Psychiatry Flashcards
(244 cards)
1
Q
what is an illusion?
A
altered perception of a real object
2
Q
what is a pareidolic illusion?
A
perceived meaningful images from vague stimulus
3
Q
what is a delusion?
A
fixed false belief held despite evidence to the contrary
not explained by patient’s background
4
Q
what is the most common delusion?
A
persecutory/paranoid (i.e. being hunted by FBI)
5
Q
Ekbom’s vs formication
A
Ekbom’s: belief that one if infected with parasites
Formification: tactile hallucinations
6
Q
what is capgras syndrome?
A
believing close acquaintance has been replaced by an imposter
7
Q
what is Folie a deux?
A
shared delusions/ hallucinations between people
8
Q
What is neurosis?
A
inappropriate emotional/behavioural response to perceived stressor (e.g. phobia, GAD, OCD)
neurotic person never loses touch with reality, has normal mental functioning
9
Q
what does the MCA cover?
A
capacity rather than mental health
covers physical health
10
Q
what is section 4 of the MHA?
A
emergency admission
72 hour duration
1 doctor, 1 AMHP
11
Q
what are the discharge applications for section 2?
A
- NR to MHRT within 14 days
- by responsible clinician
12
Q
what are the discharge applications for a section 3?
A
- by patient to MHRT at any time
- by NR to hospital (can be barred by responsible clinician)
- under S17 (leave)
- By RC
13
Q
what is section 35?
A
- assessment of a patient accused of committing a crime
- 28 days
- cannot appeal
14
Q
what is section 37?
A
- treatment of convicted criminal
- applied for by court if evidence from 2 doctors
- 6 months
- can appeal (within 21 days to court, after 6 months to MHRT)
15
Q
what is the role of the independent mental health advocates?
A
- help people find out their rights
- can’t have with sections 4, 5, 135, 136
16
Q
what is the MOA of atypicals?
A
blocks D2 and 5-HT2 receptors
17
Q
what is the MOA of clozapine?
A
blocks D1 and D4
18
Q
what do you need to be careful with all antipsychotics?
A
lower seizure threshold
cause QTc prolongation
19
Q
what is the most common side effect of clozapine?
A
constipation
20
Q
what can increase the concentration of clozapine?
A
caffeine
21
Q
what is the monitoring that you need with clozapine?
A
- weekly FBC for first 18 weeks
- then every 2 weekly until 1 year
- then monthly
22
Q
what are the side effects of risperidone?
A
- hyperprolactinaemia (makes pregnancy harder)
- dyslipademia
23
Q
what are the features of aripiprazole?
A
- low SE profile
- takes 2 weeks to work orally
- can be given as depot
24
Q
what is dystonia?
A
involuntary painful sustained muscle spasm
e.g. oculogyric crisis and torticolis
25
what is tardive dyskinesia?
rhythmic involuntary movements of mouth/face/limbs/trunk
26
what is the treatment of dystonia?
anticholinergic e.g. procyclidine
27
what is the treatment of akathisia?
switch/lower dose
propanolol
BDZ
28
what is the treatment of the parkinsonism?
increase dose
| anticholinergic
29
what is the treatment of tardive dyskinesia?
switch meds
| tetrabenazine
30
how long does EIS do follow up?
3 years
31
SSRI SEs?
5 S's, hyponatraemia, blurred vision
32
what should SSRIs not be taken with?
- triptans (ask about migraines)
| - NSAIDs/aspirin (if need = PPI)
33
what is important to remember about fluoxetine?
increased half life
34
what are the side effects of SNRIs?
- increased BP
- headache
- avoid in arrhythmia
35
what is the MOA of MAOIs?
increase MAO levels
don't give with SSRIs = serotonin syndrome
e.g. Phenelzine, Selegiline
36
give an example of a RIMA
moclobemide
37
what BDZ should you use in hepatic impairment?
oxazepam
38
describe the withdrawal process from zopiclone/BDZs?
1/8th daily dose reduction every 2 weeks
e. g. diazepam 40mg/day
- dec dose by 5mg every 2 weeks until 20mg/day
- dec dose by 2mg every 2 weeks until 10mg/day
- dec dose by 1mg every 2 weeks until 5mg/day
- dec dose by 0.5mg every 2 weeks until stoped
39
what are the disadvantages of benzo/Z drugs?
