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Psych conditions

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imo132's version from 2016-11-21 00:54

Conditions

Question Answer
2' psychosisTo EtOH, withdrawal, cocaine, marijuana, amphetamines, TBI, tumour, epilepsy, MS, encephalitis, HIV, neurosyphilis
Schizoaffective disorderMood disturbance with psychosis, depression in older patients, bipolar in younger, respond better to mood stabilisers than pure bipolar
Schizoaffective Dx>2 weeks psychosis then mania/depression, must not be substance related
Major depressive Dx2 weeks of >5 of low mood, anhedonia, weight/sleep/psychomotor change, fatigue, low cognition, worthlessness, suicidal ideation
Dysthymia DxLow mood for 2 years with >2 of sleep/appetite change, fatigue, low self-esteem, low cognition, hopelessness, Sx free for <2 months
Schizophrenia epidem1%, onset 15-30, M>F (young men, old women), child onset rare, early death, high in developed/urban/immigrants
Schizophrenia RFFHx, developed country, urban area, immigrant, 2nd tri infxn, prenatal famine/trauma
Schizophrenia relapse RFDiscontinuation of meds, low belief in need for treatment, increases negative Sx & non-response to Rx
Schizophrenia prognosis30% recover (full in half), depends on duration of undiagnosed psychosis, personality & premorbid condition
Positive SxHallucinations (mostly auditory via Heschl), illusions, delusions (persecutory, grandiose, reference, thought control, identity)
Negative SxAffective blunting, anhedonia, amotivation, alogia (concrete thinking, poverty), asociality, predict poor outcome, prominent in type 2
Mood disturbance SxSuicide (5% schiz), anxiety (40%, with obsessions & social anxiety)
Substance dependence Dx>3 of craving, impaired control, higher priority, increased tolerance, withdrawal, continued use despite harm
Harmful drinking RxFeedback & intervention
Substance dependence effectsBlunted response to normal activities, low mood, raised GGT (sensitive), AST, ALT, CDT (specific)
Depression epidem7% women, 4% men per year, half seek Rx, 40% genetic
Non-melancholic depressionMost common, mostly 5HT issue
Melancholic depression2nd most common, mostly NA issue, with insomia, early waking, loss of appetite, flat affect, psychomotor change, anhedonia
Psychotic depressionLeast common, mostly DA issue, mood congruent
Non-melancholic depression RxTCA = SSRI = CBT, slightly more effective than placebo
Melancholic depression RxTCA > SSRI, very effective
Psychotic depression RxAD (25% effective), AD & AP, ECT (very effective)
Depression Rx effectivenessECT > MAO-I > TCA > SNRI > SSRI > mirtazepine
Depression responseDecrease in HAMD by half, 2/3 people with first agent
Depression remissionDecrease in HAMD to 7, half with first agent
Bipolar2%, recovery between episodes, high recurrence risk, onset 17-21, 8 year delay to Dx, chronic in 20%, high suicide, with substance abuse & anxiety
Bipolar prognosis50% asymptomatic, 30% depressed, rest manic/mixed
Bipolar cause60% FHx, corticosteroids, ADs, stimulants, shift work, jet lag
Bipolar RxMood stabiliser + ECT (bilateral better) + AD for depression (venlafaxine & TCA) or AP for mania (typicals)
Bipolar Rx egAripiprazole for mania, olanzapine/quetiapine for mania & depression
Suicide in bipolarMost while off medication, must not cease or relapse inevitable
Bipolar non drug RxSocial rhythms therapy
Social phobia epidemIn 3%, F=M, onset teens, more likely single, unemployed, low SES, alcoholics (consequence of disorder)
Social phobia RFFHx, difficulty sleeping or irritability in new situations, avoidance of contact with new people in 1st year of life
Panic disorderIn 1%, F>M, onset 25
Panic disorder prognosis30% recover, 50% chronic with fluctuations (mild), 20% continuous
Panic disorder causeAmygdala & locus ceruleus
Anxiety disorders25% lifetime prevalence, panic disorder has high CVD
GADIn 6%, chronic pathological worry with fluctuations, rarely occurs alone, most common anxiety disorder in old age, begins in teens, long delay in seeking Rx
