Psychiatry - conditions Flashcards
What is a mood disorder?
Marked disruptions in emotions - severe lows (depression)/ highs (mania)
What two sets of diagnostic criteria are frequently used for psychiatric conditions?
- ICD-10/11
- DSM-5 (shitty American version)
What are the three core symptoms of depression?
- Low mood
- Anhedonia (lack of interest)
- Anergia (lack of energy)
What are some other symptoms of depression (7)?
- Weight change
- Sleep changes
- Reduced libido
- Worthlessness/ guilt
- Decreased concentration
- Thoughts of self harm
- Psychomotor sx (e.g. slow movements)
What sleep change is typical of depression?
Early morning wakening (typically 2-3 hours early) - although sleeping more/ less overall are both common
What 3 criteria should be fulfilled for a diagnosis of depression?
- Impair daily function + cause distress
- Symptoms most days for more than 2 weeks
- Not due to substance use or grief
What are some risk factors for depression (8)?
- Chronic pain
- Post partum
- Hypothyroid
- Trauma + abuse
- Bereavement (although this itself is not depression)
- Divorce
- Stress
- Female
What group of people are a higher suicide risk when depressed?
Male
What are two theories that could lead to or worsen depression/ other psychiatric disorders?
- Stress-vulnerability model = positive outcome more likely if stress minimised
- Monoamine hypothesis = deficiency of catecholamines (e.g. norepinephrine) –> depression
How is depression initially assessed (3)?
- Psychiatric: history, MSE, risk assessment
- Bloods: FBC, U&E, LFTs, TFTs, Ca2+, B12/folate, glucose, CRP/ESR
- Questionaries
What questionnaire is commonly used for depression?
PHQ-9
What scores are suggestive of different levels of depression in the PHQ-9?
Out of 27:
* <10 = mild
* 10-19 = moderate
* >19 = severe
What symptom can occur alongside severe depression?
Psychosis
What is psychosis?
Symptoms that occur when the mind has difficulty determining what is real and what is not
What are some symptoms of psychosis (3)?
- Hallucinations
- Delusions
- Disorganised speech/thought
What is a delusion?
A false belief based in incorrect inference about reality
How is mild depression managed?
Psychotherapy - guided self help, CBT, group exercises/ mindfulness
Only give antidepressant if requested
How is more severe depression treated?
- Offer antidepressant (SSRI/ SNRI)
- Psychotherapy (less group activities than mild depression)
What PHQ-9 score should antidepressants be offered as first line?
16 or more
under 16 should only be given if requested
When should initial follow up appointments be arranged for depression after starting antidepressants?
2 weeks
Who should be seen 1 week after starting antidepressants?
- 18-25 year olds
- High risk of suicide
How soon should antidepressants begin to have a clinical effect?
Within 4-6 weeks
What should be done after 4-6 weeks of treatment if there has been no improvement in depression (3)?
- Re-evaluate + manage risk factors for depression
- Check compliance with medication
- Consider differential diagnoses
How long after symptoms resolve should an antidepressant be taken for?
6 months
How frequently should those on long term antidepressants be seen?
Every 6 months
What treatment can be offered for extremely severe, life threatening depression?
ECT
What are the pharmacological options and order typically given for depression (6)?
- SSRI
- Another SSRI
- SNRI/ mirtazapine
- TCA
- MAOIs
- Treatment resistant depression –> lithium/ antipsychotics/ AEDs
When should a patient with depression be referred?
Treatment resistant depression/ very severe depression
Other than depression what are some other affective disorders (mood disorders) (6)?
- Bipolar disorder
- Dysthmia
- Postnatal depression
- Seasonal affective disorder
- Premenstrual dysphoric disorder (PMDD)
- Schizoaffective disorder
What is dysthymia?
Persistent (2-5 years) sub-threshold depressive symptoms
What is postnatal depression?
Depression within first year of giving birth, persisting beyond 2 weeks after birth
What severe symptoms can occur alongside postnatal depression?
Psychosis (postpartum psychosis)
What is the “baby blues”?
Depression that resolves within 2 weeks of giving birth
How is postnatal depression medically managed when mother is breastfeeding?
Sertraline/ paroxetine
low levels pass into breast milk
What is seasonal affective disorder (SAD)?
Depression usually during autumn/ winter with remission between
What is a specific treatment for SAD?
Light therapy
What is adjustment disorder?
Negative reaction to stress involving negative thoughts, strong emotions and changes in behaviour.
May occur with depressive symptoms
How long does adjustment disorder last?
