Psychiatry Flashcards
1
Q
TCAs 9 SEs
A
Anticholinergic Cardiotoxicity (QT, Arrythmia, QRS elongation) Weight gain Sexual dysfunction Serotonin syndrome Exanthema Sedation Reduced seizure threshold Insomnia SUICIDE
2
Q
SSRI 5 SEs
A
GIT Sexual dysfunction Weight gain Insomnia SUICIDE
3
Q
Atypical antidepressants and their indication
A
Bupropion less weight gain less sexual dysfunction (NDRI) Mirtazapin without sexual dysfunction (A2 block) Venlafaxin without sedation (SNRI)
4
Q
Dual effect of antidepressants
A
Acute: Sedating also in healthy
Chronic: Mood altering only in sick
5
Q
KI of SSRI
A
Acute manic phase
Combination with MAO inhibs bc Serotonine Syndrome
6
Q
KI of TCA
A
Acute delirium
Cardiac disease
MAO Inhibit
7
Q
Groups of TCA and their special effects
A
Imipramin-Type: only affects mood
Amitryptiline-Type: psychomotor sedative
Desipramin-Type: psychomotor activating
8
Q
SSRI Names (4)
A
Citalopram
Escitalopram
Sertralin
Fluvoxamin
9
Q
History of psychiatry overview (9 Stations)
A
1) Ancient times:
Egyptians (oldest documentation 1500BC and King Saul (Depressive, Bipolar, Suicide)
2) Hippocrates:
MDs bc of dysbalance of bodily fluids (sanguinous, melancholic, phlegmatic, choleric); treatment by sweating, laxatives, venipuncture
3) Roman empire:
Soranus recommended to permanently friendly supervise mentally ill
4) Middle ages:
Malleus Maleficarum; Witch hunts; Exorcism
“Demonological interpretation of MD”
5) Renaissance:
Return to humanism; MDs as diseases;
1st psychiatric revolution by Johann Weyer 1550 ==> No blame for affected, they should be examined properly
6) Enlightment:
Rationalism, Logic, Humanism
2nd psychiatric revolution by Phillipe Pinel 1800 ==> No restraint system in two prison that became mental institutions
7) 1800 - 1900:
Acceptance of psychiatry as medical field
Foundation of mental insitutes esp. at edge of towns
Sigmund Freud 1900: Psychoanalysis, Theory of Unconscious
8) WW2
Euthanasia and Sterilization of mentally ill
Aktion T4: kill mental inmates to save ressoucres
9) from 1950
3rd psychiatric revolution with psychopharmaca, social approaches (bc of american wars ==> PTSD), community psychiatry (outpatient care, self help groups etc.)
10
Q
Vascular dementia types
A
Cortical - several small infarcts (slow onset) or one large (quick onset)
Subcortical/Binswanger - Gait problems, Incontinence, milder dementia than in cortical
11
Q
Symptoms/associations of vascular dementia (4)
A
Emotional liability
Delirium
Personality unchanged typically
Hypertension/Atherosklerose
12
Q
Alzheimer types (2)
A
Early onset <65 - quick progression, personality changes, sudden onset, loss of cortical functions (aphasia, apraxia, alexia, agraphia)
Late onset >65 - slow onset, slow progression, personanlity changes, mainly memory and cognitive impairment
13
Q
Etiopathogenese Alzheimer (5)
A
APP ==> beta-amyloid extracellular plaques
Cytoskeleton ==> tau protein intracellular neurofribrillary tangles
Both lead to inflammation
Atrophy esp. Hippocampus and Temporallappen
Loss of Cholinergic neurons
14
Q
Diagnostic of Alzheimer
A
Dementia Slow progression Non explicable by other stuff NO specific neurological signs (as opposed to vascular dementia) MRT for brain atrophy CSF examination
15
Q
Therapy Alzheimer
A
1) Cognitive (only slowing down)
- ACh-Esterase inhibitors (Rivastigmine, Galantamine, Donepezil)
- Nootropics/Antioxidants (Vit E und Gingko)
- NMDA Blockers (Memantine)
- NSAIDs (ASS)
2) Non-cognitive
- Psychoses (Neuroleptics 2nd gen. Risperidon, Clonazapine)
- Antidepressants (SSRIs)
- Hypnotics (BZ-like, Clomethiazole)
3) Psychotherapy
- Skill/Task oriented training
- Alzheimer communities esp. good for family
16
Q
Therapy Vascular Dementia
A
- Treat HTN
- Statins
- Anticoagulants
- Antidiabetic (Metformin)
17
Q
Dementias except Alzheimers (10) (5 Names, 3 Infections, 2 other) and metabolic dementias
A
1) Creutzfeld-Jakob (Prion disease, pyramidal and extrapyramidal symptoms)
2) Huntington (AD, Middle age, mainly basal ganglia, Strong genetic component, Choriform movements)
3) M. Wilson (Copper metabolism disorder)
4) Parkinson (Lewy Bodies, Parkinson symptoms, dementia is late stage)
5) Picks Disease (Frontotemporal dementia, Middle Age, Behavioural symptoms [Euhporia, Blunt emotionally, coarse social interactions] similar to syphilis, Pick bodies/Tau protein)
6) Syphilis (3rd stage 15y after infection, Treponema is found in CSF, [Malariatherapy), Generalized Paralysis of the Insane = Tabes Dorsalis, Behavioural changes similar to Picks disease, Delusions, Neurological signs like Argyl-Robinson-Pupils, Meningitis); Pathogenesis: Atheritis
7) HIV (Late stage by inflammation caused by infected microglia etc.)
8) Neuroboreliosis
9) CO Poisoning (Suicide, Industrial)
10) Normal pressure hydrocephalus
Metabolic: Hyponatremia, Anemia, Intoxications, Hormonal disturbances esp, hypothyroidism, Korsakoff/Wernicke, Uremia, Hepatic encephalopathy
18
Q
Classifications of Dementias (2)
A
1) Degree of dementia
-Mild - Can look after oneself but forgetful and hard to
learn new stuff
-Moderate - Memory declines, severe handicaps
-Severe - Completly dependent, disoriented, only
fragmented memory
2) Types of dementia
- Primary atrophic dementia (Alzheimer, Huntington, Parkinson, Pick)
- Secondary (Vascular, Prion, Infectious, Injury, Tumor, Drugs, Metabolic)
19
Q
Mental disorders caused by alcohol (11)
A
1) Acute intoxication (Desinhibition, poor concentration/cognition,
2) Alcohol pathological intoxication (Sudden change of conciousness with aggressive behaviour with even low amounts of alcohol)
3) Dependence (deterioration of social life, behavioural changes)
4) Withdrawl (Tremor, anxiety, seizure)
5) Delirium tremens (Delirium in evening in heavy drinkers esp. during withdrawl)
6) Alcohol hallucinoses (Severe anxiety, voices etc.)