- sedation, confusion, anterograde amnesia, ataxia
- potentiates other CNS depressants (i.e. alcohol)
- tolerance and dependence
40
what increases the free plasma concentration of benzo/ z drugs?
when given with aspirin or heparin
41
what is the disadvantage of zopiclone in pregnancy?
cleft lip
42
what are the MOAs of stimulants?
- potentiate effects of MOA neurotransmitters = increase energy, alertness, euphoria
- increases monoamine pathway activity = increase concentration and learning maturation
43
give 2 examples of stimulants
methylphenidate
| dexamphetamine
44
what levels cause lithium OD vs toxicity?
OD > 1.2 mmol/L
| toxicity > 1.5mmol/L
45
what are the triggers for lithium OD?
- dehydration
| - drugs (NSAIDs, ACEi, ARBs, diuretics, SSRIs)
46
what is the only anti-epileptic that can be used for acute mania?
sodium valproate
| other ones are prophylaxis
47
what is an important interaction of carbamazepine?
CYP450 inducer
48
what is a bad side effect of lamotrigine?
SJS
49
what is the treatment of acute mania relapse in known bipolar patient?
1. inc dose of mood stabiliser
2. antipsychotic augmentation
3. ECT
50
what are the first line psychotropics in perinatal period?
- sertraline: expressed in breast milk but considered safe
- olanzapine: 1st line, present in breast milk so stop
- avoid mood stabilisers and benzo's
51
describe the rigidity in NMS
lead pipe
52
difference in muscle tone in NMS vs SS
NMS: more rigidity
SS: more hyperreflexia, myoclonus
53
what is the efficacy rate of ECT?
80%
54
what do you need to do prior to ECT?
reduce antidepressant dose prior to procedure
55
how can you describe CBT to a patient?
a way of thinking about your thinking
56
what is the process of CBT?
- targets thoughts that lead to emotions and behaviours
- especially negative automatic thoughts (NATs)
- thoughts --> emotions --> behaviours
57
describe the longitudinal method
- detailed Hx including early life
- identify NATs and cognitive distortions
- challenge distortions
- explore core beliefs
58
what is the psychodynamic psychotherapy?
- problems shaped by childhood experiences and family environment
- causes conflict between conscious and unconscious mind
- therapy helps reveal unconscious mind
59
what is the aim of psychodynamic psychotherapy?
deep seated change in personality and emotional development
60
what is the difference between psychoanalytic vs psychodynamics?
```
psychoanalytics = internal conflicts
psychodynamic = inter-personal conflicts
```
61
describe delirium
- mental status change
- quick onset
- disorientated
- inattention
- change from baseline
62
why do anticholinergics worsen delirium?
cholinergic neurones impacted by delirium and are underactive so anticholinergics worsen it
63
what is important to exclude in derilium?
undiagnosed dementia
64
treatment of delirium
PO antipsychotics
| 1st line = Haloperidol
65
what is important to remember for rapid tranquilisation?
- follow local protocol
| - do not give haloperidol to patients with cardiac disease/DLB/Parkinsons
66
depression SIGECAPS mnemonic
```
Sleep changes
Interest Loss
Guilt (worthlessness)
Energy loss (fatigue)
Cognition/concentration difficulties
Appetite Loss +/- weight loss
Psychomotor (agitation)
Suicidal ideation
```
67
what is subthreshold depression?
<2 core symptoms
| no functional impairment
68
what is mild depression?
2 and 2 other symptoms
| still can continue with most activities
69
what is moderate depression?
2 core symptoms + 3 others
| considerable functional impairment
70
what is severe depression?
- 3 core symptoms and 4 others
| - major impact
71
what are some organic causes of depression?
anaemia
thyroid
diabetes
hypercalcaemia
72
management of children depression
- self help "youngminds.org"
- mild = IAPT 6-8 sessions, psychoeducation
- 2nd line: CBT
- needs not met = referral to CAMHS
73
what are the different low intensity psychosocial interventions for depression?
- group CBT
- computerised CBT
- guided self help
- structured group physical activity programme
74
over how long is sertraline increased?
over 6 weeks
75
what is the catch up phenomena?
if someone recovers from depression and then medication is suddenly stopped, if they experience depression again, then they will be in a worse state
76
what are the complications of paroxetine in pregnancy?
1st: congenital heart defects
3rd: persistent pulmonary HTN
77
what are the characteristics of hypomania?
