Psychiatry Flashcards
(23 cards)
Definitions
- Delusion
- Hallucination
- Illusion
Delusion - fixed, false peculiar belief
Hallucination - Perception without an existing external stimulus
Illusion - misperception of an actual stimulus
Schizophrenia
- Definition
- Diagnosis
Disorder characterised by
Positive symptoms
- Psychotic symptoms (hallucinations, delusions)
- Disorganisation - (thought disorder, behavioural disturbances)
Negative symptoms
- (poverty of affect, thought and social interaction)
Risks - Family history, drug use
History
2 or more symptoms for 6 or more months + social or occupational dysfunction
Positive symptoms (DDDBH) (hallucinations, delusions, disorganised speech, bizarre behaviour, disordered thought)
Negative symptoms (AAAES) (flat affect, decrease emotional reactivity, property of speech, lack of purposeful actions, anhedonia)
Differential for Schizophrenia
Psychotic disorder (brief psychotic disorder, schizophreniform disorder, shcizophrenia, schizoaffective disorder (= schizophrenia _ major affective disorder - Bipolar, major depressive disorder)
Delusional disorder
Substance induced psychosis
Medical illness
Anticholinergic symptoms
Extra pyramidal symptoms
dry mouth, urinary retention, constipation
-can give benztropine to reduce this
EPS -
acute dystonia - benztropine
dyskinesia (psudoparkinsonism) - shuffling gait, cogwheel regiditiy. benztropine, dopamine agonsit
akinesia - decrease drug, propanolol, benzo, anticholinergic
Akathesia - decrease drug, change drug.
Tardive dyskinesia
Nueroleptic malignant syndroem - stop medicaiton
Atypical antipsychotic side effects
Resperidone, quetiapine, olanzapine, clozapine, aripiprazole
Fewer EPS and anticholinergic than typical antipsychotics
- Weight gain, T2DM
- somlonence, sedation
- QT prolongation
Clozapine specific side effects
- -argranulocystosis (urget FBC w fever)
- constipation/bowel obstruction
- Cardiac - carditis, cardiomyopathy
- Increased secretions
- QT prolongation
- Weight gain, T2DM
-Smoking can increase your level
Neuroleptic malignant syndrome
Dopamine related
- Fever, muscle rigidity, autonomic instability, elevated CK, WBC, clouded consciousness
- STOP medication
- ICU care
- Dantrolene
Side effects of SSRI Buspirone BBlockers benzos
SSRIs - nausea, GI upset, somnolence, sexual dysfunction, agitation
Buspirone - seizures
BBlockers - bradycardia, hypotension
Benzodiazepines - decrease sleep duration, risk of abuse/tolerence, dependence, disinhibition, confusion
Generalised Anxiety Disorder
Anxiety/excessive worrying for 6 or more months
+ 3 other symptoms
-restlessness, fatigue, difficulty concentration, irritability, muscle tension, disturbed sleep
Treatment
- Benzos (short term)
- SSRI, psychotherapy, lifestyle changes (long term) , venlafaxine, buspropion
Panic disorder
- period of intense fear or discomfort in which at least 4 of the following smptoms peak within 10 mins
- tachypnoea, chest pain, palpitations, diaphoresis,nausea, trembling, dizzines,s fear of dying, depersonalisation, hot flashes
(hyperventilation resulting in low O2 status)
Treatment
Short term - Benzos
Long term - CBT, SSRI, TCAs
DDX - panic disorder
Medical conditions - angina, MI, arrythmia, hyperthyroidism, pheochromocytoma
Psych - substance induced anxiety, GAD, PTSD
Major Depressive disorder
Mood one or more major depressive episodes.
Depressed mood or anhedonia (loss of pleasure) + 5 or more for 2 week period
-SIG E CAPS
Differential diagnosis - Depression
Mood disorder secondary to medical condition
(hypothyroidism, parkinsons, CNS neoplasm, stroke, dementia, parathyroid)
Substance induced mood disorder
Adjustment disorder w depressed mood
Normal bereavement
Dysthymia (milder, chronic depression, depressed mood >2 years)
Treatment
- Medication
- ECT (SE - post-ictal confusion, arrhythmias, headache, anterograde amnesia)
- phototherapy (Seasonal pattern)
- TMS
Serotonin syndrome
Serotonin syndrome (fever, myoclonus, hyperreflexia, metal status changes, cardiovascular collapse) --> leads to rhambdomyalisis, coma, death
DDx - drug withdrawal, anti-cholinergic toxicity, meningitis
SSRI side effects
Sexual dysfunction GI, nausea, agitation, insomnia, tremor, diarrhoea
Serotonin syndrome
Bupropion side effects
-decrease seizure thershold
SNRI
vomiting, nasuea, weight, anorexia
TCAs
- cardiac arthymia
- anticholinergic effects - dry mouth, constipation, urinary retention, sedation
toxicity - coma, cardiac arythmia, convulsions
DIG FAST
distractibility insomnia grandiosity flight of ideas/racing thoughts activities/psychomotor agitation sexual activity talkativeness/pressured speech
Bipolar
Type 1 - at least 1 manic episode -
Type 2 - major depressive episode and one hypomanic episode
Manic episode - 1 week of persistently elevated, expansive or irritable mood + 3 DIG FAST symptoms. (can also have psychotic symptoms)
hypomania - similar, but not marked functional impairemnt or psychotic symptoms
Treatment
-Antipyschotics, lithium, valproate
mood stabalises
carbamazipine
valproic acid
lamotrigine
Lithium side effects
Thirst, polyuria, DI, tremor, weight gain, hypothyroidism nausea, Diarrhea, seizures, teratogenicity, acne, vomiting
toxicity - ataxia, dysarthria, delirium, acute renal failure
- Need to measure blood levels regularly
- Cannot use in reduce renal function
Carbamazepine
nausea, rask, leukopenia, AV block, teratogenicity
Valproic acid
gi side effecs, tremor, sedation, alopcia, weight gain,
