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3A > Psych - Part 2 > Flashcards

Psych - Part 2 Flashcards

1
Q

Dementia vs delirium

A

Dementia

  • Slow and progressive
  • Alert
  • Thought poverty
  • Non-reversible

Delirium

  • Rapid
  • Fluctuating
  • Clouded consciousness
  • Hallucinations
  • Reversible
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2
Q

What is dementia

A

Global
Progressive
Intellectual deterioration

Without impaired consciousness

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3
Q

Alzheimer’s RFs

A 
Family history 
Smoking 
Increasing age 
Head injuries 
Downs 
Hypercholesterolaemia
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4
Q

Alzheimer’s prognosis

A

8-10 years

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5
Q

Alzheimer’s S/S

A

Short-term memory impairment

Difficulty decision making
Less flexible
Inability to learn new information

Confusion
Personality changes
Mood changes
Sleep disturbances

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6
Q

Severe Alzheimer’s

A

Dysphagia
Weight loss
Urinary incontinence
Loss of speech

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7
Q

Dementia DDx

A 
Depression
Delirium 
Hypothyroidism 
Infection 
B12 and thiamine deficiency 
Drugs and alcohol 
Hypercalcaemia
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8
Q

Dementia screening tools

A 
MMSE - Mini mental state exam 
10-CS - 10-point cognitive screen
6CIT - 6-item cognitive impairment test 
GPCOG - General practitioner assessment of cognition 
AMTS - Abbreviated mental test score 
MoCA - Montreal cognitive assessment
ACE-R - Addenbrooks cognitive test
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9
Q

Alzheimer’s diagnosis in secondary care

A

MRI - Cerebral atrophy

Biopsy

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10
Q

Alzheimer’s

Non-pharmacological management

A

Group cognitive stimulation therapy

Group reminiscence therapy

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11
Q

Dementia

Pharmacological management

A

Ach-esterase inhibitors

  • Donepezil
  • Galantamine
  • Rivastigmine

NMDA receptor antagonist - Memantine

Consider antipsychotics

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12
Q

Vascular dementia presentation

A

3 FACTORS

  1. Associated RFs
  2. Stepwise progression
  3. FND
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13
Q

Vascular dementia management

A

Mixed - Ach-esterase inhibitor and NMDA receptor antagonist

Pure vascular

  • Control BP - ACE-I
  • Lower cholesterol - Statin
  • Control BM
  • Control BMI
  • Aspirin
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14
Q

Vascular dementia prognosis

A

Likely death from MI or stroke

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15
Q

Fronto-temporal dementia cause

A

Pick’s disease

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16
Q

Fronto-temporal dementia syndromes

A
  1. Fronto-temporal dementia - Behavioural changes with preserved memory and visa-spatial skills
  2. Progressive non-fluent aphasia - Understanding intact but struggle with fluency
  3. Semantic dementia - Loss of vocabulary
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17
Q

Fronto-temporal dementia presentation

A

Insidious
Onset < 65
Personality changes

Intellectually functional
Preservation of memory and visuospatial skills

Memory loss occurs later

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18
Q

Fronto-temporal dementia investigations

A

MRI

  • Knife blade atrophy
  • Pick bodies
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19
Q

Fronto-temporal dementia management

A

S/L therapy

SSRIs for behavioural problems

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20
Q

Fronto-temporal dementia prognosis

A

8-10 years

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21
Q

Lewy body dementia pathophysiology

A

Cytoplasmic inclusions consisting of alpha synuclein

  • Substantia nigra - Parkinson’s
  • Paralimbic areas - Memory impairment
  • Neocortical areas

Insidious onset
Progressive

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22
Q

Lewy body dementia presentation

A

TRIAD!!!

  1. Parkinson’s
  2. Hallucinations
  3. Fluctuating consciousness

REM sleep disorder
Frequent falls

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23
Q

Lewy body dementia investigations

A

BLOODS
ECG - Heart block
SPECT - 123-I-FP-CIT

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24
Q

Lewy body dementia prognosis

A

8-10 years

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25
Q

Lewy body dementia management

A

NO HALOPERIDOL

Ach-esterase inhibitors

  • Donepezil
  • Rivastigmine

NMDA receptor antagonist - Memantine

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26
Q

Reversible causes of dementia

A

HHHHHHHHHHHHHHs

Haematoma 
Hydrocephalus 
Hypothyroidism 
Halcohol
Hinfection
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27
Q

Dementia bloods

A 
FBC 
LFT 
U/E 
TFT 
B12 
Thiamine 
Ca 
Glucose 
Na 
Tox screen
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28
Q

