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Year 5 Psych > Neuropsychiatry and Substance Use > Flashcards

Neuropsychiatry and Substance Use Flashcards

(58 cards)

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1
Q

Depressant misuse-tx

A

Medical stabilization if needed
Safe injection practices/needle exchange
If dependent-managed detox, maintenance prescribing

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2
Q

Solvent misuse

A

Red rash around nose and mouth
Mostly young boys
Initial euphoria then drowsines
Psych dependence > physical dependence

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3
Q

Short acting benzos

A

More addicting, although sometimes better for old folks

Temazepam, oxazepam

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4
Q

Medium acting benzos

A

Lorazepam, alprazolam

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5
Q

Long acting benzos

A

Least addicting. Caution in elderly

Diazepam, nitrazepam, chlordiazepoxide

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6
Q

PCP

A

Angel dust
Smoked
Euphoria and peripheral analgesia, impaired consciousness or psychosis

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7
Q

Khat

A

Men from Somali/Yemeni communities
Contains cathionine, an amphetamine-like stimulant
Excitement and euphoria
Not a controlled substance in UK

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8
Q

Nicotine

A

1/4 British adults smoke

Tx-counselling, nicotine replacement therapy, varenicline, bupripion may help cessation

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9
Q

Cannabis

A

Most commonly used illegal drug
Can exacerbate chronic psychotic illness
THC is active ingredient-acts on cannabinoid receptor. Also opiate-like effects and barbiturate-like effects
Mild euphoria, sense of well-being, subjective sense enhanced sensation, relaxation, altered time sense, increased appetite

Not associated with physical dependency but heavy users if suddenly stop can get insomnia, anxiety, irritability

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10
Q

Alcohol abuse

A

Regular or binge consumption alcohol sufficient to cause physical, neuropsychiatric, or social damage

Safe limits: 21u/week for men, 14u/week for women

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11
Q

Alcohol-MOA

A

Enhancement GABA-A transmission (anxiolytic)
Release Da in mesolimbic pathway (reward)
Inhibition NMDA-mediated glutaminergic transmission (amnesic)

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12
Q

Bio-Psycho-Social causes EtOH dependence

A

Genetics: high acetaldehyde producers less likely to abuse (worse hangover). E.g. Japanses people and “flush reaction”
Psycho: FHx depression, other psych or physical illness, esp chronic pain. Imitation, classical conditioning, social reinforcement
Social: Occupation (armed forces, doctors, publicans, journalists), culture (Scots, Irish high whereas Jewish, Muslim low)

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13
Q

Wernicke’s encephalopathy

A

EtOH.
Thiamine deficiency causes mamillary body damage
Ataxia, ophthalmoplegia, acute confusion

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14
Q

Depressants (misuse)

A

Benzos.
Pleasurable anxiolytic and relaxant properties
Used to come down after stimulant use

Can cause forgetfulness, drowsiness, impaired coordination
Chronically- impaired concentration and memory, depressed mood
Dependency after 3-6w regular use
Withdrawal can be complicated by seizures and delirium

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15
Q

Korsakoff’s psychosis

A

Profound short-term memory loss characterized by confabulation

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16
Q

Viral encephalitis

A

Herpes simplex
50% survivors experience disturbaces of behavior, concentration, or social adjustment
May have chronic cognitive impairment

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17
Q

Tertiary syphilis

A

Rare
Neurosyph “general paralysis of the insane”:
Personality change (disinhibition, irritability, lability)
Cognitive impairment and poor concentration
Dementia
Depression
Grandiosity
Rarely, mania and schizophrenia-lie psychoses

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18
Q

Prion disease

A

Human forms of spongiform encephalopathy are rare.
vCJD, kuru,
Rapidly fatal dementia
Classic CJD presents with physical sxs
vCJD starts with psych sxs–mood swings, fatigue, social withdrawal

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19
Q

HIV and AIDS

A

Worried well: preoccupation with possibility of becoming infected

Psychological reactions to HIV infection: periods of crisis after learning of infection, starting HAART, tests indicating problem with tx, development HIV-related illness. Adjustment disorder, acute stress reaction, risk deliberate self-harm

Psychiartirc illness: depression (NB AIDS-like dementia can present similarly), acute mania, schizophrenia-like psychoses

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20
Q

Epilepsy-psychological aspects

A

Psychosocial consequences of dx, psych syndromes directly attributed to epilepsy, neuropsych effects of medications

Prodromal sxs: tension, dysphoria, insomnia days-hrs before
Ictal:
-automatisms. Usu

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21
Q

Anti-epileptics that also improve mood

A

Carbamazepine and lamotrigine

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22
Q

Post-concussional syndrome

A

Anxiety, depression, irritability, emotional lability, insomnia, hypersensitivity to noise and light, reduced concentration, chronic tiredness

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23
Q

Punch-drunk syndrome

A

Repeated minor head injuries.
Clinical picture of dementia with movement disorder
Retired boxers

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24
Q

Psych complications to cerebrovascular disease

Study These Flashcards
A

1/3 develop depression within 1 year
May also have anxiety disorder, apathy, emotional incontinence
Progressive CVSs can lead to picture of dementia

