Psychiatry Flashcards
(42 cards)
Patient - elderly man, inpatient in hospital becomes acutely confused following UTI, hallucinating, w/ sleep wake reversal
Delirium
Delirium Aetiology
- Infection
- Drugs - BZ, opiates, L-Dopa, Digoxin
- Hypoglycaemia
- Dehydration and electrolyte imbalance
- Decreased O2
- Alcohol withdrawal
- Surgery
RF’s
- Age
- Dementia or brain injury
- New environment
- Sleep deprivation
- Immobilization
- Visual or hearing impairment
Delirium Presentation
- Sleep/wake reversal
- Incoherent thought and speech
- Visual hallucinations
- Persecutory delusions
- Hyperactive = agitated and upset
- Hypoactive = Drowsy and withdrawn.
Delirium Ix
1) Hx and Exam to identify underlying cause.
2. Septic screen
Delirium Rx
- Nurse in a quiet and safe area.
- Re-orientate
- Avoid psychoactive drugs (can use haloperidol if severe)
- Treat cause
Patient - Young male, cannabis user, auditory hallucinations, thought echo, though withdrawal and passivity.
SCH
SCH Aetiology
- UK
- Genetics - FHx
- Dopamine excess (only explains positive Sx)
- Daily cannabis use is a RF.
SCH Presentation
First rank Sx; 3rd person auditory hallucinations + thought echo + thought interference + delusional perception + passivity phenomenon.
- Sx must be present for 6 months.
SCH: Paranoid
- Common, hallucinations and delusions are persecutory
SCH: Hebephrenic
- Disorganised SCH w/ fleeting affect, hallucinations and delusions.
SCH: Catatonic
- Stupor, posturing and negativism (withdrawal, self-neglect, blunted affect)
SCH Ix
1) Clinical
2) Rule out brain pathology such as FTD or LBD. Brain scan for mass lesions.
SCH Rx
1) Antipsychotic (neuroleptic drugs)
- Block D1 and D2 receptors.
- Manage acute +’ve Sx.
- Extra-pyramidal SE; parkinsonism due to Dopamine blockade.
- Common SE = Akathisia, parkinsonism, tardive dyskinesia, hypotension, dry mouth, weight gain, urinary retention.
Antipsychotics
1st gen = Chlorpromazine, haloperidol
2nd gen = risperidone, olanzapine, clozapine
Patient - 5 days after first dose of haloperidol, becomes hyperthermic, rigid, w/ increased HR and pallor.
Neuroleptic malignant syndrome
NMS Aetiology
- Due to dopamine blockade, triggers massive glutamate release, neurotoxic and muscle damage.
NMS Presentation
- Pyrexia
- Muscle rigidity
- Antonomic lability, HTN, high HR, high RR.
- Agitated delirium and confusion
- LOC
NMS Ix
1) Clinical w/ Hx of Antipsychotics or levodopa (when stopped)
2) Bloods; CK and FBC (leucocytosis)
NMS Rx
1) Stop offending drug.
2) ITU for nursing
3) Dantrolene to decrease muscle tone
4) Bromocriptine (dopamine agonist) enhances dopaminergic activity.
Patient - Periods of depression and low mood punctuated with periods of elation and psychotic behaviour
Bipolar disorder.
BPD Aetiology
- UK
- Genetics
- Biochemical - increased serotonin
BPD Presentation
- Develops in late teens.
- Type 1 = mania and depression
- Type 2 = Hypomania and depression.
Mania
- Abnormal elevated mood or irritability
- In mania there is severe functional impairment or psychosis for 7 days or more.
- Hypomania is less severe or less prolonged.
- Delusions of grandeur, pressure of speech, flight of ideas etc, sexual promiscuity.
BPD Rx
1) Lithium is the drug of choice. Alternative = valproate.
2) Mania management = stop antidepressant and start antipsychotic therapy - olanzapine or haloperidol.
3) Manage depression w/ talking or fluoxetine.
Lithium;
- TFT, parathyroid and U&E prior to starting.
- Toxicity can occur
- Interacts w/ NSAID’s and diuretics.
- Monitoring week following first dose and 12hrs following last dose. + every 3 months when stable.
- TFT and U&E every 6 months
