Psychiatry (Quesmed) Flashcards
What is Korsakoff’s Syndrome?
What condition leads to it and what type of Amnesia is seen?
What 3 other symptoms are seen in addition to amnesia? (VCA)
What underlies the symptoms?
Wernicke’s Encephalopathy progresses to Korsakoff’s Syndrome if left untreated
It presents as Profound Anterograde Amnesia with Limited Retrograde Amnesia
Therefore patients may fabricate memories to mask memory deficits
In addition to memory issues:
1) Issue with coordination and balance
2) Issue with Vision
3) Apathy
It is thought to occur due to Mammillary Body degeneration
Which questionnaire quickly screens for Alcohol Abuse?
CAGE
Cut down? (Have YOU ever felt the need to cut down)
Annoyed? (other people annoyed you saying you drink too much?)
Guilt?
Eye Opener? (Drinking in the morning to calm down your nerves)
then AUDIT
Where is alcohol absorbed in the body?
Proximal small intestine
What is Transient Global Amnesia?
It is the temporary destruction of both long and short term memory (hence GLOBAL AMNESIA)
All other cognitive functions are normal
What is the presentation of Transient Global Amnesia?
Patients are found wandering the street far away from their home as they forget RECENT and OLD memories
But this may be TRANSIENT as
This may last for hours before resolving on its own
What are the 3 criteria that must be met for a patient to be treated under the Mental Health Act?
(Treated without their consent)
They must have a Mental Disorder
They must be a risk to their own Health and Safety or someone else’s health and safety
There must be a treatment (including Nursing Care or drugs)
(Only for mental health conditions UNLESS a physical condition is the cause or result of a mental health condition)
What are the 5 principles of the Mental Capacity Act?
1) A person is assumed to have capacity unless proven otherwise
2) HELP- Steps must be taken to help a person have capacity
3) UNWISE- An Unwise decision does not mean that the person lacks capacity
4) BEST- Any decision made under the MCA must be made in the person’s best interests
5) LEAST- Any decisions made must be the LEAST RESTRICTIVE decision to the person’s rights and freedom
How is capacity assessed?
A person has capacity if they show a disturbance in the functioning of the mind AND they are unable to:
- Understand the information
- Retain the information
- Weight up the information
- Communicate a decision
What is Section 2 of the Mental Health Act?
What is a requirement that must be met by at least one of the other doctors?
- Admission for assessment for up to 4 weeks
- This decision is made by an Approved Mental Health Professional or the patient’s nearest relative
- Requires the recommendation of 2 doctors (one of whom must be approved under Section 12(2) of the MHA)
What is Section 3 of the Mental Health Act?
- Admission for up to 6 months, renewable
- It requires an Approved Mental Health Professional and 2 doctors- both of who must have seen the patient in the past 24 hours
Also after 3 MONTHs an independent doctor must review
What is Section 4 of the Mental Health Act?
- Used in Emergencies if the doctor is NON-PSYCHIATRIC where Section 2 would cause an “Undesirable Delay”
- You need the recommendation of only 1 doctor and either an AMHP or their nearest relative
- They can be detained for up to 72 hours, where it is then converted to a Section 2
What is Section 5(2) of the Mental Health Act?
- A voluntary patient in HOSPITAL can be legally detained by a doctor for 72 hours
What is Section 5(4) of the Mental Health Act?
Like Section 2 but it is used by Nurses and only for 6 hours
What is Section 17 of the Mental Health Act?
It is a Supervised Community Treatment
(You can get leave but you can get recalled to the hospital if you stop taking medication or if your condition worsens)
What is Section 135 of the Mental Health Act?
It is a court order that allows Police to enter a property and move a patient to a place of safety (Police Station or A&E)
What is Section 136 of the Mental Health act?
The police can bring someone from a public place who appears to have a mental health condition to a place of safety
What are the side effects of First Generation Antipsychotics (HALOPERIDOL)?
