Week 2 - Bipolar, Psychosis and Alcohol

Question 1

What are the symptoms of mania?

(DIG FAST)

Answer 1

D - distractibility

I - irresponsibility

G - grandiosity

F - flight of ideas

A - activity increases

S - sleep deficit

T - talkativeness

Question 2

What is the difference between mania and hypomania? x3

Answer 2

In hypomania symptoms have less impairment on functioning - there are no psychotic symptoms and they are unlikely to require hospitalisation

Question 3

Describe the 6/7 stages in the Stages of Change model

Answer 3

Question 4

What kind of form of thought might someone with schizophrenia present with?

Answer 4

• Form
  
  • Difficult to follow
    
    • Knight’s move (Sudden change of topic with no logical connection)
  • Thought block (abrupt stop of train of thought)
  • Neoligisms - New word formation by patient or ordinary word used in a new way

Question 5

What kind of content of thought might someone with schizophrenia present with?

Answer 5

Content - delusions:

1. thought insertion (belief that thoughts can be put into the patient’s mind)
2. thought withdrawal (belief that thoughts can be removed from patient’s mind)
3. thought broadcasting (belief that others can hear the patient’s thoughts)
4. thought echo (more a perception)
5. Delusion of control / passivity / influence (belief that another person / force controls one’s general thoughts, feelings, impulses, or behavior)
6. Delusional perception (normal perception that patient gives special meaning e.g. traffic light is green therefore I am king)
7. Delusion of reference (belief that insignificant remarks, events, or objects have personal significance)
8. Delusions of persecution (someone is out to get patient)

Question 6

What kind of perceptions (hallucinations) might someone with schizophrenia have?

Answer 6

1. hallucinatory voices commenting or discussing the patient in the third person
2. thought echo

Question 7

What are the negative symptoms of schizophrenia?

Answer 7

1. Appearance and Behaviour:
   
   • psychomotor slowing;
   • underactivity;
   • poor self-care and social performance.
2. passivity and lack of initiative;
3. Communication:
   
   • poverty of quantity or content of speech;
   • poor nonverbal communication by
     
     • facial expression,
     • eye contact,
     • voice modulation (flat tone) and
     • posture
4. blunting of affect

Question 8

What are the common EPSE (extra-pyramidal side effects)?

Answer 8

1. Acute dystonias
   
   1. develops after weeks starting the drug
   2. Symptoms:
      
      1. involuntary movements (restlessness, muscle spasms, protruding tongue, fixed upward gaze, neck muscle spasm)
      2. often accompanied by symptoms of Parkinson’s disease
      3. Tremour
      4. Rigidity
   3. declines over time
   4. treatable by removing drug
2. Tardive dyskinesias
   
   1. develops after months / years
   2. Symptoms: involuntary movements, including trunk - can be v. disabling
   3. often untreatable

Question 9

What are the common unwanted effects of antipsychotics?

Answer 9

1. Motor - EPSEs
2. Endocrine - hyperprolactinaemia
3. Sedation, hypothermia, weight gain
4. Obstructive jaundice sometimes occurs with phenothiazines (end in -azine)
5. Other side effects (dry mouth, blurred vision, hypotension, etc.) are due to block of other receptors, particularly muscarinic receptors and α adrenoceptors.
6. Some antipsychotic drugs cause agranulocytosis as a rare and serious idiosyncratic reaction. With clozapine , leukopenia is common and requires routine monitoring.
7. Antipsychotic/neuroleptic malignant syndrome is a rare but potentially dangerous idiosyncratic reaction

Question 10

What is the difference between Neuroleptic malignant syndrome and seratonin syndrome?

Answer 10

Question 11

What is the mnemonic for neuroleptic malignant syndrome (reaction vs antipsychotic)

Answer 11

M - myoglobinuria

F - fever

E - enzyme elevation (↑CK)

V - vital sign instability (↑HR)

E - encephalopathy (altered mental state)

R - rigidity of muscles

Question 12

what is the management for serotonin syndrome?

Answer 12

Management

1. stop drug responsible
2. supportive including IV fluids
3. benzodiazepines
4. more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

Question 13

what is the management for Neuroleptic malignant syndrome?

Answer 13

Management

1. stop antipsychotic
2. patients should be transferred to a medical ward if they are on a psychiatric ward and often they are nursed in intensive care units
3. IV fluids to prevent renal failure
4. dantrolene may be useful in selected cases
5. thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
6. bromocriptine, dopamine agonist, may also be used