Mental Health Flashcards
(53 cards)
1
Q
Characteristics of vascular dementia ?
A
Represents cumulative effect of many small strokes:
- sudden onset and stepwise deterioration
- evidence of vascular pathology (hypertension, past stroke, focal CNS signs)
2
Q
Characteristic presentation of Lewy body dementia ?
A
- fluctuating cognitive impairment
- detailed visual hallucinations (e.g. Small animals or children)
- Parkinsonism
- histology= Lewy bodies in brainstem and neocortex
3
Q
Characteristics of picks dementia ?
A
- frontal and temporal atrophy without Alzheimer’s histology
- linked to genes on chromosome 9
- executive impairment
- behaviour and personality change
- early preservation of episodic memory and spatial orientation
- disinhibition
- hyper orality
- emotional unconcern
4
Q
What are the positive symptoms of dementia ?
A
- wandering
- aggression
- flight of ideas
- logorrhoea
5
Q
Pathogenesis if Alzheimer’s disease
A
accumulation if beta amyloid peptide (degradation product of amyloid precursor protein) results in:
- progressive neuronal damage
- neurofibrillary tangles
- increased no. Amyloid plaques
- loss of acetylcholine
- defective clearance of beta amyloid plaques by macrophages
- selective neuronal loss
6
Q
Which areas are vulnerable to neuronal loss in AD ?
A
- hippocampus
- amygdala
- temporal neocortex and subcortical nuclei
7
Q
Risk factors for AD ?
A
- first degree relative with AD
- Down’s syndrome
- vascular risk factors
- depression and loneliness
8
Q
Presentation of AD ?
A
Progressive and GLOBAL cognitive impairment (unlike any other dementia which affect certain domains)
- visuospatial skills (gets lost)
- memory
- verbal ability
- executive function
- ansognosia (lack of awareness)
9
Q
Pharmacological treatment for cognitive decline in AD
A
- donepezil (acetylcholinesterase inhibitor)
- rivastigmine (parasympathomimetic) - also for Parkinson’s
- galantamine (cholinesterase inhibitor) - vascular origin
10
Q
What is Huntington’s disease ?
A
Incurable, progressive, Neurodegenerative disorder presenting. Middle age
- often prodromal phase of mild symptoms (irritability, depression, incoordination)
- progresses to chorea, dementia +/- fits
- death ~15 years after diagnosis
11
Q
Pathogenesis of huntingtons
A
- Atrophy and neuronal loss of striatum and cortex
- genetic basis: expansion of CAG repeat on chromosome 4
- no treatment prevents progression
12
Q
Pathogenesis of CJD
A
- Prion protein (PrPSc), misfiled form of normal protein that can turn other proteins into prions
- increased PrPSc -> spongiform changes (tiny cavities) in brain
13
Q
Signs of CJD
A
- progressive dementia
- focal CNS signs
- myoclonus
- depression
- eye signs: diplopia, supranuclear palsy, Hallucinations etc
14
Q
What are the 8 signs of delirium ?
A
DELIRIUM: globally impaired cognition, awareness/consciousness
D- disordered thinking
E- euphoric, fearful, depressed or angry: labile mood
L- language impaired: reduced, repetitive, disruptive
I- illusions, delusions, hallucinations (tactile or visual)
R- reversal of sleep-wake cycle
I- inattention: distractable
U- unaware/disorientated
M- memory deficits
15
Q
Causes of delirium
A
- systemic infection (pneumonia, UTI, malaria, wounds
- intracranial infection: encephalitis, meningitis
- drugs: opiates, sedatives, anticonvulsants, levodopa
- alcohol withdrawal
- metabolic: uraemic, liver failure etc
- hypoxia
- head injury
- epilsepsy
16
Q
Investigations in delirium
A
- FBC, U&Es, LFT, blood glucose,
- ABG
- septic screen (urine dipstick, CXR, blood cultures)
- ECG
- malaria films
- LP
- CT/MRI
- EEG
17
Q
What is somatisation
A
Multiple, recurrent and frequently changing physical symptoms usually present for several years with negative investigations
18
Q
Which conditions is somatisation associated with ?
A
- IBS
- chronic pain
- post traumatic stress disorder
- antisocial personality disorder
19
Q
Pathogenesis of somatisation ?