Less than 6 months
What are some key differential diagnoses for low mood (4)?
- Affective disorders (e.g. depression, bipolar, SAD…)
- Hypothyroidism
- Bereavement
- Cancer/ terminal illness
What is bipolar disorder?
The presence of both depressive and (hypo)manic episodes
What is mania?
Abnormally elevated mood lasting for more than 1 week resulting in impairment in social and occupational functioning. Psychotic symptoms often present
What is hypomania?
Elevated mood lasting for more than 4 days that does not significantly impact on the persons functioning
What are the types of bipolar disorder (3)?
- Type 1 = mania + depression
- Type 2 = hypomania + depression
- Cyclothymia = hypomania + subclinical depression
What criteria are needed for a diagnosis of each of the bipolar disorders?
- Type 1 = manic episode, don’t need depressive episode
- Type 2 = hypomanic AND depressive
- Cyclothymia = hypomania and subclinical depression (much faster alternating) lasting 2 years
What are some symptoms of a manic episode (8)?
- Elevated mood
- Increased activity
- Grandiose ideas
- Decreased need for sleep
- Easily distracted
- Psychotic symptoms
- Pressure of speech, flight of ideas
- Changing appearance + overspending money
The lack of what features would point toward a hypomanic episode (3)?
- Grandiosity
- Psychosis
- Lack of insight (so would have some insight)
What can precipitate a manic episode (3)?
- Positive life events
- Getting up early
- Drugs/ alcohol
What are some risk factors for bipolar (4)?
- Family history (first degree)
- Trauma/ abuse
- Stress
- Substance abuse
What might be considered a typical person at risk of developing bipolar?
Female < 30 with family history of bipolar
What activities pose a risk to those in a manic episode (3)?
- Reckless behaviour/ aggression
- Sexual promiscuosity
- Lack of self care for physical illnesses
What are some organic causes of bipolar disorder (3)?
- Endocrine e.g. hyperthyroidism
- Neurological - MS, CVA, epilepsy, tumour
- Drugs - steroids, antidepressants
How is bipolar diagnosed (2)?
- Clinical diagnosis
- Bloods, imaging and other Ix used to rule out organic causes
How should bipolar be immediately managed (2)?
- Manic episode = urgent referral
- Hypomanic episode = routine referral
What is rapid cycling bipolar disorder?
Having 4 or more manic episodes in 1 year
What is the medication pathway to treat a manic episode (3)?
- Antipsychotic (haloperidol, risperidone, quetiapine, olanzapine)
- Offer second antipsychotic
- Add sodium valproate/ lithium
What should be stopped during a manic episode?
Antidepressants - tapered and stopped
How is a depressive episode in bipolar managed with medication (3)?
- Antipsychotics
- Olanzapine + fluoxetine
- Lamotrigine
What is the medication pathway for the long term management of bipolar?
- Lithium
- Sodium valproate
- Olanzapine
How should lithium be monitored when started for bipolar disorder?
Concentration measured 12 hours after dose weekly until stable, then every 3 months
What non pharmacological options are there for those with bipolar disorder?
- Education about bipolar and early warning signs (with involvement of family)
CBT can be used - not particularly effective
What are some differential diagnoses for bipolar disorder (3)?
- Unipolar depression
- Schizophrenia
- Emotionally unstable personality disorder (EUPD/BPD)
What is schizophrenia?
An acute mental health state resulting in psychosis (delusions and hallucinations) and dissociation from reality
What are 3 types of delusion?
- Grandeur = belief of inflated self importance (e.g. that they are the queen)
- Paranoid
- Somatic = believe they have a terrible illness
What are some risk factors for schizophrenia (6)?
- Family history (1st degree) = biggest factor
- 16-30 years
- Previous illicit drug user
- Trauma + abuse
- Traumatic birth
- Emigrating
What broad groups are the symptoms of schizophrenia divided into (3)?
- Positive symptoms
- Negative symptoms
- Cognitive impairment
What is a positive symptom in schizophrenia?
Those present in people during a psychotic episode
What is a negative symptom in schizophrenia?
Deficits of normal emotional responses
What are some examples of positive symptoms in schizophrenia?
- Delusions
- Hallucinations
- Thought disorders
- Disorganised speech/ behaviour
What types of hallucinations are common in schizophrenia?
Auditory (however talking to the voices is rare)
visual and olfactory hallucinations are rarer in schizophrenia
What types of disorganised speech sometimes occur in schizophrenia (6)?
