Psychology Flashcards
Adjustment Disorder(not a medical disease) onset3mth / resolve6mth
the stressful event is not life threatening (e.g., divorce, death of a loved one, or loss of a job). In posttraumatic stress disorder (PTSD), it is.
unable to cope with a specific life event.
depression triggered by a significant change in a person’s life(death of someone close: husband ).
It is not the same as clinical depression
it is transient.
onset within 3 months
start to resolve within 6 months.
Anorexia Nervosa(static state/ no cycle) FOR DIAGNOSIS BMI must be 17.5 or less
Self starvation»_space; stop eating completely»Distorted wt goals (<17.5BMI)
Starvation» Catabolic state»Shut down Sex hormones» AMENORRHOEA and Osteoporosis
LANUGO (infant hairs) d/t ↓body heat (d/t ↓T3»_space;> heat regulation)
acute drop K and PO4 (d/t refeeding $)
↑Growth hormones and cortisol
Impaired glucose tolerance
↑Carotin(pigment)
↑Cholesterol (fat breakdown)
Tx- CBT
Bulimia Nervosa (Cycle of Binging n Purging ) Might have N weight (sometimes underweight but greater than AN ie > 17.5 )
Emotional relation to food
Stress is a Trigger
Look for BINGE and PURGE CYCLES
Might have NORMAL WEIGHT(BMI>27.5)
Purging Patterns ; Exercise Vomiting (Russell's Sign on knuckles / Erosion of back of incisors teeth) Laxatives Diuretics
Tx - CBT
Schizo-phrenia (splitting of mind)
only Auditory hallucination
(Visual Hallucination in Delirium )
May Commit Crime
TWO POINT THINKING
1st thought is realistic (the sun is bright)
2nd thought doesn’t make sense(the world will end)
Look for First Rank Symptoms
1. Auditory Hallucinations (Comment , Echo, Two ppl discussion )
2.Thought Disorder (Insertion, Stealing, Withdrawal, Broadcasting )
*******
3.Passivity Phenomenon(SOMEONE ELSE is controlling : action , feelings , impulses , bodily sensations)
The DEVIL MADE ME DO THE CRIME
Tx -
- Oral Antipsychotics
- Depot Preparation IM(a few months for non compliment pt )
- CBT (reserve the changes of mind )
- CVS risk Mgx
Somatization Disorder (S stand for SYmptoms )
Multiple Symptoms
At lest 2 year
Pt refuse to accept the reassurance or negative test results
Arrange trusting relationships with medical team
Hypo Chondral Disorder (H-HIV C- cancer and Multiple sclerosis )
Pt belief in presence of serious illness
Refusal to accept reassurance
They google it and know a lot of medical background (google patient )
Speech
Broca’s aphasia (baba mar pyit Frontal)
Frontal lobe
can’t get words out, UNDERSTAND EVERYTHING
Wernicke’s aphasia
Temporal lobe
May articulate FLUENTLY but the words NONSENSE.
Clang association(Cardi B )
Words used in a sentence connected by Rhyme rather than by meaning.
Seen in schizophrenia.
Neologism.
A newly created word whose meaning is unknown
(from Greek – neo = “new” + logos = “word”).
common in children,
indicative of brain damage or schizophrenia in adults.
Pregnancy and PSY
PP BLUE (Mostly Crying) >>>> 3-7 days / common in primiparas Anxious , Tearful , Irritable Cares for Baby
PP DEPRESSION (Worries abt baby health / being good mother)
»»
Peaks 3-4 weeks / within 6 months
Depression $
Mostly Cares / Frequent thoughts of HARMing the baby
Feels like she Cannot LOOK AFTER THE BABY
PP Psychosis (Auditory Hallucinations ) >>>> Begins 2 days and Peak at 2 weeks Severe Mood Swings Thoughts of Harming the baby Audi Hallu - baby is evil or has evil eyes Delusion - Baby is evil or deformed Insomnia / Disorientation Sucidal thoughts
Pregnancy
Postpartum Blues:
Normal ,
only reassurance,
a couple of days ,
crying for no reason
Postpartum depression:
a couple of weeks,
guilty feeling of not taking care of the baby,
loss of weigh and appetitie ,
feels that someone is harming her baby
Postnatal psychosis:
within 2 weeks ,
start with depression ,
thinks that the baby is evil or malformed ,
intention of killing the baby
Lithium Toxicity (Acute GI / Chronic confusion convulsion )
•Before starting lithium do .
