PSYCHIATRY REVISION

KEY POINTS
Differential Diagnosis Pyramid: OPAPS
ental Healt! A"t
PATIENT MUST FULFIL ALL 5 CRITERIA:
1. The person appears to have a mental illness (a medical condition characterized
by a disturbance in thought, mood, perception and memory)
2. The person req!res immediate treatment "h!#h "an #e o#tained $%
!nvo&ntar% a'(!ss!on
). The person req!res r*ent treat(ent +or the !ealt! and safety o+ the(se&ves
an' others (or to prevent 'eter!orat!on,
-. The person !s na$&e to or ref$ses to gi%e "onsent. 'e to the!r !&&ness
5. The pat!ent "annot #e treated !n a (anner that !s less restri"ti%e
Cogniti%e Assessment
Orientation /ate. /a%. 0ear. Season. Lo#at!on. Contr%
emory Re*!ster. Re#a&&. Lon* Ter( (!(press!on,. Con+a$&at!on
Con"entration /a%s o+ the "ee1 $a#1"ar's. Spe&& 23RL/ 4a#1"ar's
Intelligen"e 5enera& !(press!on +ro( !nterv!e"
&rontal 'o#e 2or' L!sts (16 +r!ts,
A$stra#t tho*hts ('!++eren#es7 s!(!&ar!t!es. prover$s,
Parietal 'o#e /%spra8!a () step #o((an'. !nterse#t!n* penta*ons,
A*nos!a (na(!n* +!n*ers. "r!t!n* on s1!n,
'ang$age /%sphas!as 9 +&ent. non:+&ent
:1:
Cluster A: mad
Cluster B: bad
Cluster C: sad
Delirium, Dementia, GMC
Drugs/Toins
Amnestic disorder
!chizophrenia, !chizophreni"orm,
!chizoa""ecti#e, Deulsional, Brie"
$sychotic, !hared psychotic,
$sychosis due to GMC/Drugs
Depression, Dystyhmic,
Bipolar %/%%, Cyclothymic
Mood due to GMC/Drugs $anic & Agoraphobia
!peci"ic/!ocial phobia
'CD, $T!D, Acute stress, GAD
(Ad)ustment disorder *ith
depressed mood, !omato"orm
Persona&!t%
3r*an!#
Ps%#hot!#
Moo'
An8!et%
So#!a&7Env!ron(ent
PSYCHIATRY REVISION
Psy"!oti" Disorders
S"!i(o)!renia
Definition:
: A ps%#h!atr!# '!sor'er #hara#ter!;e' $% '!str$an#es !n spee#h. e(ot!on.
#o*n!t!on. per#ept!on an' vo&!t!on. ('e&s!ons. ha&&#!nat!ons. or '!sor*an!;e'
spee#h an' tho*ht,
E)idemiology:
: 171666 Astra&!a
: Ma&e:Fe(a&e. 1:1
: 3nset &ate teens. ear&% t"ent!es
: Ma&es (ore severe&% a++e#te' than +e(a&es (ear&!er onset,
Aetiology:
: S$t&e '!srpt!ons !n $ra!n 'eve&op(ent an' (atrat!on !n tero
: Co($!nat!on o+ *enet!# an' env!ron(enta&7non:*enet!# !n+&en#es
: Ph%s!#a& #on'!t!on $ro*ht ot $% a &!+e stressor (e*. Start!n* #o&&e*e. ne" <o$,
Ris* fa"tors:
: Fa(!&% =8
: Prenata& >!rs
: 4!rth #o(p&!#at!ons7tra(a
: Canna$!s se ? 1@%rs
Sym)toms:
Positi%e Negati%e Cogniti%e
=a&&#!nat!ons
/e&s!ons
/!sor*an!se' spee#h
/!sor*an!se' $ehav!or
La#1 o+ (ot!vat!on
Poor se&+:#are
4&nte' a++e#t
Re'#e' spee#h otpt
I(pa!re' p&ann!n*
I(pa!re' !ns!*ht
I(pa!re' (e(or%
Re'#e' (enta& +&e8!$!&!t%
DS IV:
: A '!str$an#e &ast!n* A B (onths. "!th at &east 1 (onth o+ A#t!ve s%(pto(s
(pos!t!ve or ne*at!ve, "!th res&tant so#!a&7o##pat!ona& '%s+n#t!on.
: E8#&'es s#h!;oa++e#t!ve. (oo' '!sor'er. s$stan#e a$se. *enera& (e'
#on'!t!on (5MC,
: N4: S#h!;ophren!+or( !s t%p!#a&&% se' as a pre&!(!nar% '!a*nos!s +or
s#h!;ophren!a. /e to the #o(p&e8!t!es o+ s#h!;ophren!a. an !n!t!a& '!a*nos!s !s
ver% o+ten tentat!ve an' s#h!;ophren!+or( !s there+ore se'.
dD+ for Psy"!osis:
1. Ps%#hos!s 'e to ps%#hoa#t!ve 'r* (!nto8!#at!on or "!th'ra"a&,
2. Pr!(ar% S#h!;ophren!+or( ps%#hos!s
). 4or'er&!ne7S#h!;ot%pa& '!sor'er "!th 'e#o(pensat!on
:2:
PSYCHIATRY REVISION
Assessment:
1, En*a*e Pat!ent +or =!stor% an' E8a(!nat!on
: Thoro*h ph%s!#a&. (enta& h!stor% an' e8a(!nat!on !s !'ea&
: Ma% not $e rea&!st!# 'epen'!n* on pat!ent state
: Ma% nee' #orro$orat!ve h!stor% +ro( +a(!&%7#arers
: Use open en'e' qest!ons !n!t!a&&%
C +as anything happened lately that has upset you
( ,hat is the most important thing you *ould li-e help *ith
C +a#e you noticed anything suspicious going on around you
( +a#e you "elt li-e people are tal-ing about you, or *atching you in an unusual
manner
(+as anything on the T. or radio, or in the ne*spapers, seemed to re"er to you
personally
(+a#e you heard people tal-ing to you or about you *hen there *as nobody
around
2, Assess R!s1
: Past r!s1 o+ se&+ har(
: Crrent r!s1 o+ se&+ har(
: R!s1 o+ har( to others (!n#&'es: 'epresse' (oo'. a*!tat!on. a**ress!on,
: Nee' +or hosp!ta& a'(!ss!on7!nvo&ntar% treat(ent
), Eva&ate tr!**ers
: S$stan#e a$se
: Me'!#at!on non:#o(p&!an#e
: Stress+& &!+e event
-, Assess #rrent treat(ent
: Me'!#at!on #o(p&!an#e
: A'verse e++e#ts (e8trap%ra(!'a&,
: Att!t'es to"ar's (e'!#at!on7treat(ent
: Ins!*ht
5, Past =!stor% 9 Re&evant Isses
: Leve& o+ +or(a& e'#at!on
: Most re#ent t!(e o+ h!*hest &eve& o+ ps%#hoso#!a& +n#t!on!n*
: F!rst onset o+ ps%#hot!# s%(pto(s
: /e*ree o+ re#over% $et"een ep!so'es
: Att!t'es to"ar's +a(!&% an' s!*n!+!#ant others
: Fa(!&% h!stor%
B, Ph%s!#a& E8a(!nat!on
: >!ta& s!*ns
: =%'rat!on an' 38%*en satrsat!on stats
: 4&oo' 5&#ose
: Ur!nana&%s!s D To8!#o&o*% (a(pheta(!nes,
: R&e ot or*an!# +a#tor 9 !n+e#t!on. (eta$o&!#
E, Frther !nvest!*at!ons
: EE5
: CT7MRI
: Th%ro!'
: F4E
: Sero&o*%: =I>
: >!t 4127Fo&ate
:):
4ase&!ne (easre(ents !+ start!n* R8:
:2e!*ht. EC5. 4&oo's. TFTs. LFTs.
5&#ose. &!p!'s
: Repeat B712 !+ treat(ent #ont!nes
PSYCHIATRY REVISION
anagement
1, Ps%#hoe'#at!on
a. Pat!ent E'#at!on (ear&% "arn!n* s!*ns. strate*!es +or ear&% !ntervent!on:
e*. !n#rease ant!ps%#hot!#s. a'' $en;o. a$sta!n +ro( 'r*s. stress
(ana*e(ent. he&p see1!n*,
$. Fa(!&% E'#at!on
2, Ps%#hoso#!a& Intervent!on
a. M&t!'!s#!p&!nar% approa#h: 5P. Ps%#h!atr!st. So#!a& "or1ers
$. Invo&ve +a(!&% !n treat(ent (+a(!&% therap%: pro$&e( so&v!n*. stress
(ana*e(ent. &!sten!n* s1!&s,
#. Co*n!t!ve 4ehav!ora& Therap%
'. So#!a& S1!&&s Tra!n!n*: &earn!n* to $ehave !n s!tat!ons. e*. E%e #onta#t.
spee#h vo&(e. &en*th o+ response et#.
e. En*a*e serv!#es to ass!st "!th: =3PELESS (hos!n*. o##pat!on.
pr!(ar% spport. e'#at!on. &e*a&. e#ono(!#. serv!#e a##ess. so#!a&
env!ron(ent,
+. A''ress #o:(or$!' s$stan#e a$se (Mot!vat!ona& !nterv!e"!n*,
), Me'!#at!on
a. 4en;o'!a;ep!nes (Short:ter( se,: +or !((e'!ate s%(pto(s an'
!nso(n!a. an8!et%. a*!tat!on. a**ress!on.