- Word salad - completely mixed up sentence
- Neologism - made up word
- Flight of thought - jumps from one idea to another with associations
- Knights move thinking - jump from ideas with no associations
- Pressure of speech - fast talking
- Circumstantiality - take ages to get to the point
What type of thought disorders occur in schizophrenia (3)?
- Insertion - thoughts put in mind
- Withdrawal - thoughts taken from mind
- Broadcasting - thoughts told against will
- Passivity - lack of control over them
What negative symptoms can be present in those with schizophrenia (5)?
- Alogia - impoverished level of thinking (poverty of speech)
- Anhedonia - loss of pleasure
- Apathy - lack of enthusiasm
- Blunting of affect (emotionless)
-
Slowness of thought and movement
AAABS
What other symptoms can be present in those with schizophrenia (5)?
- Depression
- Anxiety
- Agitation
- Withdrawal
- Self harm
What are Schniders first rank symptoms for schizophrenia (more historical criteria) (4)?
- Auditory hallucinations
- Broadcasting, insertion, withdrawal of thoughts
- Control (passivity) - others controlling actions + thoughts
- Delusional perceptions
What are some differential diagnoses for psychosis (4)?
- Psychological disorders
- Delirium tremens
- Drugs e.g. cannabis
- Organic disorder e.g. epilepsy
What psychological disorders cause psychosis (5)?
- Schizophrenia
- Bipolar disorder
- Brief psychotic disorder
- Delusional disorder
- Major depressive disorder
How long should a brief psychotic disorder last?
less than 1 month, often with a precipitating factor
What is delusional disorder?
Similar to schizophrenia but without significant hallucinations, though disorders or mood disorders
How is schizophrenia investigated (4)?
- FBC + LFTs
- Drug screening
- EEG - for epilepsy
- CT/ MRI - enlarged lateral ventricles
How long should symptoms of schizophrenia be going on for before a diagnosis is made?
28 days
What is important to tell people with a diagnosis of schizophrenia?
Can’t drive until well for 3 months
What is indicative of a poor prognosis for schizophrenia (4)?
- Slower onset
- Family history
- Abuse history
- Negative symptoms
What is late onset schizophrenia?
After age 45
What is the prognosis for later onset schizophrenia?
Better prognosis
What risks are associated with those with schizophrenia (3)?
- Self neglect - exacerbate physical health conditions
- Risk to others
- Suicide - thoughts/ auditory hallucinations
How is schizophrenia managed pharmacologically?
- Trial 2 atypical antipsychotics (risperidone, olanzapine, aripiprazole, quetiapine)
- if no effect … clozapine
What non pharmacological treatments are offered to those with schizophrenia (3)?
- CBT
- Early warning signs education
- Family therapy (they can recognise the signs)
What is schizoaffective disorder?
Schizophrenia + mood disorder (e.g. depression/ bipolar)
What “state” do some people with schizophrenia sometimes end up in?
Catatonia
What is catatonia?
Ceases in movements/ speech, sometimes with abnormal movements
Other than schizophrenia what is catatonia associated with (2)?
- Major depressive disorder
- Mania/ bipolar disorder
What is the most common anxiety disorder affecting 15% of people?
Specific phobias
How could a specific phobia be defined?
Irrational fear of particular thing/ situation
What is a symptom of specific phobias (2)?
- Avoidance behaviours
- Catastrophising
What are some examples of specific phobias (1)?
- Agoraphobia = fear of public places/ unknown environment
How is a specific phobia treated (2)?
- Exposure responce prevention
- Consider SSRIs
What is the second most common anxiety disorder?
PTSD
What is PTSD?
Onset of symptoms such as flashbacks for more than 1 month after a particularly traumatic event
What is ‘PTSD’ that does not continue 1 month past the traumatic event known as?
Acute stress reaction
What are the 3 main symptoms of PTSD?
- Flashbacks/ nightmares to event
- Avoidance behaviour of things that remind them of the event
- Hypervigilance - exaggerated responce to stimuli
What is the first line treatment for more mild PTSD?
Trauma focused CBT + exposure therapy
What is the gold standard treatment for chronic PTSD?
Eye movement desensitisation and reprocessing (EMDR)
What is a pharmacological treatment for PTSD?
SSRI or venlafaxine
Other than PTSD and phobias, what are some other anxiety disorders (3)?
- Panic disorder
- GAD
- OCD
What 3 features are suggested in models that result in the development of panic/ anxiety disorders?
- Stress
- Loss of control
- Genetics
What are some risk factors for the development of anxiety/ panic disorders (6)?
- Genetics
- Stimulant drugs
- Palpitations
- Hyperthyroid
- Trauma/ abuse
- Stress
How many panic attacks are required for a diagnosis of panic disorder?
