Units in a bottle of red wine
10
Recommended Tx plan for pt injecting heroine mixed with crack
- # 1: Confirm opiates + titrate onto methadone
Initial dose is determined by titration: give them small amount and watch, and increase dose until the withdrawal Sx are gone
-#2: harm reduction: needle exchange + HIV test
Define dependence syndrome
3 or more at once in the last year:
- Strong desire or compulsion to use
- Persistent use despite adverse consequences
- Difficulty controlling use
- Neglect of other activities
- Withdrawal symptoms
- Tolerance to effects o the drug
Normal changes to raging brain
- Ventricle size increases
- Cortical weight decreases
- Nerve cell loss in cortex/hippocampus/cerebellum/fewer cell connection
- Amyloid plaques, protein tangles, Lewy bodies = this doesn’t result in Sx
Features required to diagnose dementia
Triad:
- Cognitive decline (eg poor MoCA score)
- Functional decline
- Irreversible
(+ not organic cause)
Delirium
Disturbance of CONSCIOUSNESS and change in COGNITION that develop over SHORT period of time
Types of hallucination most common in dleirium
Visual or Tactile
Mx of delirium
- Prevention - hydration,
- Review medications
- Tx the cause
- Environmental management - access to natural light, remind them of time place person
Sx-atic Tx: only if necessary for SAFETY or DISTRESS of patient
e.g. small doses of Benzos or Antipsychotics
1 Mx for someone with high risk of developing Wernicke’s
High potency vitamins - Pabrinex
Frontal lobe dementia suspected. What abnormal findings would you expect to be elicited: - L R disorientation - Alexia - Impaired understanding of proverbs - Word salad -
- Impaired understanding of proverbs
How to assess cognition and consciousness - give 4 egs
GCS
Orientation to TPP
AMTS
MMSE
6 key things to ask in suspected dementia
Memory Orientation Judgment/problem solving In home Outside home
How to assess attention/executive function?
Take 7 from 100
How to test memory
Apple
Pen
Table
^ ask them if they’ve heard it, then recall
3 features of frontal lobe problems
Disinhibition
Poor motivation
Perseveration
How to test frontal lobe function
Can you say as many words as you can beginning with F
- test vocabulary, if they say fuck (disinhibition),
How to test abstract thinking
“Too many cooks spoil the broth”
what do you think this means?
Frontal lobe dysfunction –> will take it way too literally
Define psychosis
Loss of contact with reality
First rank Sx of schizophrenia
- Controlled by others
- Thought disorder
- Running commentary/thought echo
- 3rd person hallucinations
Risk of relapse in a pt with 1st episode psychosis with a family of highly expressed emotion
60%
What is the disorder:
“The train rain braine me. He ate the skate, inflated yesterdays”
Clang associations
Capgras Syndrome
Delusions that someone you know has been exchanged for someone else - a fixed belief
“I know it sounds silly but i can’t get it out of my head that my baby has been exchanged for my neighbour’s little girl”
OCD
Ekbom’s syndrome
Delusional parasitosis
