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Year 3 - Diseases > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Define delirium

A
  • Acute confusion
  • Inattention
  • Cognitive impairment
  • Reduced awareness
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2
Q

Describe the symptoms and signs of delirium

A
  • Inattentive
  • Drowsy/ hyperalert
  • Picking at clothes/sheets (carphologia)
  • Not getting out of bed
  • Not interacting with others
  • Unwell
  • Fluctuates
  • Loss of appetitie
  • No lucid conversations
  • Paranoid, disturbed, overzealous affection.
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3
Q

List causes of delirium

A
  • Hypoxia
  • Anticholinergic drugs (dementia drugs are cholinesterase inhibitors and increase ACh)
  • Constipation
  • Urosepsis
  • Change of environment
  • Sedatives
  • Withdrawal from sedatives
  • Electrolyte disturbances
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4
Q

Describe management of delirium

A
  • Treat underlying cause
  • Supportive care
  • Orientation
  • Appropriate environment
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5
Q

List the types of dementia and define them

A
  • Alzheimer’s disease (AD) is a chronic neurodegenerative disease with an insidious onset and progressive but slow decline. AD is the most common type of dementia
  • Frontotemporal dementias (FTDs) are the second most frequent primary neurodegenerative brain diseases (after Alzheimer’s disease) in adults <65 years of age. Dementia with atrophy of the frontotemporal lobes
  • Vascular dementia is a chronic progressive disease of the brain bringing about cognitive impairment.
  • Lewy body dementia is memory impairment with fluctuating cognition, hallucinations and parkinsons symptoms
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6
Q

Describe epidemiology of Alzheimers dementia

A
  • Most common dementia
  • 60-70% of dementia
  • 5% population below 70
  • 30% population over 80
  • More common in women and black people
  • Early onset 1% of cases, autosomal dominant inheritence
  • Predicted 17 mil dementia patients in 2050
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7
Q

Describe epidemiology of frontotemporal dementia

A
  • 15 cases per 100000 in age 45-64
  • Higher prevalence in men
  • 8-17% of all dementia cases
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8
Q

Describe epidemiology of vascular dementia

A
  • 17% of dementia cases
  • Significant overlap with alzheimers
  • 3.8 per 100 000
    Highest in those age over 90
  • Men more affected than women
  • Higher rates in asian and black populations
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9
Q

Describe epidemiology of lewy body dementia

A
  • 10% of dementia
  • 0.1% per year
  • Increases with increasing age
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10
Q

List risk factors for Lewy body dementia

A
  • Older age
  • Male sex
  • Familial occurence
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11
Q

Describe aetiology of lewy body dementia

A
  • Toxic protein aggregation
  • Abnormal phosphorylation
  • Nitration, inflammation, oxidative stress, lysosomal dysfunction
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12
Q

Describe aetiology of vascular dementia

A
  • Infarction
  • Lekoaraiosis (disease of white matter)
  • Haemorrhage
  • AD
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13
Q

List risk factors for vascular dementia

A
  • Over 60
  • Obesity
  • Hypertension
  • Smoking
  • Diabetes mellitus
  • High cholesterolaemia
  • Alcohol abuse
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14
Q

List risk factors of frontotemporal dementia

A
  • Mutations in MAPT gene
  • Mutations in PGRN gene
  • Head trauma
  • Thyroid disease
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15
Q

Describe aetiology of alzheimers dementia

A
  • Amyloid hypothesis (excess of A beta peptoids)
  • Tau aggregation (microtubule-associated protein)
  • Late onset associated with alphalipoprotein E4
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16
Q

Describe risk factors of alzheimers dementia

A
  • Advanced age
  • Family history
  • Genetics
  • Down’s syndrome
  • Cerebrovascular disease
  • Hyperlipidaemia
  • Lifestyle (smoking, obesity, diet high in saturated fats, and alcohol consumption)
  • Less than secondary school education
  • Low IQ
  • Traumatic brain injury
  • Depression
  • Female sex
  • Elevated plasma homocysteine level
  • Artificially sweetened soft drink consumption
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17
Q

List symptoms and signs of alzheimers dementia

A
  • Memory loss
  • Disorientation
  • Nominal dysphasia
  • Misplacing items/getting lost
  • Apathy
  • ADLs decline
  • Personality change
  • Unremarkable initial physical exam
  • Mood changes
  • Poor abstract thinking
  • Prospagonosia and autoprosopagnosia
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18
Q