Dementia practical aids

A 
Start a routine 
Post-it notes 
Big clock 
Avoid stress 
Sleep hygiene
Newspaper with date
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29
Q

Other dementia investigations

Not bloods

A

MSU - RULE OUT DELIRIUM
ECG

Neuroradiology

  • Atrophy
  • Enlarged ventricles
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30
Q

Alzheimer’s microscopic changes

A

Beta-amyloid plaques

Neurofibrillary tangles

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31
Q

Alzheimer’s mAcroscopic changes

A

Cortical atrophy
Hippocampal atrophy
Enlarged ventricles
Increased sulcal swelling

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32
Q

Alzheimer’s neurotransmitter defects

A

Noradrenaline
5-HydroxyTriptamine
Ach

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33
Q

Frontal lobe dementia features

A 
Emotional blunting
Personality changes 
Apathy 
Disinhibition 
Taking things literally
34
Q

Temporal lobe dementia features

A

Language changes

35
Q

Behavioural and psychological symptoms of dementia

A

PADDA-1

Psychosis 
Anxiety 
Depression
Disinhibition 
Agitation

…
1

36
Q

What is delirium

A

Acute confusional state

Can be hyperactive, hypoactive or mixed

37
Q

Delirium diagnosis

A
  1. Impaired consciousness
  2. Perceptual and Cognitive disturbance
  3. Rapid onset and fluctuating
  4. Evidence it may be related to a physical cause
38
Q

Delirium causes

A

PINCH ME!!

Pain/post-op
Infection - UTI/pneumonia
Nutrition - B12 
Constipation 
Hypoxia/hydration decreased
Medications/metabolic 
Environmental

VT

Vascular - Stroke
Trauma - Head

39
Q

Drugs causing delirium

A

SSAAALLAD

Steroids 
Statins 
Anticonvulsants 
Anticholinergic 
Antihistamine 
Lithium 
Levodopa 
Antispasmodics 
Digoxin
40
Q

Delirium investigations

A

Bloods bloods and more bloods

CXR - Pneumonia

CT head

  • Trauma
  • Bleed
  • Infection
  • Tumour
41
Q

Delirium management

A

ABC
Treat cause

Antipsychotic - Unless LBD

Benzos for alcohol related

42
Q

Alcohol screening aids

A

CAGE
TWEAK
FAST
AUDIT

43
Q

CAGE questionnaire

A

2 = Problemo

Have you considered cutting down?
Have people annoyed you by criticising you?
Have you ever felt guilty?
Eye opener?

44
Q

TWEAK questionnaire

A

3 = Problemo

Tolerance - How many drinks can you have? 
Worried - Are people worried about you? 
Eye-opener? 
Amnesia?
Considered cutting down?
45
Q

ICD-10 addiction criteria

A

TRAM WC

Tolerance increased
Repertoire narrowing
Abstinence difficult
Maintaining intake is priority

Withdrawal symptoms
Compulsion awareness

46
Q

Long-term alcohol problems - BIOLOGICAL

A

Wernicke’s
Memory loss

Pancreatitis

Arrhythmia’s
HTN

Fatty liver
Hepatitis
Cirrhosis

Osteoporosis

Malignancy - GI and breast

Pregnancy - CHD

47
Q

Alcohol dependence management

A

Disulfiram - Blocks alcohol
Acamprostate - Acts on GABA, decreases cravings
Naltrexone - Opioid antagonist

48
Q

Alcohol dependence

When to admit

A 
Previous delirium 
Autonomic activity 
< 18 
Safeguarding 
Failure of home detox 
Wernicke's
49
Q

Wernicke’s encephalopathy cause and presentation

A

Thiamine B1 deficiency!!

COW TRIAD

  1. Confusion
  2. Ophthalmoplegia
  3. Ataxia - WOBBLY
50
Q

Wernicke’s findings

A

Decreased red cell transketolase
MRI
Muscular atrophy

51
Q

Wernicke’s management

A

PABRINEX

52
Q

Wernicke’s Korsakoff

A

Confabulation
Anterograde amnesia
Irreversible
Hippocampal involvement

53
Q

Delirium tremens BASIC CAUSE

A

Alcohol withdrawal
48-72 hours post-withdrawal
Worse at night

54
Q

DT pathophysiology

A

Alcohol = Increased GABA + Decreased NMDA

Withdrawal = Decreased GABA + Increased NMDA

Jittery and hyper AF

55
Q

Alcohol withdrawal presentation

A

6-12 hours - FASTT

  • Formication
  • Anxiety
  • Sweating
  • Tremor
  • Tachycardia

36 hours - Seizures

48-72 hours - DELIRIUM TREMENS

  • Coarse tremor
  • Ataxia
  • Confusion
  • Seizures
  • Delusions
  • Hallucinations
56
Q

