Psych 1 - Organic, Psychoses, and Mood Flashcards
(142 cards)
1
Q
Define dementia
A
Generalised psychological dysfunction of higher cortical functions without impairment of consciousness
2
Q
Give three reversible causes of dementia
A
Vitamin B3 or B12 deficiency
Subdural haematoma
Hypothyroidism
3
Q
Give three domains that dementia affects
A
Memory Orientation Language Thinking and judgement Emotional control Social behaviour
4
Q
How does delirium differ from dementia?
A
Acute onset
Impaired consciousness
Fluctuating course with lucid intervals
Reversible
5
Q
How is memory assessed in dementia?
A
Mini mental state examination
6
Q
What part of the cortex does Alzheimer’s disease and Pick’s disease affect?
A
Posterior-parietal
Fronto-temporal
7
Q
Give three risk factors for Alzheimer’s disease
A
Family history Female Down's syndrome Age Risk factors for vascular disease
8
Q
What is seen on MRI of Alzheimer’s patients?
A
Global atrophy
Ventricular enlargement
Widened sulci
9
Q
Where are neurofibrillary tangles found in AD, and what do they contain?
A
Cortex, hippocampus, substantia nigra
Tau protein
10
Q
What are Hirano bodies?
A
Silver staining neuritic plaques (senile plaques) seen in Alzheimer’s disease, containing a core of beta-amyloid protein
11
Q
Which enzyme has reduced activity in Alzheimer’s disease?
A
AChE
12
Q
Give three early symptoms of AD
A
Disorientation
Failing memory
Wandering and irritability
13
Q
Give three middle symptoms of AD
A
Intellectual and personality deterioration
Aphasia, apraxia, agnosia
Impaired visuo-spatial skills and executive function
14
Q
Give three late symptoms of AD
A
Physical deterioration including seizures and tremor
Incontinence
Depression and aggression
15
Q
In diagnosis of AD, what investigation excludes delirium and CJD?
A
EEG
16
Q
What does a PET scan show in AD?
A
20-30% reduction in oxygen and glucose metabolism in temporal and parietal lobes
17
Q
What are the initial investigations for dementia?
A
Physical examination and history
Bloods and urine to exclude reversible causes
Cognitive testing
Specialist: PET or SPECT
18
Q
What is the pharmacological treatment of AD and what is a possible side effect??
A
AChE inhibitor: donezpezil/galantamine/rivastigmine
Heart block
19
Q
What is 2nd line treatment for severe AD?
A
NMDA antagonist: memantine
20
Q
What subgroups are used in AD?
A
Mayeux
21
Q
What are the risk factors for vascular dementia?
A
Family or personal history of CV disease Smoking Hypertension Diabetes mellitus Hyperlipidaemia Polycythaemia
22
Q
What are the characteristics of vascular dementia?
A
Emotional and personality changes, followed by a stepwise decline in cognition and memory
Sundowning
23
Q
Vascular dementia may follow…
A
CVA
24
Q
What signs occur in vascular dementia?
A
Rigidity, akinesia, brisk reflexes, PBP, seizures
25
What is Biswanger disease?
Progressive small vessel disease
| Lacunae formation from multiple microinfarcts
26
What are the three subtypes of vascular dementia?
Cognitive deficits following a single stroke
Multi-infarct dementia
Progressive small vessel disease
27
What are the symptoms of Lewy Body dementia?
```
Dementia with lucid episodes
Parkinsonism
Visual people and animals hallucinations
Depression
Autonomic dysfunction - constipation
REM sleep disorder - acting out dreams
```
28
What are Lewy-Bodies?
Eosinophilic intracytoplasmic neuronal inclusions of abnormally phosphorylated neurofilament proteins aggregated with ubiquitin and alpha-synuclein
29
What is seen on SPECT FP-CIT in Lewy Body dementia?
Decreased putamen
| Reduced dopamine transporter uptake
30
Why are anti-psychotics avoided in Lewy-Body dementia?
Severe sensitivity reactions e.g. irreversible 4Parkinsonism
31
What medications are used in Lewy-Body dementia?
Rivastigmine for cognitive decline
Clonazepam for REM sleep disorder
Levodopa can help with movement problems but may worsen psychosis
32
When does Pick's disease present?