RFT and TFT and Ca lvl
•Check lithium level - **12Hr AFTER Last TABLET(7th day) of the first week /
every 3 months
•Check RFT every 6 months
LiTHIUM side effects: Low thyroid Toxic with Thiazide Heart: ebstein anomaly Insipidus ( nephrogenic DI) Unwanted Movement: COARSE (fine) tremor
Tx - Fluid and dialysis
4 types of delusions
Types
Four types of delusions outlined in the DSM-5 include:1
Bizarre delusions
are implausible or impossible, such as being abducted by aliens.
Non-bizarre delusions
could actually occur in reality, such as being cheated on, poisoned, or stalked by an ex.
Mood-congruent delusions
are consistent with a depressive or manic state, such as delusions of abandonment or persecution when depressed, and delusions of superiority or fame when manic.
Mood-incongruent delusions
are not affected by the particular mood state.
They may include delusions of nihilism (e.g., the world is ending) and delusions of control (e.g., an external force controls your thoughts or movements).
People with delusions may also exhibit confusion, agitation, irritability, aggressiveness, depression, and self-referential thinking.
Themes of Delusions
Capgras delusion:
This is the belief that a loved one like a mother or sibling has been replaced by an imposter.
Cotard delusion: (Naihilistic + depression )
This occurs in Cotard’s syndrome, and is characterized by the belief that you are dead or your body or body parts have disintegrated or no longer exist.
Delusion of control:
This refers to the belief that an external entity is controlling your thoughts, behaviors, and impulses. This entity may be an individual like a manager, a group, or some undefined force.
Delusion of grandiosity:
This is an exaggerated or inflated self-belief regarding power, fame, knowledge, skill, talent, or strength. For example, a person may believe they are an Instagram influencer despite not having a following.
Delusion of guilt or sin:
This refers to unwarranted and extreme feelings of remorse or a severe sinking feeling that you’ve done something horribly wrong.
Delusion of thought insertion or thought broadcasting:
This refers to the belief that thoughts have been inserted into your mind or are being broadcasted to others.
Delusion of persecution:
This refers to the belief that you or someone close to you is being unfairly mistreated, harmed, or watched. The conviction is so strong that the person may seek help from the authorities.
Delusion of poverty:
This is the belief that you are or are about to become destitute, are destined to fall into poverty, or are impoverished.
Delusion of reference:
This refers to the belief that something like a poster, song, or advertisement has a direct reference to or a hidden meaning for you. A person with this delusion may see a sign that has nothing to do with them, but change their whole life plan as a result.
Delusional jealousy:
This is the belief that your sexual partner is being unfaithful.
Erotomanic delusion:
Also known as erotic or love delusion, this is the belief that someone, usually someone famous or otherwise out of reach, is in love with you. A person with this delusional disorder subtype may obsessively contact or try to connect with that person and make excuses for why they’re not together.
Nihilistic delusion:
This is the belief that you or parts of you do not exist, or that some object in external reality is not actually real.
Religious delusion:
This refers to any delusion involving a god, higher power, or spiritual theme (e.g., believing that you have special powers or are the embodiment of a prophet). This may be combined with other delusions such as the delusion of control or grandeur.
Somatic delusion: This refers to the belief that one or more of your bodily organs are functioning improperly, or are diseased, injured, or altered.
Depression and tx
Mild depression... CB Moderate depression... SSRIs(CSF citalopram/sertraline/fuloxetine) Severe depression..... ECT Psychotic depression... ECT Manic depression (bipolar).. Lithium.