>3 characteristics lasting 4+ days
| no functional impact
78
what is the treatment of rapid cycling BPAD?
sodium valproate
79
what if there is depression co-existent with mania?
can't use anti-depressants alone
| give with mood stabiliser or anti-psychotic
80
what is the use of CBT in BPAD?
- sense of perspective
- identify release indications
- relapse prevention strategies
81
what are the types of schizophrenia?
1. paranoid
2. hebephrenic (incoherent/irrelevant speech)
3. catatonic (psychomotor disturbance)
4. simple (negative symptoms, apathy, social withdrawal)
82
how long do the symptoms of schizophrenia need to last for?
present most of the time for more than 1 month
83
what ratings/assessments need to be done in Schizophrenia?
Brief Psychiatric Rating Scale
| ADL assessment and Housing and Finance
84
Schizophrenia Bio-Psycho-Social management
Bio: aripiprazole (low dose)/olanzapine + education/support
trial for 6 weeks before change
Psych: CBT - reality testing, family therapy
Social: social skills training, education, benefits, housing
85
what could you use in non compliance?
zuclopenthixol depot
86
what is the DSM-V definition of schizoaffective disorder?
1. Psychotic state (>2 weeks) without concurrent affective symptoms
2. 2 episodes of psychosis: 1 episode lasting >2w without mood disorder symptoms, 1 episode requires overlap of mood/psychosis sx
87
how do you treat schizoaffective disorder?
treat as per schizophrenia
| add mood stabiliser if affective component not being controlled
88
what is delusional disorder?
persistent life long delusions with few/no hallucinations
<3 months = temporary
>3 months = persistent
89
if you have delusional disorder, what cannot you have?
- auditory hallucinations
- schizophrenic symptoms
- evidence of organic disease
90
what are the RFs for delusional disorder?
- old age
- substance abuse
- social isolation
- premorbid personality disorder
- head injury
91
what are examples of delusional disorders?
- erotomania
- othello syndrome
- fregoli syndrome
- factitious disorder
- folie a deux
92
what is the treatment of delusional disorder?
- limited evidence for drugs
- BDZ for anxiety
- Psych: CBT, psychoeducation
- Social: social skills training
93
what neurotransmitters are underactive in anxiety disorders?
serotonin
NA
GABA
94
what should you ask about in anxiety? (SEDATED)
```
Symptoms of anxiety
Episodic or continuous
Drink and drugs
Avoidance and escape
Timings and triggers
Effect on life
Depression
```
95
what are the different anxiety rating scales?
- Beck Anxiety Inventory
- HADS
- GAD-7
96
what do the different scores in GAD mean?
- mild = 5
- moderate = 10
- severe = 15
97
what are the criteria for a GAD diagnosis?
3+ symptoms for more than 6 months
98
what drug should not given in anxiety?
BDZ
99
when should you follow up in anxiety?
weekly F/U after starting medication in anxiety
100
what are the properties of obsessions in OCD?
- self recognized as product of own mind
- thoughts of carrying out are not pleasurable
- commonly themed
- egodystonic
- unpleasantly repetitive
101
what are compulsions?
irrational belief they will prevent a dreaded event
102
what drug for OCD? how long should it be continued for?
Fluoxetine
| 12m after remission
103
what are the 4 phases of cognitive therapy for OCD?
1. Relabel (hands are not dirty)
2. Reattribute (OCD telling me to feel this, my hands are not dirty)
3. Refocus (divert attention when thoughts come up)
4. Revalue (don't give importance to OCD thoughts)
104
how long do ASD symptoms need to persist for?
3+ days
105
what is acute stress disorder?
- transient disorder
- individual without any other apparent mental disorder
- response to exceptional physical and mental stress
- subsides within hours/days
106
what is an adjustment disorder?
- onset within weeks
- lasts <6 months
- symptoms of anxiety and depression without biological symptoms
- arise in period of adaption to significant life change/event
107
how long can a grief reaction last for?
up to 2 years
108
what are the features of an abnormal grief reaction?
- delayed onset
- greater intensity
- prolongation of reaction
- preoccupation with negative thoughts
- suicidal ideations
- hallucinatory experience
109
what is PTSD?
delayed/ protracted response to stressful event of exceptionally threatening or catastrophic nature
110
what are the signs and symptoms?
