11.6.2013(psychiatry,schizhophrenia,mood Disorders) 34 Flashcards by rakesh durai

Who described hebephrenic?

Hacker

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Who described catatonia

Kahlbaum

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Neurotransmitters implicated in schizhophrenia

Increased:
 Dopamine
 Serotonin
 Norepinephrine 
Decreased:
 GABA
altered:
 Glutamate
 CCK 
 Neurostatin

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Major metabolite of dopamine

Homovanillic acid

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Drugs causing schizhophrenia like syndrome

Amphetamine
Mescaline
LSD
Cocaine
Alcohol withdrawal
Ketamine/phencyclidine
Barbiturate withdrawal
Belladona

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Diseases causing schizhophrenia like syndrome

Early Huntington 
Wilson
Hemochromatosis 
AIP
homocystinuria

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Amphetamine causes features similar to

Paranoid schizhophrenia

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Characteristic features of LSD

Flashbacks

Bad trips

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Characteristic features of cannabis

Run amok
Flash back
Amotivation syndrome

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Characteristic features of cocaine

Magnan symptoms

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Morbid jealousy is seen with which substance abuse

Alcohol

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Mc Ewan sign

Alcohol

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Mental disorders with heritability of 80%

Schizhophrenia

Bipolar disorder

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Risk of schizhophrenia if family members are affected

Monozygotic twin:50%
Both parents:40%
One parent:12%
Non twin sibling:8%

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Type of delusion in first rank symptoms

Primary autochthonous delusion

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Most common hallucination in schizhophrenia

Auditory

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First symptom to disappear after Rx of schizhophrenia

Auditory hallucination(1st symptom to reappear after resistance)

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Characteristic feature of Hebephrenic schizhophrenia

Senseless giggling and mirror gazing

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Commonest type of schizhophrenia

Paranoid

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2nd most common type of schizhophrenia

Hebephrenic

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Schizhophrenia types with worst prognosis

Hebephrenic

2. simple

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Schizhophrenia with best prognosis

Catatonic

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Onset of catatonic schizhophrenia

Acute and late

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Types of catatonic schizhophrenia

Excitatory

Stuporous

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Acute lethal catatonia

``` Pernicious catatonia Severe excitement Rigidity Hyperthermia Dehydration Death ```

Features of stuporous catatonia

Motoric Immobility Extreme negativism Peculiar movements

Snout cramp

Schauzkrampf

Excessive compliance

Mitgehen

Mannerism and grimacing are found in ___________ schizhophrenia

Stuporous subtype of catatonic

Residual schizhophrenia

Chronic schizhophrenia | Predominantly negative symptoms for 1 yr

According to crow structural brain damage is found in which type of schizhophrenia

TypeII(deficit)

Risk of suicide is high in type________ of schizhophrenia

Type1

Physique of pt of schizhophrenia with poor prognosis

Asthenic Fatty(pyknic) have good prognosis

Presence of precipitating factor is a sign of ___________ prognosis in schizhophrenia

Good

Initial clinical symptoms associated with bad prognosis in schizhophrenia

OCD | autism

Genes associated with schizhophrenia

``` Indicate bad prognosis NRG-1 COMT NMDA2A DTNBP1(dysbindin) G72 DAAO RGS4 PRODH(proline dehydrogenase) ```

Schizhophrenia with late onset

Paranoid

Risk of tardive dyskinesia is highest with

Very late onset schizhophrenia

Criteria for diagnosis of delusional disorder

Non-bizarre delusions Present for 1 month duration No social or functional impairment Criteria for schizhophrenia not met

Schizhophrenia which is difficult to diagnose

Simple

No Past H/o delusions or hallucinations are present in

Simple

Conversion disorder

>=1 motor or sensory symptoms Preceded by stressor Not factitious

MC adulterant of heroin

1.Quinine Sucrose Chalk Cellulose

Post psychotic depressive disorder of schizhophrenia occurs in which type

Residual

Longest acting antipsychotic

Fluphenazine

Most common cause of premature death in schizhophrenia

Suicide

Drug that can prevent suicide ideation in schizhophrenia

Clozapine

Incidence of schizhophrenia

1-5 per 1000 Prevalence :1%

Defect of conation is seen in

Catatonic schizhophrenia

Term demence precoce was used by

Benedict morel

Content of thought in delusional paranomia

Smell

Diff btw alcohol withdrawal related hallucinations and delirium tremens

Presence of clear sensorium in former

Common hallucinations in alcohol withdrawal

Auditory

Alcoholic paranoia is associated with

Fixed delusions

Persistent delusional disorder

Non bizarre,circumscribed,systematic delusion No criteria A symptoms of schizhophrenia Lasts for >1month

