psychiatry - shelf review

7/23/2019 Psychiatry - Shelf Review

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Psychiatry Basics:

A Shelf Review

Sonya Gabrielian

UCLA Psychiatry Clerkship


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Agenda

Psychotic Disorders

Mood Disorders

Anxiety Disorders Personality Disorders

Substance Use Disorders

Cognitive Disorders Other Disorders


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Agenda

Psychotic Disorders

!


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What is psychosis?

Delusions

"alse# $xed# and culturally inappropriatebelie%s that cannot be altered by rational

argu&ents

Perceptual disturbances

'allucinations and illusions

Disordered thinking Proble&s (ith thought content and

process

)


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Hallucinations

A perception *+,'OU, external sti&ulus

+llusions are &isinterpretations o% ,-U. S,+MUL+

Auditory hallucinations

,hink schi/ophrenia or other psychotic disorder 0isual or tactile hallucinations

,hink drug or alcohol intoxication1(ithdra(al

Ol%actory hallucination

,hink sei/ure disorder# e2g2# te&poral lobeepilepsy

3


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Dierential Diagnosis

4rie% psychotic disorder 56 day to 6 &onth7 Schi/ophreni%or& disorder 5689 &onths7 Schi/ophrenia 5:9 &onths7

Schi/oa;ective disorder Delusional disorder Depression or bipolar disorder (ith

psychosis

Substance8induced psychotic disorder Deliriu&1De&entia Psychosis secondary to general &edical

condition

9


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Schiophrenia

,hree key phases

Prodro&e

Decline in %unction be%ore initial psychosis2

O%ten socially (ithdra(n# irritable#


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Schiophrenia !ont"

Positive sy&pto&s

'allucinations# delusions# disorderedthought# bi/arre behavior

?egative sy&pto&s

Less


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Schiophrenia !ont"

A;ects 6B o% population

Men present earlier than (o&en

Strong genetic predisposition

Chronic and debilitating

0arious neurotrans&itters arei&plicated

Likely relationship (ith increased dopa&ine

Likely role o% elevated serotonin andnorepinephrine


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Schioaective Disorder

Patients &eet criteria %or &aor depressive#&anic# or &ixed episode during a ti&e in(hich they also &eet criteria %orschi/ophrenia

Mood sy&pto&s are present %or substantialportion o% psychotic illness

?eed to have delusions or hallucinations %or

at least (eeks (ithout &ood sy&pto&s Do not con%use schi/oa;ective disorder (ith

&ood disorder (ith psychotic %eatures

6E


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Delusional Disorder

?onbi/arre# $xed delusions %or at least 6&onth Delusions &ay be eroto&anic# so&atic#

persecutory# grandiose ?o signi$cant %unctional i&pair&ent

Do not &eet criteria %or schi/ophrenia

O%ten occurs in patients a%ter age )Eyears

Antipsychotics are o%ten less e;ectivethan in other psychotic disorders

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Antipsychotics

,ypical neuroleptics Dopa&ine 5&ostly D7 antagonists

,reat positive sy&pto&s : negative sy&pto&s

+&portant side e;ects to &e&ori/e# (ithgreater incidence o% .PS than in atypical agents

Atypical neuroleptics Dopa&ine 5D7 and serotonin 538',7

antagonists 4etter treat&ent o% negative sy&pto&s than

typical agents

6


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#ypical $euroleptics

?ot as i&portant to &e&ori/e eachindividual typical agent

-e&e&ber that there are lo( and high

potency agents Potency re%ers to action on dopa&ine

receptors

Lo( potency agents reFuire bigger doses

'igh potency agents reFuire s&all doses

'igh potency agents have &ore .PS thanlo( potency agents

6!