$. T%p!#a& Ant!ps%#hot!#s7At%p!#a& Ant!ps%#hot!#s
#. /epot Ant!ps%#hot!#s (on&% !+ ora& D ps%#hoso#!a& spport +a!&s,
'. C&o;ap!ne (+or treat(ent res!stant #ases: a*ran&o#%tos!s. (%o#ar'!t!s,
e. F ECT
+. F Ant!'epressants
*. F Moo' sta$!&!sers
-, Ma!ntenan#e
a. F!rst ep!so'e pat!ents "!th e8#e&&en#e response (a% have (e'!#at!on
+ree tr!a& a+ter 1:2 %ears ($t #ont!ne ps%#hoso#!a& !ntervent!ons,
$. Repeate' ep!so'es or /8 o+ s#h!;ophren!a req!res (e'!#at!on +or at
&east 5 %ears
#. Cons!'er /epot +or pers!stent re&apse "h!#h 'oes not respon' to
ps%#hoso#!a& !ntervent!on ((e'!#at!on #o(p&!an#e enhan#e(ent,
'. Cons!'er CT3 +or pat!ents "ho +a!& to #o:operate "!th #o((n!t% $ase'
#are ((a!nta!n +or at &east B (onths,
e. 5P #are +or ph%s!#a& hea&th: (eta$o&!# S7E. poor se&+ #are
Prognosis
: Re&apses (@6G,an' #ont!n!n* '!sa$!&!t% are #o((on
: Pro*ress!ve 'eter!orat!on !s not !nev!ta$&e
: /!sa$!&t!% '!(!n!shes "!th t!(e. (a% even re(!t
: 1716 pat!ents "!th #hron!# ps%#hos!s retrn to +&& t!(e "or1
:-:
PSYCHIATRY REVISION
Anti)sy"!oti"s:
Ty)i"al Aty)i"al De)ot
Ch&orpro(a;!ne
Per!#%a;!ne
Th!or!'a;!ne
!edation ///
0trapyramidal /
A(!s&pr!'e 1!olian2)
Ar!p!pra;o&e 1Abili"y2)
C&o;ap!ne 1Clopine2)
3&an;ap!ne 13yprea2)
Het!ap!ne 1!ero4uel2)
R!sper!'one 15isperdal2)
I!pras!'one 13eldo2)
R!sper!'one
15isperdal
Consta2)
/roper!'o&
F&penth!8o&
F&phena;!ne
=a&oper!'o&
P!(o;!'e
Tr!+&opera;!ne
I#&openth!8o&
!edation /
0trapyramidal ///
Mo'e o+ A#t!on:
: var%!n* a++!n!t% +or /2 re#eptors
: $&o#1a'e
Response:
: onset 2:) "ee1s
: at%p!#a&s ten' to have &ess E8trap%ra(!'a& s!'e e++e#ts (EPS,
S!'e E++e#ts: SHE ,AS E
Se'at!on
H%potens!on: postra&
E8trap%ra(!'a&: '%ston!a. a1athes!a. par1!nson!s(. tar'!ve '%s1!nes!a
,e!*ht
Ant!#ho&!ner*!#: 'r% (oth. $&rre' v!s!on. #onst!pat!on
Se8a& /%s+n#t!on
eta$o&!#: *&#ose to&eran#e. ser( &!p!'s
En'o#r!ne: h%perpro&a#t!nae(!a (*%nae#o(ast!a. *a&a#torrhea. a(enorrhea.
&!$!'o,
C&o;ap!ne:
S!'e e++e#ts:
: A*ran&o#%tos!s (1G, !n +!rst 26 "ee1s
: M%o#ar'!t!s !n +!rst B "ee1s
: Se!;res
: Car'!o(e*a&%
: /!srpt!on o+ #ar'!a# e8#!ta$!&!t%
: JS=E 2AS MEK
Mon!tor!n*:
: 4ase&!ne hae(ato&o*!#a& an' #ar'!a# (EC5. EC=3. Ser( tropon!n,
: ,ee*ly ,CC for first -. /ee*s0 t!en mont!ly for d$ration of treatment0
t!en for - mont! after sto))ing
: Fast!n* $&oo' *&#ose an' &!p!'s ever% B (onths
:5:
PSYCHIATRY REVISION
S$#stan"e A#$se
Syndromes:
S$ stan#e A$se
: A (a&a'apt!ve pattern o+ s$stan#e se. "h!#h #ases #&!n!#a&&% s!*n!+!#ant
!(pa!r(ent or '!stress
Criteria: 67 s in a 89 month period
1. +a!&re to +&+!&& ro&es
2. se !n ph%s!#a&&% ha;ar'os s!tat!ons (e*. /r!v!n*. heav% (a#h!ner%,
). re#rrent &e*a& pro$&e(s
-. re#rrent !nterpersona&7so#!a& pro$&e(s 'e to the s$stan#e
S$stan#e /epen'en#e:
: A (a&a'apt!ve pattern o+ s$stan#e se. "h!#h #ases #&!n!#a&&% s!*n!+!#ant
!(pa!r(ent or '!stress
Criteria: 67 s in a 89 month period
1. To&eran#e: nee' L a(ont to a#h!eve 'es!re' e++e#t
2. 2!th'ra"a& (s8 sa&&% the oppos!te o+ the 'r*s e++e#t D
an8!et%7'epress!on7s&eep '!str$an#e,
). Preo##pat!on: sa&!en#e. #rav!n*. M#ontro&. #ont!nat!on
pr!or!t% o+ 'r!n1!n* (Sa&!en#e,
#o(p&s!on to se (Crav!n*,
!(pa!re' #ontro& over a&#oho& se (Contro&,
#ont!ne' se 'esp!te har(+& e++e#ts (Cont!nat!on,
Aetiology:
1. The natre o+ 'r*
a. P&easra$&e ps%#ho&o*!#a& e++e#ts
$. Rap!' a#t!on
2. The !n'!v!'a&
a. 5enet!# pre'!spos!t!on (esp. a&#oho&,
$. Persona& #hara#ter!st!#s (poor !(p&se #ontro&. &!(!te' pro$&e( so&v!n*
s1!&&s. ne*at!ve (oo',
#. Up$r!n*!n* ((o'e&!n* $% parents. #op!n* s1!&&s,
'. Ps%#h!atr!# !&&ness ('epress!on. an8!et%. s#h!;ophren!a. 3C/,
). So#!o:C&tra& +a#tors
a. C&tra& a##eptan#e
$. Ava!&a$!&!t%
#. Pr!#e
:B:
PSYCHIATRY REVISION
P!ysi"al Conse1$en"es:
S$stan#e an' E++e#t Me#han!s( o+ =ar(
Al"o!ol
Disinhibition, increased amounts leads
to sedation:
$eripheral #asodilation 1*arm "lush,
reducing core body temp)
Diuretic
2!'esprea' t!sse 'a(a*e
A#te
: 5astr!t!s. A#te pan#reat!t!s. Tra(a
Chron!# /!sease
: C!rrhos!s. Pan#reat!t!s. Car'!o(%opath%
2!th'ra"a& State
: A#te
: Severe: /e&er!( Tre(ens
Tra(a "h!&e n'er the !n+&en#e
Re'#e' I((ne Fn#t!on
Ntr!t!ona& /e+!#!en#%: v!t $12. th!a(!ne
Sedati%es2Hy)noti"s
Aniolytic, !edati#e, +yponotic action
/e&!$erate 3/
M!8 "!th A&#oho& or other CNS 'epress.
(4en;os re&at!ve sa+e !n 3/,
2!th'ra"a& s%n'ro(e 9 rese($&es an8!et%
Canna#is
$roduces a ;high< intensi"ication o"
normal senses, euphoria, laughter,
tal-ati#e, "loating on air:
Tachycardia, postural hypo 1light
headed), +unger
%mpaired memory, concentrartion
Co*n!t!ve !(pa!r(ent ('ose response,
Ps%#hos!s (parano!'. a'7v!s ha&&#!n,
Heroin and ot!er O)iates
%. heroin use results in a =rush>
euphoria, *armth, ;-ic-< resembling
orgasm in lo*er abdomen: ?ollo*ed by
se#eral hours o" "loating/euphoria:
Dro*siness, labiliy, mental clouding
Shar!n* Nee'&es (=I>. =ep 47C,
/!s!nh!$!t!on7=!*h r!s1 $ehav!or (ST/,
3/ (resp 'epress!on. pp!& #onstr!#t,
2!th'ra"a&
: !n!t!a&: #rav!n*. rest&ess. +&:&!1e
: &ate: Lan8!et%7#rav!n*. p!&oere#t. pp!&
'!&at!on. N7>7/
Psy"!oStim$lants:
: Co#a!ne
!mo-ing crac- !hort acting high 1@A
8Bmins), "ollo*ed by intense depression
and cra#ing
: A(pheta(!nes (E#sta#% ICE,
0uphoria, ecitement, tal-ati#iess
%ncreased se dri#e, reduced sleep
Dilated pupils, tachycardia, nausua
2!th'ra"a& s%n'ro(e 9 &ethar*%. !nan!t!on.
'epress!on
Ps%#hos!s (a#te or #hron!# se, 9 $%
'e+!n!t!on (st pers!st N-@hors
Hall$"inogens 3'SD4
%ncreased sensory a*areness 1#i#id
smell, colour), altered perception and
ability to di""erentiate sel" C en#:
:E:
PSYCHIATRY REVISION
Ot!er5
Chron!# A&#oho& Use:
2ern!#1e:Oorsa1o++s: a(nest!# '!sor'ers #ase' $% th!a(!ne 'e+!#!en#%
: 2ern!#1e(a#te. revers!$&e,: 3#&ar pa&s%. ata8!a. vest!$&ar. 'e&!r!(
: Oorsa1o++s (#hron!#,: (ar1e' short ter( (e(or% &oss. #ant &earn ne" !n+o.
antero*ra'e a(nes!a. #on+a$&at!on
/a& /!a*nos!s
: #o:o##rren#e o+ ps%#h!atr!# #on'!t!ons an' s$stan#e se !s h!*her than
e8pe#te' !n pop&at!on
: )6G "!th (enta& '!sor'er are '!a*nose' "!th s$stan#e se '!sor'er (2:) h!*her
than pop&at!on,
: S$stan#e se #an e8a#er$ate ps%#h '!sor'er (v!#e versa,: r!s1 o+ s%(pto(
e8a#er$at!on. re&apse. #o(pro(!se' (e'!#at!on e++!#a#%. poor #o(p&!an#e.
Psy"!oso"ial Conse1$en"es:
Psy"!ologi"al So"ial
2!th'ra"a& Featres
Neroses (an8!et%. so#!a& pho$!a,
3ther pho$!as
Ps%#hoses
S!#!'a& atte(pt7!'eat!on
/o(est!# an' a&&!e'
3##pat!on
F!nan#!a&
Le*a&
Assessment:
1. Co((on presentat!onsP
a. A#te !nto8!#at!on7"!th'ra"a&:
!. /e&!r!(
!!. Ps%#hos!s
!!!. S&eep '!str$an#e
!v. An8!et%
v./epress!on
v!. A*!tat!on
$. Chron!# se
!. /epress!on
!!. /e(ent!a
!!!. Pho$!as
!v. Ps%#hos!s
2. =!stor%
a. A&#oho&:
!. se a Qtop 'o"nR approa#h $% s**est!n* h!*h a(onts an'
a&&o"!n* the( to #orre#t 'o"n"ar's.