SSRI contraindicated in BIOPOLAR and MANIA because they increase the cycle of mania and depression
Types of Phobia (spider , height , crowd , )
Agora(Market)phobia - fear of open spaces (Dev intense anxiety )
LEAVING HOME
and travelling in PUBLIC TRANSPORT
to go to SHOPPING CENTRE
Archnophobia(Arachnids - insects ) - SPIDERS (John whelsly )
Acrophobia - HEIGHT
Agoraphobia and Social anxiety disorder and Claustrophobia
Claustrophobia (Closed spaces ) being in and not able to get out
an irrational or disproportionate fear of being in CONFIMED or SMALL places and being unable to escape.
Agoraphobia: (CANNOT GO OUTSIDE ALONE)
- Person perceives their ENVIRONMENT to be unsafe with no easy way to escape.
- Intense fear of leaving the house or fear of going to public spaces ( open & enclosed) e.g malls, resturants, theatres, public transports, crowds, standing in line
- Not all agoraphobes are house bound some may have “safe zones” places they feel comfortable going to (in the stem the lady is going to her aunt’s) or a person they feel comfortable going out of the house with (the husband)
Social anxiety disorder: (CAN GO OUTSIDE ALONE BUT NO INTERACTION)
MEETING /PUBLIC SPEAKINGS + being judged
1. Fear of DIRECT INTERACTION with people that bring on feelings of self consciousness or BEING JUDGED & negatively evaluated (fear of rejection)
2. Worry about being CRITIZED / REJECTED (shaking, stammering or excessively blushing during interactions)
e.g: Raj’s GF Lucy on the Big Bang Theory :D
fear of interacting in a society. shy to face the society
GAD(Generalized Anxiety Disorder) vs PANIC attacks Vs Anxiety attacks
GAD Chronic Happens THROUGHOUT THE YEAR Excessive worry not related to cause/ NO SPECIFIC TRIGGERS Symptoms most days > 6months
Panic attacks (a type of Anxiety attack)
sudden and rapid / CANNOT FIND THE TRIGGER / so stay at home / less social and depression
2 attacks (no longer than 20-30 minutes / 1hr very rare )
At least 2 month of worry
Anxiety Attack
Know the trigger(if afraid of dog bit / stay away form dog)
Can avoid
➥Gad :at least 6months
➥PTSD: at least 1 month
➥adjustment disorder:within1/3months of stressor and no longer than 6 months
Alcohol withdrawal CY3142 Drug for wedding
Deterrent: Disulfiram
Craving: Acamprosate
With drawl: Chlordiazepoxide
Delirium tremens: :Lorazepam ( before operation develops signs of withdrawal)
Disulfiram does not reduce craving by nausea / vomiting
t acts as a deterrent because the patient fears the consequences.
Acamprosate and Naltrexone
first line treatment options for alcohol use disorder
markedly reduce craving.
Most people do not experience significant withdrawal when they stop or reduce drinking.
Disulfiram is a deterrent which means it makes the alcohol tastes bad and makes the patient feels horrible after drinking (not giving the patient the usual desirable buzz after drinking)
Neuro plastic Malignant S and Hyperthermia S
Neuroleptic malignant syndrome mnemonic:
Caused by : Antipsychotics and Anti Dopaminergic(Metoclopramide )
FALTER F--- Fever A--- Autonomic dysfunction L--- Leukocytosis T--- Tremor E--- Elevated liver enzymes R--- Rigidity
Hyperthermia
Caused by : Halothane and Succinylcholine (GA and Ms relaxant used in OT)
Parkinsonism – BRIT –
any condition that presents with many (but not all) of the movement abnormalities seen in Parkinson’s disease
– BRIT – bradykinesia, rigidity (cogwheel), instability (postural) and tremor (resting).
Possible causes include Medications, Infections and Carbon monoxide poisoning.
SIDE effects of Haloperidol
How to Know if Schizophrenia or PSY Depression (PY2006)
Duration is the key
Schizo is <6 months
Psychiatric Depression Dx has 2 major components-
criteria & time.
3 months-it does not fit the time requirement for schizophrenia despite having delusion & hallicination.
She has guilt and it probably hints depression.