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Antipsychotic Side%ects

.xtrapyra&idal sy&pto&s 5.PS7 Dystonia 5spas&7 o% %ace# neck# tongue Parkinsonis&

Akathisia 5restlessness7 Anticholinergic sy&pto&s

Dry &outh# constipation# visual blurring

,ardive dyskinesia

Darting1(rithing &ove&ents o% %ace# tongue Condition can beco&e per&anent Most co&&on in older (o&en

6)


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Atypical Antipsychotics

,ry to re&e&ber key side e;ects -isperidone 5-isperdal7

'yperprolactine&ia

Olan/apine 5yprexa7 'yperlipide&ia# (eight gain# glucose intolerance# liver

toxicity

Huetiapine 5SeroFuel7 Sedation# orthostatic hypotension

Clo/apine 5Clo/aril7 Agranulocytosis# sei/ures

iprasidone 5Geodon7 So&e association (ith H,c changes ?eed to take &edication (ith %ood

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$euroleptic &alignantSyndro'e

"AL,.- "ever 5high7 Altered &ental status Leukocytosis,achycardia1elevated blood pressure .levated CPI -igidity 5


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Agenda

Mood Disorders

6>


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What is ('ood?)

Description o% internal e&otionalstate

Generally# people have a (ide rangeo% &ood and %eel that they haveso&e


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!o''on &ood Disorders

Maor depressive disorder

4ipolar disorder 5+ or ++7

Dysthy&ic disorder Cyclothy&ic disorder

6


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&a*or Depressive%pisode

"ive sy&pto&s# including depressed&ood or anhedonia# %or at least (eeks

S+G . CAPS

Sleep +nterest Guilt .nergy Concentration Appetite Psycho&otor activity Suicidal ideation

E


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&a*or DepressiveDisorder

At least one &aor depressiveepisode

?o history o% &ania1hypo&ania

Li%eti&e prevalence is around 63B

Depressive episodes are usually sel%8

li&ited in the long ter butantidepressant &edications are Fuitehelp%ul

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Depression Secondary to a+eneral &edical !ondition

Cerebrovascular disease

.ndocrinological abnor&alities

Cushings# AddisonJs# 'ypoglyce&ia#

'ypothyroidis 'yperthyroidis 'ypocalce&ia#'ypercalce&ia

ParkinsonJs disease

Cancer# e2g2# pancreatic &alignancy#

ly&pho&a Collagen vascular disease# e2g2# lupus

0iral illness# e2g2# &ononucleosis


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Su,stance-.nducedDepression

Alcohol

4arbiturates

4en/odia/epines

Antihypertensives# e2g2# beta8blockers

Corticosteroids

Sti&ulant# e2g2# cocaine# a&pheta&ine

(ithdra(al Anticonvulsants

Many &oreK

!


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#ypes of Antidepressants

Selective serotonin reuptake inhibitors5SS-+s7

Atypical agents# e2g2# dual8action

inhibitors ,ricyclic antidepressants 5,CAs7

Monoa&ine oxidase inhibitors 5MAO+s7

Aduvant &edications Sti&ulants# antipsychotics# lithiu thyroid

hor&one

)


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SSR.s

Mechanis& +nhibit presynaptic serotonin pu&ps Lead to increased availability o% serotonin in

synaptic cle%t

Advantages "airly sa%e in overdose ?o %ood restrictions

Co&&on side e;ects Gastrointestinal disturbance +nso&nia Sexual dys%unction

3


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SSR.s/ cont"

Used %or depressive and anxiety disorders -e&e&ber a %e( key points about each agent "luoxetine 5Pro/ac7

Longest hal%8li%e# so&e(hat activating

Sertraline 5olo%t7

'ighest rate o% G+ upset Use%ul %or elderly# least (t gain

Paroxetine 5Paxil7 Most activating agent# highest anticholinergic burden

"luvoxa&ine 5Luvox7 0ery short hal%8li%e# approved %or OCD only

Citalopra& 5Celexa7 Co&&only used given &ini&al drug8drug interactions

.scitalopra& 5Lexapro7 L8enantio&er o% citalopra so use approxi&ately hal% the dose Signi$cantly &ore expensive than Celexa

9


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Atypical Agents

0enla%axine 5.;exor7 Serotonin1norepinephrine reuptake inhibitor

Can increase blood pressure

*ithdra(al pheno&enon (ith


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Atypical Agents/ cont"

,ra/odone 5Desyrel7

Serotonin antagonist and reuptake inhibitor

Co&&only used to aid (ith sleep

-arely used as an antidepressant Side e;ects to re&e&ber sedation and priapis&

Mirta/apine 5-e&eron7

?orepinephrine and serotonin antagonist

O%ten used in elderly patients

Side e;ects to re&e&ber sedation and (eightgain


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#ricyclic Antidepressants0#!As1