!!. Avo!' ter( Qa&#oho&!#R
$. /r*s: e&!#!t the na(e o+ ever% 'r* se' 9
!. Hant!t%
!!. Freqen#%
!!!. /rat!on
!v. Rote o+ se
v.Last se
v!. Cost
:@:
PSYCHIATRY REVISION
v!!. Sor#e: C'o#tor shopp!n*. prost!tt!on. #r!(e
v!!!. Assess S$stan#e re&ate' pro$&e(s
!8. Assess S$stan#e 'epen'en#e
1. Crav!n*
2. I(pa!re' #ontro&
). Pr!or!t!sat!on
-. 2!th'ra"a&
5. To&eran#e
B. Cont!ne' se 'esp!te har(
#. Past Use
'. /r* o+ Cho!#e
e. Most pro$&e(at!# /r*
+. Prpose an' (ean!n* o+ 'r* to #&!ent
!. Reasons +or s$stan#e se
!!. Pre#!p!tants
!!!. E++e#ts
!v. Conseqen#es
*. Fa(!&% =!stor%
h. Treat(ent =!stor%
!. R!s1:Ta1!n* 4ehav!or
<. Assess Mot!vat!on +or Chan*e
!. =o" !ntereste' are %o !n #han*!n* %o substance seC
!!. /o %o +ee& than %o nee' to #han*e %or substance seC
!!!. /o %o rea&&% "ant to stop s!n*C
!v. 2hat #o&' %o 'o to *et on top o+ %o seC
v.=o" #on+!'ent are %o that %o #an a#h!eve th!sC
). E8a(!nat!on
a. Ev!'en#e o+ s$stan#e se: s(e&&. tra#1 (ar1s
$. /e#&!ne !n *&o$a& +n#t!on!n*
!. Poor *enera& appearan#e
!!. =%*!ene
!!!. 3vera&& hea&th
!v. Ntr!t!on
-. Invest!*at!on
a. Ur!ne
$. Ser(
#. 4reathtests
5. Mana*e(ent
a. Mot!vat!ona& Interv!e"!n*
!. FLA5S S Fee'$a#1. L!sten!n*. A'!v!#e. 5oa&s. Strate*!es
$. Asses Sta*e o+ Chan*e
!. Pre:#onte(p&at!on: 'o not "!sh to #han*e
!!. Conte(p&at!on: a($!va&en#e
!!!. A#t!on: 'e#!s!on to #han*e an' !(p&e(ente' strate*!es
!v. Ma!ntenan#e
v.F Re&apse
:T:
PSYCHIATRY REVISION
A&#oho&
1. =ar(+&7=a;ar'os se
1. 5G o+ (a&es
2. 2G o+ +e(a&es
). N -6* (- stan'ar' 'r!n1s, +or (a&es
-. N26* (2 stan'ar' 'r!n1s, +or +e(a&es
5. 1 #an $eer S 1.5 S/
B. 1 $ott&e "!ne S @ S/
E. 1 $ott&e sp!r!ts S 25 S/
2. /epen'en#e
1. Sa&!en#e
2. Crav!n*
). Contro&
-. Cont!ne' se 'esp!te har(
5. 2!th'ra"a&
B. To&eran#e
). A&#oho& 2!th'ra"a&
1. Can &ast +ro( 2- hors 9 2 "ee1s
2. Chara#ter!se' $% CNS h%pera#t!v!t%
). Can ran*e +ro( M!&' /e&er!( Tre(ens (/Ts,
-. M!&' S nasea. tre(or. s"eats. an8!et%. se!;res
5. Co(p&e8 S Con+s!on. '!stra#t!$!&!t%. ha&&#!nat!on. parano!a
B. /Ts S e8tre(e h%pera#t!v!t%. se!;re. 'e&!r!( &!+e threaten!n*
-. Mana*e(ent
1. Mot!vat!ona& !nterv!e"!n*
2. /!a;epa(
5. A&#oho& 2!th'ra"a& S#a&e
J Peop&e Th!n1 A&& A&#oho&!#s Trave& =n* 3verK
1. Persp!rat!on
2. Tre(or
). An8!et%
-. A*!tat!on
5. Te(peratre
B. =a&&#!nat!ons
E. 3r!entat!on
(6:-,
(6:),
(6:-,
(6:-,
(6:-,
(6:-,
(6:-,
Tota&: 72E
S#ore:
1:- S (!&' "!th'ra"a&
5:T S (o'erate
16:1- S severe
A15 S ver% severe
((e' rev!e" !+ N16,
:16:
PSYCHIATRY REVISION
AN6IETY DISORDERS
Post2Tra$mati" Stress Disorder
Definition:
: The re:e8per!en#!n* o+ an e8tre(e&% tra(at!# event a##o(pan!e' $% s%(pto(s
o+ !n#rease' arosa& an' avo!'an#e o+ st!(&! asso#!ate' "!th the tra(a.
E)idemiology:
: Ma&e:Fe(a&e S 1:2
Aetiology:
: Un#&ear as to the !nterre&at!onsh!p $et"een Stressor an' Persona& v&nera$!&!t%
: Tra(at!# event #ases (ar1e' ps%#ho&o*!#a& '!stress an' +ee&!n*s o+
horror7+ear7hope&essness
: There !s a +a!&re to !nte*rate tra(at!# event an' there !s '!srpt!on !n the "a%
the (e(or!es an' pro#esse' an' &a!' 'o"n
: Me(or!es #an then $e tr!**ere' $% (eans o+ pr!(!t!ve #on'!t!on!n* "h!#h
ssta!ns he!*htene' arosa&
: Avo!'an#e7N($!n* !s the ho(eostat!# atte(pt to (o'&ate th!s +ee&!n* o+
#onstant nease.
Ris* &a"tors:
: Fe(a&e
: Natra& /!saster
: 2ar
: Rape
: Assa&t
: Motor >eh!#&e A##!'ent
: Pre'ator% >!o&en#e
Sym)toms:
Intr$si%e P!enomena Hy)eraro$sal A%oidan"e7N$m#ing
Re#o&&e#t!on
N!*ht(ares
F&ash$a#1
1Associated *ith intense
psychological distress)
/!++!#&t% s&eep!n*
E8a**erate' start&e
=%perv!*!&an#e
Irr!ta$!&!t%7An*er
/!++!#&t% #on#entrat!n*
Tho*hts7Fee&!n*7Conversat!ons
A#t!v!t!es7Peop&e7P&a#es
Ina$!&!t% to re#a&& aspe#ts
/!(!n!she' !nterest !n a#t!v!t!es
Fee&!n*s o+ estran*e(ent
Restr!#te' a++e#t
4&ea1 ot&oo1 o+ +tre
DS IV:
1, Tra(at!# Event: person e8per!en#e'7"!tnesse'7"as #on+ronte' $%:
a. A#ta&7Threatene' 'eath or ser!os !n<r% to se&+
$. Threat to ph%s!#a& !nte*r!t% o+ se&+ or others
#. Res&ts !n +ee&!n*s o+ !ntense +ear. he&p&essness. horror
2, Re:e8per!en#!n*
), =%perarosa&
-, Avo!'an#e7N($!n*
5, /rat!on N1 (onth
:11:
PSYCHIATRY REVISION
Assessment:
1, Eva&ate tra(a
a. Event
$. Response: +ee&!n*s. tho*hts. $ehav!ors
#. Seqe&ae: avo!'an#e. h%perarosa&
2, Chara#ter!;e #orse
a. A#te (?)712,
$. Chron!# (N)712,
#. /e&a%e' onset (NB712 a+ter stressor. Ma% $e rea#t!vate' $% other stress,
'. N4: A#te Stress /!sor'er &asts N1712 a+ter stressor
), Assess So#!a& Fn#t!on!n*
a. 2or1 ha$!t
$. Re&at!onsh!ps
#. /!sso#!at!on
'. >&nera$!&!t% to s$seqent stressors (#han*e !n ho" &!+eRs stressors are
per#e!ve',
e. An% &e*a& ra(!+!#at!ons7#o(pensat!on #&a!(s
-, Assess other Ps%#h!atr!# Seqe&ae
a. S$stan#e A$se
$. So#!a&7Spe#!+!# Pho$!as
#. /epress!on
'. JThr!&& see1!n*K
anagement:
A!(s:
1, /a(pen 'o"n arosa&
2, Eva&ate (ean!n* o+ tra(a
), S%ste(at!# 'esens!t!;at!on
-, Pro(ote Cop!n* s1!&&s
Metho's:
1, Ps%#hoe'#at!on
2, Ps%#hotherap%
a. E*. C4T
), Me'!#at!on
a. SSRI (F&o8et!ne. Sertra&!ne. Paro8et!ne, S short ter( to +a#!&!tate
therap%
$. F Short ter( Ant! ps%#hot!#s +or severe #ases
Prognosis:
: Reso&ves !n B6G o+ o$v!os #ases
: Ma% have &on* ter( res!'a& s%(pto(s
:12:
PSYCHIATRY REVISION
Pani" Disorder
Definition:
: Re#rrent. ne8pe#te' pan!# atta#1s a$ot "h!#h there !s !ntense. pers!stent.
#on#ern.
E)idemiology:
: 4e*!ns !n teens. ear&% 26s
: Later onset (!e. -6s, s**ests or*an!# #ase
Aetiology: o+ten n#&ear 8
Ris* &a"tors: 8
Sym)toms:
1. Pan!# Atta#1:
: /!s#rete per!o' o+ !ntense +ear7'!s#o(+ort. rea#h!n* pea1 "!th!n 16
(!ntes.
: -71) s%(pto(s:
Somati" Sym)toms Cogniti%e Sym)toms
Pa&p!tat!ons
Chest Pa!n
S"eat!n*
Tre($&!n*7Sha1!n*
Shortness o+ $reath
Sense o+ Cho1!n*
Nasea7A$'o '!s#o(+ort
/!;;%
N($7T!n*&!n*
Ch!&&s or hot +&sh
/epersona&!sat!on
Fear o+ '%!n*
Fear o+ &os!n* #ontro&
2. A*orapho$!a:
: Avo!'an#e or an8!et% !n p&a#es or s!tat!ons !n "h!#h 9 es#ape (!*ht $e
'!++!#&t%7e($arrass!n*. he&p (a% not $e ava!&a$&e.