- re-experiencing (flashbacks, nightmares)
- avoidance of triggers
- hyperarousal (hypervigilance, insomnia, irritability)
- other: MH problems, self-destructive behaviour
111
management of PTSD
trauma focused CBT
| EMDR if >3m after non-combat related event
112
what are the features of dependency?
(3+ in last month)
- tolerance
- craving
- withdrawal
- problems controlling use
- continued use despite harm
- salience/primacy
- reinstatment
- narrowing repertoire
113
how do you calculate a unit?
volume x (% alcohol/1000)
114
what are the symptoms of alcohol withdrawal after 4-12 hours?
- course tremor
- sweating
- insomnia
- tachycardia
- N+V
- psychomotor agitiation
- anxiety
- hallucinations
115
what are the symptoms of alcohol withdrawal after 36 hours?
- alcohol withdrawal syndrome with seizures
| - grand mal seizures
116
what are the symptoms after 48-72 hours?
delirium tremens
117
what are some measures of 1 unit of ETOH?
- 10mL/8g pure ethanol
- 25mL 40% proof alcohol
- half a pint, small glass of wine (125mL)
118
what are the different rating scales for alcohol dependence?
- AUDIT (>20 possible dependence)
- SADQ
- FAST (in A&E)
- CIWA-Ar (for severity of withdrawal)
119
which people need admission for a detox regimen?
- acute alcohol withdrawal
| - Wernicke's encephalopathy
120
what happens if there are less serious signs of dependence?
alcohol addiction service
| if less serious signs of dependence
121
how do you manage patients expectations in acute alcohol withdrawal?
detox will be worse in first 48 hours
| don't stop abruptly
122
what are the criteria and follow up of community based assisted withdrawal?
criteria: >15U/day or >20 on AUDIT
| 2-4 meetings/week (up to 3 weeks)
123
what are the criteria and follow up of inpatient admission
| withdrawal?
criteria: >30U/day, >30 on SADQ, PMHX of epilepsy, withdrawal related seizure)
admitted to hosptial
124
what is the acute treatment of alcohol withdrawal? for how long?
up to 7 days
Outpt: oral chlordiazepoxide + IV/IM thiamine
Inpt: oral lorazepam + IV/IM thiamine
125
what is the chronic treatment and when do you start it?
after 7 days, start only after successful withdrawal
1. acamprosate/naltrexone
2. disulfuram
126
why should you not give IV dextrose to heavy drinkers before IV Pabrinex?
as glucose can precipiate Wernicke's
127
what is the bio-psycho-social for chronic management of alcohol withdrawal?
Bio: acamprosate, naltrexone, then disulfuram
Psychosocial: AA, SMART recovery, drink diary
1. Motivational interviewing 2. CBT
128
what is the MoA of acamprosate?
increase GABA
| decrease craving
129
Psychosocial management for chronic treatment
AA
SMART recovery
Drink diary
1. Motivational interviewing
2. CBT
130
when does heroin withdrawal start, peak and last?
- starts 6 hours after
- peak at 36-48 hours
- last 5-7 days
131
S/S of heroin withdrawal
- flu like symptoms
- D+V
- lacrimation
- rhinorrhoea
- Goose-flesh (pilomotor unit erection)
- mydriasis (dilation)
132
for how long is heroin in the urine?
2 days
133
what is the opiate withdrawal scale?
COWS (Clinical Opiate Withdrawal Scale)
134
steps to management of heroin withdrawal?
1. appoint a key worker
2. harm reduction (needle exchange, vaccination for BBV, naloxone in case of OD)
3. health education (sleep hygiene, support e.g. SMART recovery, narcotics anonymous)
135
what are the 2 ways of opioid substitution therapy?
1. Maintenance: stabilise lifestyle and reduce harm (methadone, buprenorphine)
2. Detoxification detox and abstinence (12 weeks outpt)
136
what are the different options for detox?