(All 4 are MOVEMENT RELATED- uncontrollable movements)
Extra Pyramidal Effects
- Akasthisia (inability to sit still)
- Dystonia (spasms and contractures)
- Parkinsonism
- Tardive Dyskinesia (twitching, jerking, involuntary blinking)
What are 5 examples of Second Generation Antipsychotics?
(ARIP, RIZ and the PINEs)
- Ariprazole
- Risperidone
- Quetiapine
- Olanzapine
- Clozapine
What are the 3 main side effects of Second Generation Antipsychotics?
(Uncontrollable Sugar, Lipids and Weight)
What can Clozapine in particular cause?
Weight Gain
Worsening Glycaemic Control
Dyslipidaemia
Clozapine- leads to Agranulocytosis, Confusion, Ataxia
What are the side effects of ALL Antipsychotics?
Stopping Insanity Comes with High Stakes, Remember NMS
- Sedation
- Increased Risk of Stroke
- Cardiac Arrhythmias
- Hyperprolactinaemia (Switch to Aripiprazole)
- Sexual Dysfunction
- Reduction in Seizure Threshold
- Neuroleptic Malignant Syndrome (Measure CK)
What are the signs of Neuroleptic Malignancy Syndrome?
Patient is rigid and sweating and all readings are high
Confusion
Diaphoresis (Sweating)
Rigidity
Pyrexia (Fever)
Tachycardia
Tachypnoea
Hypertension
What are the 6 side effects of SSRIs?
QA GG SS
1) QT Prolongation
2) Anxiety and Agitation
3) GI Upset
4) Gastric Ulcer
5) (Salt) Hyponatraemia
6) Sexual Dysfunction
What are the side effects of Tricyclic Antidepressants?
SAD DOWNS
S - Sedation/ Dizziness
A - Arrhythmia
D - Dry mouth
D - Difficulty urinating/ Constipated
O - Orthostatic hypotension
W - Weight gain
N - Nausea
S - Sexual dysfunction
What are the 4 cautions of SSRIs?
Should be omitted in Mania
Should be used with caution in Children and Adolescents
Sertraline is BEST for Ischaemic Heart Disease
Do NOT use with anticoagulants- Give Mirtazapine instead
What are the cautions of Tricyclic Antidepressants?
DRILLER, USE C4 to SQuasH their HEARTS!!
Diabetes, Urinary Retention, Cytochrome 4 (liver disease, warfarin, statins, antiepileptics), Schizophrenia, Long QT, “hypertension- BP- actually stands for Breastfeeding and Pregnancy” , Heart disease
- CONTRAINDICATED in Previous Heart Disease
- Can exacerbate Schizophrenia
- May exacerbate Long QT Syndrome
- Use with caution in Breastfeeding and Pregnancy
- May alter blood sugar in Type 1 and Type 2 Diabetes
- May precipitate Urinary Retention (so careful with people with Large Prostates)
- It uses the Cytochrome P450 pathway so AVOID in LIVER DISEASE, WARFARIN, STATINS and ANTIEPILEPTICS
What is a side effect of SNRIs?
High Blood Pressure
So contraindicated in uncontrolled BP
What are the signs of Serotonin Syndrome?
Remember the TRIAD of:
1) Mental status changes
2) Autonomic hyperactivity
3) Neuromuscular abnormalities.
S - Sweating
E - Elevated temperature
R - Restlessness/ Agitation
O - Oculation (dilated pupils)
T - Tremor/ Rigidity/ Clonus
O - Overreactive reflexes
N - Nausea
What is Postpartum Psychosis?
How is it different from Postpartum Depression with Psychosis?
What is the management of Postpartum Depression?
It develops in the first 2 weeks after birth
A woman may experience Paranoia, Delusions, Hallucinations, Mania, Depression or Confusion
A differential is Postpartum Depression with Psychosis but this presents with a more Insidious onset of Low Mood, Tearfulness and Anxiety
PAROXETENE is used to manage postpartum depression
What are the signs of Postpartum Psychosis (What warrants admission)?