Schizhophreniform disorder

Criteria A symptoms of schizhophrenia present | Duration of symptoms btw 1-6months

Brief psychotic disorder

Category A symptoms except negative symptoms | Lasts >1day but <1month

Sun downing is seen in

Delirium

Somatization disorder

``` 4 pain 2 GIT 1 sexual 1 pseudoneurologic Symptoms present for atleast 2 YEARS ```

Delusion of infidelity

Othello

Other name for othello syndrome

Conjugal paranoia

Erotomania

De clerambault | Psychose passionale

Delusional parasitosis

Ekbom syndrome

Delusion that the person is werewolf

Lycanthropy

Visual hallucination of transparent phantom of one's own body

Autoscopic psychosis

Delusion that one is possessed by monster

Witigo | Windigo

Illusion de sosies

Capgras delusion

Delusion that Different people are infarct one person is seen in

Fregoli delusion

Delusion that a person has changed both physically and psychologically into another person

Intermetamorphosis

Match box sign is seen in

Delusional parasitosis

Paranoid litigants

Querulent delusions

The delusion that their penis is shrinking

Koro

A sudden onset of crying,screaming,tearing of clothes among Eskimos

Piblokto(arctic hysteria)

False of delusion of losing everything(money,health,even internal organs)

Cotard delusion

Feeling that Objects in external world are strange and unreal

Derealization

Feeling that body or self is unreal,feels detached from body

Depersonalisation

Depersonalisation is ego _________

Dystonic

Organic cause of psychosis is indicated by _________ hallucination

Visual

Characteristic symptom of organic psychosis

Transient delusion

Neurosis

``` OCD Anxiety disorders All phobias Conversion disorder Dissociative disorder ```

Most common psychiatric disorder

Major depression

Depression commonly affects

Middle aged females

Most common psychiatric disorder associated with medical condition

Depression

Lifetime prevalence of major depression

17%

Chromosomes linked with bipolar disorder

``` Chr 18 Chr 22(maternal inheritance) ```

Chr associated with unipolar depression

Chr2 | C-AMP response element binding protein(CREB1)

Chr associated with both bipolar disorder and schizhophrenia

Chr21

Imaging studies in depression

Decreased left prefrontal cortex blood flow

Otto veraguth fold

Triangular fold of skin in nasal corner upper eyelid

Nihilistic delusions are seen in

Endogenous depression Double depression Cotard depression Schizhophrenia

Periods of depression when suicide risk is high

Early stages Involution Within 3 months of recovery from depression

Suicide risk in depression is more common I

``` Middle aged(>40yrs) Males ```

Ganser syndrome

Vorbeidren | Approximate answers

Depressive symptoms should be present for atleast __________

2 weeks

Major depression

>=5 symptoms at least one of which is depressed mood or loss of interest or pleasure

Minor depression

2-4 symptoms

Types of conduct disorder

- conduct disorder confined to family context - unsocialised conduct disorder - socialised conduct disorder - oppositional defiant disorder

Conduct disorder is diagnosed in children

18yrs (antisocial personality disorder >18yrs)

Involutional melancholia

Old age Intense nihilism Somatisation Marked agitation and dejection

Key feature of melancholic depression

Psychomotor disturbance Impaired cognitive processing Motor retardation and agitation

Arrange types of depression based on severity

Non melancholic depression

Other name for melancholic depression

Endogenous depression

Other name for non melancholic depression

Neurotic or reactive depression

Current classification of major depression

Melancholic Atypical Catatonic Seasonal

Interpersonal rejection sensitivity is seen in

Atypical depression

Diff btw atypical and endogenous depression

Mood reactivity Weight gain Hypersomnia Are seen in atypical depression

Leaden paralysis

Atypical depression

Seasonal depression

Occurs in winter or fall for last 2 years

SSRI without any effect on CYP450

Sertraline

SSRI should not be combined with

MAO inhibitors

Side effects of SSRI

Insomnia/sedation Anxiety GI distress Sexual dysfunction

Side effects of MAOI

Insomnia Anorgasmia Weight gain Hypotension

MAOI are useful in Rx of

Atypical or treatment resistant depression

Norepinephrine reuptake inhibitors of TCA

Desipramine Maprotilin Nortryptiline Protryptilline

NE and 5HT reuptake inhibitors of TCA

Amitryptiline Imipramine Doxepin Trimipramine

SNRI

Venlafaxine Mirtazapine Duloxetine

SNRI used in neuropathic pain and stress incontinence

Duloxetine

Antidepressants without sexual dysfunction

Mirtazapine Nefazodone BUPROPION

Neutropenia is a side effect of which antidepressant

Mirtazapine

Antidepressant with risk of liver failure

Nefzadone

Mech of action of bupropion

Dopamine reuptake inhibitor

Side effects of bupropion

Seizures | Psychosis

Weight gain is not a side effect of which anti depressant

Bupropion

Priapism is adverse effect of which anti depressant

Trazadone

Drug with both antipsychotic and antidepressant properties

Amoxapine

Mech of action of tianeptine and amineptine

Enhance serotonin reuptake

Mech of action of mianserin

Blocks alpha2 presynaptic receptors

Antidepressants which reduce seizure threshold

Mianserin | Bupropion

Rx of psychotic depression

SNRI TCA ECT

Rx of depression with suicidal risk

SSRI(safe in overdose)

