Psychiatry short Flashcards
A SUMMARY OF MAIN CONDITIONS IN PSYCHIATRY
Lewy-body dementia
Dementia caused by accumulation of misfolded alpha-synuclein protein in the brain.
Clinical features: fluctuating cognition, visual hallucinations (usually small animals), parkinsonism.
1st line: AChE (Acetylcholinesterase) inhibitor: donepezil
Caution with antipsychotics as exacerbates parkinsonism
Non-pharmacological interventions: cognitive stimulation, physical therapy, and occupational therapy.
Supportive care: progressive disease so palliative and end-of-life care considerations
Alzheimer’s disease
Progressive neurogenerative disorder
Accumulation of amyloid plaques and tau tangles in the brain leads to cognitive decline.
4As:
- Amnesia - recent memory lost first
- Aphasia - word-finding difficulties and disjointed/muddled speech
- Agnosia - difficulties with recognition
- Apraxia - difficulties with skilled tasks despite normal motor function
Dx: detailed history and neuro exam, cognitive screening e.g. 10-point cognitive screen (10-CS), GPCog, 6CIT
Mx: education and support for patient and family, memory clinic, cognitive stimulation therapy
Medical: acetylcholinesterase inhibitors e.g. donepezil (duh-neh-puh-zil) and NMDA receptor antagonist e.g. memantine (rhymes with clementine) if more severe
Vascular dementia
Cognitive impairment due to cerebrovascular disease - stepwise decline (gets better then worse again).
Clinical features:
- Cerebrovascular risk factors e.g. smoking, high BMI, stroke
- Memory disturbances
- Sensory or motor symptoms
Gait/speech/emotional disturbance
Dx: detailed history and examination, cognitive screening, exclude medication or organic causes e.g. B12 deficiency, MRI to visualise vascular changes
Mx: optimise management of co-morbidities, cognitive stimulation therapy, and medication e.g. donepezil or memantine
Frontotemporal dementia
Neurodegenerative disorder mainly affecting the frontal and temporal lobes of the brain.
Younger onset 60 - 70
- Personality changes: apathy, disinhibition
- Language impairment: word-finding and aphasia
- Cognitive decline
- Motor symptoms: muscle weakness, dysarthria
Associated with ALS
Mx: Counselling, behavioural modification, SSRI, speech and language, physio, OT
Differentiating LBD and PD
- If cognitive and motor symptoms occur within 1 year of each other = LBD
- If motor symptoms develops and cognitive symptoms occur > 1 year after = PD
Mx: memory clinic, cognitive stimulation therapy, physiotherapy
Medical Mx: acetylcholinesterase inhibitors e.g. donepezil
Schizophrenia
Positive symptoms - ABCD - Auditory hallucinations, Broadcasting of thought, Control of thought/actions, Delusions
Negative symptoms: alogia, anhedonia, avolition
Dx:
Rule out organic causes first always
- ICD11 - symptoms present for at least one month, causing significant distress
- DSM5 - at least 6 months, with one month of active-phase symptoms (at least one ABCD)
Mx: 2nd gen antipsychotics e.g. olanzapine, risperidone, clozapine if resistant (monitor for agranulocytosis)
Bipolar affective disorder
Bipolar type 1: one or more manic episodes at least 1 week, and one or more depressive episodes
Bipolar type 2: episodes of MDD and hypomania (at least 4 consecutive days)
Mania episodes = persistently elevated, expansive or irritable mood, hypomanic symptoms less severe
Mx: Rule out organic causes first always! Otherwise clinical Dx
- Stop SSRI if recently started “manic switch”
- Acute: 2nd gen antipsychotics if psychosis - IM if agitated, PO if not
- Maintenance with lithium and psychotherapy
Anorexia nervosa
- BMI < 17.5kg/m2
- Severe dietary restriction
- Weight and shape preoccupation
- Distorted body image
- Restrictive or bulimic subtype
Blood tests:
- Low K, Ca and Mg
- Metabolic alkalosis if bulimic subtype
- Low FSH, LH, testosterone and oestrogen
- High cortisol
- Normal T4, low T
Mx:
- CBT for eating disorder
- 1st line for under 18s = AN-focused family therapy
- SSRI to help co-existing depression/anxiety
- Sectioning under MHA
Bulimia nervosa
- Patients often have normal BMI
- At least 3 months of cycles binge-eating then inappropriate compensatory behaviours to prevent weight gain e.g. vomiting, laxatives, fasting, excessive exercise
- Dental erosion, parotid gland swelling, Russell’s sign (calluses on knuckles from scraping teeth), amenorrhoea
Mx:
- Adults: 1st line: BN focused guided self-help, and specialist referral
- Children: BN-focused family therapy +/- fluoxetine
Difference between anorexia vs bulimia - EXAM FODDER
BMI is a key distinguishing feature
AN is defined by BMI < 17.5kg/m2
Patients with BN have normal BMI or BMI within the “healthy range”
Emotionally unstable personality disorder (EUPD)
4 domains:
- Unstable self-image
- Difficulties maintaining relationships
- Impulsivity
- Recurrent suicidal or self-harm behaviour
Mx: Dialectical behavioural therapy (DBT)
Depression
Persistent sadness or low mood, loss of interest (anhedonia), and/or reduced energy lasting for at least two weeks
Other symptoms: change in sleep, >5% weight gain or loss, excessive guilt, hopelessness, thought of suicide and self-harm
Mild- at 5 symptoms but only mild functional impairment
Moderate: functional impairment between mild and severe
Severe: all or most symptoms and marked functional impairment +/- psychotic features
Dx: FBC, TFT, U_E, LFT, Patient Health Questionnaire (PHQ-9)
Mx:
Mild - low-intensity psychotherapy e.g. self-guided help, online CBT
Moderate to severe:
- 1st line - high-intensity CBT + SSRI
Severe depression with poor oral intake: electroconvulsive therapy
Delirium tremens
Severe alcohol withdrawal characterised by acute confusion, hallucination (visual/tactile), sweating, hypertension, seizures
Occurs around 72 hours after stopping drinking alcohol
Mx:
- Acute: 1st line is oral lorazepam
- Maintenance: chlordiazepoxide, eventually tapered, adequate hydration, Pabrinex, referral to local drug and alcohol liasion team
Define the Mental Health Act
The Mental Health Act 1983 as amended by the Mental Health Act 2007 sets out a legal framework for the care and treatment of individuals with mental health disorders.
Sections under MHA
- Section 135: allows police to enter a person’s home and remove them
- Section 136: allows police to remove a person with suspected/confirmed mental condition from a public place to place of safety e.g. hospital
- Section 5(2) - doctor’s holding powers, detains a patient for 72 hours while waiting for mental health assessment - change to section 2 or remove
- Section 2 - 28 days assessment order - compulsory detention for assessment, can be extended to section 3
- Section 3 - up to 6 months treatment order, compulsory detention for diagnosis and treatment for a mental health disorder