4 or more within 1 month
usually last 10-30 min
Who is typically affected by panic disorder?
Female (20-30 years old)
What are 8 symptoms of a panic attack?
- SoB
- Chest pain
- Lightheaded/ dizzy
- Palpitations
- Shaking
- Sweating
- Parasthesia
- Fear of dying
What phobia do people with panic disorder often develop?
Agoraphobia - fear of unknown surroundings
What questionnaire is used to diagnose panic disorder?
PHQ-PD
How is panic disorder treated (4)?
- Psychoeducation
- CBT/ ERP = gold
- SSRI
- Beta blockers (propanolol)
What is OCD?
Obsessive thoughts and recurrent ritualistic behaviour (for relief)
What are the 2 symptoms/ features of OCD?
- Recurrent unwanted intrusive thoughts
- Behaviours that result from the obsessive thoughts believed to prevent a bad outcome
How long should OCD be going on for to get a diagnosis?
More than 4 days per week for more than 2 weeks
What are some common OCD behaviours (3)?
- Handwashing
- Checking lights/ locks
- Cleaning
Do patients with OCD have insight into their behaviours?
Yes they know it is unnecessary
What is the cycle of emotions in OCD?
Obsession –> anxiety –> compulsion –> temporary relief
What questionnaire can be used to help diagnose OCD?
Y-BOCS (Yale-brown OCD scale)
How is OCD managed (3)?
- Exposure and response prevention (+CBT)
- 1st = SSRIs (for at least 12 weeks)
- 2nd = clomipramine (TCA)
What is generalised anxiety disorder?
Numerous worries cause anxiety throughout the day and in various situations
How long should symptoms go on for a diagnosis of GAD?
6 months
What are 3 key features of the anxiety in GAD?
- Pervasive
- Persistent
- Non-specific
What are some physiological reactions to anxiety (6)?
- Decreased blood flow to gut
- Smooth muscle contraction in gut
- Increased blood flow to skeletal muscle
- Dilation of pupils
- Nausea
- Increased HR/BP
What are the 6 key signs/ symptoms of GAD?
- Restlessness
- Fatigue
- Irritability
- Poor concentration
- Sleep disturbance
- Muscle tension
How is GAD investigated (2)?
- Bloods
- GAD-7 questionnaire
How is GAD treated (4)?
- Psychoeducation - explain the diagnosis
- Guided self help + breathing techniques
- CBT
- Pharmacological Tx
What drug treatments are offered to those with GAD in primary care (3)?
- Sertraline = 1st
- SSRI/SNRI (particularly duloxetine and venlafaxine)
- Pregabalin
What drug treatments are offered for GAD in secondary care?
Antipsychotics (e.g. quetiapine)
What medications can be offered for symptom relief in those with GAD?
Beta blockers (e.g. propanolol)
What medication is used for short term symptomatic relief of GAD?
Benzodiazapines e.g. diazepam
Why should long term use of benzodiazepines be avoided (4)?
- Addiction risk
- Adverse effects on mood
- Reduced motivation
- Oversedation
What percent of men and women have GAD?
- Men = 2-4%
- Women = 3-5%
What is it known as when there is a focus/ exaggeration of physical symptoms?
Somatisation = symptoms
What is concern of a serious illness known as?
Hypochondriasis = cancer
What is a personality disorder?
A longterm, persistent pattern of inner experiences and behaviour that differs markedly from cultural expectations leading to distress/ impairment
When do personality disorders typically develop in life?
Early adulthood/ adolescence
What are some risk factors for personality disorders (2)?
- Traumatic childhood without any strong connections with other people
- Family member with personality disorder
What theory has been suggested to contribute to the development of personality disorders?
Attachment theory - idea that children need one relationship with primary caregivers for their survival
What areas of functioning do personality disorders affect (5)?
- Interpersonal functioning
- Affectivity
- Cognition
- Impulse control
- Occupational/ social performance
What questionnaire can be used to diagnose and distinguish different PDs?
Personality diagnostic questionnaire 4 (PDQ-4)
Are behaviours/ emotions exhibited due to personality disorders easy to change?
No, they are deeply ingrained + enduring
What are the 3 broad categories of personality disorders?
- A = Suspicious/ odd
- B = Emotional/ impulsive
- C = Anxious
What personality disorders are within group A - odd/ eccentric (3)?
- Paranoid - suspicious, sensitive, unforgiving
- Schizoid - emotionally cold, lack of interest, detached
- Schizotypal - magical thinking, unusual perceptions, inappropriate affect
What personality disorders are within group B - emotional/ erratic (4)?