Early - 50s
33
What are the three forms of Pick's disease?
Disinhibited
Apathetic
Stereotypic
34
What is the pathophysiology of Pick's disease?
Bilateral atrophy of frontal and anterior temporal lobes
| Striatal degeneration
35
What are the most common symptoms of Pick's disease?
Impaired social conduct and insight
Dietary, speech, and perserverative changes
Cognitive decline
36
What medications are prescribed to control the behavioural symptoms of dementia?
SSRIs
37
What is a prion and in what disease is it seen?
Small infectious pathogen lacking nucleic acid
| CJD
38
What percentage of CJD cases are sporadic?
85% (15% hereditary)
39
What is the pathophysiology of CJD?
Grey matter of cortex gets vacuoles from prion infection
40
Give three symptoms of CJD
Dementia
Motor changes including paralysis and tremor
Seizures
Dysarthria and dysphagia
41
What is seen on EEG in CJD?
Periodic wave complexes, triphasic pattern
42
What does neurosyphilis typically present as?
Progressive frontal dementia
43
Give three symptoms of neurosyphilis
Grandiosity, euphoria, mania, disinhibition
| Personality change
44
Give three signs of neurosyphilis
```
Argyll-Robertson pupils
Tremor
Hyperreflexia
Ataxia
Dysarthria
```
45
Give three psychiatric symptoms of Wilson disease
Mood disturbance
Subcortical dementia
Psychosis
46
What are three causes of frontal-lobe syndrome
Head injury
CVA
Neoplasm
47
Give three symptom of frontal-lobe syndrome
Anhedonia
Loss of abstract thought
Change of affect
48
What is echopraxia and in what conditions is it seen?
Meaningless repetition/imitation of movements
| Frontal lobe syndrome, AD
49
What is normal pressure hydrocephalus?
Dilatation of cerebral ventricles but normal CSF pressure at lumbar puncture
50
What are the causes of NP hydrocephalus?
50% idiopathic
| 50% mechanical obstruction of CSF flow e.g. SAH
51
What is the triad of NP hydrocephalus?
Ataxia
Urinary incontinence
Dementia
52
What is the cause of gait ataxia in NP hydrocephalus?
Pyramidal UMN paraparesis
53
What is the treatment of NP hydrocephalus?
Ventriculoperitoneal shunt
54
What is the most common form of psychosis?
Schizophrenia
55
Give three risk factors of schizophrenia
Family history
Prematurity
Psychosocial stress
56
What is the typical age of onset in schizophrenia?
15-45 years, males earlier
57
What is the cause of the clinical symptoms of schizophrenia?
Central dopaminergic hyperactivity in the mesolimbic mesocortical system
58
What is schizophrenia?
Mental disorder characterized by abnormal social behaviour and failure to understand what is real
59
What brain pathology is seen in patients with schizophrenia?
Ventricular enlargement
Decreased cortical grey matter
Reduced hippocampal size and neurones
60
What are the first rank symptoms of schizophrenia?
Thought alienation
Passivity phenomena
3rd person auditory hallucinations
Delusional perception
61
What type of auditory hallucinations do patients with schizophrenia experience?
Running commentary
Talking/arguing amongst selves
Thought-repeating voices
62
How many first rank symptoms are required to indicate schizophrenia?
>1
63
Name three secondary symptoms of schizophrenia
Other persistent delusions or hallucinations
Breaks in train of thought
Catatonic behaviour
Negative symptoms
Change in personal behaviour e.g. anhedonia, social withdrawal
64
What is catatonic behaviour?
Stupor and excitement
Posturing
Waxy flexibility
65
What are the negative symptoms of schizophrenia?
```
Decrease or absence of normal function:
Lack of emotion
Neglect of personal hygiene
Loss of motivation/interest
Social withdrawal
```
66
What type of schizophrenic symptoms present first?
Negative
67
What type of schizophrenic symptoms respond better to anti-psychotics?
Positive
68
What are the five types of schizophrenia?
```
Paranoid
Hebephrenic/disorganised
Catatonic
Residual
Simple
```
69
What does paranoid schizophrenia consist of?
False beliefs and hearing things that aren't there
| Delusions
70
The schizophrenic type that consists of inappropriate/incomprehensible thoughts, speech and behaviour is...
Hebephrenic
71
What are three differentials for schizophrenia?