List symptoms and signs of frontotemporal dementia

A

Picks disease

  • Coarsening of personality, social behaviour and habits - disinhibition
  • Loss of language fluency or comprehension
  • Memory impairment, disorientation, apraxias
  • Progressive self neglect and abandonment of work, activities and social contacts
  • Altered eating habits
  • Inattentiveness, impulsive responding
  • Signs of ALS (progressive asymmetrical weakness)
  • Fasciculations, atrophy, hyperreflexia, MND
  • Glabellar, snout, sucking, rooting, grasp reflex
  • Loss of bladder and bowel control
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19
Q

List signs and symptoms of vascular dementia

A
  • Difficulty solving problems
  • Apathy
  • Disinhibition
  • Slowed processing of information
  • Poor attention
  • Retrieval memory deficit
  • Frontal release reflexes (glabella tap, jaw jerk)
  • Focal neurological signs
  • Impaired gait and balance
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20
Q

List signs and symptoms of dementia with lewy bodies

A
  • Cognitive fluctuations, progressive insidious onset
  • Visual hallucinations
  • Motor symptoms (shuffling gait, trmor, increased tone)
  • REM sleep behavioural disturbance
  • Severe antipsychotic sensitivity
  • Depression
  • Repeated falls and syncope
  • Orthostatic hypotension
  • Urinary incontinence
  • Constipation
  • Attention and visuospatial abnormalities
  • Delusions
  • Hypersomnia
  • Hyposmia
  • Auditory hallucinations
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21
Q

List investigations for alzheimers dementia

A
  • Bedside cognitive testing
  • FBC
  • Metabolic panel
  • TSH
  • B12
  • Urine drug screen
  • CT
  • MRI (generalised atrophy, beta amyloid plaque, neurfibrillary tangles)
  • CSF analysis, HIV
  • Neuropsychological testing
  • EEG
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22
Q

List investigations for frontotemporal dementia

A
  • Cognitive testing
  • MRI and CT (atrophy of frontal and anterior temporal lobes, pick cells and pick bodies in the cortex)
  • FBC
  • ESR
  • CRP
  • TSH
  • T4
  • Metabolic panel
  • Urea
  • Creatinine
  • LFTs
  • B12
  • Folate
  • Syphilis
  • ## HIV testing
23
Q

List investigations for vascular dementia

A
  • FBC
  • ESR
  • Glucose
  • Renal and LFTs
  • Syphilis serology
  • B12
  • Folate
  • Thyroid function
  • CT MRI brain (cerebrovascular lesion)
  • ECG
24
Q

List investigations for lewy body dementia

A
  • FBC
  • Metabolic panel
  • TSH
  • B12
  • Folate
  • VDRL (rule out syphilis)
  • Urine drug screen
  • Urinalysis
  • HIV testing
  • CT/ MRI (generalised cortical atrophy, lewy bodies in cortex and midbrain)
  • EEG
  • CSF
  • Neuropsychological testing
  • PET, decreased basal ganglia dopamine transporter uptake
  • Eosinophilic cytoplasmic inclusions of alpha-synuclein proteins
25
Q

Define alcohol withdrawal

A

Physical and psychological symptoms associated with a sudden decrease in alcohol consumption

26
Q

Describe epidemiology of alcohol withdrawal

A
  • 43% worlds population consumes alcohol
  • 20% of patients admitted for illnesses not related to alcohol drink to hazardous levels
  • 25% of alcohol withdrawal experience hallucinations, seizures occur in 10%
27
Q

Describe aetiology/risks of alcohol withdrawal

A
  • Chronic alcohol use up regulation of NMDA receptors, downregulation of GABA. decrease in alcohol causes imbalance between NMDA and GABA
  • Caused by abstinance from alcohol
  • History of alcohol withdrawal, past history of seizures and/or DT
28
Q

List symptoms and signs of alcohol withdrawal

A
  • Minor within 6 hours anxiety, agitation, palpitations, GI upset, sweating and tremor N and V
  • Major within 12 hours visual/tactile hallucinations
  • Major 36 hours short generalised tonic clonic seizures
  • 48-72 hours delerium tremens - delerium , severe tremor, fever, high BP and HR
  • 3% develop status epilepticus
29
Q

