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Transcript of Phase 3a Phoebe Barrett and Natasha Hussain The Peer Teaching Society is not liable for false or...
![Page 1: Phase 3a Phoebe Barrett and Natasha Hussain The Peer Teaching Society is not liable for false or misleading information…](https://reader036.fdocuments.net/reader036/viewer/2022062518/56649de45503460f94adb812/html5/thumbnails/1.jpg)
Phase 3a
Phoebe Barrett and Natasha Hussain
Psychiatry
The Peer Teaching Society is not liable for false or misleading information…
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• We will ask you lots of questions
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The Peer Teaching Society is not liable for false or misleading information…
Psychiatry ClassificationBehavioural
Developmental
E.g. Learning disorders and pervasive developmental disorders (autism/ADHD)
E.g. Eating disordersPersonality disordersPsychosexual disorders
Mental Illness
OrganicFunctional
Organic Substance abuse
E.g. DeliriumDementiaHypothyroidism
Psychoses(loss of contact with reality)
Neuroses(severe “normal” experience)
Schizophrenia
Mood disordersBipolar, depression, mania
Anxiety Phobias
OCD
Psych emergencies
Acute dystonic reactionNeuroleptic Malignant SyndromeLithium toxicity
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The Peer Teaching Society is not liable for false or misleading information…
Psychiatry ClassificationBehavioural
Developmental
E.g. Learning disorders and pervasive developmental disorders (autism/ADHD)
E.g. Eating disordersPersonality disordersPsychosexual disorders
Mental Illness
OrganicFunctional
Organic Substance abuse
E.g. DeliriumDementiaHypothyroidism
Psychoses(loss of contact with reality)
Neuroses(severe “normal” experience)
Schizophrenia
Mood disordersBipolar, depression, mania
Anxiety Phobias
OCD
Psych emergencies
Acute dystonic reactionNeuroleptic Malignant SyndromeLithium toxicity
![Page 5: Phase 3a Phoebe Barrett and Natasha Hussain The Peer Teaching Society is not liable for false or misleading information…](https://reader036.fdocuments.net/reader036/viewer/2022062518/56649de45503460f94adb812/html5/thumbnails/5.jpg)
The Peer Teaching Society is not liable for false or misleading information…
• What is it?
(1) Schizophrenia
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The Peer Teaching Society is not liable for false or misleading information…
• A psychotic mental illness characterised by ≥ 1 month of a number of certain symptoms
• What are the symptoms of schizophrenia? (at least 8)
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The Peer Teaching Society is not liable for false or misleading information…
Schizophrenia symptoms•Thought echo/insertion/broadcast/withdrawal or breaks in train of thought/knight’s move thinking
•Delusions of control/influence/passivity (+ passivity phenomenon)
•Auditory hallucinations (3rd person, running commentary)
•Persistent delusions e.g. Religious/super power
•Catatonic behaviour
•Negative symptoms: poverty of speech, blunting of affect, lack of volition, socially withdrawn
What are the purple ones?
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The Peer Teaching Society is not liable for false or misleading information…
• Who gets schizophrenia and what the are main risk factors for getting it?
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The Peer Teaching Society is not liable for false or misleading information…
• Adolescents/young adults, both sexes get it (men it occurs earlier)
• RF – heavy cannabis/skunk use, FH, complications in pregnancy, severe maternal malnutrition
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The Peer Teaching Society is not liable for false or misleading information…
• What investigations might you do to rule out organic pathology
(name investigation or a differential you are trying to rule out)
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The Peer Teaching Society is not liable for false or misleading information…
• Bloods – FBC, U&E, LFTs, TFTs, glucose, Calcium, cortisol
• Drug and alcohol screen• ECG• Urine dipstick/MSU• CT/MRI head
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The Peer Teaching Society is not liable for false or misleading information…
• Treatment of schizophrenia?
