Psych 4 Flashcards
What is charles-Bonnet syndrome?
= persistent/recurrent complex visual (/auditory) hallucinations occurring in clear consciousness, usually on a background of visual impairment
- in absence of significant neuropsych disturbance
- 1/3 find the hallucinations unpleasant/disturbing; insight usually preserved; usually transient for a few years
RFs for charles-bonnet syndrome?
commonest ophthalmological ass conditions?
- advancing age
- peripheral visual impairment
- social isolation
- sensory deprivation
- early cognitive impairment
- AMD commonest, also glaucoma & cataract common
Failure to conform to social norms with respect to lawful behaviours - repeating acts that are grounds for arrest;
Deception - repeatedly lying, use of aliases, or conning for personal profit/pleasure;
Impulsiveness or failure to plan ahead;
Irritability & aggressiveness - repeated physical fights/assaults;
Reckless disregard for safety of self/others;
Consistent irresponsibility - repeated failure to sustain consistent work behavior or honour financial obligations;
Lack of remorse - indifferent to or rationalizing having hurt, mistreated, or stolen from another
Antisocial PD
Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism/rejection.
Unwillingness to be involved unless certain of being liked
Preoccupied with ideas that they are being criticised or rejected in social situations
Restraint in intimate relationships due to the fear of being ridiculed
Reluctance to take personal risks due to fears of embarrassment
Views self as inept and inferior to others
Social isolation accompanied by a craving for social contact
Avoidant PD
Efforts to avoid real/imagined abandonment
Unstable interpersonal relationships which alternate between idealization & devaluation
Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
Recurrent suicidal behaviour
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts
Borderline PD
Difficulty making everyday decisions without XS reassurance from others
Need for others to assume responsibility for major areas of their life
Difficulty in expressing disagreement with others due to fears of losing support
Lack of initiative
Unrealistic fears of being left to care for themselves
Urgent search for another relationship as a source of care & support when a close relationship ends
Extensive efforts to obtain support from others
Unrealistic feelings that they cannot care for themselves
Dependent PD
Inappropriate sexual seductiveness
Need to be the centre of attention
Rapidly shifting & shallow expression of emotions
Suggestibility
Physical appearance used for attention seeking purposes
Impressionistic speech lacking detail
Self dramatization
Relationships considered to be more intimate than they are
Histrionic PD
Grandiose sense of self importance Preoccupation with fantasies of unlimited success, power, or beauty Sense of entitlement Taking advantage of others to achieve own needs Lack of empathy Excessive need for admiration Chronic envy Arrogant and haughty attitude
Narcissistic
Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities
Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness
Obsessive-compulsive PD
Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others
Preoccupation with conspirational beliefs and hidden meaning
Unwarranted tendency to perceive attacks on their character
Paranoid PD
Indifference to praise and criticism Preference for solitary activities Lack of interest in sexual interactions Lack of desire for companionship Emotional coldness Few interests Few friends or confidants other than family
Schizoid PD
Ideas of reference (differ from delusions in that some insight is retained) Odd beliefs and magical thinking Unusual perceptual disturbances Paranoid ideation and suspiciousness Odd, eccentric behaviour Lack of close friends other than family members Inappropriate affect Odd speech without being incoherent
Schizotypal PD
MoA of benzodiazepines?
what can they be used for?
Enhance effect of inhibitory GABA by increasing frequency of chloride channels
- sedation
- hypnotic
- anxiolytic
- anticonvulsant
- muscle relaxant
How long should benzodiazepines be prescribed for?
Why ?
How should they be withdrawn?
What if they’re having difficulty?
- only prescribe for short period 2-4weeks
- can develop tolerance & dependence quickly
Withdraw in steps of about 1/8 daily dose every fortnight
If difficulty:
- switch to equivalent diazepam dose
- reduce dose every 2-3wks in steps of 2-2.5mg
- time needed for withdrawal can vary from 4wks-1yr+
Features of benzodiazepine withdrawal syndrome?
- can occur unto 3 wks after stopping a long-acting drug
- insomnia, irritability, anxiety
- tremor, tinnitus, perspiration
- loss of appetite, perceptual disturbances, seizures
Indications for electroconvulsive Rx?
Absolute C/I?
Short & long-term side-effects?
- severe refractory depression
- psychosis
- raised ICP absolute C/I
- nausea, headache
- short-term memory impairment, memory loss of events prior to ECT
- cardiac arrhythmia
long term some report impaired memory
- multiple physical Sx for at least 2yrs
- pt refuses to accept reassurance or negative test results
Somatisation disorder
- persistent belief in presence of underlying serious disease e.g. cancer
- pt refuses to accept reassurance/negative test results
Hypochondrial disorder
- Pt has Sx that involve loss of motor/sensory function
- they may be indifferent e.g. la belle indifference
Conversion disorder
- separating off certain memories from normal consciousness
- psychiatric Sx
Dissociative disorder
- if multiple personality disorder, is terms dissociative identity disorder (most severe form)
factitious disorder with the intentional production of physical/psychological Sx
Munchausen’s syndrome
fraudulent simulation/exaggeration of Sx with the intention of financial or other gain
Malingering
Features of anorexia nervosa?
- reduced BMI
- bradycardia
- hypotension
- enlarged salivary glands
Physiological abnormalities in anorexia nervosa?
- G & Cs are raised: GH, Glucose, salivary Glands, cortisol, cholesterol, carotinaemia
- low K
- low T3
- low FSH, LH, oestrogens & testosterone
Causes of aphonia?
Can’t speak
- recurrent laryngeal nerve palsy
- psychogenic
Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive
The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape & size in Anorexia Nervosa)
Body dysmorphic disorder/dysmorphophobia
Post-partum in 2/3 of women typically seen 3-7 days after birth, more common in primips
- anxious, tearful, irritable
- Rx?
Baby blues
Reassurance, health visitor support
Screening for depression postpartum?
Edinburgh Postnatal Depression Scale
Post-partum in 10% with features of depression, usually start within a month & typically peaks at 3months?
Rx?
Postnatal depression
Support etc
- CBT
- some SSRIs can help if severe e.g. paroxetine & sertraline (but secreted in breast milk)
Post-partum in 0.2% with onset within first 2-3wks after birth
- severe mood swings & disordered perception?
Rx?
Puerperal psychosis
- hospital admission
- 20% recurrence in future pregnancies