Blood phobiaIn 5%, F=M, tachycardia then vasovagal & syncope, later onset (teens), FHx,
PhobiasIn 5%, F>M, onset 10, earlier for animal phobia (childhood)
OCD epidem1%, F=M, onset early 20s, earlier for males, 8 year delay to Rx, remission 20%, fluctuating <50%, steady <50%, progressive <15%
OCDUncontrollable, dysfunction of 5HT & DA in limbic system & BG
Anxiety drug RxWith comorbid depression, most effective for PAD/GAD, least for specific phobia
Remission of anxietyPatient must take Rx every day for 6+ months, aim for highest dose, switch or augment if failure, ceased if remission for 6 mo and patient ready
PD RxClomipramine, SSRI, imipramine, benzo, venlafaxine 1st, TCAs & benzos 2nd
GAD RxBenzos, venlafaxine, imipramine, SSRI, pregabalin/duloxetine, quetiapine, busiprone
SAD RxMAO-I, benzos, venlafaxine, SSRI, exposure to social situations, social skills training
SAD, PD, GAD 1st lineSSRI, venlafaxine, duloxetine/pregabalin (GAD)
SAD RxSSRI, SNRI, pregabalin 1st, benzos 2nd
OCD RxSSRI high dose for 12 weeks, 50% respond, then clomipramine + AP
Baby blues70%, onset 3-5 days pp, with anxiety, depression, tearfulness, labile mood, irritability, benign/transient course, from stress & hormones
Antenatal depression10%, any time in pregnancy
Postnatal depression10%, gradual onset over 3-6 months
Postpartum melancholiaEarly onset within 4 weeks pp, biological, related to bipolar disorder, needs AD or ECT
Postnatal depression RFGenes, early trauma, young age, low SES, dysfunctional relationships, poor support, oestrogen sensitivity, personality, previous depression/anxiety
Postnatal depression effectsLower IQ in children, cognitive & relationship problems, depression & anxiety
Postnatal depression RxCounselling, psychoeducation to prioritize activities, CBT, IPT
AD in postnatalIndicated in mod-severe, comorbid panic disorder, previous good response to AD, bipolar (with mood stabilizer)
Antenatal depressionMore preterm, LBW, SGA, PIH, effect on placenta (glucocorticoids), developmental delay & mental illness for child
AD in pregnancyIncreases heart defects by 2x (to 3%), PPH (SSRI after 20 wks), low maternal weight gain, preterm, low birthweight, PIH
Poor neonatal adaptationWithdrawal from AD, mostly venlafaxine & paroxetine (short half-life)
Bipolar in pregnancy50% relapse within first 3 weeks if unmedicated, faster than schizophrenia
Schizophrenia in pregnancyRelapse within first few months (slower than bipolar), highest time of admission for psychosis across lifetime
Puerperal psychosis0.1%, onset first 3 weeks, with confusion, delusions (infant-related), mania, indecisiveness, hallucinations, depression, mania, catatonia, remits with Rx, from oestrogen sensitivity
Puerperal psychosis RxDon’t separate mum & baby, use typical AP, AD, mood stabilisers (no BF with lithium), benzos for catatonia, ECT
DeliriumDisturbance of consciousness with reduced attention, change in cognition (memory deficit, disorientation), perceptual disturbance, develops over hours to days, worse at night
CAM for deliriumPresence of acute onset and fluctuating course, inattention, disorganised thinking or AMS
DementiaMultiple cognitive deficits with memory impairment, aphasia, apraxia, agnosia, executive deficits, 10-20 moderate, <10 severe
Personality disorder epidem10% overall, each 1%, M>F, borderline & antisocial less common with age, higher in cities and prisons
Child personality disorderDiagnosed if >1 year except ASPD
Borderline RxDBT (self-harm), psychodynamic therapy, good clinical care (problem solving), supportive psychotherapy
Meds for borderlineTreat comorbidities, symptomatic, no difference to core Sx (emptiness, identity disturbance, fear of abandonment) or outcome, mood stabilisers may be helpful
Personality disorder RxPsychotherapy (structured for Sx reduction, insight-oriented/dynamic to change personality), AD only if comorbid depression
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