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The Peer Teaching Society is not liable for false or misleading information…
• Anti psychotics (typicals v atypicals?)• Benzodiazepines• Procyclidine (why?)• Plus talking therapies, family therapy,
education, CBT, social/housing/community support
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The Peer Teaching Society is not liable for false or misleading information…
Typical anti-psychotics Atypical anti-psychotics
Old school Newer
Worse side effect profile Still some pretty bad side effects
E.g. Haloperidol, cholpromazine E.g. Olanzapine, clozapine, risperidone, aripiprazole
So what are these side effects?(at least 6)
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The Peer Teaching Society is not liable for false or misleading information…
• P - ↑ prolactin and extra-Pyramidal side effects (EPSEs)
• S – sexual dysfunction• Y – You get fat• C – CV effects - ↑ HR, BP changes, arrhymias, QT
prolongation• H – Hyperglycaemia and Diabetes• O – other – Anti-muscarinic side effects e.g. Dry eyes,
mouth, constipation -Bad withdrawal if stopped
“PSYCHO”
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The Peer Teaching Society is not liable for false or misleading information…
• Acute dystonic reaction• Akathisia• Parkinsonism• Tardive dyskinesia
Extra-pyramidal side effects
What are they?
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The Peer Teaching Society is not liable for false or misleading information…
Psychiatry ClassificationBehavioural
Developmental
E.g. Learning disorders and pervasive developmental disorders (autism/ADHD)
E.g. Eating disordersPersonality disordersPsychosexual disorders
Mental Illness
OrganicFunctional
Organic Substance abuse
E.g. DeliriumDementiaHypothyroidism
Psychoses(loss of contact with reality)
Neuroses(severe “normal” experience)
Schizophrenia
Mood disordersBipolar, depression, mania
Anxiety Phobias
OCD
Psych emergencies
Acute dystonic reactionNeuroleptic Malignant SyndromeLithium toxicity
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The Peer Teaching Society is not liable for false or misleading information…
• What is it?
Neuroleptic Malignant Syndrome
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The Peer Teaching Society is not liable for false or misleading information…
• Severe motor/mental/autonomic dysfunction• ↑ temp• Muscle rigidity• Unstable BP, ↑ HR, ↑ sweating• Dysphagia• Mutism• Urinary incontinence
A rare, life threatening reaction to anti-psychotics (or can be to anti-depressants or anti-convulsants) within first 10/7 Tx
High mortality
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The Peer Teaching Society is not liable for false or misleading information…
Psychiatry ClassificationBehavioural
Developmental
E.g. Learning disorders and pervasive developmental disorders (autism/ADHD)
E.g. Eating disordersPersonality disordersPsychosexual disorders
Mental Illness
OrganicFunctional
Organic Substance abuse
E.g. DeliriumDementiaHypothyroidism
Psychoses(loss of contact with reality)
Neuroses(severe “normal” experience)
Schizophrenia
Mood disordersBipolar, depression, mania
Anxiety Phobias
OCD
Psych emergencies
Acute dystonic reactionNeuroleptic Malignant SyndromeLithium toxicity
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• Depression– Antidepressant therapy– ! Serotonin syndrome
• Mania and bipolar affective disorder– Mood stabilisers– ! Lithium toxicity
The Peer Teaching Society is not liable for false or misleading information…
(2) Mood Disorders
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What classification system can we use?
What are the symptoms of depression?= 3 core ones
At least 2 of these, every day, for 2 weeks
The Peer Teaching Society is not liable for false or misleading information…
Depression
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• D Depressed mood• E Energy ↓ = ‘ANERGIA’• P Pleasure, interest and enjoyment ↓ = ‘ANHEDONIA’• R Retardation (psychomotor) – N.B. atypically
agitation• E Eating changes: ↓appetite and weight – ↑in
atypical• S Sleep disturbance (EMW)• S Suicidal/self harm thoughts• I I’m a failure • O Only me to blame • N No concentration or attentionThe Peer Teaching Society is not liable for false or misleading information…
Symptoms
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Which are biological? Cognitive?