7) Pathological jealousy (Delusion)
8) Korsakov psychosis (Severe disorder of recent memory, confabulations, no insight, bad prognosis)
9) Wernicke encephalopathy (Acute life threatening condition caused by B1 deficieny typically in heavy drinkers)
10) Alcoholic dementia (esp. personality changes)
11) Suicidal behaviour
20
Q
Treatment of alcoholism
A
In withdrawl - BZ, Clomethiazole
For abstinence - Naltrexon (opioid) for primary stop of drinking and Acamprosat (NMDA Antagonists) for maintenance of abstinence
Psychotherapy with anonymous alcoholics
21
Q
Anxiety vs Fear Def
A
Fear: Spec object of fear, disappears if threat is gone
Anxiety: no spec object
22
Q
Typical comorbidity of anxiety
A
Depression (Mixed depression-anxiety disorder)
Untreated anxiety leads to depression
23
Q
Phobic anxiety disorder subtypes
A
Agoraphobia (Fear of leaving home basically)
Social phobia (Fear of scrutiny of other people)
Specific phobias
24
Q
Phobic anxiety disorder description and symptoms
A
External situation/stimulus causes increased stress levels
Leads to avoidance of situations
Symptoms: Palpitations, Fear of dying
25
Panic Disorder description and symptoms
No specific trigger, sudden extreme pain lasting max. 20 minutes
Somatic symptoms that may be similar to heart attack or choking etc. leading to frequent visit of emergency services
26
General anxiety disorder description and symptoms
More than 6 months lasting anxiety with no specific trigger
27
Etiology of phobias
Conditioned
Genetic/Neurobiology including psychoactive substance abuse
Early trauma
28
Therapy of anxiety disorders
```
Psychotherapy: Cognitive behavioural therapy
Pharmacotherapy:
BZ for acute attacks only bc dependence
Beta blockers
Antihistaminics
SSRIs (first line)
```
29
Graphs of Phobic Anxiety Disorder, Panic disorder and generalized anxiety disorder
1st: Trigger ==> Plateau until out of situation
2nd: Randomly extreme and short panic
3rd: COntinous increased stress
30
OCD definition, obsession vs compulsion
Impulses or thoughts repeatedly enter patients mind in stereotyping form
Obsession: Intrusive thought/image/urge that often feels alien/inappropiate/violent/suicidal
Compulsion: Repetetive stereotypical action that decreases stress/obsession
31
Obsession vs schizophrenia
Obsession are recognized by patient as his own thoughts and know that they are inappropriate
32
Examples of compulsions
Repetetive hand washing
| RItualistic checking
33
Typical comorbidity of OCD
Depression
34
OCD onset?
Early teens or 20s
35
OCD etiology
Neurobiological stuff
Psychodynamic
Genetic
Behavioural
36
OCD Specific types
Trichotillomania (hair pulling disorder typical after trauma in puberty)
37
OCD Therapy
Psychotherapy: Cog-Behave-Therapy
Pharmatherapy: SSRI
Family therapy to teach family how to work with disease
38
Acute stress reaction def
PTSD def
Adjustment disorder def
Acute stress reaction: Directly after event severly increased emotions (esp. anger and sadness), often with inital incomprehension of situation and strong autonomic response (Ger: Nervenzusammenbruch)
PTSD: Delayed reaction to catastrophic event with flashbacks, emotional numbing and hyperarousal (irritability), 6m after event
Adjustment disorder: Bad adjustment to new life situation (strong predisposing/genetic elements) leading to depression, feeling of maladjustment, anxiety; not longer than 6 months
39
Acute stress reaction therapy
Talking and BZs
40
PTSD symptoms
```
Insomnia
Anxiety
Social withdrawl
Flashbacks
Hypervigility
Suicide
```
41
PTSD Comorbidities
Panic disorders, Depression, Alcoholism
42
PTSD Therapy
Psychotherapy: Cog-Beh-Therapy
Pharmacotherapy: SSRIs, BZs, Betablocker, Antipsychotics
Something about virtual reality
43
Adjustment disorder therapy
Psychotherapy
44
Def. conciousness
Awareness of self and surrounding
45
Conciousness disorders
Qualitative:
Delirium: Altered relation to reality (illusions, hallucinations, mood disorders (aggressive), often amnesia after recovery (complete or incomplete)
Obnubilation: abrupt start and end, complete amnesia, Patient is disoriented, acting aimlessly, sometimes agressive (Schlafwandellike)
Transitory delirium/Dissociative disorder: High stress situation leads to pathological affect (e.g. wife kills husband in affect)
Quantitative: Reduced vigility/alertness
Somnolence: Slowed thinking (also when ill or before sleep)
Sopor: Motionless patient, can be awakened, reacts to painful stimuli and with 1-2 words then falls asleep
Coma: No reaction to any stimuli, pathological reflexes present
46
Causes of delirium
Drugs, Serious illness, high fever, Delirium tremens, withdrawl, post-op, nighttime etc.
47
Causes of obnubilation
Temporal epilepsy, metabolic states like hypoglycemia, rarely in drunkness
48
Disturbances and definition of perception
Perception is process of becoming aware
Pseudoillusions: Distorted perception of objects which may occur because of reduced sensory stimulation (perception of a tree as human in darkness), might be physiological
Illusion: Pathological, difference to pseudillusion is insight, Typical in qualitative disturbances of consciousness, Misinterpretation of actual existing stimulus
Hallucination: Perception without any stimulus, might be elementary (flashes, whistles) or complex (voices, seeing people), may be auditory, visual, olfactory, gustatory, tactile etc.,
Pseudohallucination: Patient has insight, knows what he perceives is unreal
Inadequate hallucinations: Perception via inadequate organs e.g. hearing with a tooth
49
Disorders of thinking
Qualitative: = Psychosis
Delusions: A judgement held firmly on inadequate grounds (e.g. FBI is controlling my brain) with absence of insight
Quantitativen:
1) Pressure of thought - abundance of ideas typical in manic syndrome
2) Povery of thought - lack of ideas and thoughts typical in depression
3) Flight of ideas - Thoughts move quickly between topics, one train of thought isnt finished
4) Perservation - =Obsession (inappropriate pesistent repetition of same ideas) typical in OCD (if combined with compulsions)
5) Loosening of associations - Incoherent, unstructured thinking typical for schizophrenia
50
Subtypes of delusions
1) Paranoid d.: D. of jealousy, Control, possesion of thought typical in schizophrenia, paranoia, psychosis
2) Megalomanic d.: D. power, worth, noble status, supernatural skills typical in GPI and organic disorders
3) Micromanic d.: D. of worthlessness, guilt, nihilism typical in depression
51
How to differentiate between Alzheimer's and vascular?
Hachinsky score
0-18 points, >5 is multi Infarct dementia
Includes abrupt onset, typical neurological symptoms ans history of CV disease
52
Pseudodementia?
Dementia caused by depression
| Rapid progression, sudden onset, insight present
53
Definition of dementia
Decrease of memory and cognitive function from a previously higher level (as opposed to retardation)
54
Parkinson symptoms
Rigidity, tremor, depression, subcortical dementia, hallucinations, urinary problems, insomnia
55
Difference between psychosis and schizophrenia?
