Symptoms and Syndromes

Question 1

Delerium Symptoms Triad

Answer 1

• Acute confusion
  
  • Disorientation
  • Impaired memory
• Disturbed consciousness
  
  • Disordered thoughts
  • Hallucinations usually visual
  • Vague paranoid delusions
• Altered activity
  
  • Hypo/hyperactive
  • Sleep disturbances

Question 2

Frontal Lobe Injury - Presentation

Answer 2

• Emotional
  
  • Disinhibition/impulsivity
  • Emotional blunting
  • Aggression
• Behavioural
  
  • Hyperorality/overeating
  • Perservative behaviours/speech
• Cognitive
  
  • Memory problems
  • Difficulty with planning/learning new info

Question 3

Frontotemporal Dementia Symptoms

Answer 3

• Personality/behaviour change
• Early decrease in interpersonal skills
• Disinhibition
• Hyperorality
• Inflexibility
• Poor hygeine
• Affective flatterning
• Echolalia/repetitive speech
• Planning difficulties

Question 4

Lewy Body Dementia - Key Symptoms

Answer 4

• Fluctuating cognition
• Short term memory less affected in early stages
• Executive dysfunction
• Visual hallucinations
• EPSEs/parkinsonsism
• Neuroleptic sensitivity

Question 5

Autism Triad Symptoms

Answer 5

• Social interaction
• Language and communication
• Restricted interests/repetitive behaviours

Question 6

Dementia - 4 As Symptoms

Answer 6

• Aphasia
• Agnosia
• Apraxia
• Amnesia

Question 7

Delerium Tremens - Onset and Symptoms

Answer 7

• Peak onset 48 hours after last drink
• Psychiatric symptoms
  
  • Disorientation
  • Hallucinations - usually visual lilliputian

Question 8

Conduct Disorder Symptoms

Answer 8

• Towards adults
• Towards others
• Towards objects

Question 9

Alcoholic Hallucinosis - Symptoms and Onset

Answer 9

• Typically seen in chronic alcoholics who abruptly stop drinking - onset within 24 hours
• Auditory hallucinations elementary then –> voices
  
  • Heard in clear consciousness and whilst sober

Question 10

Drug/Alcohol Dependence Criteria

Answer 10

• Compulsive use
• Difficulty controling use
• Withdrawal state
• Tolerance
• Neglect of alternative pleasures
• Persistence use despite evidence of harm

Question 11

Opiate Withdrawal Onset and Duration

Answer 11

• Onset within 6-24 hours after last use
• Duration 5-7 days

Question 12

Opiate Withdrawal Symptoms

Answer 12

• Muscle aches
• Abdominal cramps, diarrhoea, nausea + vomiting
• Lacrimation/rhinnorhea
• Restlessness/anxiety
• Insomnia/yawning
• Sweating
• Goosebumps
• Dilated pupils/blurry vision
• Tachycardia/hypertension

Question 13

Wernicke’s Encephalopathy Symptoms

Answer 13

• Clouded consciousness
• Ataxia
• Nystagmus
• Opthalmoplegia

Question 14

Korsakoffs Psychosis - Symptoms

Answer 14

• Retrograde/anterograde amnesia
• Confabulation
• Disorientation in time

Question 15

Alcohol Withdrawal - Physical Symptoms

Answer 15

• Tremor
• Sweating
• Insomnia
• Tachycardia
• Nausea and vomiting
• Agitation
• Generalised anxiety
• Seizures

Question 16

Refeeding Syndrome - Symptoms

Answer 16

• Oedema
• Constipation/diarrhoea
• Vomiting
• Lethargy
• Seizures
• Arrythmias
• Heart failure

Question 17

Serotonin Syndrome - Somatic Symptoms

Answer 17

• Myoclonus
• Hyperreflexia
• Tremor
• Headache

Question 18

Serotonin Syndrome - Cognitive Symptoms

Answer 18

• Agitation
• Hypomania
• Confusions
• Hallucinations
• Coma

Question 19

Serotonin Syndrome - Autonomic Symptoms

Answer 19

• Shivering
• Sweating
• Hyperthermia
• Vasoconstriction
• Tachycardia
• Nausea
• Diarrhoea

Question 20

Serotonin Syndrome - Management

Answer 20

• Stop causative drug
• Medical admission
• IV fluids
• Cooling if needed
• Monitor renal function as at risk due to rhabdomyolysis
  
  • Increased urine output
  • Urine alkanisation with sodium bicarbonate
• Benzodiazepines for muscle rigidity/agitation/seizures
• 5HT antagonists - cyproheptadine, mirtazapine, propanolol

Question 21

Delerium Tremens Incidence

Answer 21

• 5% of all alcohol withdrawal episodes

Question 22

Serotonin Syndrome - Prognosis

Answer 22

• Most cases resolve within 24h
• Sometimes confusion may last a few days

Question 23

Korsakoff’s Psychosis - Risk from Wernicke’s Encephalopathy

Answer 23

• 80% of untreated Wernicke’s Encephalopathy –> Korsakoff’s

Question 24

Hyperprolactinaemia - Levels and Management

Answer 24

• Normal 0-530 mIU/L
• Elevated 530-2500 mIU/L
  
  • Decrease dose
  • Switch to aripiprazole, quetiapine, clozapine
  • Augment with aripiprazole
  • Discuss risks/benefits
• Very elevates >2500 mIU/L - refer to endorcinology to rule out a prolactinoma

Question 25

QTc Prolongation - Levels and Treatment

Answer 25

* Normal: * \<440 men, \<470 women * Prolonged * 440-500 men, 470-500 women * Decrease dose * Switch antipsychotic * Repeat ECG * Very prolonged * \>500 * Stop drug * Send to A+E for monitoring and cardiology review

Question 26

Neuromuscular Syndrome - Symptoms/Features

Answer 26

* Rigid muscles * Unstable HR/BP * Fever * Raised WCC/CK * Confusion

Question 27

NMS incidence and mortality

Answer 27

* Incidence - \<1/100 * Mortality 10-20% overall (including out of hospital)

Question 28

NMS Immediate Management

Answer 28

* Stop drug * Admission to medical unit * Monitor vitals and CK levels * IV fluids * Cooling * Benzos to relax muscles * D2 antagonists - bromocriptine

Question 29

NMS - Management After

Answer 29

* Cautious reintroduction of antipsychotic starting at a low dose * Ideally from a different structural class * Low D2 affinity antipsychotics also better - Clozapine, Quetiapine