Mechanis& +nhibit reuptake o% norepinephrine and

serotonin

+ncrease availability o% these neurotrans&ittersin the synapse

Side e;ects to re&e&ber Lethal in overdose# usually due to (idened H-S

Convulsions# co&a# cardiotoxicity

Orthostatic hypotention# tachycardia

Dry &outh# constipation# urinary retention

Sedation


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&onoa'ine 23idase.nhi,itors 0&A2.s1

+rreversibly inhibit MAO8A and MAO84

Prevent inactivation o% norepinephrine#serotonin# dopa&ine# tyra&ine

Co&&on side e;ects Orthostatic hypotension

Dro(siness

*eight gain Sexual dys%unction

Sleep dys%unction

!E


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&A2. Side %ects toRe'e',er

Serotonin Syndro&e

Lethargy# restlessness# con%usion# ushing#diaphoresis# tre&or# &yoclonus

Can lead to hyperther&ia# rhabdo&yolysis#kidney inury# co&a# death

Usually occurs (ith MAO+ N SS-+

'ypertensive crisis Can occur i% tyra&ine is ingested (hen on

an MAO+

!6


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&anic %pisode

Abnor&ally and persistently elevated#expansive# or irritable &ood# %or at leastone (eek

D+G "AS, 5need three o% the %ollo(ing# or

%our i% &ood is irritable7 Distractability +nso&nia Grandiosity

"light o% ideas Activity1agitation Speech 5pressured7,houghtlessness

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&ania vs" Hypo'ania

&ania Hypo'ania

Lasts > days Lasts at least ) days

Causes severe i&pair&ent ?o &arked %unctional i&pair&ent

May reFuire hospitali/ation Does not reFuire hospitali/ation

May have psychotic %eatures ?o psychosis

!!


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&ania Secondary to a+eneral &edical !ondition

'yperthyroidis&

Multiple sclerosis

?eoplas& '+08related

Stroke

.pilepsy# e2g2# te&poral lobe sei/ures

!)


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Su,stance-.nduced&ania

Corticosteroids

Sy&patho&i&etics

Dopa&ine agonists 4ronchodilators

Antidepressants 5controversial7

!3


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&ood Sta,iliers

Lithiu&

Carba&a/epine 5,egretol7

0alproic Acid 5Depakote7 La&otrigine 5La&ictal7

Antipsychotics

!9


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4ithiu'

.xact &echanis& is unkno(n

?arro( therapeutic range 5E2> 627

?eed to &onitor ,S' and Creatinine

*atch out (hen also using diuretics# AC.+#?SA+Ds

Side e;ects 'ypothyroidis&

?ephrogenic diabetes insipidus,re&or1ataxia

Polyuria# thirst

*eight gain

!>


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2ther 'ood sta,iliers

Carba&a/epine 5,egretol7 Anticonvulsant ?u&erous side e;ects# including leukopenia# hyponatre&ia#

aplastic ane&ia# agranulocytosis# transa&initis Monitor C4C and L",s

0alproic Acid Anticonvulsant ?u&erous side e;ects# including alopecia# (eight gain#

hepatotoxicity# thro&bocytopenia Ai& %or level o% Q6EE in treat&ent o% acute &ania

La&otrigine

Anticonvulsant Must %ollo( a care%ul titration schedule "a&ous side e;ect is Steven Rohnson Syndro&e Used %or depression predo&inant bipolar disorder

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Agenda

Anxiety Disorders

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What is an3iety?

Subective experienceo% %ear and itsresultant physical

&ani%estations

?or&al and co&&onresponse to perceived

threat

)E

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!o''on An3ietyDisorders

Generali/ed anxiety disorder Obsessive8co&pulsive disorder Panic disorder

Agoraphobia Posttrau&atic stress disorder Acute stress disorder Speci$c and social phobias Substance8induced anxiety disorder Anxiety disorder secondary to general

&edical condition

)6


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+eneralied An3ietyDisorder 0+AD1

Persistent# excessive anxiety andhyperarousal %or at least six &onths

Anxiety surrounds daily events and

activities 0ery co&&on in general population#

especially in (o&en

Associated (ith restlessness# %atigue#

di@culty concentrating# irritability#&uscle tension# sleep disturbance

SS-+s and behavioral therapy are use%ul

)

2, i ! l i


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2,sessive !o'pulsiveDisorder

Obsession -ecurrent and intrusive thought that

causes &arked anxiety Person atte&pts to suppress thought Person reali/es that the thought is a

product o% his or her o(n &ind

Co&pulsion -epetitive behavior that person per%or&s to

respond to his or her obsession An unrealistic atte&pt to alleviate distress

caused by obsession

)!


