MH Flashcards
(17 cards)
EPSEs (5)
1) Acute dystonia • Oculogyric crisis • Retrocollis, torticollis • Tongue protrusion • Laryngeal/pharyngeal spasm 2) Parkinsonism - last 5-90 days • Rigidity • Bradykinesia • Tremor 3) Akathisia • Restlessness • Motor agitation 4) Tardive dyskinesia (late) • Irregular jerky movements • Head, limbs, trunk 5) Neuroleptic malignant syndrome • Fever, • Muscular rigidity • Altered mental status • Autonomic dysfunction
DSM - GAD
1) >6mo excessive anxiety/worry present most of the time
2) Inability to manage Sx
3) At least three of physical or cognitive Sx: • Muscle tension • Irritability • Sleep disruption • Tired/fatigued • Impaired conc • Restlessness 4) Sx affect fx
(Sx not due to medications, drugs, other medical probs)
(Sx not part of another psych disorder eg. panic disorder)
DSM 5 - OCD
1) Presence of obsession, compulsions or both
2) Obsessions or compulsions result in:
• Marked distress >1 hour per day
• Impair routine, occupational/academic fx, social
activities or relationships
3) Exclusion of general medical condition
4) Exclusion of other psychiatric disorder
Features of obsessions
1) Thoughts/urges/ images are:
• Persistent, recurrent
• Intrusive, unwanted
• Cause marked anxiety or distress
2) Attempts to:
• Ignore or suppress
• Neutralise thoughts with another action
Features of compulsions
1) Repetitive behaviours/mental acts:
• Driven to perform in response to obsession
• According to rules that must be applied rigidly
• eg. praying, counting, repeating words silently
2) Behaviours or mental acts:
• Aimed to prevent/reduce distress
• Prevent dreaded event/situation
• Not connected in real way to obsession, or are excessive
DSM -Adjustment disorder
1) Emotional or behavioral symptoms
• Low mood
• Anxiety
• Conduct disturbance
2) Response to stressor within 3 months
3) Distress out of proportion to stressor or significant impaired fx
4) After termination of stressor (or its consequences), Sx do not persiste longer than 6mo
DSM - PTSD
> 1mo Sx, causing distress or fxal impairment
1) Stressor
• Exposure to death, serious injury, sexual violence
○ Directly experiencing the event
○ Witnessing the event
○ Event occurred to someone close
○ Repeated indirect exposure to details
2) Intrusion Sx
• Traumatic event is persistently re-experienced:
○ Recurrent, involuntary intrusive memories
○ Traumatic nightmares
○ Dissociative reactions eg. flashbacks
3) Avoidance
• Effortful avoidance of distressing stimuli:
○ Trauma related thoughts or feelings
○ Trauma-related external reminders
4) Negative alterations in thoughts and mood
• Dissociative amnesia
• Distorted negative beliefs about self/the world
• Restricted affect
5) Alterations in arousal and reactivity • Trauma-related alterations in arousal/reactivity: ○ Irritable or aggressive behaviour ○ Self-destructive or reckless behaviour ○ Hyper-vigilance ○ Exaggerated startle response ○ Problems in concentration ○ Sleep disturbance
DSM 5 - Depression
2+ weeks of: low mood + anhedonia plus 5 of:
- Sleep - Interest (anhedonia) - Guilt/worthlessness/helplessness - Mood, memory - Energy - Concentration - Appetite change - Psychomotor retardation/agitation - Suicidal ideation
DSM 5 - BPAD
Presence of manic episode:
- At least 1 week OR - Leads to hospitalisation OR - Significant impairment in occupational or social functioning
Manic episode criteria
1 week profound mood disturbance, characterised by:
1) Elation OR
2) Irritability OR
3) Expansiveness
PLUS at least 3 of:
Mood elevation Activity - increased, goal-focused Distractibility Grandiosity Reduced Sleep Impulsive, irritability Talkativeness Sleep (less)
DSM 5 - Schizophrenia
At least 6mo of (if less, schizophreniform):
Two of:
1. Delusions 2. Hallucinations 3. Disorganised Speech/Thought 4. Grossly disorganized or catatonic behaviour 5. Negative Sx: - Alogia - Avolition - Amotivation - Anorgasmia - Affect flattening - Anhedonia - Paucity of Thought
Affecting function
Drug-induced psychosis
Criteria:
1. Onset of Sx and Drug Exposure has clear temporal sequence 2. Resolution of Sx with Drug Cessation 3. Relatively short duration of Sx (<1m)
Dopamine pathways and their roles
- Mesocortical pathway
• Hypoactivity
• Negative Sx
• Cognitive impairment - Mesolimbic pathway
• Hyperactivity
• Positive Sx - Nigrostriatal pathway
• EPSEs - Tuberoinfundibular pathway
• Inhibits prolactin release (monitor prolactin on anti-psychotics)
Side effects of SSRIs
- CNS • Restlessness • Tremor • Insomnia • Headache - GIT • n/v/d • Abdominal cramps - Weight gain - Sexual dysfunction
General approaches for management of GAD
- General approaches - symptom control • Relaxation techniques • Deep breathing • Visualisation • Progressive muscle relaxation • Coping skills • Stress management • Activity scheduling • Modifying lifestyle factors • Problem-focused counselling
Pharmacological management of GAD
- Pharmacological - if psychological insufficient/ unavailable
• SSRI
• citalopram 10-40mg
• fluoxetine 20-80mg
• sertraline 50-200mg
Take 4-6wks for effect, continue 6mo before stopping• SNRI
○ duloxetine 30mg
○ venlafaxine - 75mg• Benzodiazepines
○ Short-term pharmacotherapy (<2wks) if:
§ Sx severe
§ Significant impairment of fx
§ Inadequate response to psych Rx
○ Diazepam 2-5mg, single dose, up to 2wks
○ Temazepam
○ Safe prescribing of benzos
§ Screen for hx EtOH or drug abuse
§ Caution prescribing to unfamiliar pts
§ Carefully discuss potential for addiction
§ Prescribe small quantities for short term
§ Ensure regular review• Clomipramine - TCA - used for refractory cases
Management OCD
- Psychological
• Psychoeducation
• CBT
○ Cognitive challenging
○ Graded exposure therapy + exposure response prevention
○ Pts may require initial response to pharmacotherapy before commencing psychological therapies - Pharmacotherapy
• SSRI - often require higher dose than for depression, wait 6 wks for effect
○ fluoxetine 20-80mg
○ sertraline 50-200mg
