Subtypes: - stroke - related - subcortical - SVD - mixed - VD + Alzheimers ``` RF: smoking lipids AF HTN Past HX - stroke/TIA DB CHD FHx ``` NINDS-AIREN Criteria: - Cerberovascular dx - Intefernece of ADL not secondary effects of cerebrovasc event - Relationship between above 2 Mx - Non harm: - Mx CV risk factors - specific - Mx challenging behaviour Pharm - mx - not typically used - only if assoc alzheimers.

Parkinson plus synbdrome alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the SUBSTANTIA NIGRA/PARALIMBIC/.NEOCORTICAL AREAS Ft: - progressive CI - parkinsonism - Visual hallucination Diagnosis - clinical - SPECT Mx: - Alzheimer tx - DO NOT USE NEUROLEPTICS --> irreversible parkinsonism. Q stem - may give someone with acute deterioration after starting antipsychotic --> LBD

S.e = agranulocytosis --> monitor FBC Only use after fx >/= 2 antipsych for 6-8/52 other adverse affects: - Decrease seizure threshold - constipation - Myocarditis --> ECG prior - hypersalivations

Mania: - >/= 7/7 - imoact fn/social/worj - hospitalition - psychotic sx hypomania - fx/rapid cycling --> Carbemezapan - depressive sx +++ - Valproc acid/lamotrigine.

Symptoms: - Tremor - Hyperreflexia - Acute confusion - Seizure - Coma Mx: - IVI - HAemodialysis - (if severe Li >2.0) - +/- NaHCO3-

DSM IV grading >/= 2 weeks PHQ - 9: - 0-7 = normal - 8-10 = borderline - >11 = +ve Biological - important as predictor of response to Tx: - Diurnal variation - loss of libido - loss of appetite - Loss of energy - WL - psychomotor retardation OTher sx: - low mood - annehedonia - low energy - insomnia Psychotic symptoms

Psych Flashcards by Ganesh Rajaratnam

Alzheimer’s Dx

Non pharm mx:

Well being
Group therapy

Pharm:

1) ACHEI - Donepezil/glanatamine/rivastigmine
2) Memantine = NMDA antag:
- Use as mono if ACHEI CI or v.sev alzheimers
- Use as +on in mod - sev

Ranking - MMSE score:
26 - 18 mild
17 - 10 = mode
<9 =- severe

Donepezi;:

S.e insomnia
relative CI = hypotension

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Vascular dementia

Subtypes:

stroke - related
subcortical - SVD
mixed - VD + Alzheimers

RF: 
smoking 
lipids
AF
HTN
Past HX - stroke/TIA
DB 
CHD
FHx

NINDS-AIREN Criteria:

Cerberovascular dx
Intefernece of ADL not secondary effects of cerebrovasc event
Relationship between above 2

Mx - Non harm:

Mx CV risk factors
specific
Mx challenging behaviour

Pharm - mx

not typically used
only if assoc alzheimers.

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F-T dementia

common ft:

<65 yrs
insidious onset
Preserved memory and visuospatial skills
Pernsonality change and social conduct

Pick’s dx = most common type:

Focal gyral atrophy –> KNIFE BLADE APPEARANCE

Macroscopic changes of Pick’s:
- Atrophy of F + T lobes

Microscopic:
= pcik boies - tau protein = SILVER STAINING 
- Gliosis 
- NFTs 
- Senile plaques.

Other types of f-t dementia:

CPA - non-fluent speech
Semantic - fluent speech with empty meaning - LT memeory affected (unlike Alzheimer’s)

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Lewy body demenetia

Parkinson plus synbdrome

alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the SUBSTANTIA NIGRA/PARALIMBIC/.NEOCORTICAL AREAS

Ft:

progressive CI
parkinsonism
Visual hallucination

Diagnosis

clinical
SPECT

Mx:

Alzheimer tx
DO NOT USE NEUROLEPTICS –> irreversible parkinsonism.

Q stem - may give someone with acute deterioration after starting antipsychotic –> LBD

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Charles bonnet syndrome

Persistent or recurrent complex auditory or visual hallucinations.