Alcohol Withdrawal Vs Delirium Tremens
AW within 24 hr after stopping A Tremor anxiety nausea excessive sweating Hallucinations Severe to Delirium Tremens
Oral Chlordiazepoxide / Diazepam
Thiamine IV
Tx depending on severity
Community setting and hospital setting
DT **Medical Emergency **
1-3 days after stopping A
+ altered mental state
Hallucinations (with severe confusion/ non reality)
Oral Lorazepam / Diazepam
Thiamine IV
Only Hospital Setting
Drugs For different conditions
Alcoholics Sedation - Chlordiazepoxide (benzodiazepine) Seizures - Lorazepam Wernickes - Thiamine (Vit B1) Deterrent - Disulfiram Craving - Acamprosate
Lithium Toxicity
Diuretics and NSAIDs (ibuprofen) increase lithium renal reabsorption into blood; thus, leading to lithium toxicity.
Hyponatremia induces Li toxicity as Na competes with Li for reabsorption . Nsaids causes fluid retention and diuretics excrete Na thus causing hyponatremia and hence Li toxicity
Contraindicated with Lithium: 1. NSAIDs 2. Diuretics 3. SSRI Toxicity due to resulting hyponatremia. Lithium itself can cause hyponatremia and be toxic so levels have to be closely and frequently monitored.
Alcohol dependency Q AUDIT and CAGE
AUDIT questionnaire :
A: amnesia ( forgets what happened the night before )
U: Units ( no of units consumed on a typical day ) , Units more than 6 for females , more than 8 for males
D: Doing less work than normally expected bcz of drinking
I : Injured yourself or others
T: Times ( freq of drinks) , Termination ( difficult to stop drinking when started drinking )
CAGE : C: cut down thoughts ? A: Annoyed by friends or family asking to cut down G: guilt or remorse after drinking E: eye opener
Schizophrenia or Psychotic Depression
Delusions + Hallucinations = Schizophrenia
(Delusions + Hallucinations) + Depression = Psychotic Depression
Schizoid Personality Disorder( Schizoid always wants to be Single)
Lack of interest in social relationships /
will live a solitary life
CW 3422 Capgras vs Fregoli delusion
Capgras - believes that family member is a stranger / father has been replaced
Fregoli - identifies strangers as family / one person is shape-shifting as two person
Ganser = Gangster (A person that shd be in prison) Capgrass= The caps(heads) of the grass look identical but they are not.
Todd (The frog) = Alice in wonderland= The expanding & shrinking scene Fregoli = Mr Frargoli who changes his personality & appearance every episode.
CoTarD= Go Tuss me in the Dirt already!
cotard is dead , capgras is two , ottello is jealous
Hallucinations of 1 2 3 person
1st Person: I am evil
2nd Person: You are evil
3rd Person: S/He is evil
1) Antisocial personality disorder >18 must have history of Conduct disorder
2) Conduct disorder <18
3) Oppositional defiant disorder
4) Boarder line personality disorder
1) Antisocial personality disorder reckless, doesn't abide by the rules, not remorseful , criminal records, age>18yrs.
2) Conduct disorder
defiant, negatve behaviour, aggression, antisocial behaviour in MULTIPLE PLACES.
CD is ASPD before 18.
3) Oppositional defiant disorder
negative, defiant behaviour without any serious violation of social norms/rights of others, present in one environment .
Often when to gather with familiar kids.
They Just opposes familiar kids,
no serious harm of norms or othorwsie.
4)Borderline Personality (wants boyfriend attention ) Drama Queen, self-inflicted scars, thretens to commit suicide, Unstable relationships.
Mania vs Hypo mania PY0400
Mania is characterized by energy and optimism
affect thought(switch rapidly between thoughts) , flight of thoughts
judgement and
speech (rapidly )
not sleeping and spending a lot of money
Mania»>functional impairment in social and work setting……
hypomania»>no functional impairment in social or work setting
Adjustment disorder vs Personality disorder
Adjustment disorder
Last last than 6 months
Low mood following an event ( situation depression )
Anorexia Nervosa
BMI above 17.5: food diary
Between 15 to 17.5: routine referral to eating disorder unit.
Below 15: urgent referral to eating disorder unit.