Psychosis is hallucinations/delusions only
Schizophrenia causes positive (hallucinations/delusions) and negative (loss of volition/motivation, loss of awareness of socially acceptable behaviour, flattened mood, poverty of thought) symptoms.
56
Diagnosis of schizophrenia?
Two main groups of symptoms; for diagnosis:
1 from group 1 or
2 from group 2
+ At least 1 months duration
57
Group 1 of schizophrenia symptoms include (3)
1) Delusions esp. paranoid
2) Hallucination of voices either imperative or commenting on patients behaviour
3) Insertion of thoughts into patients brain
58
Group 2 of schizophrenia symptoms include (3)
1) Persistent hallucinations of any modality
2) Incoherent train of thoughts
3) Catatonic behaviour
4) Negative symptoms
5) Significant change in personal behaviour
59
Whats catatonic behaviour?
Psychomotor activity mainly found in schizophrenia; two subtypes
1) Stuporous catatonia is characterised by immobility during which people may hold rigid poses (stupor), an inability to speak (mutism), as well as waxy flexibility, in which they maintain positions after being placed in them by someone else.
2) Excited catatonia is characterised by bizarre, non-goal directed hyperactivity and impulsiveness.
60
Schizophrenia subtypes (6)
1) Paranoid s. - Mainly delusions and hallucinations
2) Hebephrenic s. - Disorganized thinking and blunted, inappropriate emotions
3) Catatonic schizophrenia - Catatonic behaviour
4) Post-s. depression - Some residula schizophrenic symptoms but depression is main problem
5) Residual schizophrenia - Prominent negative symptoms, less positive symptoms
6) Simple schizophrenia - Basically only negative symptoms
61
DD of Schizophrenia (6)
1) Toxic psychosis
2) Psychosis due to another condition (Head injury, infection, fever, endocrine, metabolic etc.)
3) Acute schizophrenic disorder (<6m)
4) Delusional disorder (without hallucinations and neg. symptoms)
5) Dementia
6) Delirium
62
Etiology of schizophrenia (3)
1) Dopaminergic overactivity (as opposed to loss in parkinson; too high L-Dopa can lead to choroid movements)
2) Neurodevelopmental disorder: Obstetric complications and structural abnormalities of the brain
3) Disconnection theory: Fronto-temporal and fronto-temporal connection is impaired
63
Epidemiology of schizophreni (Incidence, Mortality, Cause of death, Comorbidities)
Incidence 1%
Mortality: Life expectancy is decreased by 20%, main cause of death is suicide
Comorbidities: Substance abuse
64
Phases of psychotic diseases in general and schizophrenia specifically
1) Acute psychotic episode: First episode or relapse of schizophrenia with strong psychotic symptoms, aim of treatment is to abolish psychotic symptoms and keep patient safe, typically neuroleptics
2) Maintenance phase: Prophylaxis of acute episode, rehabilitation and maximization of function, in schizophrenia acute attacks can often not be prevented even with adequate medication
65
Definition of schizoaffective disorder
Features of schizophrenia and affective disorders (manic or depressive, often cycling) in approx. equal parts
Schizophrenic and affective symptoms must be present at the same time!
66
Positive symptoms of schizophrenia
Qualitatively different from normal function:
| Delusions, Hallucinations, Schizophrenic thought disorder
67
Negative symptoms of schizophrenia
Impairment of normal function including:
| lack of drive, apathy, anhedonia, flattening of affect, blunting of affect, alogia
68
Whats schizophrenic thought and schizophrenic speech disorder?
Thought: Loosening of associations, Derailment, Thought blocking
Speech: Changes in speech like loss of associations, neologisms
69
Mood vs affect
Affect: Brief strong emotional response
Mood: subjective long lasting disposition to have correct affect in correct situation
70
Disorders of emotions (5)
1) Pathological affect - Strong affect with change of consciousness
2) Pathological mood - characterized by its origin (has a reason or not) duration (long), intensity (strong); two poles: manic and depressive
3) Blunted affect/emotions - in schizophrenia
4) Emotional lability - rapis changes of mood, normal in children, path in dementia
5) Phobia
6) Anhedonia - inability to feel pleasure
71
Structure of memory and subtypes
Sensory stores - Can hold information for 0,5s to allow processing
Short-term/Working memory - 15-20s while info is used by cognitive processes; then either deleted or put into long term memory
Long-term memory - basically as long as wanted
Executive and semantic memory
72
Disorders of memory and associated disorders
1) Dementia
2) Amnesia - Retrograde, congrade and anterograde; partial and complete
3) Confabulations - Filling of memories with usually wrong stories or answering with false contents typically with loss of insight and euphoria; typical in alzheimer and korsakoff
4) Pseudologia phantastica - Normal in childhood; making up fantastic events
5) Aprosexia - attention disorder leading to bad memory
6) Mental retardation - Leads to bad memory
73
2 New drugs working against negative symptoms
Caliprazim
| Brexipiprazole
74
Only type of reversible dementia
NPH with gait deviation, dementia, urinary incontinence (Wet wacky wobbly)
75
Classification of MDs
Psychotic
Affective/Mood (Uni or Bipolar)
Neurotic (Anxiety, OCD, Dissociative disorders, stress disorder, adjustment disorders)
These three are surrounded by personality disorders
Everything happens inside the body (Somatoform diseases, organic diseases)
76
MDs with strongest genetic component are
```
Bipolar
Schizophrenia (General pop:1%; Parents of affected 5,6%; Siblings 10,1%; Children 12,8%)
Bulimia
Panic disorder
Alcohol dependency
```
77
Genetics examples
Trisomy 21 => Alzheimer
| Huntington => Microsatellite repetitions
78
Neurobiology main systems
```
Prefrontal system
Limbic system
Basal ganglia
System of memory
System of language
```
79
Prefrontal system functions
Integration of information
Planning
Decision making
Thinking
80
Prefrontal cortex to thalamus connections and associated syndromes
Medioorbital cortex to magnocellular nucleus of thalamus => lesion leads to euphoric syndrome with hyperkinesia, euphoria and inappropriate social behaviour
Dorsolateral cortex to parvocellular nucleus of thalamus => lesion leads to apathic syndrome with decreased cognitive ability, apathy, hypomotoric
81
Other prefrontal connections
Bidirectional to all sensory areas as well as hippocampus => integration and memory
Unidirectional to hypothalamus => Mood control
82
Functions of limbic system
Memory and emotions
83
Basal ganglia connection to MDs
Huntington (disease of Ncl. Caudatus) often also displays psychosia and dementia
Basal ganglia are rich in D2 receptors which are target of neuroleptics
84
Neurotransmitter system
Cholinergic (has role in memory) in Alzheimers (Hypoactivity)
Dopamine (D1 in limbic, D2 in basal, D2 target of antipsychotics)
(Hypoactivity: Parkinson)
(Hyperactivity: Psychotic)
Serotonine
(Hypoactivity: Depression)
(Hyperactivity: Serotonin syndrome)
Noradrenergic:
(Hypoactivity: maybe part of affective disorders )
Glutamate:
(Hyperactivity: Psychosis ans neuronal death because of Calcium)
85
Psychiatric anamnesis special things
```
Drugs
Family history/events especially MDs
Sexual preference
Suicidal tendencies
Habit
```
86
Parts of psychological examination