25
Brain tumors--psych effects
Behavioral, affective, psychotic, personality, and cognitive disturbances via mass effect, hydrocephalus etc
26
Parkinson's-psych complications
Dementia: 20-30% develop some cognitive deterioration. usually subcortical dementia with slowing, impaired executive function, personality change, memory impairment Depression: 40-70%. Partly disease, partly experience thereof Can have psychosis (psychotic depression) and delirium
27
Huntington's-psych complications
Subcortical dementia: mental slowing, impaired executive function. Speech deteriorates faster than comprehension Psych disturbances v common-changes in personality and behavior. Affective disorders, schizophreniform psychoses. Not related to severity of disease.
28
Acute alcohol intoxication
Slurred speech, impaired coordination and judgment, labile affect Severe: hypoglycemia, stupor, coma
29
Acute alcohol withdrawal
Within 1-2 days abstinence Malaise, nausea, autonomic hyperactivity, tremulousness, labile mood, imsomnia, transient hallucinations DTs in 5% with mortality up to 15% 5-15%-tonic clonic seizures 6-48hrs after last drink
30
DTs
Peak incidence 48 hrs Features wthdrawal plus clouding consciousness, disorientation, amnesia for recent events, psychomotor agitation, visual/auditory/tactile halluc (Lilliputian common) Hourly fluctuations (worse at night) If severe, heavy sweating, fear, paranoid delusions, agitation, suggestibility, temp, sudden CV collapse
31
Alcohol dependence
``` Compulsion to drink Loss ability to regulate drinking Altered tolerance Withdrawal phenomena Persistence after attempted abstinence ```
32
Biological Tx-alcohol withdrawal
Benzos: Chlordiazepoxide if outpt, diazepam for inpatient Antipsychotics: prn haloperidol if increasing dose benzos does not manage hallucinations Vitamins: B1 parenterally. BEFORE glucose Most pts outpatient. Can follow up daily if worried about compliance, drinking on top of drugs Inpts if hx complicated withdrawal, comorbidities, suicide risk, Wernicke-Korsakoffs, severe N&V, lack stable home environment Provide written advice, inform GP, emergency contact #, followup
33
Disulfiram
Inhibits acetaldehyde dehydrogenase, therefore acetaldehyde builds up (causing hangover sxs). Prescribe once abstinence achieved
34
Acamprosate
Enhances GABA transmission and diminishes alcohol cravings
35
Naltrexone in alcohol misuse
Diminishes high from alcohol
36
Pysch tx for alcohol misuse
Motivational interviewing: aid pt in explaining why they need to change their behavior Plan interventions with pt Weekly limits-no saving up None if pregnant, driving Do not drink alone, avoid heavy drinkers, don't buy rounds, alternate soft drinks and alcohol, drink with meal, rehearse declining drink, plan non-drinking activities (social skills training) Problem-solving skills, relaxation training, anger management, cognitive restructuring ALCOHOLICS ANONYMOUS
37
Definition-dependence
Includes withdrawal state and tolerance | usually reduction or neglect of social, occupational, or recreational activities
38
Dependence syndrome
Drug-seeking behavior Narrowing of drug repertoire (e.g. instead of different drinks, now only Stella) Increased tolerance Loss control of consumption Withdrawal Drug taken to avoid withdrawal sxs Continued drug use despite negative consequences Rapid reinstatement previous pattern of drug use after abstinence
39
Opiates
E.g. heroin Virtually immediate euphoria. Diminished pain, feelings detachment 10% become dependent, 2-3% die annually Medical problems: N&V, constipation, resp depression, LOC with aspiration. Injected--local abscesses, cellulitis, osteomyelitis, bacterial endocarditis, septicemia, infection Withdrawal sxs: craving, flu-like, sweating, piloerection, yawning
40
Tx-opiate misuse
Bio: methadone, buprenorphine for detox. Naltrexone can be used acutely and to prevent relapse Psychosocial: safer injecting advice
41
Hallucinogens
Heightened perception, dilated pupils, periph vasoconstricton, increased temp. No dependence LSD, PCP, magic muschrooms ("liberty cap"), ketamine
42
Autobiographical memory
Aka episodic memory | Relates to specific events and issues in one's life
43
Procedural memory
Aka implicit memory. "How to do things" E.g. drive a car
44
Semantic memory
Knowledge base | E.g. nine times table
45
Topographical memory
Orientation | E.g. me forgetting how to get to St Mary's
46
Confabulation
False memories
47
Deja vu
Sense of familiarity | Seen in temporal lobe epilepsy and non-pathological states
48
Ganser's syndrome
Give approximate answers. | E.g. when asked how many legs a cow has, answers "5"
49
Jamais vu
Sense that a familiar place has never before been encountered
50
Perseveration
"Capital of UK?" "London" "Dates of WWII?" "London" Seen in organic brain disease
51
Logoclonia
Repeating last syllable-ble-ble-ble Seen in parkinsons-sons-sons
52
Harmful use
Misuse of drug >1/12 despite damage to user's physical or mental health
53
Complicated withdrawal
Associated with delirium, seizures, or psychotic features
54
Wernickes triad
Ataxia, ophthalmoplegia, confusion
55
Korsakoff's
Amnesia, normal level consciousness
56
Marchiafava-Bignami syndrome
Corpus callosum demyelinization Associated with chronic alcoholism Sudden stupor, coma, seizures, dementia, incontinence, aphasia, apraxia
57
Charles-Bonnet syndrome
Complex visual hallucinations in people with severe vision impairment. Insight retained
58
Gerstman's syndrome
L-R disorientation, dyscalculia, agraphia, finger agnosia Parietal lobe injury

Year 5 Psych (5 decks)

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