List investigations for alcohol withdrawal

A
  • CAGE questionnaire
  • AUDIT questionnaire
  • CIWA Ar scale (clinical institute withdrawal assessment from alcohol)
  • Tachycardia/temp
  • FBC
  • U&E
  • LFT INR
  • Glucose
30
Q

Describe management of alochol withdrawal

A
  • Benzodiazepines (chlordiazepoxide to prevent withdrawal, diazepam for seizures)
  • Pabrinex (B vits)
  • Glucose if hypo
  • Manage alcohol dependence with drug and alcohol liaison specialist, alcoholics anonymous, therapy
31
Q

List complications of alcohol withdrawal

A
  • Over sedation
  • Status epilepticus
  • Prolonged autonomic symptoms and insomia 6 months
32
Q

Describe prognosis of alcohol withdrawal

A
  • Delerium tremens fatal 15-20% if untreated, 1% with early management
33
Q

Define depression

A
  • Major depressive disorder is characterised by the presence of at least five symptoms and can be classified along a spectrum of mild to severe.
  • Severe episodes may include psychotic symptoms such as paranoia, hallucinations, or functional incapacitation.
  • Subthreshold (minor) depression is characterised by the presence of two to four depressive symptoms, including depressed mood or anhedonia, lasting longer than 2 weeks.
  • Persistent depressive disorder (dysthymic disorder) is characterised by at least 2 years of three or four dysthymic symptoms for more days than not. Dysthymic symptoms include depressed mood, appetite change, sleep disturbance, low energy, low self-esteem, poor concentration, and hopelessness.
34
Q

Describe epidemiology of depressive disorder

A
  • 18-44, leading cause of diability and prematire death
  • 2nd leading cause of disability in people of all ages by the year 2020
  • 1 in 5 patients in primary care had some depressive symptoms between 2005 and 2008. 10% depression serious enough to warrant treatment but only 1/3 treated
  • 20% affected in life
  • Women 2 times more than men
  • Increases 2 to 3 fold if first degree relative
  • First onset most commonly age 12-24 or over 65
35
Q

Describe aetiology of depressive disorder

A
  • Genetic component
  • Stressful life events, personality, sex
  • Postnatal
  • Corticosteroids, interferon, COCP, isotretinoin
36
Q

Describe symptoms and signs of depressive disorder

A
  • Depressed mood most of the day nearly every day for 2 weeks
  • Anhedonia
  • Functional impairment
  • Weight change
  • Loss of libido
  • Psychomotor problems
  • Low energy
  • Guilt
  • Poor concentration
  • Suicidal ideation
37
Q

Describe investigations for depressive disorder

A
  • Clinical diagnosis (more than 5 symptoms for 2 weeks is major depression)
  • Metabolic panel
  • FBC
  • TFT
  • Patient health questionnaire 2 (have you felt down, depressed, hopeless over the past 2 weeks + have you felt little pleasure) and 9 (classifies symptoms from 0-4)
  • Edinburgh postnatal depression scale
  • Geriatric depression scale
  • Cornell scale for depression in dementia
38
Q

Define substance abuse disorder: smoking

A

Substance-related disorders are a class of psychiatric disorders characterized by a craving for, the development of a tolerance to, and difficulties in controlling the use of a particular substance or a set of substances, as well as withdrawal symptoms upon abrupt cessation of substance use

39
Q

Describe epidemiology of substance abuse: smoking

A
  • 14.1% of people age 18 and above have smoked cigarettes

- In UK half a mill admissions annually attributable to smoking

40
Q

Describe aetiology of substance abuse: smoking

A
  • Nicotine from the tobacco plant
  • Stimulates nicotinic receptors in autonomic ganglia
  • High rates in HIV/AIDS patients, low socioeconomic status, and genetic influence
41
Q

Describe symptoms and signs of substance abuse: smoking

A

Intoxication

  • Euphoria
  • Tachycardia, hypertension, weight loss
  • Restlessness, anxiety
  • Increased GI motility
  • Insomnia
  • Tar staining

Withdrawal

  • Irritability, frustration, anger, restlessness, anxiety
  • Dysphoria, depressed mood
  • Insomnia
  • Impaired concentration
  • Increased appetite, weight gain
42
Q

Describe investigations for substance abuse: smoking

A
  • Pack years
43
Q

Describe the management for substance abuse: smoking

A
  • Counselling and support
  • Local service
  • Behavioural support, nicotine replacement therapy (transdermal, lozenge, gym), varenicline, bupropion, e-cigarettes
  • Combination drug and behavioural
44
Q