Drug-induced psychosis - LSD, cannabis
Encephalitis
Psychotic depression
Personality disorder
72
What is the first line treatment for schizophrenia?
Antipsychotics: risperidone or olanzapine AND
CBT
73
What is second line treatment for schizophrenia?
Change anti-psychotic (up to two times)
THEN clozapine
74
What is associated with poor prognosis in schizophrenia?
```
Childhood/adolescent onset
Gradual onset
Low IQ
Strong family history
Lack of obvious precipitant
```
75
What medication is used if rapid tranquilization is necessary?
Benzodiazepines (short acting)
76
Some antipsychotics have Parkinsonian side effects. What medication is used to combat this?
Procyclidine (anti-cholinergic)
77
What is the name of the condition characterized by non-bizarre delusions, but not hallucinations, thought, or mood disorder?
Delusional disorder
78
What are three risk factors for delusional disorder?
Low socioeconomic status
Substance abuse
Paranoid personality disorder
79
How does delusional disorder present?
Delusions influence thought and behaviour; impaired insight and judgement
80
What is the treatment of delusional disorder?
Anti-psychotics
81
What is schizoaffective disorder?
Features of affective disorder and schizophrenia present in equal proportions
82
How is schizoaffective disorder treated?
As for schizophrenia
| Treat manic or depressive symptoms as for bipolar disorder
83
What does depression consist of?
Negative affect (low mood) and/or absence of positive affect (loss of pleasure and interest)
84
For a diagnosis of depression to be made, DSM-IV states that the core symptoms present must fulfil what criteria?
Present >2 weeks and different from normal
Not secondary to drugs, medication, or bereavement
Cause significant distress and impairment of functioning
85
What are the core symptoms of depression?
```
FLIP WAP
F: feelings of worthlessness/hopelessness/guilt, fatigue
L: libido decreased
I: insomnia/hypersomnia
P: persistent sadness or low mood every day
W: weight and appetite change
A: anhedonia
P: psychomotor retardation or agitation
```
AND decreased concentration, suicidal thoughts
86
What symptoms are seen in psychotic depression that are different to depression?
Negative hallucinations
Delusions of poverty, inadequacy, guilt, deserving of punishment, nilhilism, responsibility for world events
Marked catatonic symptoms
87
Which groups may present atypically with depression?
Elderly - agitation and confusion
| Children - irritability and social withdrawal
88
What are three risk factors for depression?
```
Family history
Bad childhood experiences
Separation or divorce
Unemployment
Adverse life events
Physical illness especially if chronic or painful
```
89
What model is used in the aetiology of depression?
Biopsychosocial
90
What neurotransmitter is found to decrease in function in depression?
GABA
91
What theory of depression involves neurotransmitters?
Monoamine theory of depression
92
What are some organic differentials for depression?
```
Anaemia
Addison's disease
Hypo/hyperthyroidism
Porphryia
Syphilis or HIV
MS/Huntington's/Parkinson's
```
93
What treatment is used for first line mild depression?
Low intensity psychosocial interventions or group CBT
94
What treatment is used for first line moderate to severe depression?
High intensity psychosocial interventions such as individual CBT OR
SSRIs e.g. citalopram
95
What is the treatment of psychotic depression?
Anti psychotic started a few days before anti depressant to avoid worsening of psychosis
96
What is the management of treatment resistant depression?
Change class of anti-D
Combine two types of anti-D
Consider lithium
Consider ECT
97
What is bipolar disorder?
Chronic episodic illness associated with behavioural disturbances
Episodes of mania/hypomania and depression
98
What are the two types of bipolar disorder?
Type 1: manic and major depressive episodes
| Type 2: hypomanic (less severe and no psychoses) and depressive episodes
99
What is rapid cycling bipolar disorder?
4+ cycles of depression and mania a year, with no intervening asymptomatic episodes
100
Describe the treatment of acute manic, acute depressive, and acute mixed bipolar episodes.
Manic - antipsychotics (haloperidol, olanzapine, quetiapine, risperidone), stop anti-Ds
Dep - anti depressant with antipsychotic
Mixed - anti-psychotics
101
What is the treatment of rapid cycling bipolar disorder?
Lithium and sodium valproate
102
What is the long term treatment of bipolar disorder?