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2,sessive !o'pulsiveDisorder/ cont"

Several co&&on patterns o% obsessionsand co&pulsions Patterns include conta&ination# sy&&etry#

doubt and subseFuent checking# intrusions o% a

sexual or violent nature SS-+s are $rst line treat&ent

O%ten need higher8than8nor&al doses

4ehavioral treat&ent is also very i&portant .xposure and response prevention

-elaxation techniFues

))


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Panic Disorder

A panic attack is a brie% 5usually lessthan !E &inutes7 sudden rush o% %earand anxiety

PA?+CS Palpitations

Abdo&inal distress

?u&bness1?ausea

+ntense %ear o% death Choking# chills# chest pain

Shortness o% breath# s(eating

)3


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Panic Disorder/ cont"

,o &eet criteria %or the actual disorder#one &ust have spontaneous recurrentpanic attacks (ithout precipitant

At least one attack &ust cause (orryabout additional attacks# or behavioralchange 5avoidance7

Usually a chronic illness# but variableseverity

)9


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Consider di;erential diagnosis

Drugs

Sti&ulants# ca;eine# nicotine# hallucinogens

Alcohol# opiate# ben/odia/epine (ithdra(al

Psychiatric illness

Depression# other anxiety disorders

Medical illness ?early any cardiac# pul&onary# neurological#

endocrinological abnor&ality &ay becon%used as panic

)>


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Acute treat&ent 4en/odia/epines

Propranolol can be used %or per%or&ance

anxiety# but is not as good %or true panic Maintenance treat&ent

SS-+s start lo( and increase slo(ly#(atching %or activation

-elaxation training

Cognitive therapy

)


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Agorapho,ia

De$nition "ear o% open places

O%ten# but not al(ays# develops secondary

to panic disorder ?eed to speci%y i% panic disorder is (ith

or (ithout agoraphobia

+% you treat the panic disorder#

agoraphobia o%ten resolves Agoraphobia not associated (ith panic

is &uch &ore di@cult to conFuer

)

P#SD A t St


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P#SD vs" Acute StressDisorder

P#SD Acute StressDisorder

.vent occurred any ti&e in past .vent occurred less than 6&onth ago

Sy&pto&s last &ore than one&onth

Sy&pto&s last less than one&onth

3E

P#SD A t St


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P#SD vs" Acute StressDisorder/ cont"

Criteria %or both disorders are the sa&e

*itness trau&atic event

Persistent re8experiencing o% event

?ight&ares "lashbacks

Avoidance o% sti&uli associated (ithtrau&a

Persistent hypervigilence1increased arousal

36

P#SD A t St


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P#SD vs" Acute StressDisorder/ cont"

,reat&ent

Medication &anage&ent

SS-+s are $rst8line

Alpha86 adrenergic receptor antagonists#e2g2# Pra/osin

4ehavioral therapy

Psychotherapy nu&erous techniFues

-elaxation training

3


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Pho,ias

Most co&&on psychiatric disorder Speci$c phobia

.xaggerated %ear o% speci$c obect or situation 'eights# ani&als# ying# etc2

,reat (ith syste&ic desensiti/ation

Social phobia .xaggerated %ear o% social situations in (hich

hu&iliation could occur

,reat (ith SS-+s and cognitive therapy Phobias are ego8dystonic# i2e2# the person

kno(s that %ear is exaggerated

3!

S , t . d d A i t


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Su,stance-.nduced An3ietyDisorders

Ca;eine

A&pheta&ines

Alcohol and sedative (ithdra(al Other illicit drug (ithdra(al

Antidepressants

Carbon dioxide inhalation

Many &oreK

3)


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to +eneral &edical

!ondition .ndocrinological abnor&alities 'yperthyroidis& 'ypoglyce&ia Pheochro&ocyto&a

?eurological disorders Sei/ure disorders 4rain tu&ors Multiple sclerosis

Cardiovascular disease Pul&onary disease

'ypoxia is anxiety provoking

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How to #reat An3iety?

