Core conditions Flashcards
Alzheimers Dementia
Treatment
Gradual onset, Memory loss, increased ventricles, neurofibrilly tangles,
Treatment: ACh inhibitors Donpenezil
alZheimers donpeneZil
Vascular Dementia
signs
TX
Stepwise decrease in function
caused by infarcts and thrombolytic
TX: Aspirin and manage HTN
Fronto-temperal
syx
Treatment
Picks - earlier onset
Sx = personality disorder, social disinhibition, intellectual sparing, emotional blunting
SSRIs
Delerium
Transient change + acute disorientation
Causes: infection, neurological eg stroke, drugs
Illicit drugs
Key effects + withdrawal
Opiates: heroine, codine, morphine Cannabinoids: cannabis Hypnotics: bzs, barbiturates Stimulants: cocaine, MDMA Hallucinogens: lsd, shrooms
what brings pupils big vs down?
Opiate: Effect-decrease HR and BP + pinpoint pupils
Withdrawal: increase HR and BP and big pupils + runny nose + cravings
Cannabinoids: dry mouth, inc HR + appetite
Withdrawal: anxiety, irritability,, tremor, sweating
Hypnotics: Slurred speech,nystagmus, decreased temp (brings you down)
Withdrawal: tremor, inc HR, headache (brings u up)
Stimulant: increase moood + energy, inc HR + BP
Withdrawal: lethargy, craving, inc appeitie
Hallucinations: anxiety, depersonalisation, inc HR and pupils dialte
heroin and bzs = down and small pupil,
cocaine and lsd = big pupils
Schizophrenia
1st rank syx?
Diagnosis
Types
Treatment
- First rank symptoms Auditory hallucinations 3rd person Broadcasting of thoughts and echo Control - mood and behaviours Delusional perception
Diagnosis;: symptoms for 1 month with no drugs
PAranoid: delusions are evident
Catatonic: psychomotor distrubances
Hebephrenic: early onset, inappropriate mood, incongrious giggling
Treatment
- Antipsychotic
- CBT and family therapy and art therapy
Schizoaffective disorder
Affective (depression) and Schizophrenic symptoms occur together with equal prominence
Delusional disorder
A fixed delusion with unshakable belief
Depression
Syx
Treatment
Drug order
3 Core symptmoms= 2 needed for 2 weeks
1. Anhedonia 2. Low mood 3. Decreased energy
+ appetite, sleep disturbances, hopelessness etc
Mild = 4 syx, moderate = 6 syx, severe = 8syx
Management:
- mild = CBT
- Moderate CBT + SSRI for 6 months
- Severe = CBT + SSRIfor 6 months + ECT if catatonic
Drug order 1. SSRI -fluoxeteine (younger) or citalopram - 6 months (will know if working by 4 weeks) \+ review 1 week 2. Change SSRI to another one 3. Add SNRI eg Venlafaxine or Duloxetine 4. Try Mirtazapine Nassa if insomnia too 5. MAOI
Mania
Features
Appearance: flamboyant clothing, hats, heavy makeuup
Behaviour: hyperactive, flirty, disinhibited
Speech: Pressured, neologism
Thoughts: Grandiode, flight of ideas
Mood: euphoric, irritabble
reduced need for sleep
Bipolar affective disorder
Diagnosis
Treatment
- mainc episodes 1st line and 2nd line
- longer term
At least 2 episodes including at least one hypo/manic episode
type 1 = mani and type 2 = hypomania
Management
1. Manic episodes = 1st line Haloperidol, Risperione, Olanzpoine or Queitapine
2. Lithium or Valproate 2nd line if antipsychotics ineffective
BZs used in acute behavioural disturbance
3. Longterm = LITHIUM or valproate
Or women childbearing age use LAMOTRAGINE long term
GAD
Diagnosis
Management
- At least 6 months with prominent tension, worry and apprehension, irritability, tiredness
Managemnt:
1st line CBT, self help
2nd line SSRI Sertraline 1 year
Panic disorder
Severe panic attacks occuring unpredictably lasting 1 month and causing MALADAPTIVE behaviour
SYX: palpitations, sweating, tremor, N+V, last a few mins
TX: CBT + SSRIs
Phobia
- specific + tx
- agorophobia + tx
- social + tx
Specific = Eg heights, spiders TX = Graded exposure therapy and response prevention. Short term use of BZs eg if flight
Agorphobia = fear of crowds and public places TX = CBT
Social: most common, fear of social situations
TX = CBT, self help and SSRI if no improvement
PTSD
time frame?
Treatment?
Must be present for 1 month and onset within 6 months of the trauma
syx - persistent, intrusive thoughtd / flash backs, increase arousal, detatchment
treatment: EYE MOVEMENT DEREALISATION + REPROCESSING THERAPY
+ antidepressant
ADJUSTMENT
Depressive symtoms and inability to cope with major life event
Ususually self limiting and resolved by 6 months
TX: may respond to talking therapy
Abnormal bereavement
Delayed or unusually prolonged lasting over 6 months of inability to accept or cope with the loss
Somatisation disorder
multiple PHYSICAL symtoms present for over 2 years that has no organic cause
- spends excessive tme devoted to concerns
Patient often refuses to accept negative results
Conversion Disorder
Voluntary motor/sensory functional deficits that suggest neurologiclal conditions but doesnt fit on medical exam
Anorexia Nervosa
Signs
Management
BMI < 18.5
Signs: dry skin, fine hair, anaemia, Amenorrhea, bradycardia, risk of suicide, LOW WHITE CELL COUNT
management:
- fix BMI with refeeding 0.5kg/week
- FAMILY therapy and guided self help
- MARSIPAN guidance
- MANTRA = CBT + Motivational therapy
Complications: low K, low Na,
Hypophosphataemia is the hallmark of refeeding syndrome
Bullimia Nervosa
BMI > 18.5
Morbid fear of fatness, distorted body image, craving for food, binge and purging, self loathing
Signs: Depression, Low K, renal damage, russels sign = calluses on knuckles, mallory weis tear
Management: guided self help CBT + IPT
Fluoxetine SSRI 60mg
SSRI eg Fluoxetieine, Sertraline
SE
CI?
1st line for depression (fluoxetine in teens and longer half life)
SE: GI bleed, lowers Na, prolonged QT and increased risk of suicide
CI: epilepsy, peptic ulcer disease, under 24s, renal imparrment
SNRI
Venlafaxine 2nd line
Used for resistant depression
SE: SSRI Se + hypertension and heart disease
CI = hyptertension and heart disease
SNRI = VENLAFAXINE = HEART DISEASE
TCA eg Amitryptilline
noradrenaline AND seretonin
SE
CI
OVerdose TX
- for moderate-severe depression
- Treatment for neuropathic pain
SE: Antimuscarinic - cant shit, cant spit, cant pee cant see
sedation, hypotension, GI upset, prolonged QT
CI : ovoid in those with high risk of overdose, epilepsy, CVD, and constipation
TX: Iv bicarbonate + gastric lavage