- Antisocial - lack of concern, disregard for rules, aggression
- Borderline/ EUPD - impulsive, fear of abandonment, poor self image
- Histrionic - dramatic, crave attention, manipulative
- Narcissistic - grandiosity, lack of empathy, need for admiration
What personality disorders are within group C - anxious/ fearful (3)?
- Avoidant - fear of criticism, self-conscious, tense
- Dependant - doesn’t like to take control, doesn’t disagree, needs reassurance
- Obsessive - compulsive - perfectionist, indecisive, likes orderliness + control
What are common signs and symptoms for all personality disorders (7)?
- Strong emotions
- Low self esteem
- Impulsive
- Self harm
- Substance abuse
- Violence/ agression
- Difficulties maintaining relationships
What questionnaire is useful for diagnosis of personality disorders?
Minnesota multiphase personality inventory (MMPI)
How are personality disorders managed?
- Psychoeducation
- Dialectical behaviour therapy (+other CBT)
What is a particularly effective management of BPD/ EUPD?
Dialectical behaviour therapy
Which personality disorder is suicide/ self harm particularly common?
EUPD/BPD
antisocial as well
What are 6 psychiatric emergencies?
- Neuropleptic malignant syndrome
- Serotonin syndrome
- Acute dystonic syndrome
- Wernicke-korsakoff syndrome
- Delirium tremens
- Lithium toxicity
What causes neuroleptic malignant syndrome?
Reduced dopaminergic activity due to adverse reaction to antipsychotics (dopamine receptor antagonists) or abrupt dopaminergic withdrawal (levodopa)
What are the symptoms of neuroleptic malignant syndrome (5)?
- Fever
- Altered mental state/ confused
- Rigidity
- Fluctuating BP
- Tachycardia
How is NMS investigated (3)?
- Bloods
- CT/MRI
- Infection screen
What blood result is often raised in NMS?
Creatinine kinase
How is NMS managed (4)?
- Treat hyperthermia (e.g. with ice packs)
- Stop drug
- Dantrolene (muscle relaxant)
- Bromocriptine
What are some complications of NMS (2)?
- Rhabdomyolysis
- AKI
What causes serotonin syndrome?
High synaptic concentration of serotonin
What drugs cause serotonin syndrome (4)?
- Antidepressants
- Opioids e.g. tramadol
- St johns worts
- Stimulants e.g. ecstacy/ cocaine
How do opioids sometimes cause serotonin syndrome?
Unknown although metabolites may be SSRIs
Tramadol acts as an SNRI
What antidepressant is a particular risk for causes serotonin syndrome?
MAOIs
What are the symptoms of serotonin syndrome (7)?
- Agitation/ confusion/ hallucinations
- Tremor
- Rigidity
- Hyperreflexia
- Hypertension
- Tachycardia
- Hyperthermia
How soon after starting medications does serotonin syndrome usually occur?
Within 2 weeks
How is serotonin syndrome treated?
Chlorpromazine
Mainly supportive treatments e.g. ice packs, intubation
What medication can be given to those with serotonin syndrome?
Cyproheptadine or chlorpromazine - blocks dopamine
What is a differential diagnosis for serotonin syndrome?
Neuroleptic malignant syndrome
What can help differentiate between NMS and SS in terms of signs/ symptoms?
- NMS = (lead pipe) muscle rigidity
- SS = hyperreflexia/ clonus
How can NMS and SS be differentiated between from blood results?
NMS usually has raised WBC and CK more than SS
How is self harm often carried out (5)?
- Cutting
- Headbanging
- Burning
- Alcohol
- Overdoses
What are some risk factors for self harm (6)?
- LGBTQ+
- Female
- EUPD
- Depression
- Bereavement
- Trauma/ abuse
How is suicide often carried out (4)?
- Overdose
- Jumping from height
- Cutting
- Ligatures
What are some risk factors for suicide (10)?
- Sex = male
- Age = old/ teenager
- Depressed
- Past history of suicide attempt
- Employment = unemployed
- Rational loss (psychotic)
- Self harm
- Organised plan
- Non married/ divorced
- Sick/ chronic disease
What factors suggest a higher likelihood of a completed suicide attempt (5)?
- Makes effort not to be found
- Leaves note
- Plans death
- No regret
- Violent method
What pathway is thought to be the cause of addictive behaviours?
Mesolimbic reward dopaminergic pathway
What terms are used to describe substance dependance (8)?
