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Liaison Flashcards

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1
Q

Describe PMS

A

Collection of psychological and somatic symptoms occurring during the luteal phase of menstrual
cycle.

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2
Q

How many women with PMS suffer from severe symptoms

A

5%

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3
Q

How many women of reproductive age suffer from PMS

A

3-8%

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4
Q

Co-morbidities of PMS

A

30-70% mood disorder

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5
Q

When do symptoms of PMS occur

A

Peak is 2 days before start of menses

Last several days to 2 weeks

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6
Q

Aetiology of PMS

A

Possible increased sensitivity to normal, fluctuation of gonadal hormones

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7
Q

Treatment of mild PMS

A

Lifestyle changes
CBT
Exercise and dietary regulation

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8
Q

Treatment of severe PMS

A

SSRIs

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9
Q

Response rate of PMS to SSRIs

A

60-90%

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10
Q

Medications for PMS

A 
Fluoxetine
Sertraline
Citalopram
Escitalopram
Clomipramine
Venlafaxine
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11
Q

What is intermittent dosing in PMS

A

Taking meds during luteal phase os menstrual cycle; can be effective

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12
Q

Non-antidepressant meds for PMS

A

Long-acting GnRH agonist, estrogen and other contraceptives; use as last resort as can introduce early menopause

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13
Q

How many patients with coronary heart disease have comorbid depression?

A

20%

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14
Q

Prevalence of depression in patients with heart failure

A

21.5% - 2-3 times the rate of general population

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15
Q

Relative risk of mortality in patients with CCF who have depression

A

2:1 compared to non-depressed patients

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16
Q

Prevalence of depression in advanced cancer

A

5-15%

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17
Q

Lifetime risk of MS in UK

A

1 in 8000

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18
Q

M:F ratio in MS

A

1:2

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19
Q

How many patients with MS have steady progression with no remission

A

5-10%

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20
Q

How many patients with MS have relapsing-remitting course

A

20-30%

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21
Q

How many patients with MS have progressive deterioration following relapsing-remitting course

