Psychiatry Passmed 2 Flashcards
Post-concussion syndrome is seen after even minor head trauma
Typical features include:
headache
fatigue
anxiety/depression
dizziness
Post-traumatic stress disorder (PTSD) can develop in people of any age following a traumatic event, for example, a major disaster or childhood sexual abuse.
How long do symptoms have to have been present for a diagnosis to be made?
4 weeks
What features may PTSD present with?
re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
avoidance: avoiding people, situations or circumstances resembling or associated with the event
hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
emotional numbing - lack of ability to experience feelings, feeling detached
How can PTSD be managed?
watchful waiting may be used for mild symptoms lasting less than 4 weeks
military personnel have access to treatment provided by the armed forces
trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases
drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then venlafaxine or an SSRI e.g. sertraline should be tried
What are hallucinations?
false sensory perception in the absence of an external stimulus.
organic, drug-induced or associated with mental disorder.
What are pseudohallucinations?
a false sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating
Examples : a hypnagogic hallucination (occurs when falling asleep), a hallucination as part of a grief reaction
Psychosis is a term used to describe a person experiencing things differently from those around them.
Psychotic features include:
hallucinations (e.g. auditory)
delusions
thought disorganisation
Give some examples of thought disorganisation
alogia: little information conveyed by speech
tangentiality: answers diverge from topic
clanging
word salad: linking real words incoherently → nonsensical content
What other features may be associated with psychosis?
agitation/aggression
neurocognitive impairment (e.g. in memory, attention or executive function)
depression
thoughts of self-harm
Give some examples of conditions in which psychosis may occur
schizophrenia: the most common psychotic disorder
depression (psychotic depression, more common in elderly patients)
bipolar disorder
puerperal psychosis
brief psychotic disorder: symptoms last less than a month
neurological conditions e.g. Parkinson’s disease, Huntington’s disease
prescribed drugs e.g. corticosteroids
certain illicit drugs e.g. cannabis, phencyclidine
What is the strongest risk factor for developing a psychotic disorder?
Family hx
an episode of psychosis lasting less than a month with a subsequent return to baseline functioning = ?
brief psychotic disorder
What is the risk of developing schizophrenia when :
monozygotic twin has schizophrenia?
parent has schizophrenia?
sibling has schizophrenia?
monozygotic twin has schizophrenia = 50%
parent has schizophrenia = 10-15%
sibling has schizophrenia = 10%
Give some risk factors for developing a psychotic disorder
Fam hx - STRONGEST RISK FACTOR
Black Caribbean ethnicity
Migration
Urban environment
Cannabis use
What are the first rank symptoms of schizophrenia?
auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions
Give some specific types of auditory hallucination that may be experienced in schizophrenia
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour
Give some examples of thought disorders seen in schizophrenia
thought insertion
thought withdrawal
thought broadcasting
What are passivity phenomena? ( can be experienced in schizophrenia)
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
What happens in delusional perception in schizophrenia?
a two stage process- where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.
Give some negative features of schizophrenia
incongruity/blunting of affect
anhedonia (inability to derive pleasure)
alogia (poverty of speech)
avolition (poor motivation)
social withdrawal
Which is the best medication for managing negative sxs of schizophrenia?
clozapine
How should schizophrenia be managed?
oral atypical antipsychotics are first-line
CBT
close attention should be paid to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients (linked to antipsychotic medication and high smoking rates)
Give some factors associated with poor prognosis in schizophrenia
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
What is Seasonal affective disorder (SAD) ? How should it be managed?
depression which occurs predominately around the winter months
psychological therapies and follow up with the patient in 2 weeks to ensure that there has been no deterioration
Don’t give sleeping tablets
Which patients are specifically excluded from the mental health act?
Patients under the influence of alcohol or drugs