Clinical (Observation and Interview, more or less structure)
Results: Aggravation, Simulation, Dissimulation
Tests (standardized, object, reliable, valid)
3 types of tests:
Questionnaire: (Minneaota Multiphasic Personality Inventory MMPI);
Performance tests: measure specific ability e.g. Mini mental state exam MMSE or IQ
Projection: Inner setting of person affects perception and thus I.e. what he sees in Rorschach tests
87
5 key strategies of patient communication
1) Situational awareness (Asses what is happening and whats likely to happen, esp stage of conflict (Anxiety, Verbal agg, physical agg)
2) Non verbal communication (A)Proxemics: Leave personal space appropriate to situation, leave patient with possible exit; (B) Kinesics: mimic and gestic; (C) Prosidy
3) Listening (A) active listening: give feedback, ask questions, mirror, paraphrase (B) empathic listening: understand emotions
4) Assertive verbal management: good only in verbal aggression: (A) Take lead and respond selectively (B) Find common agreement point (C) Communicate confidently and calmly
5) Self management and preparation
88
Types of personality disorders (8)
1) Paranoid - Sensitive, Misinterpret friendly intentions, jealousy
2) Schizoid - "Verrückter Wissenschaftler", few social contacts, few activities that give pleasure, no sexual interest, preoccupation with fantasy
3) Dissocial - "Psychopath", no empathy, gross disparity between social norms and their behaviour, no guilt
4) Emotionally unstable - Impulsive, dont care about consequences, borderline personality
5) Histrionic - "Psychoinfantil", want to be center of attention, self dramatic, confabulations, shallow lability
6) Anankastic - "Perfectionists", preoccupied with details, filled with doubt, pedantic,
7) Anxious - "Avoidant", feeling of tension, avoidance of social activities
8) Dependant - Let others do their choices
9) Change after catastrophic experience - Interpersonal impairment, miatrusting, social withdrawal
89
Personality disorder therapy
Psychotherapy: Cant change personality, only behaviour in specific situations
Pharmacotherapy: SSRI and Mood stabilizers
90
Suicide risk factors
1) MDs mainly Affective Disorder, Schizophrenia, Substance abuse
2) Earlier attempts
3) Suicide in family
4) Antidepressives first 2 weeks
91
Time of the year with most suicides? (2)
1) Transition of winter to spring
| 2) New Years Eve (alcohol)
92
Protective factors for suicide
1) Job
2) Family
3) Religion
93
Suicide statistics
70% of depressed have suicidal thoughts
10% commit suicide
More women than men try, more men succeed
94
Risk factors for aggression
1) Individual (PAIN, Hunger, Thirst, Infection, drugs, withdrawal, MDs)
2) Staff (INEXPERIENCE, tiredness, stressed, <30y male)
3) Environment (LIGHT, noise temperature)
95
Social psychiatry history
1960-1970 idea that MDs might be caused by "labelling" people who cant fulfil their social duties as mentally ill and removing them from society thus leading to them actually identifying with the disease
=> lead to concept of Open Hospital with less restraints, shorter hospitalization and changes of staff-patient relationship
96
Principles (5) and definition of community psych and its problems
Care for mentally ill should be given in the community environment and segregation should be as little as possible
1) treatment close to patient home
2) Comprehensive services
3) Multidisciplinary team
4) Continous care
5) Participation of patient
Problem of this "Deinstitutionalization": Many patients could carry the burden of more "independent" treatment
97
Principles of revised community psych (4)
1) Direct patient contact
2) Individual treatment plans with possibility of all modalities
3) Rehabilitation services
4) 24hr care must be available
98
Five types of community psych
1) Hospital care: for severe disease
A) Outpatient treatment wouldn't be safe
B) Protect patient from own aggression
C) Remove patient from stressors
2) Outpatient care:
A) allows social contacts to stay intact
B) prevents/shortens inpatient stay
C) Includea psychotherapy, pharmacitherapy,
ECT etc.
3) Complementary services
A) education of social workers, teachers,
family and other healthcare staff
B) individualised for patient
4) Home care services
A) help families with patient at home
5) Shelter care services: provide special environment adapted to patients
A) Halfway house: Sleeping and living in house
with trained staff
B) Shelteres workshops: Work rehab
C) Expatient self support groups
99
What would you talk about in legal status if mentally I'll and forensic psych?(4)
1) Law in psych practice
A) Informed consent medical treatment - If
possible patient needs to be informed about
treatment and side effects
B) Compulsory admission/Detention - If
Patient is danger to himself or surrounding
he may be forcibly taken in but: a) court has
to be informed within 24 hours b) court must
decide in 1 week if admission is justified
2) Civil law
Testamentary capacity is the
persons ability to make a valid testament
4 legal criteria
A) Person knows what a testament is and
understands its consequences
B) Knows nature and extent of his property
C) Knows name and claims of close relatives
D) He is free from abnormal state of mind
Serious MDs may lead court to name a guardian for the patient
3) Criminal law
Person who committed crime undergoes psychiatric examination (Mental state of patient at time of crime and at present), report is given to court, court decides about diminished or missing responsibility (e.g. Path. Affect)
If offender is dangerous he might be ordered compulsory treatment
4) Psychiatric court report
Report done at the request of court including more extensive information (Family/Personal history, Account of crime, Mental state now and at time of crime) and the psychiatrist answers questions of court
100
Suicide risk decrease with
1) ECT
2) Lithium
3) Valproate
101
Schools of psychotherapy
1) Psychoanalysis - Founded by Sigmund Freud around 1900; try to get unconsciousness stuff into conciousness by free association and then treat it in the conciousness; three inner structures of mind (Id: primitive; Ego: How you are; Superego: How you would be), rather shitty technique cause costly and better alternatives
2) Behaviour therapy - teach self-helping techniques, therapeut-patient relationship more of a "working team"
Techniques include
A) Self-monitoring: Keep diary with progress
B) Self-reinforcement: Reward yourself for progress
C) Exposure and Desensitisation: Expose yourself to unliked environments, first mentally then actually
3) Cognitive therapy - Maladaptive ways of thinking/here-and-now-problems are identified and therapist + patient try to form plans to change maladapted thinking
Techniques include
A) Writing autobiography and reviewing
B) Diary in which thoughts and accompanying
symptoms are written down
C) Patient is taught to consider alternative ways of
thinking
4) Eclectic approach - Use different techniques according to the patient's needs, highly dependend on therapists knowledge/experience
5) Other forms
A) Hypnosis - relaxation
B) Autogenic training - basically meditation to alleviate
somatic symptoms of anxiety
C) Psychodrama - Patients act their life and thus find
their problems
D) Group therapies - Especially for addiction
102
Whats transcultural psychiatry?