A

60%

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22
Q

Lifetime prevalence of depression in MS

A

40-50%

3x higher than general population

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23
Q

Risk of trigging relapse of MS if given ECT

A

20%

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24
Q

How many deaths in MS are due to suicide

A

15%

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25
Treatment of pathological laughing/crying in MS
Amitriptyline
26
Prevalence of depression post-stroke
35% - more subcortical lesions
27
Prevalence of anxiety post-stroke
25% - more cortical lesions
28
Prevalence of apathy without depression post-stroke
20%
29
Prevalence of emotional incontinence post-stroke
20%
30
Mean duration of post stroke depression
34 weeks
31
Which type of stroke is depression common in
Infarcts of basal ganglia, especially on left hemisphere
32
Treatment of mild-moderate depression post-stroke
Increase social interaction Exercise Psychosocial interventions
33
Treatment of severe depression post stroke or emotionalism
Anti-depressants; continue at least 4 months post-recovery
34
Prevalence of depression in epilepsy
30-50%
35
Prevalence of panic disorder in epilepsy
20%
36
Prevalence of psychosis in epilepsy
3-7%
37
Prevalence of depression in Parkinsons
40-50%
38
Prevalence of hypomania in Parkinsons
2%
39
Prevalence of anxiety in Parkinsons
50-65%
40
Prevalence of psychosis in Parkinsons
40% - drug-related
41
Prevalence of cognitive impairment in Parkinsons
19% with no dementia | 25-40% with dementia
42
Risk factors for depression in Parkinsons
``` Female Younger onset Right-sided lesions Bradykinesia and gait disturbance Rapid disease progression Poorer cognitve status and ADLs ```
43
What antipsychotics can help in Parkinsons without worsening Parkinsonism
Clozapine <100mg/day | Quetiapine
44
Risk factors for cognitive impairment in Parkinsons
Older age Late onset Parkinsons Low socio-economic status and education Presence of severe EPSEs
45
Medications for Parkinsons dementia
None licensed
46
Commonest cause of viral encephalitis
Herpes simplex - commonest cause of limbic encephalitis affecting temporal lobe and limbic circuit. 70% caused by HSV1.
47
How many patients with HSV encephalitis show psychiatric sx
70%
48
Common psych sx in HSV encephalitis
Acute confusion Depression Psychosis
49
Neuroimaging of HSV encephalitis
Swelling of temporal lobes, can cause raised ICP
50
Gold standard diagnosis of HSV encephalitis
CSF PCR for herpes virus
51
What are classifications of TBI?
Mild - PTA<60 mins Moderate - PTA 1-24 hours Severe - PTA 1-7 days Very severe - PTA >7 days
52
Functional outcomes of TBI
Mild - return to work <1 month Moderate - return to work in 2 months Severe - return to work in 4 months Very severe - may require >1 year to return to work
53
When is personality change in HI most common?
Injury to orbitofrontal or temporal lobe
54
How many patients with HI develop depression and anxiety?
25%
55
In which HI is paranoia common
Left temporal injury
56
In which HI is affective psychosis common
Right temporal or orbitofrontal injury
57
How many people with HI develop schizophrenia
2.5%
58
How many people with HI develop epilepsy
Closed 5% | Open 30%
59
Recovery rate of post-concussion
50% within 3 months
60
Risk factors of developing post-concussion syndrome
Depression and anxiety | Female gender
61
Treatment of post-concussion syndrome
Early intervention - few weeks - with education and reassurance
62
What are dyssomnias?
Primary sleep disorders which cause difficulty getting to or remaining asleep or excessive sleeping during the day
63
Types of parasomnias
Arousal disorders - arising from NREM sleep Sleep-wake transition disorders REM sleep parasomnias
64
What are parasomnias?
Disorders which intrude into the sleep process
65
Prevalence of narcolepsy
0.025%
66
Symptoms of narcolepsy
Sudden sleep attacks (refreshing as REM) Cataplexy - 75% of patients Sleep paralysis - 30% Hypnagogic hallucinations
67
Prevalence of obstructive sleep apnoea
Men - 4% | Women - 2.5%
68
When does sleep walking occur during sleep
In slow-wave stages 3 and 4 - first third stage of sleep period
69
When do night terrors occur during sleep
Stages 3 and 4 of NREM sleep - first third of the night
70
What happens in REM sleep behavioural disorder
No loss of muscle tone during REM and dreams are acted as complex behaviours. Episodes occur during middle - latter third of night during REM.
71
Which disorders is REM sleep behavioural disorder occur in?
``` Idiopathic Parkinsons Diffuse LBD Multiple system atrophy Guillian Barre ```
72
Treatment of REM sleep behavioural disorder?
Clonazepam | Make sleep environment safe
73
Prevalence of restless legs syndrome
3-15%
74
M:F ratio of restless legs syndrome
1:2
75
Familial pattern in restless legs syndrome
In >50% patients
76
Diagnostic criteria of restless leg syndrome
Aged >12 with akathisia (usually with paraesthesia), motor restlessness, worse at rest and at night
77
Treatment of restless leg syndrome
``` Sleep hygiene Relaxation techniques D2 agonists - Ropinirole (licensed), Pramipexole Anticonvulsants - Gabapentin, CBZ Opioids - oxycodone Clonazepam ```
78
Predisposing factors of restless leg syndrome
``` Iron deficiency Peripheral neuropathy Sedating antihistamines Central dopamine antagonists - metoclopramide, prochlorperazine Antipsychotics Caffeine Antidepressants ```
79
Prevalence of CFS
0.5%
80
M:F ratio of CFS
1:3
81
Mean illness duration of CFS
3-9 years
82
Diagnostic criteria of CFS
Persistent or relapsing, unexplained chronic fatigue of new onset, lasting at least 6 months Four or more of the following symptoms, concurrently present for more than 6 months: impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle pain, pain in several joints, new headaches, unrefreshing sleep, or malaise after exertion.
83
Predictors of poor outcome in CFS
1. Claiming a disability related benefit 2. Low sense of control 3. Strong focus on physical symptoms 4. Being passive with reduced activity 5. Membership of self help group (does not mean self help groups worsen CFS, membership may be an indicator of perceived severity)
84
Predisposing factors of CFS
Neuroticism | Childhood inactivity or illness
85
Precipitating factors of CFS
In | Serious life eventsfectious mononucleosis, Q fever, Lyme disease
86
Perpetuating factors of CFS
``` Strong belief in physical cause Activity avoidance Poor self-control Primary/secondary gains Low self-perception of cognitive ability ```
87
Suggested biological aetiology of CFS
Abnormal HPA axis and serotonin pathway suggest altered physiological response to stress 33% have low cortisol
88
Evidence based treatment of CFS
CBT | Graded exercise therapy
89
Components of CBT for CFS
Explanation of aetiological model Motivation for CBT Challenging and changing of fatigue related cognition Achievement and maintenance of basic amount of physical activity Gradual increase in physical activity Rehabilitation e.g., rigorous self- monitoring, a safety behaviour in social phobia, can feed to the core symptoms.
90
Aims of graded exercise therapy in CFS
Based physiological model of deconditioning. Muscles strength, autonomic response and perception of exercise related sensations are affected by inactivity. Therapy aims to gradually increase the exercise and other activities thus reducing the unwanted consequences of inactivity.
91
Improvement rate of CFS with CBT
70%
92
Improvement rate of CFS with graded exercise therapy
55%
93
Use of antidepressants in CFS
Should not be used
94
Prognosis of CFS
17-65% patients improve over 5 years <10% recover for 5 years 10-20% worsen over time
95
Increased mortality with CFS?
No
96
Prevalence of depression in patients with CFS
23% | 50-75% have a history of depression
97
Lifetime prevalence of GAD in CFS
2-30%
98
Prevalence of somatisation in CFS
28%
99
How many patients with CFS meet criteria for fibromyalgia?
35-70%
100
Prevalence of depression in patients with chronic pain
10-15%
101
Non-medical treatment of chronic pain
CBT
102
Components of CBT in chronic pain
Cognitive restructuring; relaxation training; time-based activity pacing; and graded homework assignments to decrease avoidance and to encourage a more active lifestyle.
103
Prevalence of mental disorder in HIV patients
38-73%
104
Prevalence of anxiety in HIV patients
11-25%
105
Most common mental illness in HIV patients
Depression - 30-60% lifetime prevalence
106
Antidepressants for depression in HIV
SSRIs | TCAS
107
Antipsychotic treatment in HIV
Risperidone
108
Causes of mania in HIV
Illicit drug use Iatrogenic - meds like steroids and antivirals Advaned HIV
109
Prevalence of dementia in AIDS
3%
110
How many patients with AIDS develop dementia in the course of their illness
15%
111
Risk factors for dementia in HIV
Older age Decreased body mass History of IV drug use

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