: 3##rs !n T6G o+ #ases
: Usa&&% to"ar's a "!'e ran*e o+ s!tat!ons. e*. Shopp!n*. tra!ns
). 3ther S%(pto(s
: /epress!on !s #o(!n* 27)
: A&#oho&74en;o a$se
: So#!a&73##pat!ona& !(pa!r(ent
: Interpersona& '!++!#&t!es
: S!#!'e Atte(pts
DS IV:
: A 1 (onth o+ pers!stent #on#ern
: 2orr% a$ot !(p&!#at!ons o+ an atta#1
: S!*n!+!#ant #han*e !n $ehav!or re&ate' to the atta#1s
Assessment:
4e+ore '!a*nos!s:
1. Is th!s a nor(a& an8!et% response to a &!+e stressC
2. Is the an8!et% a response to a &!+e stress $t !n e8#ess o+ the e8pe#te' &eve&sC
(A'<st(ent '!sor'er,
). Is the person a ha$!ta& "orr!erC Is th!s there+ore tra!t an8!et% (an8!os
persona&!t%C,
-. I+ there !s an an8!et% '!sor'er. !s !t 1
o
or 2
o
.
a. S$stan#e !nto8!#at!on7"!th'ra"a&
$. 3TC 'r*s: #a++e!ne. nasa& 'e#on*estants. $ron#ho'!&ators
#. 5enera& (e'!#a& #on'!t!on (/INES,
:1):
PSYCHIATRY REVISION
SYSTE E6AP'E
Defi"ien"y state .itamin B89, pellagra
Inflammatory 5A, !D0
Ne$rologi"al Eeoplasm, in"ection, M!, +untingtons, ,ilsons
Endo"rine Adrenal 1$haeo), Thyroids, $ituitary
Systemi" +ypoia, +ypoglycaemia
5. Is there a #ar'!a#7ser!os pro$&e(C
a. Arrh%th(!as #an (!(!# pan!#
$. Re#rrent PERs #an (!(!# pan!#
A+ter /!a*nos!s:
B. I+ pan!# '!sor'er. are the% QspontaneosR or Q#e'R C
E. I'ent!+% tr!**ers7e8a#er$at!n* +a#tors
a. Ph%s!#a& #on'!t!ons
$. Ps%#hoso#!a& stress
#. L!+est%&e +a#tors: #a++e!ne. !na'eqate s&eep. e8#ess!ve "or1
@. Is there asso#!ate' A*orapho$!aC
T. /eter(!ne sever!t% an' 'e*ree o+ +n#t!ona& !(pa!r(ent
a. Ps%#hoso#!a&
$. 3##pat!ona&
16. Is there asso#!ate' s$stan#e a$seC
11. Is there asso#!ate' 'epress!onC
12. Assess s!#!'e r!s17sa+et%
anagement:
1. Ps%#hoe'#at!on
a. Se&+ he&p $oo1s. "r!tten !n+or(at!on
2. Ps%#hotherap% +or pan!#
a. C9T: =%pervent!&at!on. Stress (ana*e(ent
$. Cogniti%e t!era)y: $rea1!n* &!n1 $et"een $o'!& sensat!ons an' the!r
!n#orre#t !nterpretat!on
#. 9e!a%io$ral T!era)y:. Re&a8at!on Te#hn!qes
). 4!o&o*!#a&
a. Use' +or severe #ases "ho 'o not respon' to ps%#hotherap%
$. Ant!'epressants:
!. SSRIs (a% e8a#er$ate #on'!t!on $e+ore ant!:pan!# e++e#t
ta1es over
!!. TCAs are 'an*eros !n 3/. so avo!' !n s!#!'a& pat!ents
#. 4en;o'!a;ep!nes
!. 5oo' +or short ter( re&!e+
!!. R!s1 o+ (!sse
!!!. R!s1 o+ to&eran#e an' "!th'ra"a&
-. Ps%#hotherap% +or A*orapho$!a
a. C4T: h!erar#h% o+ +ear+& s!tat!ons esta$&!she' an' *ra'e' e8posre
!s se'. Can $e !n'!v!'a& or *rop.
5. A''ress #o:(or$!'!t!es
a. A&"a%s a''ress a&#oho& a$se +!rst ($e+ore an8!et%, 'eto8
$. Co:(or$!' /epress!on !n'!#ates *reater re&apse an' re#rren#e an'
#hron!#!t%. Pr!or!t% *!ven to treat!n* 'epress!on.
:1-:
PSYCHIATRY REVISION
OOD DISORDERS
De)ression
Definition:
Ma<or /epress!ve /!sor'er:
: 3ne or (ore ep!so'es o+ (a<or 'epress!on "h!#h #ases s!*n!+!#ant
ps%#hoso#!a&7o##pat!on !(pa!r(ent.
3thers:
1, /%sth%(!# /!sor'er
2, A'<st(ent /!sor'er "!th /epresse' Moo'
), /epress!ve '!sor'er N3S
E)idemiology:
: More #o((on !n +e(a&es (1BG, than (a&es (@G,
: Mean a*e o+ onset !s &ate 26s
Aetiology:
9iologi"al
5enet!# T*in studies sho* higher
concordance:
!uggests polygenetic
inheritance o" #ulnerability to
mood disorder:
4!o*en!# A(!nes Monamines "or depression
Neroen'o#r!ne A$nor(a&!t!es Altered +$A ais, o#eracti#ity in
@BF o" depressed patients:
S$stan#e In'#e' !teroids
'C$
DAD'$A
Antihypertensi#es
Antibiotics
Analgaesics
Anticon#ulsants
Benzodiazepine
0t'+
%llicit Drugs
Psy"!ologi"al
Persona&!t% tra!ts Dependent
'bsessional
+istrionic
Stress Doss
So"ial Stress
Doss o":
: relationship
: )ob
: status
: lo#ed one
: health
:15:
PSYCHIATRY REVISION
Ris* &a"tors:
: Fa(!&% h!stor%
: Stress+& &!+e event
: Con#rrent ph%s!#a& !&&ness
Sym)toms:
J D epresse' P eop&e , !&& S ee( & &at. P eop&e C an : et S !#!'a&K
1. /epresse'7Lo"ere' Moo' UU ((a% have '!rna& var!at!on. "orse !n (orn!n*,
2. Loss o+ P&easre (anhe'on!a, UU
). 2e!*ht Loss
-. S&eep /!str$an#e (ear&% (orn!n* "a1en!n* s**ests (e&an#ho&!a,
5. Fat!*e7Loss o+ Ener*%
B. Ps%#ho(otor a*!tat!on7retar'at!on
E. Con#entrat!on '!++!#&t!es7In'e#!s!veness
@. 5!&t72orth&essness
T. S!#!'a& !'eat!on7Preo##pat!on
GG Criteria 8 or 9 is mandatory
N4: Lo"er!n* o+ se&+:estee(7se&+:"orth !s pro(!nent (#+. an8!et%. *r!e+ 9 "here se&+:
estee( re(a!ns !nta#t,
N4: JNerove*etat!ve S%(pto(sK: S&eep. Ener*%. Con#entrat!on. Appet!te. L!$!'o
DS IV:
1. 57T s%(pto(s +or N2 "ee1s
2. s%(pto(s #ase s!*n!+!#ant ps%#hoso#!a&7o##pat!ona& '!stress or !(pa!r(ent
). /o not !n#&'e s%(pto(s #&ear&% 'e to *enera& (e'!#a& #on'!t!on
Ris* Assessment
C$rrent Attem)t C$rrent Ris*s
1. I'eat!on
2. Intent
). P&an
-. Means
5. F!na& A#ts
B. Pre#at!ons
E. Letha&!t%
@. =e&p See1!n*
;< Pre"i)itants
-=< Prior attem)ts
1. Crrent Pro$&e(s
2. An*er7host!&!t%7!(p&s!v!t%
). /epress!on7 An8!et%7 =ope&essness
-. /!sor!entat!on7/!sor*an!sat!on
5. S$stan#e A$se
B. Ps%#hos!s
E. Me'!#a& Stats
@. So#!a& 2!th'ra"a&
T. La#1 o+ 'es!re +or he&p
16. Poor ps%#h!atr!# past e8per!en#es
11. Poor #op!n* strate*!es (e*. /S=,
12. La#1 o+ so#!a& #onne#te'ness
:1B:
PSYCHIATRY REVISION
Assessment:
1. Con'#t MSE
5enera& Appearan#e !tooped posture
5educed sel"Acare
Doss o" *eight
$atient loo-s do*ncast, dra*n, sullen appearance
May be tear"ul
Rapport $oor eye contact
4ehav!or !lo*ed acti#ity, lac- o" spontaneous mo#ement and speech
'5
Agitated *ith handA*ringing, restlessness, pacing
Moo'7A++e#t Mood may be reacti#e 1mild) or unreacti#e 1se#ere)
A""ect may be blunted 1moderate) )or "lattened 1se#ere)
Spee#h an' Lan*a*e Dac- o" spontaneous speech
Tho*ht
: Strea(
: For(
: Content
Eegati#e, pessimistic themes
May ha#e psychotic delusions o" guilt, *orthlessness,
persecution, death, nihilism, po#erty:
Per#ept!on May ha#e auditory hallucinations located in the head,
re"erred to as ;#oices o" conscious<:
Co*n!t!on May ha#e loss o" concentration, poor moti#ation
Ins!*ht an' V'*e(ent $ercei#ed bene"it o" inter#ie* 1mild) or no bene"it 1se#ere)
May ha#e limited insight 1se#ere)
S!#!'e7R!s1 %deation and thoughts o" dying
%ntent, $lan, Means, $ast Attempts, Current 5is-
2. C&ass!+% t%pe o+ 'epress!on
: Ps%#hot!#
o /e&s!ons an' =a&&#!nat!ons
o Moo' #on*rent or !n#on*rent
: Me&an#ho&!#
o Cr!ter!on A: #ons((ator% anhe'on!a 3R non:rea#t!ve (oo'
o Cr!ter!on 4 (A),: '!st!n#t qa&!t% to 'epresse' (oo'. "orse !n (orn!n*.
ear&% (orn!n* "a1en!n*. (ar1e' ps%#ho(otor retar'at!on7a*!tat!on.
(a<or L3A or L32. nota$&e *!&t.
: At%p!#a&
o Moo' rea#t!v!t%
o Lea'en para&%s!s (&!($s +ee& heav% &!1e &ea',
o =%perso(n!a
o In#rease' Appet!te7 2e!*ht *a!n
o Mar1e' In'e#!s!veness
o Sens!t!v!t% to !nterpersona& re<e#t!on
: Post:part(
o 3nset "!th!n - "ee1s postpart(
: Cataton!#
o Motor!# !((o$!&!t%. e8#ess!ve (otor a#t!v!t%. e8tre(e ne*at!v!s(
(t!s( pe#&!ar!t!es o+ vo&ntar% (ove(ent. e#ho&a&!a. e#hopra8!a
:1E:
PSYCHIATRY REVISION
>< Frther h!stor%
: Past h!stor%. treat(ents an' responses
: Ps%#hoso#!a& tr!**ers
: Pre(or$!' persona&!t% an' #op!n* st%&e
: Fa(!&% h!stor%
-. Past (e'!#a& h8:
: An% ph%s!#a& !&&ness re&ate' to 'epress!on: Par1!nsons. MS. =n*t!n*tons.
=%poth%ro!'. Csh!n*s. SLE. RA. (a&!*nan#%. =I>
: An% #rrent (e'!#at!ons: stero!'s. L:/3PA. !sotret!no!n. !nter+eron
5. Frther Invest!*at!on
: TFTs
: F4E
: CT7MRI
B. Cons!'er '/8:
: Se#on'ar% /epress!on : Anore8!a. S#h!;ophren!a. An8!et% '!sor'ers. 3C/.