Any medical issue (bradycardia/hypotension..) regardless BMI: hospital medical word admission
SSRI and SNRI on hypotension and BPH
May have a uncommon s/e of hypotension
but having Hypotension / being on Tamsulosin / BPH will not contraindicate SSRI
If SSRI fails try SNRI
moderate depression- start SSRI-
if ineffective ->Check adherence -(not taking due to side effects )
>Increase the dose->
Change to different SSRI->
try alternative class of antidepressant (Mirtazapine)
Mini Mental Status Examination MMSE
MMSE is only a screening(not diagnostic) cognitive function test used mainly in
1) Suspected dementia
2) Following head injury
Not for Psychiatric patient
Somato / Hypo / Conv / Muchan / Malinger
Sympto / Diagno / Sudden / Treatment / Pretend to avoid
- Somatization=symptoms, symptoms, symptoms
- Hypochondriasis=Diagnosis Diagnosis Diagnosis
- Munchausen= treatment treatment treatment
- Conversion= sudden sudden sudden
Manchausen syndrome–> internal gain + willingess to undergo surgical or invasive procedures ,
Malingering–> external gain ,(avoid military service or work or school)
conversion disorder–> neurological losss after stressor, (blindness 2hr on wedding day )
Hypochondriasis–> excessive preoccupation of disease despite medical reassurances
Anorexia Nervosa BMI < 15 , BP , hypothermia
Never admit to Psychiatric ward if they are not stable BP < 90/60 , Hypothermia
Admit to Medical ward first
Most common COD in AN is Cardiac complications
Pregnancy and antipsychotics
Do not breastfeed the baby if mother is on carbamazepine, clozapine or lithium.
Taking lithium, planning pregnancy: Reduce litium gradually and stop before pregnancy is confirmed
Taking lithium, becomes pregnant: consider stopping lithium gradually over 4 weeks, if she is well
Taking Lithium during pregnancy:
a) Plasma lithium levels monthly till 36 weeks
b) Plasma lithium levels weekly after 36 weeks
Teratogenicity of lithium :
Ebstein anomaly Floppy baby syndrome
Thyroid abnormalities
If a woman taking lithium becomes pregnant and is not well or is at high risk of relapse, consider:
switching gradually to an antipsychotic or stopping lithium and restarting it in the second trimester (if the woman is not planning to breastfeed and her symptoms have responded better to lithium than to other drugs in the past) or
continuing with lithium if she is at high risk of relapse and an antipsychotic is unlikely to be effective.
Source: NICE guidline
Perioral tingling Carpopedal spasms every time before public talk / interview/ exam / arguments
only a couple of minutes with intense fear
Single most appropriate Mgx TO PRVENT FURTURE ATTACKS
BB will only help symp not definitive Tx /
PERIORAL TINGLING,CARPOPEDAL SPASM»
HYPOCALCEMIA AND RESP ALKALOSIS
» PANIC ATTACK
short acting Tx before event : propranol (not Def Tx)
actue episode : rebreath into paper bag
prevention long term CBT : (Def Tx )
CBT
Panic not social anxiety
Good responsive to SSRI x 6 months for depression after husband loss 1 year ago
Experience dramatic improvements but Now remission of thoughts of husbands
brings her mood down(depress) PY 1325
Although Remission
Have to continue therapy SSRi for at least 6 months is advised to reduce the risk of relapse
1034 Substance abuse in Night club
LSD - smelling colours and seeing sound
Estasy
Post op 72 hours Agitation , aggressive , restless , decrease attention span
possible history that can indicate the cause
1) Alcoholic hallucinosis (can appear 12-24 hours after alcohol has stopped):includes visual, auditory or tactile hallucinations
2) Withdrawal seizures (can appear 24-48 hours after alcohol has stopped):These are generalised tonic-clonic seizures.
3) Alcohol withdrawal delirium or ‘delirium tremens’ (can appear 48-72 hours after alcohol has stopped
Post op 72 hours Agitation , aggressive , restless , decrease attention span
possible history that can indicate the cause
1) Alcoholic hallucinosis (can appear 12-24 hours after alcohol has stopped):includes visual, auditory or tactile hallucinations
2) Withdrawal seizures (can appear 24-48 hours after alcohol has stopped):These are generalised tonic-clonic seizures.
