W4 liason, MUS, perinatal, personality disorders Flashcards
what are dissociative seizures?
psychologically mediated episodes of altered awareness and/or behaviour that may mimic epilepsy
1/5 of seizure pts have this
high co-morbidity - PTSD, depression, anziety, personality disorder
what is MUS medically unexplained symptom
no organic cause or out of proportion to underlying illness
30% of GP appointments, >50% 2y care appoitnments
what speciality are most MUS
gynae 66%
neuro 62%
gastro 58%
what is conceptual dualism?
2x2 table
bodily pathology + psych sx = comorbidity
BP + physical sx = medical condition
no BP +psych = mental disorder
no BP + physical sx =somatisation
what is classificatory dualism
consequnce of conceptual dualism
= existence of entirely separate though overlapping classifications for psych and medical conditions, focus on diff aspects
–> medically unexplaied GI –> somatic focus is IBS bu psych focus is GAD
–> post-stroke fatigue –> somatic is sequale of stroke, psych is depressive disorder
what is moral dualism
moral impliactaions of calling something medical or psychiatric dx
medical - out of our control, get sympathy
psych - failure of will so culpable, no sympathy just fear and contempt
what is a dissociative (conversion) disorder
= loss of distrubance of normal function (paralysis, sensory loss, aphonia, seizures)
…initially appears to have a physcial cause, but is psychologial in nature
sx not produced intentionally, no 2y gain
what is factitious disorder?
intentionally falsigy symptoms, PMH, fabricate signs
primary aim = gain medical atttention and tx
3 subtypes = wandering (mainly males), non-wandering and by proxy (mainly females)
–> diff diagnosis = malingering (2y gain)
how common is psych problems causing maternal death?
4th
how many women who die btw 6 weeks and a year after pregnancy die by suicide
1 in 6
what’s the importance of 1001 critical days
1001 days form conception to 2 yo = foundations for cognitive, emotional and physical development
epi of puerperal psychosis?
1-2 per 1000 births 1st 2 weeks postpartum rapid onset, clinical pic fluctuates responds well to tx = psych emergency --> urgent tx
risk factors for puerperal psychosis
schizoaffective disorder
FH of puerperal psychosis
risk of relapse esp high in 1st postnatal year and in subsequent pregancies
what is perinatal depression
diff from ‘baby blues’
can start in pregnancy or after
biological sympotms of depression less sensitive and specific
–> screen W with Edinburgh postnatal depression score
red flags for perinatal depression
signif change/ new sympotms
thoughts or acts or violent self harm
feeling of incompetency as a mother or estrangement from the infant
what tx is best for W with EUPD and complex trauma in perinatal
trauma focused psychological therapy or emotional coping skills groups
not always poss to do MBT and B+DBT, can be destabilising
OCD in pregnancy
2 in 100 women in pregnancy, 2-3 in 100 in the eyar after birth
ego-dystonic obsessive thoughts about images andbaby can be distressing
–> can affect ability to attend to baby care and daily life
what medication must you completely avoid in someone who can become pregnant
sodium valporate
5 dimensions of personality
extraversion agreeableness conscientiousness neurotism openness
what are key features of oersonality disorders
problematic (disruptive and impairing function)
pattern of behaviour (outside of norm)
persistent
pervasive
NO psychosis (not explaine dby another mental illness/ physical illness/ drugs)
what is different in people with PerD
disturbed way of relating –> self function, interpersonal/attachment
disturbed way of thinking
difficulties controlling affect
ICD-10 classificiations of personality disorders
paranoid schizoid dissocial emotionally unstable = impulsive type, borderline type histrioninc anakastic anxious (avoidant)
not otherwise specified
DSM-5 personality disorders classification
Cluster A, B, C
cluster A DSM5
paranoid
schizoid
schixotypal
