therapies for GAD
SSRIs
TCAs
Key therapies for OCD
SSRIs
TCAs
Key treatments for PTSD
Trauma focused CBT
SSRI/TCA
3 pillars of ADHD
Hyperactivity
Impulsivity
Distractibility
How many PDs
10
ABCD of dementia
A - activities of daily living
B - behavioural and psychiatric symptoms of dementia
C - cognitive impairment
D - decline
What is a key thing to obtain in assessing a patient for dementia
A collateral history
Most common form of dementia
Alzheimers 60%
Cognitive scoring systems
MMSE
MOCA
Drug treatment for Alzheimer’s dementia - mild to mod and mod to sev, effects
Mild-mod: Anticholinesterase inhibitors
- donezepil
- rivagstigmine
- galantamine
Slow decline and improve non-cognitive symptoms but do not halt progression
Mod-sev: Memantine
Signs of Alzheimer’s dementia
Recent memory loss Executive function changes Word finding and naming difficulties Confusion Getting lost, disorientation Misplacing things
Signs of Lewy Body dementia
Vivid visual hallucinations
Autonomic instability
Parkinson’s features (shuffling gait, bradykinesia, and falls)
Rapid eye movement sleep disorder may be present
Signs of vascular dementia
Often described as stepwise progression Look for history of atherosclerotic/cardioembolic disease May closely follow stroke Slowed processing Disinhibition Behaviour preservation Difficulty initiating movement
Risk factors for suicide
Older age Male gender Mental illness Co-morbid physical illness Chronic pain Use of drugs or alcohol Social isolation Previous suicidal behaviour High lethality of method used (& ongoing availability of method) Physical and sexual abuse
Indicators of a serious suicide attempt
Use of violent means e.g. hanging, jumping from a height They thought it would kill them They planned to do it in advance e.g. making a will, leaving a suicide note They were unlikely to be discovered Alcohol or illicit drugs involved (increases chance of death, but person less likely to have intended to die) No obvious precipitant e.g. argument with partner
Treatment options for depression
Antidepressants
ECT
CBT
IPT
Drug often used in treatment resistant schizophrenia and its class
Clozapine - atypical antipsychotic