Retajn insight

age
visual impairment
social isolation
sensory deprivation
early conginitive impairment

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First rank symptoms of schizo

ATPD

Aim. To pass definitely

Auditory hallucinations:

3rd person
running commentary
thought echo

Thought disorder +:

insertion
withdrawal
broadcast

Passivity:..

bodily sensations
actions, feelings, impulses

Delusional:
- sudden, intense, self referential delusion
- In response to common things.
-

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RF for Schizo

FHx 
Blac/carribean
migration
urban 
cannabis

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Poor prognostic ft of schizo

\+ FHx 
Gradual onset 
Low IQ
Premorbid social withdrawl 
no precipitant

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MX of sschizo

PO Atypicl antipsychotics
CBT
CV risk

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Atypical Antipsychotics

Adverse effects:

WG
Raised PRL
Clozapine –> Agranulocytosis.

In elderly pt:

Inc. stroke risk
Inc VTE

Examples:

Clozapine
Onlazapine –> raised obesity/WG
Quetiapine
Risperidone
Amisulpride
Risperidone
Aripiprazoel

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Clozapine

S.e = agranulocytosis –> monitor FBC

Only use after fx >/= 2 antipsych for 6-8/52

other adverse affects:

Decrease seizure threshold
constipation
Myocarditis –> ECG prior
hypersalivations

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Hypomania vs mania

Mania:

> /= 7/7
imoact fn/social/worj
hospitalition
psychotic sx

hypomania - <7/7 out of all the others.

Mx - short term:

BZD
Onloanzapine
Li
ECT - prolonged + resistant

Mx - Long term:

Li –> fx/rapid cycling –> Carbemezapan
depressive sx +++ - Valproc acid/lamotrigine.

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SSRIs

Cause hyponatraemia
GI effects
Increased vigillant

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Lithium

Mood stabiliser –> narrow therapeutic indec = 0.4 -1.0

Excreted by KIDNEYS

S.e. - L.I.T.H.I.U.M.S:
Levels + leucocytosis/inc urine (DI) + inc wt/tremor + thirst/Hypothyroid + hair thin/interaction/upset stomac/Muscle weakness/ Skin - Acne + psoriasis

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Li - Toxicity

Symptoms:

Tremor
Hyperreflexia
Acute confusion
Seizure
Coma

Mx:

IVI
HAemodialysis - (if severe Li >2.0)
+/- NaHCO3-

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Depression

DSM IV grading

> /= 2 weeks

PHQ - 9:

0-7 = normal
8-10 = borderline
> 11 = +ve

Biological - important as predictor of response to Tx:

Diurnal variation
loss of libido
loss of appetite
Loss of energy
WL
psychomotor retardation

OTher sx:

low mood
annehedonia
low energy
insomnia

Psychotic symptoms

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Depression grading

Subthreshold - <5 sx

Mild - 5 sx - mild impairment of fn

Mod: Mild – > Sev sx/fn’al impairment

Sev = Fnal impairmenet sev +/- psychotic sx

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Depression Mx

SSRI –> try 2nd –> try ALT

ECT

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Depression vs dementia

Dementia:

LT
Recent memory loss
Makes stuff up
consistent

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Generalised anxiety disorder

Alway rule out physical cause first - Thyroid/hear/meds (theophylline, salbutamol, steroid, antidepressant, caffeine)

Mx:

1) Educate/active monitoring
2) low intensity psychology - self help/group
3) high intensity psychology (CBT) +/- drug therapy
4) specialist inout

Drugs:
- SSRI –> sertraline (if <30 will have initialsuicidal rxn)

Panic disorder

Mx:

1) Recog + diagnose
2) TX in primary care
3) R/v + consider alt
4) R/V + Referral to specialist
5) care in specialist MH service

1st line SSRI for 12 weeks –> imipramine + clomipramine

Phobias

Mx - Behavioural therapy = graded eposure

SSRI/beta block/BZD

PTSD

> 1/12 - an event that a patient fines stresful.

HARE = Hypervigillant, avoidance, re-exposure, emotional numbing

Mild =- <4/52 –> W/W
Sev - Trauma focused CBT or EMDR

2nd line:
BEnlafexine or Sertraline
–> Fx/ severe –> Risperidone

OCD

Obsession:

recurrent
persistent and intrusice
Occurs vs pt’s will
Regarded as absurd - INSIGHT
Pt own thoughts
resisting –> anx

Compulsions = irresistable

Assoc:

Depression
schixophrenia
Anorexia nervosa
organic brain disorder.

Mx:
1) Psychological –> EXPOSURE RESPONSE PREVENTION

2) SSRI or clomipramine +/- CBT

Somatoform disorder

Somatisation: - >2 physical SYMPTOMS w/o medical eplamatio/ - Fn'al impairment Hypochondrial dx: - Persistenet belief that they have specific DISEASE(S) Mx: - psychological - anti-depressants.