Part of social psychiatry studying cultural and social influences on psychopathology.
103
Transcultural psychiatry terms? (4)
1) Cultural shock - Reaction to cultural change, first enthusiasm then disillusion, later adaptation
2) Social breakdown - Inability to adapt to a new social situation, usually immigrants
3) Gastarbeiteryndrome - Depression in workers from abroad
4) Nostalgia - Longing for home country
104
Culture bound syndromes (5)
1) Koro - Acute anxiety disorder characterised by fear of retraction of penis/vulva into abdomen with resulting death; mainly due to interpersonal conflicts
2) Brain Fag Syndrome - Feeling of crawling object inside patients head; typically in Nigerian children under studying pressure
3) Latah - In Malaysian women belonging to low social class; echopraxia, echolalia, coprolalia
4) Dhat syndrome - fear of excessive loss of semen due to masturbation/frequent sexual intercourse in indian men together with feeling of guild/fatigue
5) Windigo - Cannibalistic obsession in north-america
105
Psych examination parts
Mental state: Vigilant, Orientation, cooperativeness,
Disorders of perception consciousness thinking emotion
Anxiety
Suicidality
Drugs, allergy, disease
106
Neuroleptics classification
Typical: Haloperidil, -azines like Thioridazin
Atypical: Olanzapin, Clozapin, Risperidon
Depot-Neuroleptics:
107
Difference typical ans atypical neuroleptics
Atypical have less EPS
108
SE typical neuroleptics
1) EPS:
-Early dyskinesia reversible esp high potency
-Parkinsonoid esp high potency
-Akathisia in all
-Late dyskinesia possibly irreversible after 3
months => Use clozapine
2) Malignant neuroleptic syndrome
3) Sedation (antihistaminic)
4) Endocrine (Hyperprolactinemia)
5) Cardiac arrhythmias and hypotension
6) Anticholinergic
7) Seizures
109
Indication neuroleptics
Schizophrenia
Psychosis
Low potency typical as sedative
110
KI Neuroleptics
1) Intoxications
2) Consciousness disorder
3) Known MNS
4) Epilepsy
Typical: Parkinson
Clozapine: Hematopoesis problems
111
SE atypical neuroleptics
1) Glycemia Lipidemia changes
2) Akathisia but rarer than typical
3) Some of the typical ones
Clozapine: Agranulozytosis
112
Mood stabilizers names
Lithium
Carbamazepine
Valproate
Lamotrigine
113
Lithium stuff
```
SE: CNS (Tremor, ataxia, cramps)
Hypothyroidism because blocks TSH
Teratogenic
Hyponatremia because competes in kidney
Diabetes insipidus
Ind:Mania, Bipolar
KI: Kidney or CV disease, Pregnancy
CAVE: Very narrow therapeutic dose, monitoring
```
114
Carbamazepine stuff
Mechanism> Elongates Na open phase
Indications - Epilepsy, Trigeminusneualgia, Bipolar affective disorder 2nd choice
SE - Myelotoxicity, Diplopia, Ataxia, Somnolence, Steven Johnson Syndrome, Drug induced lupus, Teratogenic
115
Valproate stuff
Mechanism - Prolongation of inactivation phase
Indication - Epilepsy, Bipolar
SE - Weight gain, Tremor, Hepatotoxic, Pancreatitis, Teratogenic, Myelotoxic
116
Lamotrigin stuff
Mechanism - Blocks Na channels
Indication - Maintenace of bipolar
SE: Skin exanthema, Diplopia, CNS, GIT
117
Psychostimulants
Amphetamines -
Inhibits NA/Dop reuptake competetively
Methylphenidat/Ritalin -
Inhibits NA/Dop reuptake; I: Narkolepsie,
ADHD
Atomoxetin -
SNRI, 1st choice for for comorbid Tic/Anxiety
disorder, 2nd choice to ritaline if no
cormobidity
Modafinil -
Indication: Narcolepsy
SE: Less appetite, tachykardia, hypertonie (control!),
118
Psychiatric emergencies
```
1) Psychomotor agitiation
If psychoses - Haloperidol
If not - BZ
2) Delirium
Help with reorientation
Treat cause
If hallucinations maybe little haloperidol
BZ dangerous bc cause of delirium might be
alcohol
3) Quantitative disorder of consciousness
Diagnostic and intensive surveillance
No drugs until cause known
4) Acute suicidality
If psychotic - Antipsychotic + BZ
If depressed - BZ
5) Acute neuroleptic syndrome
Dantrolene, cooling, volume, stop antipsychotic
```
119
Typical neuroleptics groups
Low potency: Phenothiazides, Thioxanthenes (Thioridazine, Melperone)
High potency: Butyrophenone (Haloperidol)
120
What to use as sedative ir BZ are not possible e.g. agitation in homeless where alcohol intoxication is possible
Typical low potency neuroleptic e.g. Thioridazine
121
Epidemiology dementia
50% Alzheimer
20% Vascular
30% Rest
122
Picks disease symptomatology
```
Onset around 40-50
Personality changes (Disinhibition, Apathy, Hypersexuality, Irritability) before memory loss
```
123
Organic disorders except dementias (4)
1) Organic amnestic syndrome: loss of short and longterm memory while immediate recall is preserved; due to brain damage or ischemia or chronic alcoholism
2) Delirium due to organic causes (infection, fever, operation, dehydration, cancer etc.)