What increases the risk of this occurring?
Woman with previous history of severe mental illness are at high risk
If the risk is high to the mother or baby (like if the mother has command hallucinations, self harm or has beliefs about the baby’s identity)- then ADMIT TO MENTAL HEALTH UNIT
What is the management of Postpartum Psychosis?
Antipsychotics and sometimes Mood Stabilisers
What are the signs of Cannabis Intoxication?
DDP-ABIS
(Cannabinoid Receptors)
Drowsiness
Dry Mouth
Paranoia
Appetite increased
Bloodshot Eyes
Impaired Memory
Slowed Reflexes
What are the signs of LSD Intoxication?
(Dopamine Receptors)
LABILE MOOD (EXAGGERATED MOODS)
Sweating
Dry Mouth
Pyrexia
Hallucinations
Insomnia
Tachycardia
Hypertension
What are the signs of Stimulant (Cocaine and Meth) Intoxication?
(Cocaine- Dopamine Receptors and Meth- TAAR Receptors)
Tachycardia
Pyrexia
Hypertension
Euphoria
(High Heart, High Temp and High Mood)
and RED EYES
Cocaine- Diarrhoea (Dopamine starts with D as well)
Meth- Usually taken for Concentration (ConcenTAARation)
What are the signs of Opiate Withdrawal (like Heroin Withdrawal)?
RRS-DA-G/G
Runny Nose
Runny Eyes
Sweating
Dilated Pupils
Agitation
Goosebump Skins
GI Disturbance- Abdominal Cramps, Nausea, Diarrhoea and Vomiting
How do you treat Opiate Withdrawal?
Symptomatic Management Acutely and give Methadone or Buprenorphine for Long Term
Meth—-orphine
What are 6 examples of Medically Unexplained Symptoms?
Somatoform/ Somatisation Disorder-
- Physical Symptoms that can not be explained by Medical Condition or Drug
- Usually GI, MSK, Weakness
- Leads to loss of functioning
Conversion Disorder- Loss of Motor/ Sensory
- Neurological Symptoms without any cause (Paralysis, Sensory Changes, Pseudoseizures)
- It is linked to emotional stress
Hypochondriasis/ Illness Anxiety Disorder-
- Concern that they will develop a serious illness despite lack of evidence
- Usually No or Limited Symptoms
- If there are symptoms that they are worried about- this may be Somatisation DIsorder
Munchausen’s Syndrome/ Factitious Disorder-
- They fake signs (adding blood to urine) to get attention and play the role of the patient
Malingering-
- Faking for secondary gain (Drugs, Avoiding Work etc.)
La Belle Indifference-
- Inappropriate lack of concern over symptoms (usually associated with Conversion Disorder). Patients say there is nothing to worry about despite serious symptoms
What are the side effects of Lithium?
Also remember HYPERPARATHYROIDISM and HYPERCALCAEMIA
Fine Tremor
+
(imagine drawing a path from mouth down the GI system)
Dry mouth
Thyroid Dysfunction (Lithium affects Thyroid remember)
GI Disturbance
Polyuria and Polydipsia
What are the signs of Lithium Toxicity?
4 disturbances
Remember Dysarthria
Coarse Tremor
+
(Nerves, Heart and Eyes)
CNS Disturbances- Seizures, Impaired Coordination, Dysarthria
Arrhythmias
Visual Disturbances
What is the management of Lithium Toxicity?
3 steps
Largely Supportive
- Maintain Electrolyte Balance, Monitor Renal Function and Seizure Control
1) IV Fluids
2) Dialysis may be needed
3) Seizures and Agitation= give Benzodiazepines
What should be done if a patient misses a significant number of days of methadone?
Reinduction should be done
What are the signs of Frontotemporal Dementia?
3 Earlys
Presents at a Younger Age than other kinds of Dementia
EARLY Personality Change
Language is also affected Early On
It is often misdiagnosed and Neuroimaging may be needed
What is Pick’s Disease?