S$stan#e a$se (nee's #on#rrent (ana*e(ent,
: S#h!;ophren!a : so#!a& "!th'ra"a&. 'eter!orat!on o+ persona& ha$!ts. &oss o+
!nterest. MSE "o&' sho" tho*ht '!sor'er
: Ear&% /e(ent!a : !rr!ta$!&!t%. '!str$e' (oo'
B. Appra!se Sever!t%7S!#!'e R!s1
: C Rea#t!ve or Unrea#t!ve (oo'
: C Un'erstan'a$&e rea#t!on to #!r#(stan#es
: C Ps%#ho(otor #han*es
: C Nerove*etat!ve s%(pto(s
anagement:
1. Ps%#hoe'#at!on (pat!ent an' +a(!&%,
a. Crrent a#te7#hron!# stressors
$. Natre o+ 'epress!on: #orse. treat(ent
#. S!*ns o+ re&apse an' a#t!on p&an
'. Reassran#e
2. Ps%#hoso#!a& Intervent!on
a. C4T
$. M4CT ((!n'+&ness:$ase' #o*n!t!ve therap%. a"areness o+ onese&+ !n
the Qhere an' no"R,
#. /4T ('!a&e#t!#a& $ehav!or therap%: e8p&or!n* a&ternate so&t!ons,
'. IPT (!nterpersona& therap%: +o#s on #rrent re&at!onsh!ps,
). Ph%s!#a& Treat(ents
a. Ant!'epressants (2 "ee1s $e+ore !(prove(ent,
$. ECT
: Cons!'er !npat!ent treat(ent +or:
o Ps%#hot!# 'epress!on
o S!*n!+!#ant s!#!'e r!s1
o S!*n!+!#ant ho(!#!'e r!s1
o Una$&e to #ope at ho(e
o Ser!os&% ph%s!#a&&% n"e&&
Prognosis:
: 56:@6G have re#rrent t%pe. "!th ep!so'es &ast!n* WB (onths (2"1s 9 1 %r,
: S%(pto(s +ree t!(e !n $et"een (a% #ontra#t "!th a*e
: So(e pat!ents s++er 1 ep!so'e an' (a1e #o(p&ete re#over%
:1@:
PSYCHIATRY REVISION
Ant!'epressants
1. TCAs (Amitriptyline H0ndep2)
: 3n&% se' !n treat(ent res!stant #ases 'e to s!'e e++e#t pro+!&e
: Ms#r!n!# S7E: 'r% (oth. $&rre' v!s!on. #onst!pat!on
: =!sta(!n!# S7E: 'ro"s!ness. "e!*ht *a!n
: A'rener*!# S7E: ta#h%#ar'!a. postra& h%potens!on
: Can #ase JSerotonin SyndromeK (!+ #o($!ne' "!th other 'r*s
a++e#t!n* seroton!n,
!. A*!tat!on7Rest&essness
!!. S"eat!n*
!!!. /!arrhea
!v. =%perre+&e8!a
v.Lo#1 o+ #oor'!nat!on
v!. Sh!ver!n*7Tre(or
: TCAs are #ar'!oto8!# !n over'ose
2. MA3Is ($henelzine H Eardil 2)
: Irrevers!$&e !nh!$!tors o+ MA3 A X 4
: Usa&&% reserve' +or treat(ent res!stant #ases
: 4est +or At%p!#a& /epress!on
: Can #ase Hy)ertensi%e Crisis (JCheese Rea#t!onK,
!. Severe hea'a#he
!!. Chest pa!n
!!!. Pa&p!tat!ons
!v. St!++ ne#1
v.Intra#ran!a& hae(orrha*e
: Pat!ents (st a'here to str!#t '!et (no (atre' #heese. "!nes,
). SSRIs (0scitalopram, ?luoetine, ?lu#oamine, $aroetine, !ertraline)
: F!rst &!ne 'r*s +or n#o(p&!#ate' 'epress!on
: Never *!ven !n #o($!nat!on "!th TCAs or MA3Is (seroton!n s%n'ro(e,
: S7E !n#&'e:
:astrointestinal Central Ner%o$s System Se+$al
Anore8!a
Nasea
/!arrhoea
Const!pat!on
=ea'a#he
An8!et%
A*!tat!on
A1!th!s!a
Anor*as(!a
/e#rease' &!$!'o
E<a#&ator% +a!&re
I(poten#e
UThis category usually
persists
-. 3ther
a. Mo#&o$e(!'eS Ar!8 Y
!. 5e#erisble %nhibitor o" Monoamine 'idase A 15%MA)
ii: !a"e, *ell tolerated
iii: Eo dietary re4uirements
i#: 5arely causes seual dys"unction
$. >en&e+a8!neS E+e8or Y
i: !erotonin C Eoradrenaline 5eupta-e %nhibitor 1!E5%)
ii: Broader action
iii: $articularly use"ul "or Melancholic Depression
#. M!rta;ap!neS Avan;aY
:1T:
PSYCHIATRY REVISION
!. Eoradrenaline C !peci"ic !erotonin Antagonist 1Ea!!A)
ii: ?e*er seual problems
iii: Good i" sleep disturbance is mar-ed
'. Re$o8et!ne S E'rona8Y
i: Eoradrenaline 5eupta-e %nhibitors 1EA5%)
ii: ?e*er seual problems
iii: Good i" apathy and anergia are prominent
E&e#tro#onv&s!ve Therap% (ECT,
: Sa+e an' e++e#t!ve treat(ent
: A'(!n!stere' n'er anaesthe!sa "!th a tra!ne' ps%#h!atr!st
: A'(!n!stere' 2:) 8 "ee1. +or B:12 treat(ents
: Morta&!t% r!s1 ver% &o"
: S7E:
!. =ea'a#he
!!. Con+s!on
!!!. Me(or% !(pa!r(ent
: In'!#at!ons S Severe 'epress!on:
!. Starvat!on
!!. /eh%'rat!on
!!!. =!*h s!#!'e r!s1
!v. Ps%#hot!# s%(pto(s
v.Treat(ent res!stant
Treat(ent A&*or!th(
1. SSRI
2. M!8e' A#t!on: >en&e+a8!ne. Merta;ap!ne. Ra$o8et!ne
). TCA (or MA3I,
-. ECT
:26:
PSYCHIATRY REVISION
9i)olar Disorder
Definition:
1. 9i)olar I: A (oo' '!sor'er #hara#ter!;e' $% a$nor(a&&% an' pers!stent&%
e&evate'. e8pans!&e or !rr!ta$&e (oo'. s++!#!ent to #ase (ar1e'
ps%#hoso#!a&7o##pat!on !(pa!r(ent or hosp!ta&!;at!on.
2. 9i)olar II: A (oo' '!sor'er #hara#ter!;e' $% one or (ore (a<or 'epress!ve
ep!so'es an' at &east one h%po(an!# ep!so'e.
E)idemiology:
1. Ma&e:Fe(a&e S 1:1
2. 3nset &ate 26s (rare over a*e o+ 56,
Aetiology:
). Po&%*enet!# pre'!spos!t!on to (oo' '!sor'ers
-. /opa(!ne h%pothes!s o+ ps%#hos!s
Ris* &a"tors:
5. Can $e tr!**ere' $% ant!'epressants
B. Poor Co(p&!an#e !s $!**est #ase o+ re#rren#e (poor !ns!*ht. &!+e&on* !&&ness,
Sym)toms: ani" E)isode
? : et S o(e S &eep. & or*et D e&s!ona& A ns"ers P &ease.K
1. 5ran'!os!t%7 In+&ate' sense o+ se&+
2. S&eep 9 nee' !s 'e#rease'
). Spee#h 9 pressre'. &o'
-. F&!*ht o+ !'eas7For(a& tho*ht '!sor'er
5. /!stra#t!$!&!t%
B. A*!tat!on7A#t!v!t% 9 ps%#ho(otor a*!tat!on. *oa& '!re#te'
E. P&easre:see1!n* a#t!v!t!es 9 e8#ess!ve. ne*at!ve #onseqen#e
DS IV:
ania
1. E8pans!ve7E&evate'7Irr!ta$&e (oo' +or A 1 "ee1 (or an% 'rat!on !+
hosp!ta&!;e', D At Least ) s%(pto(s
2. Irr!ta$&e (oo' a&one +or A 1 "ee1 (or an% 'rat!on !+ hosp!ta&!;e', D At Least -
s%(pto(s
Hy)omania
E. S%(pto(at!# #r!ter!a (et +or (an!a EZCEPT
1. Shorter 'rat!on (o+ at &east - 'a%s,
2. Not severe eno*h to #ase (ar1e' +n#t!on !(pa!r(ent7 hosp!ta&!;at!on
). A$sen#e o+ ps%#hot!# +eatres
:21:
PSYCHIATRY REVISION
Assessment:
5enera& Appearan#e May seem eccentric, odd:
Rapport 0nergetic, but irritable and "rustrated under sur"ace:
4ehav!or +yperacti#e
$sychomotor agitation/ %ncreased Dri#e/Goal directed
Decreased need "or sleep
Moo'7A++e#t 0le#ated, 0pansi#e, 0uphoric mood
%rritable Mood
Spee#h an' Lan*a*e 5apid, Doud, $ressured
Tho*ht
: Strea(
: For(
: Content
?ormal Thought Disorder:
?light o" %deas/Doosening o" Associations
Io-es, $uns, $lays on ,ords
Delusions o": grandiosity, erotmania, special po*ers
Per#ept!on +allucinations in se#ere states 1God instructing them)
Co*n!t!on %mpaired concentration/Distractibility
Ins!*ht an' V'*e(ent
'"ten se#erely impaired may ha#e de#astating social
conse4uences 1business, seual, dri#ing, spending)
S!#!'e7R!s1 May be 4uite impulsi#e, rec-less
A"$te anagement
1. R&e ot or*an!# #on'!t!ons7'r* !n'#e' states
2. Ma% req!re !nvo&ntar% a'(!ss!on !+ severe
). Use >a&proate F at%p!#a& ant!ps%#hot!# !n!t!a&&% (L!th!( !s too s&o" onset,
-. F 4en;o'!a;ep!ne to &essen h%pera#t!v!t%
I+ (!&'. #an $e treate' as otpat!ent "!th >a&proate7L!th!(. $t nee' +a(!&%
(e($er to (on!tor #o(p&!an#e 'e to poor !ns!*ht.