Describe prognosis of substance abuse: smoking

A
  • 8000 fatalities annually
  • 70% want to quit and 40% make an attempt each year
  • 3-4% successful on their own
  • Highest relapse first 8 days after stopping
45
Q

Describe complications of substance abuse: smoking

A
  • Relapse
  • COPD
  • Cardiovascular disease
  • Cancer (eg. lung)
  • Fetal complications
  • Effect on glycaemic control
  • Depressive disorder
46
Q

List symptoms of dependence

A

Three or more once in the last year:

  • Strong desire for consumption
  • Difficulty controlling use/amount/recidivism
  • Tolerance
  • Neglect of other activities/primacy
  • Persistent use despite adverse consequences
  • Withdrawal symptoms
  • Narrowing of repertoire
47
Q

Describe epidemiology of delerium

A
  • 20% patients on general wards
  • 30% of elderly medical patients
  • One year mortality 30%
48
Q

List risks for delirium

A
  • Co-exsiting medical condition
  • Cognitive status
  • Decreased oral intake
  • Age over 65
  • Metabolic abnormalities
  • Functional status
  • Sensory impairment
  • Drugs.
49
Q

Describe investigations for confusion

A
  • Pulse oximetry
  • BP
  • Urinalysis
  • FBC
  • CRP
  • Renal profile
  • Calcium
  • LFT
  • Glucose
  • Blood culture
  • ABG
  • ECG
  • CXR
  • AMTS and MMSE
  • GCS
50
Q

Describe the mental state exam

A
  • Appearance of the patient (weight, tattoos, scars, stigmata of disease, personal hygiene, clothing)
  • Behaviour (engagement in the conversation, rapport, hallucinations. Eye contact, facial expression, body language threatening or withdrawn, psychomotor activity (paucity of movement and delayed responses to questions, restlessnes)
  • Abnormal movements or postures (involuntary, tremors, ticks, lip-smacking, akathisias, rocking)
  • Speech (rapid or slow, quantity- less in depression, more in mania or schizophrenia, tone of speech (monotonus in depression, schizophrenia and autism, tremolous in anxiety)
  • Volume of speech
  • Stammering or stuttering
  • Mood and affect (mood is predominant subjective internal state as described by the patient, while affect is an observed emotion)
  • Thought (form ie. organisation, speed, coherence - loose associations (jumping between topics), circumstantial thoughts (extra info), tangential thoughts (digressions), flights of ideas (pressure of speech), thought blocking (sudden cessation of thought), perseveration (repetition), neologisms (made up))
  • Thought content (delusions, obsessions, compulsions, overvalued ideas, suicidal or violent thoughts)
  • Thought possession (insertion ie. thoughts can be inserted into pts mind, withdrawal ie thoughts can be removed, broadcasting ie others can hear the patients thoughts)
  • Perception (hallucinations, pseudo-hallucinations, illusions, depersonalisation, derealisation)
  • Cognition (oriented in time, place person, attention span and concentration levels, short term memory)
  • Insidht (ability to understand the problem they are experiencing is abnormal)
  • Judgement is inability to make considered ideas
51
Q

Describe the abrieviated mental test score

A
  • Age
  • Current time
  • Ask to recall an address (42 west street)
  • Current year
  • Current location
  • Recognise 2 people
  • Date of birth
  • Year the second world war finished
  • Name of current prime minister
  • Count backwards from 20 to 1

Less than 8 cognitive impairment

52
Q

Describe the mini mental state examination

A

30 point test

  • Orientation (year, season, month, date, time, country, town, district, hospital, ward, floor)
  • Registration (ask pt to learn 2 objects, see how long it takes to learn
  • Attention and calculation (subtract 7 from 100 and repeat)
  • Ask for names of 3 objects
  • Language (name 2 objects, repeat ‘no ifs, ands or buts’ 3 stage command ‘place index finger of right hand on your nose then on your left ear’ ask patient to obey written command on a piece of paper, ask patient to write a sentence)
  • Ask patient to copy a pair of intersecting pentagons

Scoring 24-30 normal, 18-23 mild impairment, 0-17 severe impairment

53
Q

Describe korsakoff

A
  • Chronic
  • Alert (no longer confused)
  • Amnesia (reterograde and anterograde) and confabulation
  • Irreversible

Year 3 - Diseases (27 decks)

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