- Withdrawal Sx
- Tolerance
- Narrow repertoire
- Craving
- Loss of control
- Rapid reinforcement
- Primacy
- Continued use despite harm
What does a narrow repertoire refer to in the context of substance dependence?
Exhibit same behaviour - e.g. drinking around the same times each day to maintain high BAC
What does rapid reinforcement refer to in substance dependence?
Quick return to old level after stopping
What does primacy refer to in substance dependence?
Takes precedence over physiological need
What is the mechanism of action of alcohol in the brain?
Alcohol up-regulates GABA (inhibitory) receptors and down-regulates glutamate (excitatory) receptors
What is the pathophysiology of long term alcohol use?
GABA system down-regulated and glutamate system up-regulated, therefore when alcohol is not taken this results in an imbalance in the body
What is the recommended alcohol consumption each weak?
14 units
What are some symptoms of alcohol intoxication (7)?
- Ataxia
- Slurred speech
- Increased confidence
- Irritable
- Decreased GCS
- Vomiting
- Sexual arousal
What are some signs/ symptoms of excess chronic alcohol use (6)?
- Smelling of alcohol
- Slurred speech
- Bloodshot eyes
- Telangiectasia
- Tremor + other withdrawal Sx
- Decreased cognitive functioning/ memory
What are the symptoms of alcohol withdraw and what time period do they appear (3)?
- 6-12 hours = anxiety + (fine) tremor
- 24-48 hours = seizures (peak at 36 hours)
- 48 -72 hours = delirium tremens
What are the signs/ symptoms of delirium tremens (6)?
- Corse tremor
- Confusion
- Delusions
- Auditory + visual hallucinations
- Fever
- Tachycardia
How is alcohol use investigated (3)?
- Bloods
- CAGE questionnaire = screening
- AUDIT questionnaire = diagnosis
What score on AUDIT questionnaire indicates harmful alcohol use?
8/10 or more
What are the blood findings of those with alcohol use (3)?
- Raised MCV
- Raised GGT + AST>ALT
- Raised CDT
What questions are asked in the CAGE questionnaire?
- Cut down? (think about it)
- Annoyed (when people ask about alcohol)
- Guilty
- Eye opener (drink when wake up)
What is the treatment for acute alcohol withdrawal (2)?
- Chlordiazepoxide
- IM/IV pabrinex (vitamin Bs e.g. thiamine)
How is alcohol use managed in the long term (5)?
- Naltrexone = reduces pleasure
- Acamprosate = reduces cravings
- Disulfiram = induces hangover Sx with alcohol
- Oral thiamine
- Psychological therapy
What is the BAC limit for driving?
0.08%
What are some complications of alcohol consumption (5)?
- Liver cirrhosis
- Wernicke-korsakoff
- Pancreatitis
- Cancer
- Alcohol dependance + withdrawal
What is the cause of Wernicke-Korsakoff syndrome?
Poor thiamine (B1) absorption –> thiamine deficiency
What are the symptoms of wernickes encephalopathy (4)?
- Confusion
- Oculomotor disturbance/ nystagmus
- Ataxia
- AMS
What are the signs/ symptoms of korakoff (3)?
Memory impairment/ confabulation
What are some MRI findings in Wernicke-Korsakoff syndrome (2)?
- Wernicke = reversible cytotoxic oedema
- Korsakoff = mammillary body + thalamic atrophy
How is Wernicke-Korsakoff treated?
IV pabrinex (vitamin Bs/ thiamine)
What are the symptoms of opioid overuse/ toxicity (5)?
- Pinpoint pupils
- Resp depression
- Reduced GCS + confusion
- Euphoric
- Constipated
How is opioid overdose treated?
Naloxone
How is opioid use treated in the long term?
Methadone
What are some withdrawal symptoms of opioid use (6)?
- Yawning
- Anxiety
- Dilated pupils
- N+V
- Lacrimation (increased tears)
- Rinorrhoea
What is the mechanism of MDMA, cocaine, amphetamines and LSD (4)?
- MDMA (ectasy) = stimulates serotonin release + blocks reuptake
- Cocaine = blocks dopamine reuptake
- Meth = stimulates Da release + blocks reuptake
- LSD = stimulates 5-HT2A receptors (serotonin receptors) in prefrontal cortex
What are the general signs/ symptoms of MDMA, cocaine, amphetamines and LSD use (4)?
- Agitation
- Hypertension
- Hyperthermia
- Tachycardia
What are two specific features of cocaine use?
- Vasospasm
- QRS prolongation + arrhythmias
What are the two specific features of amphetamine use?
