Psych: Small Conditions Flashcards
(29 cards)
The most severe form of ethanol withdrawal
presentation + mortality
Delirium tremens
Presentation: profound confusion, psychosis, sleeplessness, autonomic over-activity,
Onset is usually 2-3 days after alcohol stopped
Mortality = 5% (by CV collapse, infection, hyperthermia, seizures, self-injury)
An acute neurological condition caused by thiamine (Vit B1) deficiency (common in chronic alcoholics*)
presentation + management
Wernicke’s encephalopathy
Presentation: confusion, ataxia. nystagmus, ophthalmoplegia (eye paralysis)
Management: thiamine
*Increased requirement of thiamine for alcohol metabolism
A chronic neurological condition (acute sequela of Wernicke’s encephalopathy) caused by thiamine deficiency (common in alcoholics*)
Presentation + management
Korsakoff’s Psychosis
Presentation: impaired recent+remote memory, impaired learning, disorientation, no general cognitive impairment
Management: thiamine
- Increased requirement of thiamine for alcohol metabolism
Alcohol withdrawal state
Presentation + pharma manegement
Presentation: Tremor, weakness, nausea, vomiting, anxiety, agitation, confusion, seizures, death
Management: benzodiazepines (commonly chlordiazepoxide)
Low-risk drinking guidelines advise what as the weekly limit for alcohol consumption
No more than 14 units per week for men AND women
= 6 pints of beer/ 6 glasses of wine / 14 shots
In cluster A personality disorders, the prominent problems are with…
e.g….
the perceived safety of interpersonal relationships
E.g... Paranoid Personality Disorder - assume everyone has malintent towards them Schizoid Personality Disorder - very afraid of emotional closeness Schizotypal Personality Disorder
A syndrome characterised by an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
A symptom of which conditions?
Psychosis
a SYMPTOM of: - schizophrenia - delirium - severe affective disorder (depressive or manic episode w/ psychotic symptoms)
NOT present in personality disorders
In cluster B personality disorders, the prominent problems are with…
e.g….
keeping feelings tolerable without acting
E.g…
Antisocial Personality Disorder
- violate others’ rights (often criminal behaviour)
Narcissistic Personality Disorder
- very entitled + grandiose, unable to see others’ needs
Borderline Personality Disorder
- try to manage feelings with self-harm
Histrionic Personality Disorder
- attention seeking driven by anxiety over how they seem
In cluster C personality disorders, the prominent problems are with…
e.g….
anxiety and how it is managed (in relationships)
(far less dramatic than A + B)
E.g.
Obsessive-Compulsive (Anankastic) Personality Disorder
- obsession with orderliness, perfectionism and control
Avoidant Personality Disorder
- social inhibition, feeling of inadequacy
Dependent Personality Disorder
- clinging + fear of separation
Management of Borderline Personality Disorder
Dialectic Behavioural Therapy (DBT)
- aims to change behavioural patterns
Mentalization-Based Treatment
- focuses on separating their own and others’ thoughts and feelings
- often successful in a group
Symptomatic prescribing
Treatment of co-occurring mental illness
A neurodevelopmental disorder defined by persistent, pervasive* and distinctive behavioural abnormalities
Cause, presentation, management
Autism spectrum disorder
Cause: Highly heritable
Presentation: deficits in reciprocity and communication, repetitive behaviour
Management: recognition of disability, establish needs, appreciate can’ts vs won’ts, psychopharmacology
Male:female = 3:1 *Pervasive = across life span (onset <3yrs) and across settings
a childhood disorder that is defined by a pattern of hostile, disobedient, and defiant behaviors directed at adults or other authority figures
features
Oppositional Defiant Disorder (ODD)
Features:
- irritable and “headstrong” temperament
- behaviour is learned
- enacted to obtain a result
- associated with adversity
Attention deficit hyperactivity disorder (ADHD)
Features
- aggression (if present) is impulsive
- poor control and ability to obtain a goal
- often remorseful
- resistant to behavioural management
- stronger genetic (than environmental) component
A condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts
But their brain is structurally normal
Management
Functional Neurological Disorder (FND)
Treatment:
explanation!, medications for comorbid mental health problems, CBT/IPT, other therapies (e.g. OT)
Repeated (2+) episodes of depression and mania or hypomania
Management
Bipolar affective disorder (just called bipolar disorder if no depression)
Management: Stop/ do not prescribe antidepressants (even in depressed phase)
Persistent (several months) symptoms of human anxiety, not confined to a situation or object
Presentation, diagnosis + management
Generalised Anxiety Disorder (GAD)
Presentation: psychological arousal, autonomic arousal, muscle tension, hyperventilation and sleep disturbance
Diagnosis: GAD-7 questionnaire
Management:
Step 1: identification + assessment
Step 2: *Self-help/ psychoeducational groups
Step 3: **CBT/ applied relaxation or drug therapy (SSRI/SNRI/pregabalin)
Step 4: specialist CMHT referral
- Low-intensity psychological intervention
- *High-intensity psychological intervention
A condition with the same core features as GAD but only in specific circumstances
Examples, presentations and management
Phobic Anxiety Disorders (e.g. specific phobias, social phobia, agoraphobia)
Presentation: phobic avoidance
Management: CBT, SSRIs
Inappropriate anxiety in a situation where pt. feels observed/ could be criticised (restaurants, shops, queues, public speaking)
Presentation
Social phobia
Presentation: blushing and tremor predominate
Obsessions or compulsions (usually both) which must impair function
presentation + management
Obsessive Compulsive Disorder (OCD)
Presentation:
- Recurrent, unwanted, intrusive, obsessional thoughts
- Compulsive, repetitive acts or rituals
- above must be ONE of the following:
1. time consuming (>1hr)
2. significantly distressing
3. causing functional impairment
Management: 1st Line: CBT (including Exposure and Response Prevention) 2nd Line: High dose SSRIs 3rd Line: Clomipramine (TCA) 4th Line: Buspirone + SSRI
Delayed and or protracted reaction to a stressor of exceptional severity
Presentation + management
Post-Traumatic Stress Disorder (PTSD)
Presentation:
- Hyperarousal (anxiety, irritability)
- Re-experiencing phenomena (flashbacks, nightmares)
- Avoidance of reminders (emotional numbness, cue avoidance, recall difficulties)
Management: survivors screened at 1 month, trauma focused CBT, medication (SSRIs, sedatives)
Recurrent panic attacks and persistent worry about further attacks
Management
Panic disorder
Management:
- mild-mod: self-help
- mod-severe: psychological therapy (CBT)/ meds (SSRI)
Mental disorders due to common, demonstrable aetiology leading to cerebral dysfunction
Types
Organic Mental Disorders
Primary – direct effect on the brain (e.g. cerebral disease, head injury)
Secondary – systemic disease affecting the brain (e.g. endocrine conditions)
Encephalopathy (delirium) seen in advanced liver disease due to build up of toxic products (e.g. ammonia)
Presentation
Hepatic encephalopathy
Presentation: general psychomotor retardation, drowsiness, fluctuating confusion, asterixis
((improves as liver function improves))
Syndrome of impairment of recent and remote memory
Cause, presentation and management
Amnesic syndrome
Cause:
- Diencephalic damage (korsakoff’s syndrome, SAH)
- Hippocampal damage (HSV encephalitis, anoxia)
Presentation: immediate recall preserved, anterograde and retrograde amnesia, confabulation, other cognitive function preserved)
Management: treat cause, parenteral vit B1 and then oral thiamine for high risk alcoholics (prevention of alcoholic amnesic syndrome)
((almost complete recovery is possible))