1. Methadone or buprenorphine
| 2. Lofexidine (alpha 2 agonist): rapid detox, mild dependence, preference
137
follow up for heroin withdrawal
drugs and alcohol service for at least 6 months
| CBT to reduce change of relapse
138
what is the active ingredient in cannabis
delta-9-tetrahydrocannabinol
139
for how long is cannabis in the urine?
up tp 4 weeks
140
what are the acute complications of cannabis?
paranoia
panic attacks
psychosis/ schizophrenia
141
what are the chronic complications of cannabis use?
dysthmia
anxiety/depressive illness
amotivational syndrome
142
complications of spice use
```
psychosis
confusion
aggressive behaviour
collapse
vomiting
```
143
side effects of phencyclidine use
violent outburst
| ongoing psychosis
144
effects of ketamine in small and large doses
```
small = dissociation
large = hallucinations, synaesthesia
```
145
stimulant drugs (e.g. cocaine, amphetamine, ectasy) SEs
- anxiety disorders
- panic disorders
- drug induced psychosis
146
side effects of chronic cocaine use
- nasal septum necrosis
- foetal damage
- panic and anxiety
- delusions
- psychosis
- Cocaine-induced delusional disorder
147
side effects of amphetamine use?
- post-use depression
| - quasi-psychotic state with visual/auditory/tactile hallucinations
148
what is ectasy death associated with?
dehydration and hyperthermia
149
what are the 2 stages to cocaine withdrawal?
1. crash phase (from 3 hours): depression, exhaustion, agitation, irritability
2. withdrawal: cravings, irritability, anergia, poor concentration, insomnia, slowed movements
150
when does a BDZ withdrawal begin?
few days to 3 weeks depending on half life
151
symptoms of BDZ withdrawal
- insomnia
- tachypnoea
- tremor
- ANXIETY
- palpitations
- risk of seizures and psychosis
- delusions
- depression
- irritability
152
what are the symptoms of a sudden withdrawal from BDZ?
delirium tremens like picture
153
what is the management of BDZ dependence?
1. address underlying need for BDZ
2. address long term complications
3. check willingness to withdraw (can it be done in primary care?)
4. assess driving risk
5. advice may take 3m to 1 year
154
what is the management of stopping smoking?
1. verbal and written into on risks/benefits (first 3-4 days are the hardest)
2. medications: NRT, Varenicline, Buproprion
155
what is important to remember Varenicline and Buproprion?
- Varenicline (partial nicotine receptor agonist, start 7-14 day before stopping)
- Buproprion (selective DA+NA reuptake inhibitor, start 7-14 days before stopping)
156
3 types of weird personality
paranoid
schizoid
schizotypa;
157
4 types of wild personality
dissocial
EUPD
histrionic
narcissistic
158
3 types of worried personality
anakastic
anxious-avoidant
dependent
159
ICD-10 personality disorder criteria
REPORT
Relationships affected
Enduring
Pervasive (occurs in all/most areas of life)
Onset in childhood/adolescence
Results in distress
Trouble in occupational/social performance
160
paranoid PD
- sensitive
- unforgiving
- suspicious
- possessive
- conspiracy theories
- excessive self importance
161
histrionic PD
- attention seeking
- concerned with appearance
- theatrical
- shallow affect
- racy and seductive
162
EUPD
- affective instability
- explosive behaviour
- impulsive
- outbursts of anger
- unable to plan
163
dissocial PD
- forms but cannot maintain relationship
- irresponsible
- guiltless
- heartless
- temper easily lost
- someone else's fault
164
anxious PD
worried about fear/rejection
165
dependent PD
- subordinate
- undemanding
- fears abandonment
- feels helpless when alone
- reassurance needed
- encourages others to make decisions
166
what is reaction formation?
immature ego defence where one suppresses unacceptable emotions and replaces them with the exact opposite
167
what is identification
someone models the behaviour of someone else
168
what is PDQ-4?
personality diagnostic questionnaire
169
what psych management do you use in anti-social PD?
CBT
| focus on interaction between thoughts, feelings, behaviours
170
what is CAT (Cognitive Analytical Therapy)?
focus on specific issues to describe, understand their origin
develop methods to change ideas surrounding specific problem
171
what is the most common ED?
binge eating disorder
172
what levels are high in anorexia?
"Gs and Cs"
- cortisol
- cholesterol
- carotenaemia
- glands (salivary)
- LFTs
173
what tests in AN?
- squat test
- ECG (long-QT in BN)
- DEXA
174
when do you admit in AN?
BMI <13
WL > 1kg/week
HR < 40bpm + long QT
suicide risk
175
ICD-10 AN definition
- BMI <17.5
- deliberate weight loss
- fear of the fat
176
when do you refer in AN?
no watchful waiting
| refer immediately
177
what AN guidelines are used in A&E?
MARSIPAN
178
what is the psych management for AN?
