mainstay in managing personality disorders
dialectical behavioral therapy
OCD vs OCPD
OCD involves ego-dystonic obsessions and compulsions causing distress; OCPD traits are ego-syntonic and perceived as appropriate by the individual.
which type of antipsychotic is associated with a main side effect and how is the SE managed
- typical antipsychotics are associated with EPSEs
- different types of EPSE but acute dystonia [including oculogyric crisis] is managed with procyclidine.
other SEs:
- hyperprolactinaemia
- reduction of seizure threshold
- increased risk of VTE and stroke in the elderly
- sedation, weight gain
- neuroleptic malignant syndrome: pyrexia, muscle stiffness
- prolonged QT
types of EPSEs
- Parkinsonism
- acute dystonia
- sustained muscle contraction (e.g. torticollis, oculogyric crisis)
- may be managed with procyclidine
- akathisia (severe restlessness)
- tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
advanced directive vs advanced statement
T/F
the mental health act can be used to treat physical conditions as well as mental health conditions whilst a pt is mentally unwell
FALSE
- The Mental Health Act cannot be used to treat physical health symptoms apart from a few exceptions including severe anorexia nervosa.
- The patient’s capacity needs to be assessed to refuse this treatment and if present, even if this decision were to be deemed unwise, is his to make.
- If absent, action should be taken to treat him in his best interests.
Schneider’s first rank symptoms
Auditory hallucinations of a specific type:
- two or more voices discussing the patient in the third person
- thought echo
- voices commenting on the patient’s behaviour
Thought disorders
- thought insertion
- thought withdrawal
- thought broadcasting
Passivity phenomena:
- bodily sensations being controlled by external influence
- actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
Delusional perceptions:
- a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.
alcohol withdrawal pattern of symptom development
by time
Alcohol withdrawal:
- symptoms: 6-12 hours
- seizures: 36 hours
- delirium tremens: 72 hours
neuroleptic malignant syndrome Vs Serotonin syndrome
- NMS causes muscle rigidity + hypOreflexia whereas SS causes myoclonus + hypERreflexia
- NMS develops over days whereas SS develops over hours
schizophrenia sx duration for diagnosis
- The diagnosis requires at least one core positive symptom (delusions, hallucinations, disorganised speech) persisting for ≥1 month with functional decline over ≥6 months.
- Negative and cognitive symptoms contribute significantly to long-term disability.
schizophrenia symptoms
Positive symptoms: ABCD These reflect an excess or distortion of normal functions.
- Delusions: Fixed false beliefs not amenable to reason, commonly persecutory, referential, or grandiose.
- Auditory Hallucinations: Perceptions without external stimuli, most commonly auditory (e.g., hearing voices).
- Disorganised speech: Thought disorder manifesting as incoherent, tangential, or derailment of speech.
- Disorganised or catatonic behaviour: Unpredictable agitation, inappropriate affect, or motor abnormalities such as stupor or rigidity.
Negative symptoms: 4A's Reflect diminution or loss of normal functions.
- Affective flattening: Reduced emotional expression.
- Alogia: Poverty of speech.
- Avolition: Lack of motivation and goal-directed behaviour.
- Anhedonia: Inability to experience pleasure.
- Social withdrawal: Reduced social engagement and interest.
Cognitive symptoms: Often subtle but significant impairments in:
- Attention and concentration
- Working memory
- Executive function
which SSRI has a favourable SE profile for pt with a history of MI
sertraline
antipsychotic SEs
Extrapyramidal side-effects (EPSEs):
- Parkinsonism
- acute dystonia
- sustained muscle contraction (e.g. torticollis, oculogyric crisis)
- may be managed with procyclidine
- akathisia (severe restlessness)
- tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
Other side-effects:
- antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
- sedation, weight gain
- raised prolactin - may result in galactorrhoea
- impaired glucose tolerance
- neuroleptic malignant syndrome: pyrexia, muscle stiffness
- prolonged QT syndrome
Mx of serotonin syndrome
benzos: lorazepam
Mx of NMS
Dantrolene
Depression vs. dementia
Factors suggesting diagnosis of depression over dementia
- short history, rapid onset
- biological symptoms e.g. weight loss, sleep disturbance
- patient worried about poor memory
- reluctant to take tests, disappointed with results
- mini-mental test score: variable
- global memory loss (dementia characteristically causes recent memory loss)
define mania and hypomania
Differentiate using the length of symptoms, severity and presence of psychotic symptoms
Mania:
- Extremely elevated mood
- causing severe functional impairment [work/social]
- May cause psychotix Sx
- for ≥7 days
Hypomania:
- milder form of mania
- functionality may improve or be impaired to a lesser degree than mania
- ## lasts <7 days - usuallu 3-4 days
types of bipolar
lithium monitoring requirements
Lithium levels
- narrow therapeutic index
- T4 monitored weekly until pt stabilised on dose OR after a dose change.
- once stable, monitored every 3 months
- target 0.6–1.0 mmol
other monitoring
- Monitor body-weight or BMI, serum electrolytes, eGFR, and thyroid function every 6 months during treatment
Sx of mania
I DIG FAST + Functional impairment
- Irritable
- Distractable
- Insomnia: Decreased need for sleep
- Gradndiose: Inflated self-esteem or grandiose delusions
- Flight of ideas: rapid thought processes that leap from topic to topic
- Activity ↑
- Speech ↑ : pressured
- Thoughtless [risky behaviour] ± psychosis: hallucinations or delsuion.
Sx of lithium toxicity
CHAVS/ CHAPS
- Coarse tremor
- Hyperreflexia
- Arrhythmias + Acute confusion.
- Visual disturbance // Polyuria 2º to nephrogenic insipidus
- Seizures [+ other CNS disturbance: dysarthria and impaired coordination, ataxia + ↓ GCS].
when should a pt with an eating disorder be admitted as an inpatient
immediate medical stabilisation and comprehensive care is indicated in:
- severe malnutrition,
- bradycardia,
- hypotension
- severe or rapid weight loss,
- significant suicide risk, or
- inability to perform the SUSS test (sit-up, squat, and stand).
- proximal muscle weakness suggests weak respiratory muscle
a new mum with an 18 month old child present with feelings of anhedonia and low mood lasting 3 months. Dx?
depression
post partum occurs within 12 months of having a baby.
had the symptoms started during the first 12 months it would be classed as postpartum.
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