It is a cause of Frontotemporal Dementia
- It is when there are TAU Proteins found on the neurons, they are found in the Frontal and Temporal Lobes
It is associated with Motor Neurone Disease- developed later in life
What is the management of Frontotemporal Dementia?
Refer to the Psychiatrist and organise Social Support
What symptoms are seen in Normal Pressure Hydrocephalus?
The Ventricles will be Disproportionately Dilated to the Cerebral Atrophy
(Can’t Walk, Can’t Think, Can’t even Pee)
Gait Disturbance
Dementia
Urinary Incontinence
What are the 8 types of Thought Disorder?
In addition to Echolalia and Neologism
Circumstantiality-
- Patient moves onto different topics and returns to the original one
- There is a train of thought that can be followed
Clang Association-
- Words sound similar so are associated
Word Salad-
- Nonsense sentences built up of random words
Knight’s Move-
- The sentences are linked but still unrelated (I went for a jog and saw a dog. Speaking of dogs I really want one for my home. My home is big, I miss it so much)
Derailment/ Tangentiality-
- The Conversation randomly moves from one topic to another
Poverty of Speech-
- Lack of Spontaneous Speech (they struggle to find the words, the speech is brief and they can’t think of what to say)
Perseveration-
- Repetition of words or ideas when another person attempts to change topic
Thought Blocking-
- Patients suddenly halt and can not continue
What are 6 examples of Eponymous Syndromes?
What are Othello’s and Ekbom’s associated with (3 each)
Capgras syndrome: “C for copycat” - this syndrome involves the delusional belief that a loved one or familiar person has been replaced by an imposter or duplicate.
Ekbom’s syndrome: “E for Eek, bugs!” - this syndrome involves the delusional belief that there are parasites or bugs living in or under the skin. It can be associated with various medical conditions including B12 deficiency, hypothyroidism, and neurological disorders.
Cotard syndrome: “C for corpse” - this syndrome involves the delusional belief that one is dead or does not exist.
De Clerambault syndrome: “D for delusions of grandeur” - this syndrome involves the delusional belief that a celebrity or authority figure is in love with the patient.
Fregoli syndrome: “F for face” - this syndrome involves the delusional belief that everyone the patient encounters is actually the same person in disguise.
Othello Syndrome
- You feel your spouse or partner is unfaithful with no evidence. It is associated with Alcohol Abuse, psychosis and Right Frontal Lobe Damage
What is Charles Bonnet Syndrome?
It is a condition in the Elderly who have VISUAL DEFECTS
The brain fills in for this defect and produces hallucinations
This is due to AGE RELATED MACULAR DEGENERATION/ GLAUCOMA and CATARACTS (in order of likelihood)
What is Acute Stress Reaction?
What 4 symptoms characterise it and PTSD?
How is it managed and what is an important differential?
It is a Transient Disorder and develops in people with no other mental disorder.
This occurs due to Stress. It usually subsides within a few hours or days but should not exceed 4 weeks (otherwise PTSD). Patients may feel Dissociated.
1) Emotional Numbing
2) Avoidance
3) Flashbacks/ Re-experiencing
4) Hyperarousal
Managed with TRAUMA FOCUSED CBT- then Benzos
An important differential is Adjustment Disorder
What is Adjustment Disorder?
It is a state of Emotional Distress that interferes with someone’s social life that occurs in response to a Significant Life Change or Stressful Life Event such as bereavement or separation
The PTSD Features should last for 1-6 months after the stressor and include:
1) Delayed or Prolonged Response to a Catastrophic or Threatening Situation
2) Episodes of Flashbacks in memories or dreams
3) “Numbness” or Detachment from other people
4) Avoidance of Activities or Situations reminiscent of trauma
5) Usually Autonomic Hyperarousal with Hypervigilance= Enhanced Startle Reaction and Insomnia, Poor Concentration