- Hallucinations
- Dilated pupils
What are two specific features of LSD use?
- Hallucinations
- Hyperreflexia
What are the general principles of management of drug overdoses (6)?
- A-E approach
- Intubate
- Reduce temperature
- Monitor BP
- Benzodiazapines (for seizure prevention)
- Psychological support
What is drug misuse vs drug abuse (2)?
- Abuse = use in a way that causes considerable harm
- Misuse = use in a way different to prescription/ unsafe setting
What are 3 common eating disorders?
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
Which eating disorder is the least common but has the highest mortality?
Anorexia nervosa
What is anorexia nervosa?
Believing they are overweight and need to loose weight despite evidence of low/ normal BMI
What are some risk factors for anorexia nervosa (7)?
- Family history
- Female
- Younger age (20-40)
- Trauma/ abuse
- Social media
- History of overweight
- Depression
What are the signs/ symptoms of anorexia nervosa (8)?
- Low BMI < 17.5/ 15% below expected
- Purging (laxatives + vomiting)
- Weight loss
- Amenorrhoea
- Lanugo hair
- Osteopenia + muscle waisting
- Hypotension
- Hypothermia
What are some common cardiac complications in those with anorexia nervosa (3)?
- Arrhythmias
- Cardiac atrophy
- Sudden cardiac death
How is anorexia nervosa investigated (4)?
- SCOFF screening questions
- SUSS test (sit-up-squat-stand)
- Bloods
- ECG
What are the SCOFF screening questions for AN (5)?
- Make yourself Sick
- Lost Control of how much you eat
- One stone in 3 months
- Food dominates life
- Fat perception
What are the blood results of someone with anorexia nervosa (4)?
- Anaemia
- Leucopenia
-
Thrombocytopenia
reduced bone marrow activity -
Hypokalaemia
everything low except growth hormone + cortisol
How is anorexia nervosa managed (5)?
- Structured eating plan + supplements
- Anorexia focused family therapy
- CBT
- Inpatient management
- Fluoxetine
What are some complications of anorexia nervosa (4)?
- Refeeding syndrome
- Osteoporosis
- Amenorrhoea
- Infertility
What is the pathophysiology of refeeding syndrome?
Low food intake = low electrolytes, when begin eating –> insulin spike –> glucose + electrolytes move into cells –> further depletes electrolytes + glucose
What are the important effects of referring syndrome (4)?
- Hypokalaemia
- Hypomagnesaemia
- Hypophosphataemia
- Fluid overload
What is bulimia nervosa?
Episodes of binge eating followed by purging (typically making oneself vomit)
Who is typically affected by bulimia nervosa?
Young female (20-30) athletes/ models
What are the signs/ symptoms of bulimia nervosa (9)?
- Preoccupation with body image
- Often normal BMI
- Binge eating then purging
- Erosion of teeth
- Russels sign (callouses on knuckles)
- Gord/ reflux
- Parotitis
- Halitosis (bad breath)
- Dental carries
What is the typical episode of a binge eating then purge like in BN?
Eating alone until uncomfortably full, feel guilty, then making themselves vomit
What are some examples of ways people with BN purge (3)?
- Vomit
- Exercise
- Laxatives/ diuretics
How is bulimia nervosa investigated (3)?
- SCOFF screening
- SUSS -ve
- Bloods
How long should bulimia nervosa typically have gone on for?
3 months with 2 episodes per week
What are the blood findings in those with bulimia nervosa?
Hypokalaemic hypochloraemia metabolic alkalosis
How is bulimia nervosa managed (4)?
- Self help + education
- CBT (eating disorder focused)
- Bulimia nervosa focused family therapy
- Fluoxetine
What are the signs/ symptoms of binge eating disorder (5)?
- Higher BMI
- Planned episodes of eating lots very quickly in private
- Loss of control
- Guilt/ disgust
- Underlying psychological distress
How long should binge eating disorder typically have been going on for for a diagnosis?
More than 3 months
How is binge eating disorder treated?
CBT
What are some common reasons children may be referred to CAMS (4)?
- Learning disabilities
- ADHA
- ASD
- Tics
What is a learning disability vs learning difficulty?
- Disability = general intelligence resulting in a lower IQ
- Difficulty = difference in the way someone learns making it harder to learn certain things
How are learning disabilities categorised (4)?
- 50-70 = mild
- 35-49 = moderate
- 20-34 = severe
- <20 = profound
measured in IQ
What are some causes of learning disabilities (5)?
