Psychiatry Flashcards
What is the function of the amygdala?
Processes info about potential threats before we know we have seen it
What is the function of the hippocampus?
Regulates memories in the right time, place and context
What is Cotards syndrome?
Seen in severe depression
Delusional belief that they are dead or non-existent
Indications for ECT in depression
Severe depression refractory to medication
Catatonia
Psychotic symptoms
Schizophrenia management steps
2nd gen antipsychotic - Risperidone (other than clozapine or olanzapine)
if not responding - try other 2nd gen
if still not responding - clozapine
Management of generalized anxiety disorder
SSRI/SNRI
Atypical antidepressant (e.g. mirtazepine)
Pregabalin
Must stay on for at least 18m (if responding)
Timeline classification of PTSD
< 48hrs = acute stress reaction
< 4wks = acute stress disorder
< 3m = acute PTSD
> 3m = chronic PTSD
Management of PTSD
if <4 wks = wathcful waiting
Trauma focused CBT
EMDR
Drug tx = paroxetine or mirtazepine
Difference between mania and hypo mania
Hypomania
- must be sustained for at least 4 days
- milder symptoms than mania
Mania -
- must be sustained for at least 1 weeks
Management of acute mania
1 - aripiprazole or olanzapine
2 - haloperidol, lorazepam
Management of chronic bipolar
Lithium carbonate (therapeutic range 0.4 - 1 mmol/L)
2nd line = sodium valproate or carbamazepine
Physiological abnormalities in anorexia
Decreased K Decreased LH, FSH, oestrogen + testosterone Increased cortisol + GH Impaired glucose tolerance Hypercholesterolaemia Low T3
Metabolic abnormalities in re-feeding syndrome
(abrupt change from catabolic - carb metabolism)
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia (may predispose to torsades)
Abnormal fluid balance
How to prevent re-feeding syndrome?
If not eaten in > 5 days - aim to refeed < 50% of requirements for first 2 days
Classification of personality disorders
Cluster A = “Weird” (odd + eccentric)
- Schizoid (“aloof”)
- Schizotypal (“awkward”)
- Paranoid (“accusatory”)
Cluster B = Wild (“dramatic + emotional”)
- Antisocial (“bad”)
- Borderline (“borderline”)
- Histrionic (“bullshit”)
Cluster C = Worried (anxious + avoidant”)
- Avoidant (“coward”)
- Dependent (“clingy”)
- Ankastic (“compulsive”)
Features of borderline PD
Unstable + intense interpersonal relationships Recurrent suidical behaviour Impulsivity Identity disturbance Chronic emptiness
Features of histrionic PD
Needs to be centre of attention Always sexually seductive Uses physical appearance to get attention Self dramatisation Suggestable
Symptoms of alcohol withdrawal
6-12 hrs = 1st symptoms (tachycardia, HTN)
24-48 hrs = peak
36 hrs = generalised seizures
72 hrs = delirium tremens
Features of delirium tremens
Hallucinations Agitation Paranoid ideation Fever Disorientation/confusion
What are the features of thiamine deficiency (Wernickes encephalopathy?
- confusion
- ataxia
- opthalmoplegia
if left untreated - Korsakoffs syndrome (amnesia, confabulation)
How to prevent alcohol withdrawal?
Start before withdrawal symptoms
- BZD’s
- Pabrinex (IV thiamine)
- Hydration
Drugs for alcohol replase prevention
Naltrexone (opiod antagonist)
Acamprostate (decrease cravings)
Disulfram (horrible reaction to alcohol)
Signs of opiod intoxication
Constricted pupils Euphoria Altered mental status Resp depression Agitation
Treatment of BZD overdose
Flumazenil