3) Organic personality disorder: significantly changed behaviour compared to premorbid state, mainly affects behaviour, not cognitive state; seen post-contusional, in epilepsy etc
4) Postconcussional syndrome: Follows head trauma with loss of conciousness; after regaining conciousness anxiety, irritability, apathy, dizziness, fatigue; complete recovery after few months
124
Criteria for diagnosis of addiction (5)
1) Craving
2) Tolerance
3) Loss of hobbies/friends
4) Keep taking drug although you know its detrimental
5) Cant control intake
125
Symptoms of opiod withdrawl
```
Muscles aches
Diarrhea
Flu like symptoms
Abdominal pain
Sympathetic hyperactitvity (mydriasis, hypertension)
Anxiety, Irritability
```
126
Opiod withdrawl therapy
1) Anxiolytics
2) Buprenorphin or methadone replacement
WITHDRAWL IS NOT LIFE THREATENING
127
Cannabinoid use MDs
1) Cognitive decline in long term use
2) Can trigger psychosis/schizophrenia in predisposed individuals
3) Anxiety/depression/apathy
128
MDs caused by stimulants
Most frequent stimulant in CR = Methamphetamine/Pervitine, others include MDMA, Cocaine
1) Psychological dependence => No somatic withdrawl
2) Long term use may lead to psychoses
3) Toxic psychosis
129
MDs caused by psychedelics
LSD, Psilocybin,
1) Optic hallucinations mainly
2) Panic, Anxiety
3) No withdrawl symptoms but sometimes micro-flashbacks
130
Epilepsy classification according to etiology
1)Genetic/idiopathic
2)Metabolic-structural/symptomatic
A)Acute brain disease (tumor, encephalitis, stroke)
B) Structural changes (Scars, Dysplasia, AV deformation)
C)Metabolic/Toxic (Hypernatremia, Hypoglycemia, Drugs)
3)Unknown/Cryptogenic
131
Triggers of seizures
1) Substances e.g. Alcohol/Drugs/Withdrawl
2) Other conditions (Fever esp children, hypernatremia, hypoglycemia, ecclampsia)
3) Situation (Physical exhaustion, sleep deprivation, strobolight)
132
Pathogenesis of epilepsy
EPSP > IPSP (Postsynaptic potentials)
leading to spreading depolarisation
If spread regionally => Focal
If spread over whole brain => Generalized
133
Types of seizure (3focal, 2 gemeralized)
Focal simple: Only part of body and concious
Focal complex: Only part of body and unconcious
Focal seizure with generalization (focal turning into general)
Generalised: Whole body with unconciousness
Generalised petit mal (clonic, tonic, absence, atonic, myoclonic)
Generalised grand mal (tonic-clonic)
134
Definition of epilepsy
Syndrome with predispositon to recurrent unprovoked epileptic seizures.
135
Phases of seizure
1) Aura
2) Tonic (Initialschrei)
3) Clonic
4) Relaxation often with amnesia if unconcious
136
Diagnosis of epilepsy
1) EEG
| 2) MRI for foci
137
Indication for therapy and therapy
Indication:
Single seizure is not indication for antiepileptic therapy, instead only start if structural abnormalities, more than 2 seizures in 6 months, EEG findings
Therapy:
A) Pharmacotherapy -
Focal: 1st choice Levetiracetam/Lamotrigin,
2nd choice carbamazepine, valproate
Generalized: 1st: Valproate, 2nd Lamotrigin
Absence: Valproin, Etosuximid
If resistant => Multitherapy
B) Surgical -
Resection of epileptic foci
Implantation of vagus stimulator rarely
Callosotomy - 2/3 or even complete
138
Therapy of acute seizure and status epilepticus
1) BZ - if possible p.o. in focal, if not then rectal
or injection (i.m. is shit bc.
pharmacodynamics)
2) Status epilepticus
A) BZ
B) Phenytoin
C) Anesthetics (Thiopental, Propofol)
D) Ketamines and inhalation narcotics
139
Complication of seizures
1) Brain edema
2) Cardiopulmonary failure
3) Complications of muscle activity (Electrolyte dybalance, acidosis, fractures)
4) Injuries from falling or bites)
140
Delusional disorders (Risk factors, Forms, Subtypes, Symptoms, Therapy
RFs: Old age, social isolation, low socioeconomic status (Verschwörungstheoretiker)
Symptoms: Delusions, not necessarily superbizarre, emotions might be affected secondarily
If <3m: Persistent delusional disorder
If >3m: Delusional disorder
Subtypes:
1) Erotomanic - Important person is in love with patient
2) Grandiose - Patient fills special role
3) Jealous - Jealous
4) Somatic - Believe they are sick
5) Persecutory - Someone means harm to patient MOST COMMON TYPE
6) Mixed - mixed
```
Therapy:
Removal from source of delusions
Psychotherapy
Antipsychotics rarely work
In general very hard to treat
```
141
Affective disorder types
1) Unipolar typically depressed
2) Bipolar (Mania and depression)
3) Recurrent depressive episodes (Seasonal affective disorder)
4) Persistent mood disorders (Cyclothymia, Dysthymia)
142
Severity of depression
1) Mild - still functioning well
2) Moderate - difficulty in daily life
3) Sever - severe impairment of daily life
143
Kinds of psychoses (hallucinations and delusions) in affective disorders
Mood congruent - fitting the mood
| Mood incongruent - not fitting the mood
144
Manic phase in affective disorder can be
With psychoses or without psychoses
145
Typical timespan between cyclds in bipolar affective disorder
average 4 months but extremly variable
| Rapid-Cycling: At least 4 episodes in 12 months
146
Persistent mood disorders
Cyclothymia: "Minibipolar", slightly instable mood with periods of slight depression and slight elevation of mood
Dysthymia: "Minidepression", slight depressed mood, tiredeness etc.; often in adult life
147
Dissociative disorder symptoms
Loss of concious control over memories, identity and motoractivity, degree of loss of control can vary considerably from day to day
Usually lasts weeks or months
148
Types of dissociative disorder
1) Dissociative amnesia: Loss of memory of one specific traumatic event (battles, accidents, bereavement)
Diagnosis: Exlusion of other causes and of simulation e.g. to avoid punishment for warcrime
2) Dissociative stupor: Almost complete loss of movement and speech, breathing, muscle tone, posture and eye opening are still present thus proving patient is awake
3) Possession disorder: Someone took over their body
4) Dissociative motor disorders: Paralysis/Ataxia etc. of part or whole body
5) Dissociative convulsion: Seizure but usually without injury or incontinence
6) Dissociative anesthesia: Numbing of senses e.g. pain sensation or vision
7) Ganser's syndrome: Grossly incorrect answers to questions frequently in stressful situation
8) Maybe multiple personality disorder but extremly rare, maybe nonexistant
149
Therapy of dissociative disorders
Psychotherapy
150
Somatoform disorders defnition
MD characterized by multiple, recurrent and frequent somatic complaints without physical cause.
151
Types of somatoform disorders
1) Somatization disorder -
A) Diagnosis:
- 2 years of multiple variable symptoms without physical cause
- refusal to accept treatment/diagnosis
- Impairment of social function
B) DD: Somatic disease, Neurotic/Affective
disorders, hypochondriasis
C) Therapy: Establish trusting relationship and
understand that disorder might be emotiona
message, try to fix underlying social
problems
2) Undifferentiated somatization disorder
Somatization disorder but not all criteria
fulfilled
3) Hypochondriac disorder -
A) Diagnosis:
-Persistent preoccupation with
-one or more physical disorders; more
focused on illness than on symptoms
( Somatization)
-refuse to accept diagnosis, frequent
change of doctor
B) DD: Somatoform disorder, neurotic
disorders
4) Somatoform autonomic disorder -
A) Diagnosis: 2 Types of symptoms
- Autonomic signs (Flushing, palpitation etc.)
- Subjective signs (Pain usually of one
system)
- No evidence of structural/functional dmg.