- ASD
- ADHD
- Genetic (e.g. downs)
- TORCH
- PANDAS
What is PANDAS?
Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections - it is a controversial diagnosis where children develop tic disorders or OCD after streptococcal infection
What is autism spectrum disorder?
Spectrum of severity of impaired communication and social interaction
What age do symptoms of ASD typically appear?
< 3 years
What 3 general categories can symptoms of ASD be placed in (3)?
- Social interaction
- Communication difficulties
- Behavioural deficits
What are some signs/ symptoms of ASD (11)?
- Lack of eye contact
- Delay in smiling
- Avoiding physical contact
- Difficulty reading non-verbal cues/ emotions
- Delay in language/ minimal language
- Difficulty with imaginative behaviour
- Repetitive use of words/ phrases
- Lack of interest in people
- Repetitive movements/ behaviours
- Fixed routine
- Deep + intense interests
In what situations should symptoms of ASD be present?
Across more than 1 setting e.g. home and school
What questionnaire can help diagnose autism?
M-CHAT
How is ASD managed?
Supportive - SENCO, psychologists, etc
What are the key features of ADHD (3)?
- Difficulty maintaining attention
- Excessive energy + activity
- Impulsivity
What are some risk factors/ causes of ADHD (3)?
- Genetics/ family history
- Pregnancy related (e.g. low birth weight, smoking, premature)
- Environmental factors
In what situations should symptoms of ADHD be present?
Consistent across all settings
What are some symptoms of ADHD (7)?
- Short attention span
- Easily distracted
- Quickly moving between activities
- Inability to complete tasks
- Constantly moving/ fidgeting
- Impulsive behaviour
- Disruptive behaviour
What assessment can help diagnose ADHD?
DIVA-5
How is ADHD managed (3)?
- Watch + wait/ conservative management
- Methylphenidate
- Lisdexamfetamine
What are some conservative management strategies for ADHD (4)?
- Structured routines
- Clear boundary
- Healthy diet
- Plenty of exercise
What type of medications are used for ADHD?
Amphetamines (CNS stimulants)
What should be monitored in people on methylphenidate + other ADHD drugs (2)?
- Baseline ECG needed as risk of RBBB
- Monitor height + weight on growth charts as meds can decrease appetite
What conditions are tics associated with (3)?
- ASD
- ADHD
- PANDAS
What are the classification of tics (2)?
- Simple (non goal orientated movements)
- Complex
What are some examples of complex tics (3)?
- Echolalie (repeating phrases others have said
- Involuntary swearing
- Involuntary obscene gestures
What is Tourettes (2)?
- More than 1 year simple tics
- Multiple complex tics
How should tics be managed?
Don’t try to suppress them
What is a Neurodevelopmental disorder?
Group of mental disorders affecting the development of the nervous system
What are some examples of Neurodevelopmental disorders (4)?
- ASD
- ADHD
- Learning disability
- Tics
What are some disorders affecting sleep (4)?
- Insomnia
- Narcolepsy
- Restless leg syndrome
- Sleep apnoea
How can insomnia be treated (2)?
- Zopiclone
- Benzos
should only be prescribed for a short period
What is narcolepsy?
Condition impairing the ability to regulate sleep-wake cycle
What are some signs/ symptoms of narcolepsy (5)?
- Cataplexy (collapse after emotional high)
- Hallucinations (visual)
- Excessive daytime sleepiness
- Sleep paralysis
- Sleep difficulty
How is narcolepsy treated?
Modafinil (CNS stimulant)
What are some criteria for gender dysphoria (6)?
- Difference between assigned gender and expressed/ experienced gender
- Desire to be rid of ones sexual characteristics
- Desire for characteristics of another gender
- Desire to be a gender other than ones assigned gender
- Belief that one has the typical reactions/ feelings of another gender
- Desire to be treated as a different gender
How long should these symptoms of gender dysphoria be going on for to have a diagnosis?
2 or more symptoms for more than 6 months
What are some causes of cognitive impairment (7)?
- Dementias + parkinsons
- Strokes
- Traumatic brain injuries
- Meningitis/ encephalitis
- Depression/ schizophrenia/ bipolar
- Substance use
- Genetics (e.g. downs)
What disorders under the scope of psychiatry are common in older people (6)?
- Depression
- Dementia
- Anxiety disorders
- Bereavement
- Delirium
- Insomnia
What factors might suggest a diagnosis of depression rather than dementia?
- Rapid onset
- Weight loss/ sleep disturbance
- Patients worried about poor memory
- Variable mini-mental test scores
- Global memory loss (dementia tends to affect recent memories)