Conversion disorder

Loss of MOTOR or SENSORY fn NOT CONSCIOUSLY

Dissociative disorder

typically involves psychiatric sx = Seperating off certain memories

Fatcious disorder

MUNCHAUSEN = Intentional

Malingering

seek material gain = FRADULENT

Anorexi anervosa

Diagnostic criteria: - WL >15% or BMI <17.5 - specific psychology - fear of fatness/low threshold for fatness - Spec endocrine ft: - delayed puberty, loss of libid, amennorhea OTher ft: - Low BP - brady - Enlarged salivary glands - low K - Low FSH/LH - High GH /Cortisol - High cholessterol

Bulimia nervosa

>once/week for 3/12 Recurrent episodes of binge Lack of control whilst bingi g recurrent compensatory self evaluation by BW/Shape/ Mx: - Refer all

Suicide Risk factors

SAD PERSONS sex/age/depressive/psych hx/excess drug use/rationale loss/seperated/organised plan/no support/sickness

Delirium causes | I WATCH DEATH

Infection ``` Withdrawl = EtOH/BZD/sedatives Acute metabolic Toxins - Opiates/steroids/anticholinergic/osychotropics CNS Hypoxia ``` ``` Deficiencies - B12/Thiamine Endocrine - thyroid/BGL/low adrenal Acute vascular Trauma Hearing ```

Delirium/Dementia

Delerium: Low consciousness Fluctuation Perceptual changes Drlusions

Alcohol withdrawl

Chronic --> increased GABA --| CNS/NMBDA glutamate receptors. Ft: - 6-12 hr - remor/sweatinf/anxietu - 36 hr - Seizure - 48-72 hr - DT Mx - any pt with complex withddrawl hx (seizure/withdrawl) --> Admit 1) BZD = chlordiazepoxide if liver fx - loazepam

Alcohol withdrawl syndroem

CAGE - thought of cut down/annoyance at others for asking to/ guilt/ eye opener Mx: - Acute withdrawl - bzd - Disulifram - inhibits Acetylaldehyde dehydrogenase -CI = IHD/PSYCHOSIS - Acomprostate - weak NMDA receptor antag --> decrease craving

Wernickes - Korsakoffss "thin thigh Gym mnemonic"

Thalamus + mamillary body Wernickes - Ataxia/confusion/opthalmoplegia-nystagmus Korsakoffs - confabulation Dry and wet beri beri (wet --> Cariomyopathhy)

Mx of hepaticc encephalopathy

LActulose Rifaximin

Sleep disorders:

Stages of sleep: Awake --> REM --> 1 - 2- 3- 4= non-rem REM sleep: - EEG = ASYNHRONOUS beta waves - bursts of conjugate eye movement - high HR/BP/penile tumerscence - low musc tone ``` NON-REM: - EEG = SYNCHRONOUS - stage 1 = theta waves 2 = sleep spindles/K complexes 3 = delta waves ``` = The Sleep Doctors BRain = theta/spindle/delta/beta

Sleep paralysis

TRansient = on waking and falling asleep = assox w/ REM Ft = paralysis + hallucination Mx if troubled --> clozapine

Typical antispyschoics

Chlorpromazine, haloperidole, flupentixol, zuuclopenthixol S.E: - EPSE - antucholinergic - anti-adrenergic - anti-histamines - hgih PRL - prolonged QTc - Reduced seizure threshold.

SSRIs

Fluoxetie, duloxetine, paroxetine, citalopram, setraline ``` S.e: - Seretonin syndrome nausea SEXUAL DYSFN inc anx initial inc suicide risk ```

TCA

Amtryptilline imipramine clomipramine S.e: - ANticholinergic - anti-adrenergic anti-histamine

antidepressant - SNRI

Venlafexine s.e - NAusea/HTN

antidepressant - MAOI

Phenelezine Anticholinergic antiadrenergic

Mirtazapine

presynaptic alpha-2 receptor antag Agranulocytosis

ECT

Catatonia refractory sev depression psychotic sx CI = ICP raised S.e headache/nausea/ ST memory loss/cardiac arrythmia LT - poor memory

Serotonin syndrome mx

IVI BZD if more sev - use seretonine antag - CRYOHEPTADINE and CHLORPROMAZIEN

Management of bipolar

1st line Lithium 2nd kine - Valproate