A
The somatising patient seems to seek the sick role, which affords relief from stressful or impossible interpersonal expectations (‘Primary gain’)
- in most societies this provides attention, caring and sometimes monetary reward (‘secondary gain’)
- this is not malingering as patient is unaware of process through which symptoms arise, cannot will them away and genuinely suffers from the symptoms
20
Q
Presenting features of somatisation
A
- patients feelings and behaviours about symptoms are disproportionate or excessive
- life long history of ‘sickliness’
- combo if symptoms with and without organic causes
- stress worsens symptoms
- cardiac: palpitations, sob, chest pain
- GI: abdo pain, bloating, diarrhoea, vomiting
- MSK: back and joint pain
- neuro: headaches, dizziness, vision changes, headaches
- urogenital: low libido, dysmenorrhea, dysuria
21
Q
Typical features pointing to somatisation for diagnosis
A
- multiple symptoms often in different organ systems
- vague symptoms exceeding objective findings
- chronic course
- psychiatric disorder e.g. depression, anxiety
- history of extensive diagnostic testing
- rejection of previous physicians
22
Q
What emotional responses of practitioner to patient should point them. To considering somatisation
A
- frustration and anger at number and complexity of symptoms snd the time required to evaluate them in an apparently well person
- a sense of being overwhelmed by a patient who has had numerous evaluations by other physicians
23
Q
What questions should you ask someone you suspect has a somatoform disorder ?.
A
BATHE:
B- background - what is going on in their life
A- affect- how do you feel about that
T- trouble- what troubles you most about the situation
H- handle- what helps you handle that
E- empathy- understand it is a tough situation to be in, your reaction makes sense to me
24
Q
Management of somatisation
A
- stress relief
- coping methods
- psychotherapy e.g. CBT
- antidepressants if anxiety or depression present
25
Investigations in dementia
- FBC, ESR , U&Es, Ca, LFT, TSH, autoantibodies, B12/folate,
- syphilis serology
- CT/MRI For vascular damage , structural path etc
26
Diagnostic criteria for major depression
At least one core symptom:
- persistent sad or low mood almost every day
- loss of interests or pleasure in most activities
Plus some of the followng:
- fatigue or loss of energy
- worthlessness, excessive or inappropriate guilt
- recurrent thoughts of death, suicidal thoughts, suicide attempts
- diminished ability to concentrate
- psychomotor agitation /retardation
- insomnia/hyper insomnia
- changes in appetite and/or weight loss
*5 required to make diagnosis, present for at least 2 weeks causing significant distress
27
Risk factors for depression
- female sex
- past history of depression
- chronic illness
- other mental health problems e.g. Dementia
28
What percentage of depressed patients present with somatisation ?
~2/3
29
Which medications may cause depression ?
- centrally acting antihypertensives e.g. Methyldopa
- lipid soluble beta blocker (e.g. Propanolol)
- benzodiazepines or other CNS depressants
- progesterone contraceptives esp. Injection
30
What conditions are associated with depression ?
- eating disorders
- substance misuse
- other psych e.g. Anxiety, panic, OCD
- Parkinson's
- chronic disease e.g. DM, Stroke, cancer, autoimmune
31
First line antidepressant in children and young people ?
Fluoxetine (SSRI)
32
First line antidepressant in adults ?
SSRI as same effectiveness as tricyclics but less side effects and less toxic in overdose
- citalopram, paroxetine, Sertraline
33
Risk factors for generalised anxiety disorder
- aged 35-54
- being divorced or separated
- living alone or a line parent
34
Diagnostic criteria for generalised anxiety disorder ?
Excessive anxiety or worry occurring more days than not about wide range of events. Difficult to control worry. Associated with 3+ of:
- restlessness/on edge
- easily fatigued
- difficulty concentrating/mind blank
- irritability
- muscle tension
- sleep Disturbance
PLUS 4 of following, 1 from first group:
- autonomic arousal: palpitations, sweating, shaking
- chest & abdo: difficulty breathing, choking feeling, chest pain discomfort, abdominal distress
- mental state: dizzy, derealisation/depersonalisation, going crazy, fear of dying
- general: hot flushes, numbness, tingling, muscle tension aches and pains
- non-specific: being startled, persistent irritability, difficulty getting to sleep
35
First line drug treatment for generalised anxiety disorder
Sertraline
36
Define self harm
An act with nonfatal outcome in which an individual did 1+ of:
- a behaviour intended to cause harm (e.g. Cutting)
- ingesting a substance in excess e.g. Prescribed drug or illicit drug
- ingesting a non-ingestible substance or liquid
37
Which conditions are associated with self harm?