- CBT-ED (1-2-1, 40 weekly sessions)
- MANTRA (20 sessions, focus on cause of anorexia)
- SSCM (explore problems and future)
- Family therapy if child
179
what can a low phosphate cause?
hypophosphatemic HF
180
what screening questionnaire can be used in AN and BN?
SCOFF
181
when do you need to make an urgent referral to CEDS in BN?
- daily purging
- significant electrolyte imbalance
- comorbidity
182
what is the management of BN?
1. guided self help programme (BN-focused)
| 2. CBT-ED (if 1st line ineffective for 4 weeks)
183
what is dissociative disorder?
disorders of physical functions under voluntary control and loss of sensation
184
what is somatisation disorder?
disorders involving pain and autonomically controlled sensations
185
management of dissociative (conversion) disorder?
supportive therapy
- encourage return to normal activity
- avoid reinforcing behavior
- address physical stressors
186
what is somatisation?
multiple recurrent and frequently changing physical symptoms
| >2 years duration
187
subtypes of somatisation
1. undifferentiated
2. hypochondrial disorder
3. somatoform autonomic dysfunction
4. persistent somatoform pain disorder
188
what is somatoform autonomic dysfunction?
symptoms presented as if due to physical disorder under control of ANS (cardio/resp/GI)
e.g. palpitations/ tremor, fleeting aches/pains, bloating
189
management of somatisation
explain and reassure
1. broaden clinical agenda from physical to physical AND psychological
2. be clear about NEGATIVE clinical findings and link symptoms to psych cause
3. explain no further investigations
4. emotional support and coping strategies
5. encourage normal function
then CBT
190
what is BPSD?
Behaviour and Psychological Symptoms of Dementia
1. mood changes
2. abnormal behaviour
3. hallucinations/delusions
191
what are the different cognitive assessments?
- screening: AMTS, GPCOG
| - detailed: Addenbrooke's (ACE-R), MMSE, MoCA
192
what is included in the dementia/delirium screen?
- TFTs (hypothyroid = cognitive decline)
- LFTs (Korsakoff's)
- U+Es, dipstick (infection, diabetes)
- HbA1c
- Vit B12 and folate
- Calcium
193
what scan is important in Lewy Body Dementia?
DaT Scan
194
what questions in the AMTS assess orientation in TIME?
1. what is the time to the nearest hour?
2. what year are we in?
3. How old are you?
(state address)
195
what question in AMTS test orientation in SPACE?
4. Where are you now?
196
what question in AMTS assess orientation in PERSON?
name 2 people here
197
what questions in AMTS assess long-term MEMORY?
6. What is your DoB?
7. When did WW2 end?
8. Who is our current prime minister?
198
what are the last 2 questions in AMTS that assess short term memory?
9. Count backwards from 20-1
| 10. Recall the address I told you
199
what does the PrP immunostain detect?
CJD (Creutzfeldt-Jakob Disease)
200
management suggestions for depression in the eldery
- problem-solving, increasing socialisation, day-time activities
- psychological therapies (e.g. CBT, group therapy, family therapy, couple therapy)
- Age UK
201
what are the 3 Alzheimer's pathophysiology theories?
- amyloid
- tau
- inflammation
202
what is the amyloid theory?
1. APP cleaved by beta-secretase
2. sAPPbeta released, C99 fragment remains
3. C99 digested by gamma-secretase, releases beta-amyloid protein
4. alpha-beta protein forms toxic aggregates
203
what is the tau theory?
1. hyperphosphorylated tau is insoluble = self aggregates
2. self aggregates form neurofibrillary tangles
3. tangles = mictotubule instability and neurotoxic damage to neurones
204
what is the inflammation theory?
1. increase inflammatory mediators and cytotoxic proteins
2. increase phagocytosis
3. decreased levels of neuroprotective proteins
205
what are the genetics for familial/early onset AD?
- presenilin 1 gene (Chr 14)
| - preseniln 2 gene (Chr 1)
206
with what syndrome is dementia caused by beta-amyloid precursor protein (APP) gene on Chr 21 associated with?
Down Syndrome
207
the signs and symptoms of Alzheimer's are due to which 4 key elements of the pathophysiology?
1. Plaque formation (beta amyloid, triggers inflammation, damage to blood vessels)
2. Neurofibrillary tangle formation (severity of AD most closely associated with number of NFTs in neocortex)
3. Cortical atrophy follows from neuronal loss
4. Cholinergic loss
208
what are the 4 A's of Alzheimers?