3) Alcohol withdrawal delirium or ‘delirium tremens’ (can appear 48-72 hours after alcohol has stopped
CJ3310 Pt lost husband 2 year ago / depressive signs , hearing her husband for a short time / unable to sleep
Psychotic depression : as she is hallucinating or hearing
Severe depression : if she had suicidal thoughts
Lithium
before initiate lithium: -
Thyroid AND renal function must be checked.
lithium level then checked
1 Week later and (7 days after starting Lithium )- take sample 12hr from the 7th dose
every 3 months later.
every 6 months: check Liver and renal functions.
CT 2210 15 year old girl / not interested in her new school and miss her old friends / sleep disturbances / loss of interest in her hobbies
becomes tearful
Single most appropriate management
You are GP (cannot prescribe SSRI to <18 yr )
Psychotherapy (CBT is a form of psychological treatment )
SSRI (< 18 year cannot prescribe )
For < 18 years old : Fluoxetine > Sertraline
PY3090 Pt depressed + on Warfarin for AF
SSRI (contraindicated in GI bleeding )
Mirtazapine
SSRI is contraindicated with warfarin, aspirin, heparin, triptans and NSAID .
SSRI is contraindicated in WANTS - warfarin, aspirin/heparin, nsaids, triptans
Warfarin not used with like Azithro, Tri/sulfa, Cipro and Flucanazole , NSAIDs , Antiplatelets
Heroine Overdose Naloxone or Methadone ?
nalOxOne = OverdOsed methadone= withdrawal (M=W) reverse of M
Naloxone is used to treat opioid overdose.
Methadone is used to treat addiction or withdrawal symptoms.
This is because methadone has a very long half life and does not provide the same level of euphoria, so it stays longer in their system without necessarily given them the same euphoric effects.
Naloxone… Opiod antagonist so we use it to treat overtoxicity. ( must repeated)
Methadone… Opiad agonists.. We use it instead of heroin to withdraw the heroin as it can be much easier withdown than heroin.
Naloxone–overdose Naltrexone– Prevent relapse( Urine for opoid–negative) Methadone– Maintainance/Detoxification( Urine for opoid–positive)/Dependence/Addiction/Withdraw
4 Doggies
4 druggies approach a locked door. the one on heroin will feel too lazy to open it. the one on coke will attempt to break it. the alcoholic will shout at the door and..
the alcoholic will shout at the door and try to berate it. while the one on cannabis will suggest running backwards and jumping through its keyhole.. (eitherway, it loses its sense when translated)
Alcohol : hypoglycemia / vomiting / retching / antisocial behavior / disorientation / ataxia
Heroine : Meiosis / altered consciousness / needle marks / slow
Cocaine : Mydriasis / ↑alertness / confidence / Euphoria
Cannabis : Euphoria / relaxation / bloodshot eye / dry mouth
CT1438
Alcohol addict going to operation / want to quit / stopped drinking 6 hours ago / what to give
2 types of medication
To reduce alcohol withdrawal symptoms ; Chlordiazepoxide
To manage alcohol dependence
only after going to the Detoxication Programme
GIVE ; Disulfiram(↑Vomiting ) and Acamprosate(↓craving )
Othello Syndrome
Delusional jealousy - husband cheating having an affair
Ekborn Syndrome- Honey comb (insects crawling delusion)
PY4480 12 year old girl with ADHD Difficulty sleeping / sleeping at 2am and next day at school cant concentrate
Increase the ADHD drug or sleep hygiene
ADHD drugs : Methylphenidate / Lis dexa fetamine (side effect : insomnia )
First line - sleep hygiene
Second line - Melatonin
Schizophrenia
Mesolimbic pathway
- High levels of dopamine
- Positive symptoms
- Dellusion / Hallusination / Disorganised thoughts
Mesocortical pathway
- Low levels of Dopamine
- Negative symptoms
- Lack of motivation
- Social withdrawal
- Flat Affect ( no feeling)
Atypical Antipsychotics
Decrease Dopamine relaease in Mesolimbic pathways
And Increase dopamine release in Medocortical pathway
Treating both +n - symptoms
Clozapine Olanzepine Quietiazepine Paliperidone Risperidone Lurasidone Ziprasidone Aripiprazone
OCD treatment
ERP (exposure and response prevention )
Autism Spectrum Disorder PY763
affect on social and communication skill and forming relationships
more prominent at time of stress and change like moving to new place (moving new school uni / death of spout )
Mostly occurs in children
sometimes
THREE MAIN FEATURES:
1-LANGUAGES DIFFICULTIES
2- ANTISOCIALITY
3-REPETETIVE STEREOTYPED BEHAVIOURS (lining up toy cars like 500 )
PY 1333 Post partum psychosis BEST TX OPTION
ADMISSION TO THE HOSPITAL WITH SPECIAL MOTHER_BABY UNIT
Best tx option : ECT
Next tx option : (SSRIs / Antipsychotics)
This is from NICE guidelines: It is recommended that electroconvulsive therapy (ECT) is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening, in individuals with: catatonia a prolonged or severe manic episode.