- borderline personality disorder
- depression
- bipolar
- schizophrenia
- drug or alcohol abuse
38
Risk factors for self harm
- socioeconomic disadvantage
- bullying, physcial/mental abuse
- mental health conditions
- eating disorders
- South Asian women
39
What symptoms of depression are most likely to present first ?
- chronic fatigue
| - headache
40
What is dysthymia?
Chronic low grade unipolar depressive illness that lasts for 2 years or more and is characterised by tiredness and low mood
41
What abnormal blood results may point to alcoholism ?
- Abnormal LFTs
- macrocytosis
- raised MCV and deceased platelets
* gamma-GT best indicator of excessive alcohol consumption
42
What are the two main aspects of alcohol assessment ?
- is their alcohol a problem
| - do they have any illnesses relating to alcohol intake - physical, psychological and social
43
What are the aspects of alcohol use needed to ask about in order to determine dependence ?
- strong desire to drink
- difficulty controlling alcohol
- physiological withdrawal when intake reduced
- tolerance e.g. Increasing amount to get same effect
- harm from alcohol use e.g. Work, relationships
44
What are the symptoms of alcohol withdrawal?
- hyperactivity, anxiety and coarse peripheral tremor
- mild Pyrexia, tachycardia, hypertension
- sweating, nausea and retching
- seizures
- auditory and visual hallucinations
- delirium tremens= severe form of above symptoms + circulatory collapse and ketoacidosis
45
What signs of disease due to alcoholism should be looked for ?
- malnourishment
- signs of acute withdrawal e.g. Coarse tremor, tachycardia
- liver disease: palmar erythema, gynaecomastia, spider naevi, jaundice
- hepatomegaly ( in chronic alcoholic liver disease= shrunken)
- Ascites
- AF
- Wernicke's-korsakoff syndrome
46
What is Wernicke's-Kirsakoff syndrome ?
Encephalopathy resulting from thiamine deficiency, usually due to alcoholism
47
Pathogenesis of Wernicke's-Korsakoffs syndrome ?
Chronic alcohol consumption can result in thiamine deficiency by causing:
- inadequate nutritional thiamine intake
- decreased absorption of thiamine from GI tract
- impaired imagine utilisation in cells
Thiamine is required as cofactors in enzymatic processes and lack results in:
- neuronal loss
- interference with cellular function
48
Symptoms of Wernicke's-Korsakoffs?
- vision changes: diplopia, eye palsy, ptosis
- loss of muscle coordination
- profound loss of memory
- inability to form new memory's
- hallucinations
49
Signs of Wernicke's-Korsakoffs syndrome ?
Usually mentally alert with vocab, comprehension, motor skills, social habits and naming ability maintained:
- polyneuropathy on nervous system exam
- abnormal reflexes
- gait and coordination abnormalities
- nystagmus, bilat lat rectus palsy
- low BP and body temp
- high pulse
50
Cognitive features of Wernicke's-Korsakoffs
- confabulation: falsification on memory in clear consciousness, can answer questions promptly with inaccurate and bizarre answers
- memory loss: anterograde amnesia, disorientated in time and place
51
When should patients in alcohol withdrawal be sent for inpatient detox ?
- Disorientation, agitation or seizures occur
- suicide risk
- those without social support
- history of severe withdrawal symptoms
52
Drugs used to treat acute alcohol withdrawal
- benzodiazepines: long term (e.g. Diazepam) to reduce tremor and agitation, short acting (e.g. Lorazepam)for seizures
- vit B complex: IV pabrinex For few days then oral thiamine and multivitamins (pabrinex used to treat W-K)
- beta blockers- reduce autonomic hyperactivity (not used often)
53
Treatment for maintenance of abstinence from alcohol
- Calcium acetyl-homotaurinate (acamprosate): blocks GABA and reduces NMDA receptor glutamate-related excitation, neuro protective, reduces cravings, doesn't interact with alcohol
- Naltrexone: reduces pleasure effects of alcohol by competitively binding to opioid receptor (preventing endogenous opioid from binding)
*all treatment in conjunction with psychosocial interventions