Amnesia
Aphasia (speech muddled)
Agnosia (visual)
Apraxia (dressing)
209
how can you explain AD to a patient
AD causes dementia which describes a set of symptoms including memory loss and difficulties with thinking, problem-solving or language
AD is a physical disease that affects the brain
210
what are the absolute contraindications to anticholinesterases?
- anticholinergics
- beta blockers
- NSAIDs
- muscle relaxants
211
medical treatment to help in vascular dementia
aspirin
212
Psych treatment in dementia
- structural group cognitive stimulation sessions
- reminiscence therapy
- multisensory therapy
213
what are lewy bodies?
abnormal eosinophilic, intracytoplasmic neuronal structures composed of alpha-synuclein with ubiquitin
214
differences between PD and DLB
PD: Lewy bodies in brainstem, parkinsonian symptoms first
DLB: Lewy bodies in brainstem, angulate gyrus, neocortex, dementia symptoms first
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symptoms of LBD, what medication to not offer?
- fluctuating confusion
- vivid visual hallucinations
- Parkinsonism
- do not offer antipsychotics
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3 clinical presentations of FTD
1. Frontotemporal dementia: frontal lobe syndrome
2. Semantic depression: progressive loss of understanding of verbal and visual meaning
3. Progressive non-fluent aphasia (1st naming difficulties, 2nd mutism)
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what are the 2 pathologies in FTD
1. Tau +ve: Pick's bodies (hyperphosphorylated Tau)
| 2. Tau -ve: no tau = FTLD with ubiquinated inclusions
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what is the psych treatment in FTD?
same as AD
| OT, SALT, physio
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what are the Huntington's disease S/S?
- movement: chorea, speech/swallowing, stumbling/clumsiness
- cognitive: organizing tasks, flexibility, impulse control, difficulty concentrating
- psych: depression, irritability, mood swings, personality change
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what is chorea?
involuntary jerking or fidgety movements that tend to follow from one area to another
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what gene is implicated in Huntington's?
HTT gene
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what should you do when managing a conduct disorder?
pay attention to "protective" or "resilience" factors
| e.g. time spent together as family, regular exercise, regular sleep
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features of ADHD
impaired attention
overactivity
impulsivity
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rating scale in ADHD
Conner's Comprehensive Behaviour Rating Scale
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management of ADHD
1. watch and wait for 10 weeks
2. group based ADHD focused parent training programme
3. refer to speciality
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monitoring in ADHD
- height, weight, BP, HR
- response with symptom rating scale
- assess if development of tics from stimulant meds
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ASD associations
- Fragile X syndrome
- Tuberous Sclerosis
- Neurofibromatosis
- Di George
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ASD trio of symptoms
impairment in:
1. verbal and non-verbal communication
2. reciprocal social interaction
3. restrictive and repetitive behaviors
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ways to assess ASD
ADI-R
ADOS
Childhood Autism Rating Scale (CARS)
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management of ASD
MDT
1. psychosocial play based intervention
2. applied behavioural analysis (focus on improving speech behaviours)
3. reduce impairment in communication (consider visual aids)
4. reduce reinforcement of behaviour
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when are pharmacological treatments indicated in ASD?
used if behaviours making psychosocial training ineffective
| e.g. anti-psychotics
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what is it called when there are symptoms of conduct disorder are present before age of 10?
oppositional defiant disorder
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management of conduct disorder
1. parent management training programme
| 2. child interventions (problem solving, anger management)
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Learning difficulty definition
- IQ < 70
- impaired social/ adaptive functioning
- onset in childhood
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what is an important physical sign of LD?
have a poor sleep wake cycle
| Tx: melatonin
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what is a mild IQ?
50-70
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at is a moderate IQ?
35-50
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what is a severe IQ?
20-35
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what is a profound IQ score?
<20
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what is a way to remember these?
20,15,15,20
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investigations in LD
```
WAIS III or IQ
ABAS II (assess adaptive and social functioning)
```
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what is the management of LD?
Biopyschosocial
- general helo: communication aid, scheduling board, health promotion
- meds: tx comorbid problems, melatonin
- Pysch: CBT, family therapy, art therapy
- Social: support groups, alternative communication strategies
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what can be used in severe cases of post-partum psychosis?
ECT
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what is the post-partum depression aetiology?
falling levels of oestrogen, progesterone and cortisol post natally