Rx of depression during pregnancy and lactation

TCA

Only antidepressants not epileptogenic

Older MAOI

Significant therapeutic effect of antidepressants may take

3-4wks

Rx of treatment resistant depression

Li | Thyroxine

Newer modalities of Rx for treatment resistant depression

Repetitive transcranial magnetic stimulation(rTMS) Vagus nerve stimulation DBS

Most important causes of suicide

Major depression Substance abuse Schizhophrenia

Dysthymia

Longstanding subthreshold depressive symptoms Adults: 2yrs Children and adolescents: 1yr

Characterological depression

Dysthymia

Maniac symptoms should last for

1 week(or any duration if need hospitalisation)

Maniacs sleep for

<=3 hrs

Fibromyalgia can be differentiated from dysthymia by

Polysomnography

Li is used in treatment of

Neutropenia Felty syndrome Hyperthyroidism Cluster headache

Types of bipolar disorder 1

Single maniac episode | Recurrent

Types of recurrent mania

Mania- currently maniac with previous h/o one maniac or depressive or mixed episode Depression- currently in depression with previous h/o one maniac or mixed maniac episode Hypomania- currently in hypomania with previous h/o one maniac or mixed episode Mixed episode-currently in mixed episode with previous h/o one maniac or depressive episode Unspecified

Hypomaniac symptoms sould be present for atleast

4 days

Blood levels of Li

Therapeutic:0.8-1.2 Prophylactic: 0.6-1.2

Lethal levels of Li

>2.5-3

Acute toxic symptoms of Li are

Neurological

Chronic side of Li are

nephrological and endocrine

Rx of Li induced tremor

Propranolol Primadone Gabapentin

Nontoxic neurological side effects of Li

``` Coarse Tremor Peripheral neuropathy Myasthenia gravis Pseudotumor cerebri Downbeat nystagmus Lowered seizure threshold ```

Endocrine dysfunction with Li use

Hypothyroidism(most common)/hyperthyroidism Hyperparathyroidism DM

Toxic conc of Li

>1.5mEq/L

Rapid cyclers

>=4 episodes per year

Ultra rapid cycles

24-48h cycles Ultra ultra cycles: cycling within a day

Novel therapies in Rx of bipolar depression

``` Sleep deprivation Dissociative anesthesia Supra physiological thyroid treatment Agomelatine N acetyl cysteine ```

Benzodiazepine in bipolar disorder

Initially during starting treatment for acute mania

Atypical antipsychotics approved for mania

``` Olanzapine Clozapine Risperidone Quetiapine Arpiprazole Ziprasidone ```

Anti convulsants used in management of MDP

``` Valproate Carbamazepine Lamotrigene Clonazepam Lorazepam ```

Drugs other than antipsychotics and anti convulsants used in Rx of MDP

``` Levothyroxine Verapamil Nimodipine Clonidine SSRI bupropion MAOI ```

Late onset schizhophrenia

>45yrs | Very late onset: >60yrs

Best marker for ECT

BDGF(brain derived growth factor)

Clinical effects of ECT are due to

Generation of new neurons in hippocampus

Indications of ECT

``` Psychotic depression Depression with suicidal risk Severe psychosis(schizhophrenia/mania) Schizhoaffective disorder Severe catatonia ```

Neurotic depression

Dysthymia

ECT is useful in depressive phase of MDP because

It reduces duration of depressive episode

Amnesia that is common in ECT

Retrograde

Most common side effect of direct ECT

T4-T8

Memory loss in ECT recovers in

6-9 months

Anterograde amnesia in ECT resolves within

5 hours

Absolute contraindication for ECT

Raised ICT

In direct ECT intra ocular tension is

Reduced

Relative contraindications of ECT

``` CVA MI severe hypertension Pheochromocytoma Severe pulmonary disease Retinal detachment ```

Schneiderian first rank symptoms are found in

Schizhophrenia Schizhoaffective disorder Mood disorder

11.6.2013(psychiatry,schizhophrenia,mood Disorders) 34 Flashcards

(174 cards)