Alcohol withdrawal imbalances

A

Metabolic acidosis

Hypoglycaemia

57
Q

Alcohol withdrawal management

A

ABCDE

Chlordiazepoxide
PABRINEX

Dextrose

Carbamazepine - Seizures
Magnesium - Seizures and arrhythmias

58
Q

Opioid misuse presentation

A 
Rhinorrhoea 
Lacrimation 
Drowsiness 
PIN POINT PUPILS 
Track marks
59
Q

Opioid misuse management

A

Naloxone

Dependence

  • Methadone
  • Buprenorphine
  • Naltrexone
60
Q

Opioid misuse complications

A

Infection

  • Site
  • Endocarditis
  • Hep B/C
  • HIV

Social

  • Depression
  • Homelessness
  • Unemployment

VTE
Respiratory depression

61
Q

Dependence syndrome criteria

A
  1. Strong desire to take substance
  2. Difficulty controlling use
  3. Physiological withdrawal state
  4. Tolerance
  5. Neglect of activities
  6. Persistent use despite negative effects
62
Q

Anorexia causes

A

Genetics
Childhood - Trauma/bullying?
Depression
OCD

63
Q

Anorexia diagnostic criteria

A

Restricted intake
Intense fear of gaining weight
Body dysmorphia or denial of low body weight

64
Q

Anorexia symptoms

A

Underweight

Lanugo hair
Dental caries

Swollen tender abdomen due to constipation
Amenorrhoea and sub fertility

Libido changes
Sleep disturbances

Cold intolerance
Dizziness

65
Q

Anorexia investigations

A

SCOFF questionnaire

Sit-up test
Squat test

LFT
Amylase
Bicarb - Alkalosis

Hormones - Gs/Cs are HIGH, everything else is LOW
Decreased - LH, FSH, Oestrogen
Increased - GH, Cortisol, Glucose, Cholesterol, Carotin

ECG - Bradycardia and prolonged QT

DEXA

66
Q

SCOFF questionnaire

A 
Sick - Have you ever made yourself sick?
Control - Have you lost control?
One stone lost in 3 months? 
Fat - Ever thought you're fat? 
Food - Does food control your life?
67
Q

Anorexia management

A

Family therapy
CBT-ED

Pharmacological

  • Chlorpromazine
  • SSRI - Fluoxetine
68
Q

Anorexia complications

A

Amenorrhoea and sub fertility

Psychological

  • Depression
  • OCD

Refeeding syndrome
Constipation

Peripheral neuropathy
Osteoporosis

AKI and renal calculi
Pancytopenia
Cardiac

69
Q

Cardiac complications of anorexia

A

Prolonged QT
T wave changes
Bradycardia
ST elevation

70
Q

Anorexia risk assessment

A

Rapid weight loss
Not responding to treatment
Electrolyte imbalance

Physiological changes

  • Temp < 35
  • Brady < 45
  • Cardiac changes

Psychosis
Risk of suicide

71
Q

Refeeding syndrome

A

Rapid introduction of food after > 10 days of malnutrition

HYPO HYPO HYPO

Hypokalaemia
Hypophosphataemia
Hypomagnesaemia - TREAT FIRST!

Impaired glucose sensitivity = ^ Insulin = hypokalaemia

72
Q

How to avoid refeeding syndrome

A

U+Es
Increasing calories slowly
Thiamine

73
Q

Malingering

A

Making up symptoms for the intention of financial or other gain

74
Q

Somatisation disorder

A

Multiple physical symptoms persistent for at least 2 years

Multi-organ

75
Q

Hypochondriasis

A

Persistent belief in the presence of underlying disease

Refusal to believe medical results

76
Q

Conversion disorder

A

Loss of motor/sensory function

No conscious faking

77
Q

Personality disorders categories

A

MAD
BAD
SAD

78
Q

Personality disorders - MAD

A

Paranoid
Schizoid - Detached and cold
Schizotypal - Eccentric and odd beliefs
Antisocial - Aggressive, lack of consciousness, criminal behaviour

79
Q

Personality disorders - BAD

A

Histrionic - Attention seeking, seductive, manipulative, exhibitionist
Borderline - Self-harm, intense relationships, ashamed, impulsive
Narcissistic - Grandiose thoughts, seeking power

80
Q

Personality disorders - SAD

A

OCPD - Worrying, perfectionist, controlling
Anxious - Timid, desire to be liked, anxious
Dependent - Excessive need for care, feels abandoned, helpless when single

3A (31 decks)

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