'ong Term anagement:
1. Eva&ate &on* ter( (oo' sta$!&!;!n* opt!ons +or pat!ent
: 2arrente' +or 2 ep!so'es !n 2 %ears. (a% $e*!n a+ter <st s!n*&e ep!so'e
2. Ps%#hoe'#at!on +or $oth pat!ent an' +a(!&%
: A$ot !&&ness. natre. #orse. treat(ent. s!*ns o+ re&apse
). Ps%#hoso#!a& !ntervent!on
: C4T. IPT. Fa(!&% therap%
: Can he&p !(prove #o(p&!an#e an' prevent re#rren#e. In'!v!'a&!se.
-. 4!o&o*!#a& Treat(ent
1. L!th!(. >a&proate. Car$e(a;ap!ne
2. Mon!tor S7E
). Prevent $oth e&at!on an' 'epress!on !n @6G o+ pat!ents
:22:
PSYCHIATRY REVISION
Moo' Sta$!&!sers
1. L!th!(
a. F!rst &!ne or 4!po&ar 1
$. Narro" therapet!# "!n'o" req!res (on!tor!n*
#. 4&oo' tests to #he#1 &eve&s
'. S!*n!+!#ant ro&e !n (a!ntenan#e an' re'#!n* s!#!'e r!s1
(ant!'epressants #an tr!**er (an!a or rap!' #%#&!n*. avo!' !+ poss,
'it!i$m Profile
S!'e E++e#ts
Usa&&% sett&e over t!(e
!hort Term
Po&%'!ps!a
Po&%r!a
N7>7/
Meta&&!# Taste
/!++!#&t% #on#entrat!n*
Fat!*e
Tre(or72ea1ness
2orsen!n* a#ne7psor!as!s
Dong term
2e!*ht *a!n
Rena& #han*es
/r% S1!n
Hy)ot!yroidism (o+ten
nee' th%ro8!ne,
To8!#!t%
Can o##r 'e to :
-. 3ver'ose
5. /r* !ntera#t!on
(NSAIDS.
'!ret!#s. ACEI,
B. /eh%'rat!on
E. Sa&t 'epr!vat!on
(3thers (!*ht th!n1 %o
&oo1 'rn1,
S&rre' spee#h
4a&an#e '!str$an#e
>!sa& '!str$an#e
Severe N7>7/
Severe tre(or7t"!t#h
Severe 'ro"s!ness
Avo!' 'eh%'rat!on
/o not #han*e sa&t !nta1e
Sto) dr$g immediately
N#7 Terato*en!# 1
st
tr!(.
2. So'!( >a&proate
a. F!rst &!ne +or 4!po&ar II. Rap!' C%#&!n*. S#h!;oa++e#t!ve /!sor'er
$. 4etter to&erate' than &!th!(
Val)roate Profile
S!'e E++e#ts
Usa&&% sett&e over t!(e
Nasea7In'!*est!on
2e!*ht 5a!n
Se'at!on
Trans!ent =a!r Loss
Discuss *ith doctor
Teratogenic in 8
st
trim:
To8!#!t% L!ver Fa!&re
=ae(ato&o*!#a& A&terat!ons
($&oo' '%s#ras!as,
Sto) dr$g immediately
). Car$e(a;ap!ne
a. Use' !n (an!a an' prevent!n* $!po&ar re#rren#e
-. La(otra*!ne
a. Can $e se' +or 'epress!ve s%(pto(s !n $!po&ar I
Prognosis:
: 5enera&&% req!res !n'e+!n!te treat(ent an' ps%#hoso#!a& spport
:2):
PSYCHIATRY REVISION
EATIN: DISORDERS
Anore+ia Ner%osa
Definition:
: The re&ent&ess prs!t o+ th!nness #hara#ter!;e' $% (ar1e' se&+:!n'#e' "e!*ht
&oss an' a re+sa& to (a!nta!n nor(a& $o'% "e!*ht.
E)idemiology:
: A'o&es#ent an' %on* "o(en
: 3nset [ 15:1T (no" %on*er,
: L!+et!(e preva&en#e 6.5G
: Ma&e:+e(a&e [ 1:16
: /eve&ope' "or&'
Aetiology:
: 5enet!# #ontr!$t!on
: Env!ron(ent e8posre
: 3+ten 'eve&ops as #h!&' tr!es to 1eep #ontro& o+ the!r "or&'
Ris* &a"tors:
: Stress+& so#!a& env!ron(ent 9 parenta& #on+&!#t. +a(!&% '%s+n#t!on
: Per+e#t!on!s(
: Lo" Se&+:estee(
: 2e!*ht #on#erne' env!ron(ent
: Un'er"e!*ht7th!n +a(!&%
Sym)toms:
Cogniti%e 9e!a%io$ral Ne$ro%egetati%e
3$sess!on "!th Th!nness
Preo##pat!on "!th +oo'
Foo' R!ta&s7R(!nat!ons
In#rease' !nterest !n +oo'
/en!a& o+ hn*er7'!et!n*
Restr!#t!n*
La8at!ves
E8#ess!ve e8er#!se
/!ret!#s
In'#e' >o(!t!n*
/epresse' (oo'
/e#rease' &!$!'o
/e#rease' #on#entrat!on
Lethar*%7Fat!*e
/!srpte' s&eep
DS IV:
1. Fa!&re to (a!nta!n nor(a& $o'% "e!*ht ("e!*ht ? @5G o+ that e8pe#te'. or
N15G $e&o" nor(a&. or 4MI ?1E.5 +or those over 1@. Un'era*e. se #harts,
2. Intense +ear o+ *a!n!n* "e!*ht7$e#o(!n* +at (tho*h n'er"e!*ht,
). /!storte' per#ept!on o+ $o'% shape7Un'e !n+&en#e o+ $o'% "e!*ht7shape on
se&+:eva&at!on. or 'en!a& o+ ser!osness o+ #rrent &o" $o'% "e!*ht.
-. A(enorrhea !+ post:(enar#ha& (a$sen#e o+ at &east ) #onse#t!ve per!o's,
C&ass!+% T%pe:
a. Restr!#t!n* : Not re*&ar&% en*a*e' !n $!n*e!n*7pr*!n*
$. 4!n*e!n*7Pr*!n* : Re*&ar&% en*a*e' !n $!n*e!n*7pr*!n*
:2-:
PSYCHIATRY REVISION
Assessment:
1. =!stor%:
: 2hen "ere %o &ast "e&&C
: /o#(ent a&& eat!n* '!sor'er s%(pto(s
: E++e#ts o+ !&&ness on her &!+e
: S%(pto(s o+ starvat!on
: Co:(or$!' 'epress!ons. 3C/. so#!a& pho$!as. past ps%#h h8C
: Mot!vat!on +or #han*e
: Prev!os he&p so*ht
: Rea#t!ons o+ +a(!&% an' +r!en's
: Co&&atera& h!stor%
: Re&evant +a(!&% pro$&e(s
2. Ph%s!#a& E8a( (#onseqen#es o+ starvat!on,
= Eot 0ating +as Many %ntense 0""ects: Girls 5arely !tay Con"ident:>
Ne$ro%egetati%e /epresse' (oo'. attent!on. &!$!'o. s&eep. appet!te
Ele"trolyte Lo" OD. P3-
)::
. M*. Ca
Haematologi"al Anae(!a o+ #hron!# '!sease (nor(o#%t!#7#hro(!#,
eta#oli" =%pother(!a. =%po*&%#ae(!a. =%per#ho&estero&
Imm$nologi"al 4a#ter!a& !n+e#t!on
Endo"rine A(enorrhea
:astrointestinal Ma&&or% "e!ss. s"o&&en sa&!var% *&an's. 'enta& #ar!es. M(ot!&!t%
Renal Oetones. a#te7#hron!# rena& +a!&re
S*in79one /r% s1!n. &an*o ha!r. +a#!a& prpra. 3steopen!a
Cardia" Arr%hth(!a. 4ra'%#ar'!a
). MSE
5enera& Appearan#e May ha#e Do* BM%
Doo- "or layering o" clothes
Rapport A
4ehav!or A
Moo'7A++e#t Dysphoriac a""ect
%rritibility
Spee#h an' Lan*a*e A
Tho*ht
: Strea(
: For(
: Content
$reoccupation *ith *eight/shape
?eelings o" inade4uacy
Per#ept!on A
Co*n!t!on $oor concentration
Cogniti#e "unction reduced
Ins!*ht an' V'*e(ent May be limited
S!#!'e7R!s1 A
:25:
PSYCHIATRY REVISION
In%estigations:
1. S#reen +or n'er&!n* or*an!# !&&ness (ESR. TFT. Coe&!a# s#reen,
2. S#reen +or a#te (e'!#a& #o(p&!#at!ons
a. F4E 9 anae(!a
$. ESR 9 severe seps!s
#. UDE as "e&& as O. M*. Ca. Phospate (nee' to as1 spe#!+!#a&&%,
'. LFTs. a&$(!n. tota& prote!n 9 (a&nor!sh(ent
e. Ran'o( 5&#ose 9 h%po*&%#ae(!a or '!a$etes
+. EC5 9 $ra'%#ar'!a. arr%ht(!a. h%po1a&ae(!a (&on* HT,
*. CZR 9 T4 or staph
h. /EZA or 4one /ens!to(etr% (!+ N12 (onths a(enorrhea,
). Anna& 4one /ens!t%
-. Mon!tor phosphate 'r!n* re+ee'!n*: h%pophosphatae(!a #an present as
'e&!r!(. #ar'!a# +a!&re 9 #an $e pre#!p!tate' $% I> 'e8trose,
dD6:
: Nor(a& "e!*ht &oss (anore8!a has pervas!ve #on#ern an' n#o(pro(!s!n*
att!t'es,
: Ma<or 'epress!ve '!sor'er
: 3C/
: Ph%s!#a& /!sor'er: th%roto8!#os!s. U&#erat!ve #o&!t!s. (a&!*nan#%. !n+e#t!on
: S#h!;ophren!a
:eneral anagement:
1. Ps%#hoe'#at!on 9 (&t!'!s#!p&!nar% apprao#h
a. Pat!ent an' Carers
$. A#1no"&e'*e a($!va&en#e
#. Prov!'e !n+or(at!on an' a##ess to spport *rops
'. Restore ntr!t!on
e. Invo&ve /!et!#!an
2. Ps%#hotherap% (o+ten &on* ter(,
a. Fa(!&% therap% (e++e#t!ve +or a'o&es#ents,: non:$&a(!n* te#hn!qe
$. 4ehav!ora& te#hn!qes 9 re"ar' "e!*ht *a!n
#. Co*n!t!ve therap% 9 #ha&&en*e anore8!# att!t'es. !'ent!+% ro&e o+ AN
). 4!o&o*!#a&
a. SSRI +or #o:(or$!' 'epress!on
Admission to Hos)ital7Psy"! Referral S)e"ialist Eating Disorder @nit
: 4MI ? 1B
: Rap!' "e!*ht &oss (-:51*7"ee1 or 11*7"ee1 over (an% "ee1s,
: A$nor(a& !nvest!*at!on res&ts: EC5. LFTs. F4Es
: Severe 'eh%'rat!on an' 4P ?T6
: Severe $ra'%#ar'!a an' +a!ntness
: S!#!'a& r!s1
: E8tre(e /!ret!#7La8at!ve se
: Fa!&e' to !(prove as otpat!ent
: E8tre(e so#!a& !so&at!on7+a(!&% s!tat!on
: Mar1e' #o:(or$!'!t!%
N47 Re+er to pae'atr!#!an !+ prep$es#ent
:2B:
PSYCHIATRY REVISION
Prognosis:
: Usa&% 'rat!on o+ !&&ness W E %ears
: Those treate' ear&% (a% re#over
o -6G (a1e *oo' 5 %r re#over
o -6G have res!'a& (!nor s8
o 26G have (a<or on*o!n* !&&ness
: Res!'a& (or$!'!t% !s #o((on
o Stnte' *ro"th. !n+ert!&!t%
o 3steoporos!s
o /enta& eros!on
o Me(or% an' &earn!n* 'e+!#!ts
o Pro8!(a& (%opath%
s
1. 5oo' pro*nost!# +a#tors:
a. A$sen#e o+ severe e(a#!at!on (4IMN1E.5,
$. A$sen#e o+ (e'!#a& #o(p&!#at!ons
#. /es!re to #han*e
'. Spport!ve +a(!&%7+r!en's
2. Poor Pro*nost!# +a#tors
a. Lon*er 'rat!on o+ !&&ness
$. 3&'er a*e o+ onset
#. /!str$e' +a(!&% re&at!onsh!ps
'. Co:(or$!' ps%#h!atr!# #on'!t!ons
:2E:
PSYCHIATRY REVISION
9$limia Ner%osa
Definition:
E)idemiology:
: 1:)G o+ "o(en ? -5
: 0on* "o(en
: 3nset &ate teens:ear&% a'&t
: More #o((on !n "estern "or&'
Aetiology:
1. Co*n!t!ve 4ehav!ora& >!e"
a. Lo" se&+:estee(
$. 3ver:#on#ern a$ot shape an' "e!*ht
#. E8tre(e /!et!n*
'. 4!n*e Eat!n*
e. Co(pensator% pr*!n*7over:e8er#!s!n*7+ast!n*
Ris* &a"tors:
: =!stor% o+ 3$es!t%
: =!stor% o+ parenta& pro$&e(s
: Restr!#t!n* '!etar% !nta1e
: Per+e#t!on!s(
: Moo' '!sor'er
: Se8a&7ph%s!#a& a$se
: Ear&% (enar#he
: Parenta& a$se
Sym)toms:
Cogniti%e 9e!a%io$ral
: /epresse' (oo' a+ter $!n*e
: Se&+:'epr!#at!n* tho*hts a+ter $!n*e
: Rea&!sat!on that eat!n* pattern a$nor(a&
: Sense o+ sha(e7&a#1 o+ #ontro&
: Cons(pt!on o+ =!*h #a&or!e7eas!&%
#ons(e' +oo's 'r!n* $!n*es.