Incongruent affect / Emotional liability / Flat Affect
Unaware laugh / Aware Stroke survivors / No facial expression and emotion
Incongruent affect: = Patient unaware of ‘out of place’ behaviour, like laughs when pet dies. = Seen in Schizophrenia and Bipolar patients.
Emotional liability : = Same behaviour as IA but patient is ‘Aware’ of it, but cannot control the behaviour. = Seen in stroke survivors .
Flat Affect: Monotonic voice with No Facial Expressions.
PY4010 29 year old financial advice to GP for sick leave
History of panic attack / last year also fit note for 6 weeks rest
SINGLE MOST APPROPRIATE ACTION
Advice her to see Occupational Health
not a Occupational therapist
3 differential diagnoses that share the same picture:
1. NMS, 2. Li toxicity, 3. Serotonin syndrome.
“coarse tremors” once I saw that, I knew it was lithium overdose
Fine tremors - therapeutic dose
Coarse tremors - Overdose
Acute stress reaction VS PTSD (4 weeks )
Adjustment disorder VS Abnormal Grief reaction (6 month )
starts within miutes to hours after an event and lasts less than 4 wks
> acute stress reaction
after major life event + flashback+ more than 4 wks but less than 6 months
> PTSD
after life event + anxiety + more than 6month
> abnormal grief reaction
Adjustment disorder less than 6 months while
Abnormal grief reaction is more than 6 months.
Acute stress reaction less than 4 weeks while
PTSD more than 4 weeks
Cocaine story: PY2075 / perforated nasal septum
you take it from nose-- you perforate your nose-- you even go higher-- perforate your cerebral vessels( SAH and Stroke)-- you come down-- pound your heart-- precipitate MI--- a short period of intense activity and you crave for more... END of the story...
Cocaine story: PY2075 / perforated nasal septum
you take it from nose-- you perforate your nose-- you even go higher-- perforate your cerebral vessels( SAH and Stroke)-- you come down-- pound your heart-- precipitate MI--- a short period of intense activity and you crave for more... END of the story...
8 hr after Paroxetine 25 tablets and suicidal attempt and drink vodka EN2300
Most appropriate action for the AnE doctor ?
Paroxetine is SSRI (Fatalities are uncommon with overdose )
Peak plasma concentration at 5-7 hours (watched for 6hours )
Refer to the psychiatric liaison team to be reviewed before discharge
CT0041 Panic disorder vs GAD
PD - 2 attacks and at least a month of worry
comes in waves and suddenly out of the blue
GAD - > 6months / chronic excessive worry which is not related to particular circumstance
anxiety at same level on most days (family, housing and finance )
Hypono GOGIC or POMPIC hallucination (hears his mother mother calling out his name when he is about to fall asleep)
HypnoGOgic=GOing to bed
HypnoPOMPic=POMPing out of bed
Tricyclic Anti depressants
Monoamine antidepressants
PE 0520 ADHD read again
PY2060 Atypical depression read again
as
A