Lithium
| Lithium and valproate 2nd line
103
When does post-natal depression usually develop?
After the 3rd week following delivery
104
What are the risk factors for postnatal depression?
Previous psychiatric disorder
Family history
Physical problems during pregnancy
105
What scale is used to identify mothers at risk of post natal depression?
Edinburgh
106
What extra features occur with post-natal depression?
Despondency and tearfulness
Fatigue and anxiety
Fears about baby
Symptoms worse at night
107
What is the treatment of post-natal depression?
Anti-depressants and CBT
108
When does puerperal psychosis occur post partum?
2 weeks
109
What occurs in the prodrome of puerperal psychosis?
Insomnia
Irritability
Restlessness
Refusal of food
110
What type of psychoses occur in puerperal psychosis?
Depressive psychosis
Schizophrenia
Manic episode
111
What is the management of puerperal psychosis?
Treat the psychotic cause e.g. treat mania
112
What is the recurrence risk of puerperal psychosis?
50%
113
What is cyclothymia?
Mood disorder characterised by persistent instability of mood (mild depression and elation)
114
How long must symptoms be present for to diagnose cyclothymia?
2 years
115
When does cyclothymia present?
Teens-early adulthood
116
What is the treatment of cyclothymia?
Lithium
| Psychotherapy such as CBT
117
What is baby blues?
Short-lived disturbance of emotion 3-5 days after delivery
118
What is mania?
A distinct period (>1w) of abnormally and persistently elevated or irritable mood
119
Give three symptoms of mania
```
Increased energy
Elevated mood
Increased self esteem
Reduced attention
Inappropriate spending/sexual behaviours
```
120
How might increased energy present in mania?
```
Overactivity
Pressure of speech
Flight of ideas
Racing thoughts
Decreased need for sleep
```
121
Give three psychotic symptoms of mania
```
Delusional grandiose ideas
Incomprehensible speech
Violent behaviour
Manic stupor
Total loss of insight
```
122
How is mania treated?
Lithium, valproate, or carbamazepine
123
How is hypomania treated?
Atypical antipsychotics such as risperidone,
| Lithium
124
What is the difference between mania and hypomania?
Lesser extent
| No psychoses
125
What is word salad?
Disorganised speech, sentences do not make sense
126
What is neologism?
Making up new words
127
What is Cotard syndrome?
Patient believes they are dead
128
When is ECT indicated?
Catatonia
Severe depression
Severe mania
Treatment resistant schizophrenia
129
If a patient is started on an anti-psychotic, what are the regular investigations that should be done regularly to monitor for side effects?
BMI
ECG
Bloods - FBC, UE, LFT, lipids, glucose, HbA1c, prolactin
130
What receptors do atypical antipsychotics target?
Serotonin-dopaminergic D2 receptor
131
What delusions are seen in paranoid schizophrenia?
Persecutory delusions
Grandiose delusions
Delusions of reference
132
What are three mild symptoms of lithium toxicity?
D+V
Dystonia
Weakness/tremor
Hypothyroidism
133
What are three symptoms of severe lithium toxicity?
Brisk tendon reflexes
Seizures
Hypotension
Coma and death
134
Which SSRI has the highest risk of congenital malformations in the first trimester?
Paroxetine
135
What is the risk of taking SSRIs in pregnancy?
1st trimester - small increased risk of heart defects
2nd trimester - no increased risk
3rd trimester - risk of persistent pulmonary hypertension in the newborn
136
In which conditions are flight of ideas, and knight's move seen?
Flight of ideas - mania
| Knight's move - schizophrenia
137
Which medication can be used to treat sleep paralysis?
Clonazepam
138
What is a short term side effect of ECT?
Arrhythmias
139
What drug is used to combat cardiovascular complications caused by overdose of TCAs?
Bicarbonates
140
What are the first and second line treatments of catatonia?
1. ECT
| 2. 2nd/3rd gen anti-D e.g. fluoxetine or citalopram
141
Which tool is used to monitor patients in alcohol withdrawal?
Clinical Institute Withdrawal Assessment
142
What does a PET scan of a patient with schizophrenia and OCD show?
Schizo - hypoactivity of the prefrontal cortex, symmetrical enlargement of ventricles
OCD - hyperactivity of the prefrontal cortex