: In#onsp!#os eat!n* (#on#ea&e' +ro(
+a(!&%,
: Se&+:!n'#e' vo(!t!n*7a$'o pa!n 7 so#!a&
!nterrpt!on7s&eep +o&&o"!n* $!n*e
: Repeate' atte(pts to &ose "e!*ht
(restr!#te' '!ets. vo(!t!n*. &a8at!ves.
e8er#!se,
DS IV:
1. Re#rrent ep!so'es o+ $!n*e eat!n*
a. Eat!n* an a(ont o+ +oo' s!*n!+!#ant&% &ar*er than "hat other peop&e
"o&' eat !n a s!(!&ar t!(e !n s!(!&ar #!r#(stan#es.
$. A sense o+ &oss o+ #ontro&7sha(e a$ot $!n*e!n*
2. Inappropr!ate or e8#ess!ve #o(pensator% $ehav!ors to prevent "e!*ht *a!n
). 4!n*!n* an' #o(pensator% $ehav!ors o##rs 28 "ee1 +or ) (onths
-. Se&+ eva&at!on !s n'&% !n+&en#e' $% $o'% shape7"e!*ht
C&ass!+% T%pe:
a. Pr*!n* : =as re*&ar&% en*a*e' !n se&+:!n'#e' vo(!t!n* or (!sse o+
&a8at!ves. '!ret!#s or ene(as
:2@:
PSYCHIATRY REVISION
$. Non:Pr*!n* : =as se' other #o(pensator% $ehav!ors (!e. +ast!n* or
e8#ess!ve e8er#!se, $t has Not re*&ar&% en*a*e' !n se&+:!n'#e'
vo(!t!n* or (!sse o+ &a8at!ves. '!ret!#s or ene(as
Assessment:
1. Ph%s!#a&
: =a!r &oss. a#ne. 'r% s1!n
: /enta& eros!on. 'e#a%
: Moth &#ers. s"o&&en parot!'s
: 4&oo'shot e%es
anagement:
1. Ps%#hoe'#at!on
2. Ps%#hotherap%
a. UUC4T 9 (on!tor!n* o+ "e!*ht7shape #on#erns
$. /!etar% #onse&!n*
#. Interpersona& ps%#hotherap%
). 4!o&o*!#a&
a. SSRI +or #o(or$!' 'epress!on
-. A'(!ss!on to hosp!ta& !+:
a. 2e&& 'es!*ne' 3tpat!ent treat(ent has +a!&e'
$. S!#!'a&
#. Ant!'epressants are nee'e' $t #annot have sa+e (on!tor!n* "!thot
a'(!ss!on
Prognosis:
: 52G (a1e *oo' re#over (16 %ears,
: TG have on*o!n* $&!(!a
:2T:
PSYCHIATRY REVISION
PERSONA'ITY DISORDERS
9orderline Personality Disorder
Definition:
@. A pervas!ve pattern o+ !nsta$!&!t% o+ a++e#t. se&+:!(a*e an' !nterpersona&
re&at!onsh!ps "h!#h &ea's to (ar1e' o##pat!ona& an' ps%#hoso#!a& !(pa!r(ent.
E)idemiology:
T. 16G o+ a'&t pop&at!on have a persona&!t% '!sor'er o+ so(e 1!n'
16. R!ses to )6G o+ !npat!ents present!n* "!th 'epress!on .an8!et%. s$stan#e a$se.
11. Eqa& (a&e:+e(a&e
12. 4or'er&!ne pat!ents +on' !n 1G o+ pop&at!on
1). R!ses to 16G a(on*st ps%#h!atr!# otpat!ents an' 175 !npat!ents
Aetiology:
1-. Co($!nat!on o+ *enet!#s an' env!ron(ent
Ris* &a"tors:
15. Pro+on' 'eve&op(enta& tra(a
1B. Ch!&'hoo' se8a& a$se
1E. Ch!&'hoo' ne*&e#t
1@. Parent!n* a&ternat!n* $et"een e8tre(e&% !ntrs!ve an' e8tre(e&% ne*&e#t+&
Sym)toms: ?PRAISEDA
1. Parano!' !'eas
2. Re&at!onsh!p !nsta$!&!t%
). A++e#t !nsta$!&!t%. A**ress!on. Atta#h(ent !sses
-. I(p&s!v!t%. I'ent!t% '!str$an#e
5. S!#!'a& !'eat!on7Se&+ har(
B. E(pt!ness
E. D!sso#!at!ve pheno(ena 9 'epersona&!sat!on
DS IV:
Assessment:
1T. Trans+eren#e: pat!ents tho*hts7+ee&!n*s an' +antas!se (pos!t!ve an' ne*at!ve,
to"ar's the therap!st re+&e#ts n#ons#!os re&at!onsh!ps "!th past s!*n!+!#ant
others.
26. Conter:trans+eren#e !s the therap!st response to trans+eren#e
anagement:
1. A#te (ana*e(ent:
: Me'!#a& (ana*e(ent o+ se&+ !n<r%7over'ose
: Treat(ent o+ 'r*7a&#oho& !nto8!#at!on an' "!th'ra"a&
: C Ps%#hotrop!# +or a#te ps%#h!atr!# states
: Assess s!#!'e r!s17 r!s1 to others
2. Lon* ter(
: Lon* Ter(. In'!v!'a& Ps%#hotherap%
a. Spport!ve
$. Ps%#ho'%na(!#
#. Interpersona&
'. Co*n!t!ve 4ehav!ora& Therap%
e. Inte*rate': Co*n!t!ve Ana&%t!# Therap%
: F Mar!ta&. +a(!&% an' *rop therap!es !+ !n'!#ate'
). 4!o&o*!#a&
: 4en;o'!a;ep!ne: short ter( to #r$ an8!et%
:)6:
PSYCHIATRY REVISION
: Ant!ps%#hot!#s: &o" 'oses (a% $e se' !n!t!a&&% to #r$ a**ress!on
: Moo' Sta$!&!sers: (a% $e !n'!#ate' &on* ter( to he&p #r$ !(p&s!v!t% an'
s!#!'a&!t% (!+ the pat!ent #an #o:operate,
:
Prognosis:
: So(e "!&& !(prove $% (!''&e a*e. $t have o+ten a&!ente'
sposes7+a(!&%7+r!en's $% th!s sta*e
: =!*h r!s1 o+ s!#!'e. espe#!a&&% $or'er&!ne pat!ents (16G,
: Ps%#hotherap!es an' (e'!#at!ons #an !(prove pro*nos!s.
O#sessi%e2Com)$lsi%e Disorder
Definition:
E)idemiology:
Aetiology:
Ris* &a"tors:
Sym)toms:
DS IV:
Assessment:
anagement:
Prognosis:
:)1:
PSYCHIATRY REVISION
OR:ANIC 9RAIN DISORDERS
Dementia
Definition:
21. /eve&op(ent o+ (&t!p&e #o*n!t!ve 'e+!#!ts (an!+este' as #han*es !n Me(or%.
Inte&&e#ta& +n#t!on!n*. 4ehav!or an' Persona&!t%.
