Psychiatry Conditions 2 Flashcards
Generalised Anxiety Disorder
- a) What is it important to look for before starting treatment?
b) What would these be?
2.
a) How is it managed?
b) If pharmacological management chosen,
i) what is given?
ii) what is important to remember?
c) what can be given in conjunction with this treatment to be taken for acute flare-ups and panic attacks?
- What are the RFs for it?
1a) a possible alternative cause b) - hyperthyroidism - cardiac disease - medication induced: salbutamol corticosteroids theophylline antidepressants caffeine
2
a) step-wise approach
1. education about GAD + active monitoring
2. low intensity psychological intervention: individual non-facilitated self help, individual guided self-help, psychoeducational groups
3. high intensity psychological intervention of CBT or applied relaxation or drug therapy
4. highly specialist input
b)
i) first line: sertraline
if ineffective give another SSRI or SNRI
if these do not work or are contraindicated consider pregabalin
ii) patients under 30 increased risk of suicide or self-harm
- > therefore require weekly monitoring for the first month
c) propanolol
3
- 35-54
- being divorced / living alone
- single parent
What are the 5 stages of grief?
may have to support a patient in an OSCE
Denial: this may include numbness and pseudohallucinations (auditory and visual) of the deceased. Rarely people focus on physical objects that remind them of loved one or prepare meals for them
Anger: commonly directed against other family members and medical professionals
Bargaining
Depression
Acceptance
Insomnia
- How is it defined?
- What other clinical features can be seen?
- a) When is insomnia defined as chronic?
b) how is acute insomnia managed? - What are the RFs/causes? (to screen for I OSCE)
- How is it managed?
- difficulty initiating or maintaining sleep or early morning wakening leading to dissatisfaction with sleep quality/quantity
- this is despite given adequate time for sleep
- impairs daily functioning - daytime napping
- enlargement of tongue or tonsils
- micrognathia or retrognathia
- narrowed oropharynx
3.
a) more than 3 nights a week for 3 months
b) typically related to life event and therefore often will resolve without treatment
- female
- increased age
- widowed / divorced / spirited status
- unemployed / economic stress
- drugs: alcohol, substance abuse, stimulants, corticosteroids
- chronic illness: COPD, CAD, hypertension, heart failure, diabetes, BPH, anxiety, depression
- advise good sleep hygiene: no screens before bed, limit caffeine, fixed bedtime
if daytime impairment is severe can give either short acting benzos or Z drugs
- > SEs: sedation, poor motor coordination, cognitive impairment
- > therefore follow up at 2 weeks (cannot try any other drugs after tried one)
Korsakoff’s Syndrome
- What causes it?
- What clinical features are seen?
- thiamine deficiency cause damage and haemorrhage to mammillary bodies of hypothalamus and medial thalamus
- anterograde amnesia (inability to acquire new memories)
- retrograde amnesia
- confabulation
- often preceded by untreated wernicke’s (ophthalmoplegia [often lateral palsy or nystagmus], confusion + cerebellar signs [often ataxia])
What is meant by the following terms?
- circumstantiality
- tangentiality
- neologisms
- clang associations
- word salad
- knights move thinking
- flight of ideas
- perseveration
- echolalia
- inability to answer a question without giving excessive unnecessary detail (but eventually return back to the point)
- wanders away from a topic without returning to it
- new word formations (incl. combining 2 words)
- ideas related to each other exclusively because they sound similar or rhyme
- real words strung into nonsense sentence
- unexpected / illogical leaps from one idea to another (feature of schizophrenia)
- rapid leaps from one topic to another with topics DO have discernible link (feature of mania)
- repetition of ideas or words despite an attempt to change the topic
- repetition of someone else’s speech
OCD
- What is it?
- What factors can lead to the disease?
- How is it managed if:
a) mild functional impairment
b) moderate
c) severe
- the presence of obsessions or compulsions, commonly both
obsession = intrusive, unpleasant, unwanted thought compulsion = senseless action to reduce the anxiety caused by the obsession
- genetic
- psychological trauma
- paediatric autoimmune neuropsychiatric disorder with associated streptococcal infections
- a) CBT (can include ERP: exposure and response prevention which involves exposing the patient to the anxiety provoking situation)
(If doesn’t work offer SSRI
b) SSRI (fluoxetine if a body dysmorphic disorder) or more intensive CBT
c) SSRI + CBT
what is othello’s syndrome?
person is convinced their partner is cheating on them without any real proof
What is post-concussion syndrome and what clinical features can be seen?
syndrome which can be seen even after minor head trauma
symptoms
- headache
- dizziness
- fatigue
- anxiety / depression
PTSD
- How long does the diagnostic criteria state symptoms must have been present for?
- What clinical features are seen?
- How is it managed?
- 4 weeks
- you can HEAR them
- hyper vigilance: hyper vigilance for threat, exaggerated startle response, sleep problems, irritability, difficulty concentrating
- emotional numbness
- avoidance (of circumstances associated with event)
- re-experiencing: flashbacks + nightmares
+ depression
+alcohol / substance abuse
+ anger
+ unexplained physical symptoms
- CBT
eye movement desensitisation and reprocessing therapy can be used in more severe cases
drug treatment not first line (venlafaxine or SSRI if indicated)
risperidone in severe cases which were refractory to other treatment
doxazocin good for managing hyperarousal symptoms
- What is a hallucination?
- What is a pseudohallucination?
- t/f: often you can reassure these patients a pseudo hallucination is normal and does not mean they will develop a mental illness
- Who are they very common in?
- false sensory perception in the absence of external stimuli
- hallucination but patient is ware they are hallucinating
- True
- grieving people
Schizophrenia clinical features
- What are the first rank symptoms?
- What other clinical features can be included?
- PTAD -
passivity - body sensations controlled by external influence
thought disorder
- insertion
- withdrawal
- broadcasting
auditory hallucinations
- voices discussing patient in 3rd person
- voices commenting on what patient is doing
- thought echo
delusions
intense delusional insight into the meaning of an event (e.g. the traffic light went green because I am the king)
2. - negative symptoms: \+anhedonia \+ incongruent / blunted affect \+ decreased speech \+ poor motivation
- impaired insight
- neologisms
- catatonia (reduced movements + emotions)
(mnemonic for neg symptoms: you would get the other 3 if you had anhedonia)
How should schizophrenia be managed?
- atypical antipsychotic
- CBT offered
- close monitoring of CV system due to increased risk (thought to be due to smoking + antipsychotic medication)
What factors are associated with a poor prognosis in schizophrenia?
- strong family history
- low QI
- gradual onset
- prodromal phase of social withdrawal
- no clear precipitating factors
How should SAD be managed?
same as depression with exception of sleeping tablets as this can make symptoms worse
Sleep paralysis
- What is it?
- What clinical features are seen?
- How can it be managed?
- paralysis of skeletal muscles occurring when awakening from or while falling to (less common) sleep
- skeletal muscle paralysis
- hallucinations during the event
- related to REM sleep
- clonazepam if effecting QoL