B) DD: GAD has less subjective symptoms
5) Somatoform pain disorder -
A) Diagnosis: Chronic pain without physical
cause
B) Often way of seeking attention but pain is
real
C) NOT to be confused with pain secondary to
depression/schizophrenia
D) Therapy: Fix psychosocial problems
152
Difference hypochondriac and somatization
Somatization: Patient is mostly preoccupied with symptoms which over time are variable, less with underlying disease
Hypochondriac: Preoccupied with illness, less with symptoms, interpretes normal sensations as signs of disease
153
Eating disorders types
Eating disorders represent a contiuum of disorders between Anorexia and Bulimia nervosa
1) Anorexia nervosa:
Affects mainly young women, increasingly
also men
A) Symptoms:
a) Weight at least 15% below
expected (<17,5 BMI)
b) Self induced weight loss
c) Changes in body perception
d) Endocrine disorders (amenorrhea)
e) Prepubertal onset leads to impaired dev.
B) DD: Somatic causes of weight loss
C) Treatment: Reach normal weight,
Cog-Beh-Therapy, rarely SSRIs for
comorbidity
D) Hospitalisation if suicidal, poor motivation,
comorbid psychiatric illness
2) Bulimia nervosa
Overeating followed by purging
A) Diagnosis:
a) Persistent craving for food
b) Purging by vomiting, laxatives, diuretics
c) Fear of fatness
d) Often history of anorexia
B) DD: Somatic diseases esp. of GIT,
persoanlity disorders, depressive
disorders
C) Therapy: Cog-Beh-Therapy, SSRI sometimes
3) Atypical forms on the spectrum between 1 and 2
154
Sleep disorders incidence and types
Very common
1) Dyssomnias
- (Insomnia, Hypersomnia, Sleep-Wake Cycle
disorder)
- Affect amount, quality and timing of sleep
2) Parasomnias
- Sleepwalking, Night Terror, Nightmare
- abnormal episodic events occuring during
sleep
155
Dyssomnias
1) Insomnia
- affects either falling asleep, duration of sleep
early awaking
- Therapy: Sleep hygiene (Same time, avoid
long wakefulness, dont use bed as place for
TV, exercise, avoid napping, get up if you
cant sleep); sometimes special CBT
- Drugs: Should only be used short term
Include BZ (Midazolam, Z Substances)
2) Hypersomnia
- Non-organic or organic (Sleep apnoe etc.)
- Excessive sleepyness, tiredness etc.
- Therapy: Sleepy hygiene and maybe
stimulants
3) Sleep-Wake Cycle disorders
- Shift workers or jet lag
- Melatonin maybe
156
Parasomnias
1) Sleep walking - minimal awarness, usually amnesia; guide back to bad gently; Complications from injuries or accidents
2) Night Terror - Short extreme panic with strong autonomic discharge and efforts of others to calm might actually increase fear, upon awakening usually amnesia
3) Nightmares -
All three are normal in childhood but less normal in adulthood, esp personality disorders
Sleep walking and Night Terror are sometimes associated with febrile
Therapy: Sleep Hygiene, BZ, maybe SSRIs
157
Sexual dysfunctions Definiton and types
Disturbance of human sexual response
1) Lack of sexual desire (no interest)
2) Sexual aversion (negative feelings)
3) Lack of enjoyment
4) Failure of genital esponse
- Erectile dysfunction (Viagra)
- Orgasmic dysfunctions
- Premature ejaculation
- Vaginismus
- Dyspareunia (no primary dysfunction like
vaginismus present)
5) Excessive sexual drive
Causes:
1) Psychological: Anxiety, Stress, Perfomance anxiety, self confidence
2) Somatic: DM, HT, alcohol etc.
Therapy:
1) Psychotherapy always
2) Drugs depending on problem (Viagra for erectile dysfunction, sex hormones for hypogonadism, dopaminergic agents for low sex drive, SSRIs for premature ejaculation)
158
Gender identity disorders definitions and types
Def: Dissatisfaction with ones gender
1) Transsexualism:
- Desire to live as opposite sex including changing primary and secondary sexual characteristics
- Very rare, often personality disorder instead
- Diagnosis: Presence of symptoms for at least 2 years
Therapy: Change of name, hormone therapy, surgery, psychothereapy
2) Transvestism:
- Desire to dress as opposite sex but only temporarily and without sexual excitement
3) Gender identidy disorder of childhood
- Persistent preoccupation with dressing, playing and toys of opposite sex
- Often indicates homosexuality later in life
159
Paraphilias def and types
Def: Culturally abnormal pattern of sexual preference
1) Fetishist
2) Fetishistic transvestite
3) Exhibitionists
4) Voyeurism
5) Pedophila
6) Sadomasochism
- Sadist: Likes to inflict pain/humiliation
- Masochist: Likes to receive
7) Multiple disorders/Mixed time
8) Others: Zoophilia, Necrophilia etc.
Diagnosis: Phaloplatysmography
Etiology: Multifactorial, social environment in 1st year of life is very important
Therapy:
Psychotherapy
Sex-drive lowering (Antiandrogenic,LRHR)
160
```
Psychostimulants names
MoA
Indication
KI
SE
Addictions
```
Methylphenidate/Ritalin, Amphetamine
Moa: Reuptake inhib and increased release of dopamine and NA
Ind: ADHD and narcolepsy
KI: Depression because increases suicide risk
Mania, Psychosis, HT, Hyperthyroidism, IHD
SE: Insomnia, Anorexia, HT, Tachycardia, Tics, Anxiety
Addictions: Usually non in ADHD but might lead to addicition if no ADHD present
161
Cognitives groups and names
1) ACh inhibitors (Rivastigmine also parenteral, Donepezile, Galantamine)
2) NMDA antagonists (Memantine)
162
Mental retardation definition and types, therapy
Arrested or incomplete psychic development before 3rd year of age as opposed to dementia
Diagnosis: Standardized IQ test + social functioning assesment
Etiology:
-Psychosocial (povery, education of parents
etc.)
-Biological (Mutations, Maternal disease like
DM or toxoplasma, brain trauma in early age)
-Biological causes are more often found in more severe retardation
1) Mild mental retardation - IQ 50-70
-80% of all retards
-Language might be delayed
-Capable of basic self care, might learn
reading and writing in special education
-usually work manual labour
-Might live alone possibly
2) Moderate mental retardation - IQ 35-50
- 12% of all retards
- Language varies
- Supervision is necessary
- Rarely live alone, can live in sheltered flats
3) Severe mental retardation - IQ 20-25
- 7% of all retards
- speech on level of sounds
- incontinent
4) Profound mental retardation - IQ <20
- 1% of all retards
- no speech
- feeding difficulties
- often other neurological problems like epilepsy, visual or auditory impairment, depression, personality disorder (also secondary to how people treat them), schizophrenia
```
Therapy:
Early intervention and family support
Pharmaco for specific symptoms
Sexual education cause easily exploitable
Adapt living space
```
163
Pervasive developmental disorders (4)
1) Autism - Severe impairment of development which presents before age of 3 years manifesting in social areas especially.
Typical features:
- Inability to relate, gaze avoidance
- Delayed development of speech
- Cognitive abnormalities esp lack of
creativity
- Stereotyped behaviour: prefer same
environment, plays and movements, small
changes can lead to aggression/depression
75% mental retardation
Ca. 0,3% prevalence, 4:1 boys:girls
Therapy: Mainly special schooling, speech etc.