Can they exhibit psychotic features?Delusions? Hallucinations?
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Depression
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Neurological DegenerativeIdiopathic/iatrogenicCongenitalEndocrine
VascularInfectiveTrauma/environmentalAutoimmuneMetabolicInflammatoryNeoplastic (+heam)
Peer Teaching Society is not liable for false or misleading information…
Surgical Sieve
+ PSYCH!!
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• Psych – schizophrenia, anxiety, PND, hypoactive delirium etc!
• Neuro – encephalitic disorder, PD, dementia, MS (CSF, brain imaging, MMSE)
• Iatrogenic (drugs);– Anticonvulsants, antipsychotics, anabolic steroids– Beta blockers,– Contraceptives (progesterone), CCBs, corticosteroids– Drugs for PD, e.g. levadopa
The Peer Teaching Society is not liable for false or misleading information…
DD and Ix
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• Endocrine;• Hypoglycaemia - glucose• Hypothyroid (hyper in anxiety) - TFTs• Cushing’s - cortisol• HyperPTH (high calcium) - PTH/ Ca and phosphate
levels• Vascular - CVD - Cholesterol• Infective - post viral, Lyme disease, neurosyphilis, AIDs
and other chronic – bloods, virology
The Peer Teaching Society is not liable for false or misleading information…
DD and Ix
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• Trauma – bleeds? - imaging• Environmental;
• Alcoholism, MCV, LFTs (gamma GT)• Drugs such as cannabis, benzodiazepines,
amphetamines - urine• Autoimmune – SLE - ANA, ESR, anti dsDNA• Neoplastic – SOL - imaging• Haem – anaemia - FBC, vit B12/folate
The Peer Teaching Society is not liable for false or misleading information…
DD and Ix
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Depression Tools
How can you diagnose depression and assess severity?
Can you ‘screen’?What is the criteria used re: screening?
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• Mild– Low intensity psychological interventions: self help/ telephone
sessions/group CBT, exercise classes• Moderate
– More intense psychological interventions – individual CBT, counselling, interpersonal therapy
– + Antidepressant drugs • Severe
– Intensive psych treatments– Drugs– ECT in emergency– ? Antipsychotics
The Peer Teaching Society is not liable for false or misleading information…
Treatment
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• SE: hypertensive crisis if eat cheese!• E.g: phenelzine• Action: block monoamine oxidase enzyme = x
breakdown of monoamine neurotransmitters dopamine, serotonin and norepinephrine
• Answer: MAOIs– Use in treatment of drug resistant/atypical
depression
The Peer Teaching Society is not liable for false or misleading information…
Antidepressants Quiz!
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• SE: – Anticholinergic: dry mouth, blurred vision,
constipation, urinary retention, postural hypotension, drowsiness, sweating
• E.g: clomipramine• Answer: TCAs • Can help with poor sleep• Problems: cardiotoxic in overdose• ECG changes??
Antidepressants Quiz!
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• SE: GI bleeds, dyspepsia• E.g: paroxetine• Action: inhibit reuptake of serotonin by
presynaptic cells • Pros: less cardiotoxic and safer in overdose
than TCAs first line drugs• Answer: SSRIs• ?Why not in children & adolescents?
The Peer Teaching Society is not liable for false or misleading information…
Antidepressants Quiz!
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• SNRIs;– E.g. duloxetine, S/E: anticholinergic– Also used in OCD, ADHD, anxiety
• Trazadone – sedating, good for anxiety• Mirtazapine – increases appetite and is
anxiolytic
The Peer Teaching Society is not liable for false or misleading information…
Other antidepressants
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Which drugs can cause this?Symptoms include;- Agitation/restlessness- Hyperpyrexia - Tachycardia- Hypertension- Loss of co-ordination- Myoclonus- Rigidity- Coma
Treatment – withdrawal of causative drug(s), benzodiazapine, cyproheptadine
The Peer Teaching Society is not liable for false or misleading information…
Serotonin (5HT) Syndrome
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When is depression unipolar?
