psych Flashcards
derranged melatonin
SAD
flattened EEG
Huntingtons
most common method of suicide (M/f)
Males -hanging
Females - overdose
3:1 male completed, >40yrs, social isolation , psychiatric illness, previous attempts is strongest predictor
schizophrenia envrionmental associations
winter bith, obstetric neonatal complications, maternal influenza, urban settings
mitral valve prolapse
panic disorder and agoraphobia
highest mortality of psychiatric disorders
and untreated mortality
anorexia nervosa
untreated mortality (10-15%) 20% recover, 20% severely ill
crohns disease given steroids, delusional thoughts, stopped steroids and recovered
organic delusional disorder
crohns is associated + steroids with mania
A 55-year-old female has been writing frequent letters to social
services about her neighbours, claiming that they have been
plotting to get rid of her. She believes that they are contaminating
her water supply with rat poison and as a result has been
drinking bottled water only. She has also been cleaning her
room meticulously to ‘decontaminate’ her room. Her daughter
says that this has been going on for several months.
Paranoid Schizophrenia ( not ocd as psychotic)
A 68-year-old male is admitted under the medical team for dehydration
after refusing to eat or drink. His wife reports that he has
been preoccupied with the belief that he has a brain tumour and
has lost pleasure in everything. He has lost 12 kg in weight and
spends most of his day in bed. He reports that he can smell rotting
bodies and believes that he has committed a sinful crime
because he has heard voices calling him a paedophile. He feels
ashamed of himself.
depression with psychotic symptoms ( older patients congurent delusion, hypochondriasis in depression, olfactory and second persion auditory hallucinations), lack of first rank symptoms
24-year-old male was brought to hospital by the police after
being found screaming in the streets. He had apparently followed
an elderly couple to their home on many occasions and
banged on their door claiming that a divine being was controlling
him. On questioning, the patient was very excitable with
an incongruous affect. He talked continuously and loudly with
marked derailment. He was laughing unstoppably, and claimed
that a device in his neck was controlling him and his emotions.
His family have been concerned about his whereabouts
and state that he had been deteriorating over a period of a
few months.
schizoaffective
A 50-year-old male is brought to hospital after he is found wandering
the streets at night. Consciousness is not impaired but
he is disorientated to time and place. Bedside tests reveal that he
has a normal digit span and there is no impairment in language
and comprehension. When the doctor returns a few hours later
the patient is unable to recall their previous meeting and reports
that the reason why he is in hospital is because he is visiting a
friend. His notes indicate a previous history of excessive alcohol
use but he denies current use
Korsakoffs psychosis, impaired ability to form new memories and retrogade amnesia. Other aspects of cognition normal. confabulation to conceal memory deficits
anterograde cant form new memories + variable retrograe amnesia ( before event)
confabulation
Mx: b1 +multivitamins, treat pysch, OT + cognitive rehab
A 28-year-old male is compulsorily admitted to a psychiatric
ward. He claims to be a member of the royal family and has been
spending money on expensive jewellery and prostitutes, accruing
huge debt. On the ward he presents with over-familiarity with
the nurses, irritable mood, and labile affect fluctuating from elation
to tearfulness within minutes. He also has marked pressure
of speech. Physical examination and investigations are normal
manic episode
grandiose risky behaviour, labile affect.
A 51-year-old male is admitted to a general medical ward following
a cerebrovascular accident. At times he has been observed to be
crying and other times he is seen laughing in his room alone.
The nurses notice that his speech has become nasal ‘like a duck’
and that his tongue is stiff and spastic. On examination, his
mini-mental state examination score is 27/30.
pseudobulbular palsy upper motor neurone, affecting muscles in eating swallowing talking, tongue is spastic and speech is characteristically duck like. The jaw jerk is also
increased and emotional lability is common. Recognised causes
include cerebrovascular accidents and multiple sclerosis. The
main differential here is that of vascular dementia, but it usually
presents with cognitive deficits which are usually unevenly
distributed and stepwise in deterioration.
Presentation of Neurosyphilis
Neurosyphilis can present with meningovascular syphilis (cranial
nerve palsies, focal deficits from gumma expansion, raised
intracranial pressure, delirium, and dementia) after 1–5 years,
‘general paralysis of the insane’ (euphoria, mania, grandiosity,
psychotic symptoms, personality changes, and dementia) after
5–25 years, or tabes dorsalis (demyelination of the dorsal roots
leading to lightening pains, loss of proprioception, paraesthesia,
and Charcot’s joints) after 8–12 years. A characteristic sign seen
in neurosyphilis is the Argyll Robertson pupils, which are small
bilateral pupils which constrict on accommodation but not to
light.
A 23-year-old male was found cutting his arms and thighs with a
knife. He claims that there are bugs crawling underneath his skin
and that he is trying to get rid of them. On examin ation, he is
tachycardic with prominent dilatation of pupils and nasal ulceration.
He appears sexually disinhibited, restless, and excited.
Formication is an abnormal skin sensation best described as
insects crawling underneath or on the skin. It is a recognised
phenomenon in substance misuse, commonly amphetamines
(especially cocaine) and alcohol withdrawal. The patient in this