Can be very demanding for family
2) Asperger's syndrome - similar to autism but no delay of speech and cognitive function
Boys to Girls 8:1
Spectrum
3) Retts syndrome - Normal development followed by partial or complete loss of motor skills and speech at 7-24 months age
- leads to hyperventilation, poor social interaction, loss of purposeful movement, bad body posture
- only described in girls
- head at some point stops growing
4) Childhood disintegrative disorders
- very rare disease
- normal development followed by loss of acquired skills, social disintegration, loss of speech etc.
- poor prognosisñ
164
Hyperkinetic disorders
Epidemiology: First five years of life, boys>girls, 3-10% of elementary school children
Symptoms: Inattention, Hyperactivity, Impulsivity
- esp. present in situations that require self
control
Etiology: Genetic, maternal deprivation, toxins, intrauterina or postnatal brain damage
Pathogenesis: Probably low NE levels
Neurological signs:
-soft signs: poor coordination, left right
confusion
-minor abonormalities in EEG
Complications: Academic failure and low self esteem leading to secondary problems like depression
Types:
1) Disturbance of activity and attention
- No features of dissocial behaviour
2) Hyperkinetic conduct disorder
- Features of dissocial behaviour
Therapy:
- Educate parents and teachers
- Short time tasks
- In breaks lots of physical activity
- Methylphenidate
165
Tic disorders & Tourette syndrome
Tic: sudden recurrent non-rythmic stereotypical movement or vocalization
Epidemiology: usually starts around 10y
20% of kids experience transient tics
3% of kids have tic disorder
males 3:1 females
Comorbidities: 90% of patients have other psychiatric problems
```
Tics can be:
Motor or Vocal
-simple
-complex
-copropraxia
-echopraxia
```
Types of tic disorders:
1) Transient tic disorder:
- At age 5-6, lasts less than 12 months, usually
eye twitching
2) Chronic motor or vocal tic disorder
- more than one year, usually multiple tics
- tics can change
3) De la tourette syndrome
- multiple vocal and motor concurrently
- onset in childhood but persist through life
often
Complications:
- bullying, poor self-conciousness, comorbidities
Management:
- Educate
- Psychosocial support
- Last resort: Drugs esp Neuroleptics/Botox
- Deep brain stimulation in severe
166
Childhood affective/neurotiic/schizophrenic disorders
1) Conduct disorders
- ADHD
- Dissocial,social and oppositional conduct
disorder
2) Emotional disorders
- Seperation anxiety after 5 year age (clear
rules, severe cases antidepressants )
- Phobix anxiety disorders esp. of animals,
insects, school (psychotherapy)
- Social anxiety disorder leading to social
isolation
- Sibling rivalry disorder: Serious hatred against
mostly newborn sibling, even aggression
3) Disorders of social functioning
- Elective mutism (no talking in specific
situations)
- Reactive attachment disorder (fearful, poor
social interaction; NOT autism bc. normal
cognition)
- Disinhibited attachment disorder (overly
friendly and attention seeking usually bc. of
frequently changing caregivers)
- Tic disorders
5) Schizophrenia in children
- very rare but poor prognosis bc of influence on
psychich development
4) Others
- Nonorganic enuresis (thereapy is sternchen im
Kalender)
- Stuttering
167
Eating disorders in childhood
1) Anorexia and Bulimia
2) Feeding disorder of infancy and childhood
- Child fails to gain weight or loses weight over
1 month period with proper feeding,
competent care givers and absence of disease
- often in instutional care children
3) Pica of infancy and childhood
- eating dirt or wall paint etc.
168
Disorders of volition
Abulia: Neg schizophrenia symptoms, depression
Hyperbulia: Mania
Hypobulia: Depression, Dementia
169
Disorders of behaviour
Quantitative: Stupor, Agitation, ADHD,
Qualitative: Catalepsy, Catatonia, Waxy flexibility, Active and passive negativism
Disorder of instinct:
- Self preservation: Suicide, self harm
- Eating: Voprophagia, bulimia, anorexia
- Sexual
- Parenting
170
Key features of acute or transient psychotic disorders (3)
- Acute onset in 2 weeks
- Typical syndromes, rapidly changing (Polymorphic) e.g. Disorders of thinking memory emotion perception
- Presence of extreme acute stress
171
Types of psychotic disorders (4)
1) Acute polymirphic psychotic disorders without symptoms of schizophrenia
2) """"""" with symptoms of schizophrenia (DD: schizophrenia but less than 1 month)
3) Acute schizophrenia like psychotic disorder (symptoms disappear in few days)
4) Others, include predominantly delusions
172
Gambling stuff
- very common addiction though usually to FB/IG
- Mechanism: Ncl. accumbens reward center with dopamine ==> Changes lead to addiction
- often insight and know its bad but cant stop
- End:
=> Go to prison bc of debt
=> Go to prison and get treatment
- similar to other addiction
Treatment: Psychotherapy
173
Depression symptoms
```
SIG ECAPS + Depressive mood
S - Sleep
I - Interest
G - Guilt
E - Energy
C - Concentration
A - Appetite
P - Psychomotor
S - Suicide
```
+ DEPRESSIVE MOOD
174
Puerperium MDs
1) Peripartal depression:
- increased risk of depression around birth
- associated with early birth, low fetal body
weight and changed fetal heart activity
- Pharmacotherapy only if very severe because
passes placental barrier
- instead psychotherapy
2) Postpartal depression
- typical q1-2 weeks after birth
- 10x more frequemt that peripartal
- "Baby blues" - normal light changes in mood
3) Both can be combined with psychoses in rare cases
175
Menstrual cycle MDs
1) PMS Premenstrual syndrome
- frequent, few days before mensturation
- Abdominal/Breast/Head pain
- GIT symptoms
- Hypobulia
- Mood swings, tiredness, anxiety
- Therapy:
Avoid triggers like alcohol
Oral contraceptives
Analgetics and antidepressants
2) PMDD Premenstrual dysphoric disorder
- more severe type of PMS
- same symptoms but hardcore
GET BETTER AFTER MENOPAUSE
176
Menopausal MDs
1) Postmenopausal depression
2) Postmenopausal
- bipolar
- OCD
- Schizophrenia
- Panic disorder
- Insomnia
Treat with antidepressants and hormones
177
Causes of mental retardation
1) Psychosocial: background, poverty, parent education and intellect=> mostly cause mild
2) Biological: Gene, Maternal infections (Rubella, Toxoplasma) Rhesus incomp, extreme prematurity, birth hypoxia
178
Treatment of ADHD
Ritalin/Methlyphenidrate
| Atomoxetin
179
Tic treatment
Antipsychotics low dose
| Extreme botulinum
180
Eating disorders in chilldhood
1) anorexia
2) bulimia
3) pica (eating paint ans dirt)
4) eating disorder of infancy