When is it part of bipolar affective disorder?
The Peer Teaching Society is not liable for false or misleading information…
Mood Disorders
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How would you describe somebody with mania?
Cardinal feature?
The Peer Teaching Society is not liable for false or misleading information…
Mania
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• Appearance/behaviour– Psychomotor overactivity – little sleep, distracted– ? Brightly coloured, mismatched clothing – Increased appetite and libido
• Mood and affect– Usually elated – Congruous
• Speech – Uninterruptable/pressured, rapid
• Perception– May have delusions of persecution or grandiose – mood congruent
• Thoughts– Flight of ideas, hallucinations (usually auditory)
• Cognition• Insight
– Often absent The Peer Teaching Society is not liable for false or misleading information…
Mania
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The Peer Teaching Society is not liable for false or misleading information…
ManiaDifferentials?- Substance abuse – esp. amphetamines,
cocaine- Schizophrenia - Personality disorders
RFs?
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• Co-ordinated care• Rapid access to support in crisis• ?Hospitalisation – MHA• Psychological care – education, promoting
social funtioning etc• Medication • Annual reviews
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Management
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- Anti-manic drugs (prophylaxis);- Lithium- Valproate- Carbamazapine - Lamotrigine
- Atypical antipsychotics – olanzapine, apiprazole, quetiapine, risperidone
- ? Rapid tranquilisation
The Peer Teaching Society is not liable for false or misleading information…
Mania Treatment
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- Treat depression- ?Rapid cycling
- Treat mania
The Peer Teaching Society is not liable for false or misleading information…
Bipolar Affective Disorder
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• Monitor– Lithium levels;
• 12 hours after administration• Weekly until levels stable after initiation/dose change• Then every 3/12
– U&E – baseline and every 6/12– TFTs – every 6/12
N.B. Pregnancy test prior – Ebstein’s anomaly
Avoid diuretics!
Lithium
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The Peer Teaching Society is not liable for false or misleading information…
EARLY• Mild diuresis• FINE tremor• Dry mouth• Metallic taste
LATE• Weight gain• Hypothyroidism• Hypokalaemia• Oedema
TOXICITY• Blurred vision• COARSE tremor• Muscle weakness• Ataxia• N and V• Hyper-reflexia• Circulatory failure• Oliguria• Seizures • Coma
Lithium SEs & Toxicity
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Treatment;– Supportive – Stop lithium dose and recheck levels– IV fluids/encourage diuresis (monitor fluid
balance)– Monitor U&Es– Consider dialysis– Treat seizures
If mild, generous amounts of sodium salts and fluid will reverse toxicity
Lithium
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The Peer Teaching Society is not liable for false or misleading information…
Psychiatry ClassificationBehavioural
Developmental
E.g. Learning disorders and pervasive developmental disorders (autism/ADHD)
E.g. Eating disordersPersonality disordersPsychosexual disorders
Mental Illness
OrganicFunctional
Organic Substance abuse
E.g. DeliriumDementiaHypothyroidism
Psychoses(loss of contact with reality)
Neuroses(severe “normal” experience)
Schizophrenia
Mood disordersBipolar, depression, mania
Anxiety Phobias
OCD
Psych emergencies
Acute dystonic reactionNeuroleptic Malignant SyndromeLithium toxicity
![Page 47: Phase 3a Phoebe Barrett and Natasha Hussain The Peer Teaching Society is not liable for false or misleading information…](https://reader036.fdocuments.net/reader036/viewer/2022062518/56649de45503460f94adb812/html5/thumbnails/47.jpg)
The Peer Teaching Society is not liable for false or misleading information…
Questions?