E)idemiology:
22. 1G o+ pop&at!on
2). More #o((on a+ter a*e B6 (preva&en#e 'o$&es ever% 5 %ears o+ a*e,
Aetiology:
1, A&;he!(erRs '!sease\\\\\\\ 56:B6G
2, Cere$rovas#&ar '!sease\\\\\.. 16:15G
), /e(ent!a "!th Le"% 4o'!es\\\... 16:15G
-, M!8e' A&;he!(erRs an' C>/\\\. 16:15G
5, 3ther\\\\\\\\\\\\\
a. Fronto:te(pora& 'e(ent!a
$. A&#oho& re&ate' $ra!n 'a(a*e
5:16G
Mne(on!#: J/EMENTIAK
: De*enerat!ve
o A&;he!(ers ((ost #o((on,
o Par1!nsons
o =nt!n*tons
o P!#1s '!sease
o Le"e% 4o'% /!sease
: E(ot!ona&
: eta$o&!# (h%po*&%#.TS=.e&e#tro&%te,7Ntr!t!ona& (v!t $12.+o&ate.n!a#!n,
: Ear7E%e !(pa!r(ent
: Nor(a& Pressre =%'ro#epha&s (*a!t apra8!a!n#ont!nen#e'e(ent!a,
: T(or (1
o
72
o
,7Tra(a (S/=,7To8!# (Et3=,
: In+e#t!on (=I>7T47CV/7S%ph!&&!s,
: Atheros#&erot!#7>as#&ar (Step"!se 'e(ent!a,
Ris* &a"tors:
2-. A&;he!(erRs: +a(!&% =Z
25. >as#&ar: stro1e. =TN. s(o1!n*. /M. AF
2B. 3ther: a&#oho& a$se
Sym)toms:
4ehav!ora& an' Ps%#ho&o*!#a& S%(pto(s o+
/e(ent!a (4PS/,
2E. Moo' #han*e
2@. /e&s!ons
2T. M!s!'ent!+!#at!on o+ +a(!&!ar p&a#e7peop&e
)6. =a&&#!nat!ons
)1. Persona&!t% #han*e
)2. E8#ess!ve (otor $ehav!or
)). No!s!ness
)-. Res!stan#e to #are
)5. A**ress!on
)B. Se8a& '!s!nh!$!t!on
Signs
)E. Poor h%*!ene
)@. Poor '!et
)T. Unsa+e se o+ app&!an#es
-6. Fa!&re to pa% $!&&s
-1. Ten'en#% to *et &ost
-2. Repet!t!ve qest!on!n*
:)2:
PSYCHIATRY REVISION
DS IV:
1, Me(or% !(pa!r(ent D A1:
a. Aphas!a Danguage disturbance
$. Apra8!a %mpaired ability to carry out motor acti#ities despite
intact motor "unction
#. A*nos!a %mpaired ability to recognize/identi"y ob)ects despite
intact sensory "unction
'. E8e#t!ve Fn#t!on %mpaired "unctions o" planning, organizing,
se4uencing, abstract thin-ing
2, 5ra'a& 'e#&!ne an' #ont!nos 'e#&!ne
), S!*n!+!#ant !(pa!r(ent !n so#!a& or o##pat!ona& +n#t!on!n*
-, S!*n!+!#ant 'e#&!ne +ro( a prev!os &eve& o+ +n#t!on!n*
Assessment:
1. =!stor%
a. As#erta!n natre7e8tent o+ #o*n!t!ve 'e+!#!t
$. /eter(!ne !(pa#t on +n#t!on
#. Corro$orat!ve h!stor% !s !(portant: 'rat!on. onset. pro*ress!on. he&p.
(oo'. ps%#hot!# s8. #ha&&en*!n* $ehav!ors.
'. /eter(!ne t!(e #orse an' Esta$&!sh #ase
e. /!a*nose #o(or$!' #on'!t!ons s#h as 'e&!r!( an' 'epress!on
+. Che#1 a'eqa#% o+ +a(!&!a& an' so#!a& spport
2. MSE
5enera& Appearan#e $erson li#ing alone may loo- neglected, malnourished
$erson li#ing *ith carers may loo- groomed/nourished
Rapport $erson may be able to conceal cogniti#e impairment "or
some time, as G$ meeting are o"ten predictable a"ter many
years:
Demands that eceed patient<s capacity may lead to etreme
emotional/physical disturbance H catastrophic reaction:
4ehav!or MildAmod dementia: alert, attending:
%" complicated by delirium, gauge arousal and attention:
1hyperaroused or dro*sy, easily distracted)
Moo'7A++e#t 9BF ha#e comorbid depression: loo- "or social *ithdra*al,
teary, agitated, noisy, insomnia, anoreia:
May o"ten loo- anious/*eary *hen as-ed about "eelings
Agitation *orse in late a"ternoon 1;sundo*ning<)
Spee#h an' Lan*a*e
,ord "inding ability pro"ound aphasia
Tho*ht
: Strea(7For(
: Content
!imple in content, rambling and repetiti#e
May be accompanied by delusions J spouse in imposter,
people stealing "rom you *hen something is misplacedK
Per#ept!on May ha#e hallucinations J #isual most commonly, o"
children and animals:
More bizarre, "lorid delusions may indicate delirium
Co*n!t!on Disorientation to time is common:
$eople o"ten blame lac- o" -no*ledge o" day, *ee-, time on
retirement, poor #ision, social isolation etc: But time should
remain intact in cogniti#ely capable people:
%mportant to do MM!0
:)):
PSYCHIATRY REVISION
Ins!*ht an' V'*e(ent '"ten lost early so patient belie#es they are coping *ell:
L!(!tat!ons o+ MMSE:
: S#reen!n* test
: Prov!'es $ase&!ne +or re+eren#e. not '!a*nost!# "!thot a''!t!ona& !n+o
: Nee' to $e !nterprete' !n the &!*ht o+ other (ater!a& o$ta!ne'
: Lo" s#ores (a% $e 'e to: poor v!s!on7hear!n*. 'epress!on. &a#1 o+ #o:
operat!on. En*&!sh +&en#%. &!(!te' e'#at!on.
: Test 'oes not assess +ronta& &o$e +n#t!on: !nsens!t!ve +or persons o+ a$ove
avera*e !nte&&!*en#e "!th ear&% 'e(ent!a.
). /'8
: S$'ra& hae(ato(a
: Cere$ra& t(or
: Nor(a& pressre h%'ro#epha&s
-. Invest!*at!ons
E8#&'e #o(p&!#at!n* +a#tors
!. Anae(!a
!!. /!a$etes
!!!. =%poth%ro!'
!v. >!t 412 'e+!#!en#%
v./r* to8!#!t%
a. F4E
$. ESR
#. 5&#ose
'. UDE
e. TFTs
+. Ur!ne (!#ros#op% D #&tre
*. 3ther: LFTs. +o&ate. s%ph!&!s. =I>
h. I(a*!n*: CT (h!*h %!e&',
anagement:
1. A#te:
!. Esta$&!sh '!a*nos!s
!!. E8#&'e treata$&e #ases
!!!. E8#&'!n* /epress!on7/e&!r( as #ontr!$t!n* to #on+s!on
2. Lon* ter(
!. Ensre opt!(a& ph%s!#a& hea&th
!!. Cont!na& assess(ent o+ A/Ls
!!!. E'#at!on an' spport +or #arers
!v. Invo&ve(ent !n 'e#!s!#ons re*ar'!n* #are 9 "!&&s. a'van#e'
'!re#t!ves
). 4!o&o*!#a&
!. Cho&!nesterase !nh!$!tors ('onepe;!&, 9 short ter( !(prove(ent. B:
12 (onths 'e&a% !n 'e#&!ne.
!!. Ant!'epressants 9 SSRI +or #o(or$!' 'epress!on
Less se':
!!!. 4en;os 9 short7(e'!( ter( to re&!eve 'a%t!(e an8!et% (r!s1
+a&&s,
!v. Ant!ps%#hot!#s 9 &!(!te' ro&e. re'#e' an8!et%. a*!tat!on.
ps%#hot!# s8. (S7E par1!nson!s(. +a&&s. tar'!ve '%s1!nes!a,
:)-:
PSYCHIATRY REVISION
v.Moo' sta$!&!;ers 9 re'#e a*!tat!on7a**ress!on
N$7 A&& ps%#hotrop!# 'r*s #an !n'#e 'e&!r!(. A&so. '!*o8!n. 5CS.ant!#onv&sants
-. So#!a&
!. =o(e he&p
!!. Mea&s on "hee&s
!!!. /a% #are
!v. Resp!te
v./osette $o8es
v!. Nrs!n* he&p 9$ath!n* et#
v!!. Carer spport 9 '!stress. !so&at!on. an8!et%. !&& hea&th. +!nan#!a&
v!!!. A'(!ss!on to res!'ent!a& +a#!&!t!es
Prognosis:
: No #re as %et
/rat!on W 16 %ears A&;he!(ers. B%ears /L4
:)5:
PSYCHIATRY REVISION
Deleri$m
Definition:
-). Trans!ent *&o$a& #o*n!t!ve !(pa!r(ent o+ pres(e' or*an!# aet!o&o*%.
--. A '!str$an#e !n #ons#!osness an' a #han*e !n #o*n!t!on that 'eve&op over a
short t!(e.
E)idemiology:
-5. 1G preva&en#e !n *enera& pop&at!on
-B. =!*her !n hosp!ta&s: 5:15G
-E. Co((on !n #h!&'ren or e&'er&%
Aetiology:
Ris* &a"tors:
-@. Coe8!st!n* 'e(ent!a (-6G 'e(ente' pat!ents are 'e&!r!os on a'(!ss!on,
-T. /epress!on
56. A#te ps%#ho&o*!#a& stress
51. S&eep7sensor% 'epr!vat!on
52. 4ereave(ent
5). 4ra!n 'a(a*e
5-. S$stan#e a$se
55. /r*7a&#oho& 'epen'en#e
5B. =ear!n*7v!sa& !(pa!re(ent
Sym)toms:
1. C&o'!n* o+ Cons#!osness: M A&ertness. A"areness. Attent!on. Arosa&
a. S&eep:"a1e #%#&e reversa&: so(no&ent 'r!n* 'a%. a*!tate' at n!*ht.
$. Ps%#ho(otor a#t!v!t%: ran*e +ro( apath% rest&ess. P!#1!n* at $e'
#&othes.
2. Co*n!t!on
a.
DS IV:
1. A '!str$an#e !n #ons#!osness 9
!(pa!re' a$!&!t% to +o#s. sh!+t or
ssta!n attent!on
5educed clarity in a*areness o" en#ironment
2. A #han*e !n #o*n!t!on or '!str$an#e
!n per#ept!on not $etter a##onte' +or
$% evo&v!n*7e8!st!n* 'e(ent!a
Memory de"icit, disorientation, language
disturbance
). 3##rs over a short per!o' an' ten's
to +&#tate thro*h the 'a%
+ours J three Days
-. Ev!'en#e (h!stor%7ph%s7I8, than
'!str$an#e !s #ase' $% '!re#t
ph%s!o&o*!#a& #onseqen#e o+ 5MC
General Medical Condition
!ymptoms during substance intoication
De#elop only a"ter *ithdra*al
More than one aetiology
Assessment:anagement:Prognosis:
:)B: