Psychiatry

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Author:
grignoter
ID:
207444
Filename:
Psychiatry
Updated:
2013-03-15 10:23:10
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psychiatry
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psychiatry
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  1. Alcohol Units
    • 10ml ethanol = 8g
    • volume an adult can metabolise in 1 hour

    Units = volume (ml) x %strength / 1000
  2. Weekly Alcohol Recommendations
    • Men: 21 units
    • Women: 14 units

    less if: CLD, low weight, malnourished, extremes of age, metronidazole, MOAI, antihistamines, benzos, opiods
  3. Units in 1 pint beer
    2
  4. Units in 175ml glass wine
    1.5
  5. Units in 1 shot 25ml spirits
    1
  6. Alcohol Withdrawal Symptoms
    • ~12 hours after last drink
    • anxiety
    • insomnia
    • sweating
    • tachycardia
    • tremor
    • seizures after 48 hours
    • 5% mortality
  7. Management of Alcohol Withdrawal
    • reducing regular benzos - chlordiazepoxide
    • IV or PO vitamin B
  8. Delirium Tremens
    • 48 hours after last drink
    • lasts 5 days
    • tremor
    • restlessness
    • increased autonomic activity
    • fluctuating consciousness with disorientation
    • fearful affect
    • hallucinations - often visual, sometimes Lilliputian
    • delusions
  9. Biological Symptoms of Mania
    • decreased sleep
    • increased energy
    • psychomotor agitation
  10. Cognitive Symptoms of Mania
    • decreased concentration
    • flight of ideas
    • lack of insight
    • circumstantiality
    • tangentiality
  11. Symptoms of Mania
    • elevated or irritable mood
    • decreased sleep
    • high energy, agitation
    • flight of ideas, poor concentration, thought disorder
    • +/- psychotic features
    • first rank symptoms (20%)
    • manic stupor
  12. Psychotic Features in Mania
    • grandiose delusions
    • persecutory delusions
    • hyperacusis
    • hyperaesthesia
  13. Manic Stupor
    • unresponsive
    • akinetic
    • mute
    • conscious
    • elevated facies
  14. Tangentiality
    speaker digresses further and further away from the initial topic via loose associations
  15. Circumstantiality
    speaker eventually gets to the point in a very roundabout way
  16. Formal Thought Disorder
    • circumstantiality
    • tangentiality
  17. First Rank Symptoms
  18. Anorexia Nervosa Diagnostic Symptoms
    (4/4 required)
    • BMI <17.5 or <15% expected
    • self-induced weight loss: dieting, exercising, vomiting
    • morbid fear of fat
    • endocrine disturbance: amenorrhoea, pubertal delay, lanugo hair
  19. Anorexia Nervosa Associated Symptoms
    • anaemia
    • interest in preparing or buying food
    • tiredness
    • coldness
    • bradycardia
    • hypotension
  20. Anorexia Nervosa Management
    • CBT
    • raising calorie intake
    • admission with weight loss >35%
  21. Anorexia Nervosa Risk Factors
    • Caucasian
    • higher social class
    • academic prowess
    • interests in ballet, modelling
  22. Anorexia Nervosa Prognosis
    • 50% complete recovery
    • 5% mortality - starvation or suicide
  23. Bulimia Nervosa Diagnostic Symptoms
    (3/3 required)
    • binge eating
    • self-induced weight loss or attempts: vomiting, purging, laxatives
    • morbid fear of fat
  24. Eating Disorders Epidemiology
    AN: 4 in 100,000, peak age 18y, 10% male

    BN: 12 in 100,000, 10:1 female
  25. Complications of Bulimia Nervosa
    • hypokalaemia
    • dehydration
    • parotid swelling
    • dental caries
    • Mallory-Weiss tear
    • osteoporosis
    • Russell's sign (thickened dorsum of hand)
  26. Bulimia Nervosa Prognosis
    • 70% recovery within 5 years
    • No increase in mortality
  27. Bulimia Nervosa Management
    • CBT
    • normalisation of calorie intake
    • SSRIs may improve bingeing
  28. Over-valued Idea
  29. Dementia
    • non-specific syndrome caused by several illnesses
    • impaired cognition may include memory, attention, language, problem solving
    • present for greater than 6 months
  30. Vascular Dementia
    • multiple small cerebral infarcts in cortex and white matter
    • clinically apparent when >100ml
    • onset in 60s
    • step-wise deterioration
    • focal neurology, fits, nocturnal confusion
    • death often within 5y due to IHD or CVA
  31. Risk Factors for Vascular Dementia
    • male
    • smoking
    • hypertension
    • diabetes
    • hypercholesterolaemia
  32. Normal Pressure Hydrocephalus
    • dementia (mainly memory)
    • gait disturbance
    • urinary incontinence

    obstruction in subarachnoid space prevents reabsorption of CSF but flow is uninterrupted so ventricles dilate but opening pressure is only marginally raised

    • Diagnosis: LP then CT/MRI
    • Management:┬áVP shunt
  33. Pick's Disease
    • frontotemporal dementia
    • "knife blade" atrophy of frontal and temporal lobes (visible on MRI if advanced)
    • cytoplasmic inclusion bodies of tau protein (Pick bodies) in substantia nigra
  34. Frontotemporal Dementia
    • disinhibition
    • inattention
    • antisocial behaviour
    • personality changes
    • later: apathy, akinesia, withdrawl, memory loss, disorientation
  35. Delirium
    • fluctuating impairment of consciousness
    • mood changes
    • abnormal perceptions
    • may be hypoactive
    • acute onset
    • average┬áduration 7 days
    • 40% die from underlying condition
    • 5% progress to dementia
  36. Physical Causes of Delirium
    • infection
    • hypoxia
    • electrolyte disturbances
    • constipation
    • drugs
    • CNS disease
  37. Management of Delirium
    • treat cause
    • calm environment
    • good lighting
    • glasses, hearing aids
    • continuity of staff
    • family, friends, familiar objects
    • PO or IM haloperidol or benzos IFF required
  38. Causes of Erectile Dysfunction
    • psychosocial: marital difficulties, financial strain
    • alcohol use
    • drugs - beta-blockers, tricyclics, benzos, antihistamines, oestrogens, statins, anti-Parkinsonisms
    • disease: neuropathy, ischaemic vascular disease, hypertension
  39. Management of Erectile Failure
    • intracavernosal injection of papaverine
    • prostaglandin E1
    • vacuum device
    • nitrate creams
    • rod insertion
  40. Indications for ECT
    • severe depressive illness
    • life-threatening behaviour
    • puerperal depression
    • mania
    • catatonic schizophrenia
  41. Contraindications for ECT
    • absolute: raised ICP
    • relative: high anaesthetic risk, cerebral aneurysm
  42. Side Effects of ECT
    • short term headaches
    • short term muscles aches
    • temporary confusion
    • working memory loss
    • possible long-term LT memory loss
  43. Antipsychotic Side Effects
    extra-pyramidal side effects
  44. Extra-Pyramidal Side Effects
    (Please Don't Act Too Different)
    • Parkinsonism (rigidity, bradykinesia, tremor)
    • dystonia
    • akasthisia (restlessness)
    • Tardive Dyskinesia
  45. Dystonia (EPSE)
    • trismus
    • tongue protrusion
    • spasmodic torticollis
    • opisthotonus
    • oculogyric crisis
    • grimacing
  46. Tardive Dyskinesia
    chewing, grimacing, sucking, darting tongue

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