-egardless o% precise disorder# usually useshort8ter& treat&ent (ith ben/odia/epines#and &aintenance treat&ent (ith SS-+s

4e %a&iliar (ith the types o%ben/odia/epines and their ti&e toonset1duration o% action

-ecogni/e abuse potential o%ben/odia/epines

4eta8blockers are use%ul %or akathisia andautono&ic e;ects o% panic1per%or&anceanxiety

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Agenda

Personality Disorders

3>

What is a personality


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What is a personalitydisorder?

+nexible pattern o% interaction thati&pairs social %unctioning

Patients do not have insight into their

proble&atic interaction style

Onset in adolescence1early adulthood

3


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#est Worthy &aterial

4e %a&iliar (ith the three clusters o%personality disorders

Ino( (hich speci$c disorders %all

into each cluster

Me&ori/e a %e( key %acts about eachdisorder# but speci$c diagnostic

criteria (ill be di@cult to test

3


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!luster A: (Weird)

.ccentric# (ithdra(n# border onpsychosis

Schi/oid Huiet and reclusive Do not desire close relationships

Schi/otypal


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!luster B: (Wild)

.&otional# dra&atic# o%ten (ith &ooddisorders

Antisocial Disregard %or sa%ety o% others Manipulate %or personal gain O%ten violate the la(

4orderline Desperate atte&pts to avoid abandon&ent Unstable and intense relationships -ecurrent suicidal thoughts# sel%8&utilation May


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!luster B: (Wild/) cont"

'istrionic

Attention8seeking behavior

"la&boyant and extroverted

O%ten sexually inappropriate

?arcissistic

.xaggerated sel%8i&portance

-eFuire ad&iration %ro& others

May exploit others %or sel%8gain

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!luster !: (Worried)

Anxious# %ear%ul#


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Personality Disorder#reat'ent

O%ten# patients have co8existing&ood and anxiety disorders

,reat co8occurring disorders (ith

&edication and therapy as appropriate

Personality disorders are di@cult totreat

Psychotherapy is the &ainstay o%treat&ent

9)


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Agenda

Substance Use Disorders

93

Su,stance A,use vs


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Su,stance A,use vs"Dependence

A,use Dependence

Pattern o% use leading toi&pair&ent %or at least one year

Pattern o% use leading toi&pair&ent %or at least one year

?eed one or 'ore o% %ollo(ing ?eed three or 'ore o%%ollo(ing

"ailure to %ul$ll obligations at(ork# school# ho&eUse in dangerous situations-ecurrent legal proble&s due tosubstance useContinued use despite socialpro,le's due to use

Patient !A$$2# 'eet criteriafor dependence/ as suchsupersedes a diagnosis ofa,use"

"ailure to %ul$ll obligations (ork#school# ho&e#oleranceWithdrawalActual use exceeds extended useContinued use despite 'edicalor psychological pro,le'sdue to usePersistent desire orunsuccessful eorts to cutdown on useSigni$cant ti&e spent using#getting# recovering %ro& 99


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5ey #er's

+ntoxication Signs and sy&pto&s di;er by drug o%

choice

O%ten con%used (ith (ithdra(al *ithdra(al

Substance8speci$c syndro&e due tocessation o% prolonged substance use

,olerance ?eed %or increased a&ount o% substance

to achieve desired e;ect

9>


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Alcohol

Most co&&only abused substance

9

Alcohol

Acetaldehyde

Acetic acid

Alcohol dehydrogenase

Aldehyde dehydrogenase

Disul$ra&5Antabuse7


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Alcohol .nto3ication

.nsure A4Cs

Monitor electrolytes

Check $nger stick glucose

Consider breathaly/er or bloodalcohol level

9


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Alcohol Withdrawal

Can be li%e threatening Mild

+rritability +nso&nia

Mild tre&or Moderate

Disorientation "ever

Severe Autono&ic instability Sei/ures Deliriu& ,re&ens

>E


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Deliriu' #re'ens

4egins (ithin 8! days o% alcoholcessation

'igh &ortality rate i% untreated

Deliriu& is the key characteristic Patients have altered# (axing and (aning

sensoriu&

May also have hallucinations 5visual ortactile7# psycho&otor changes#autono&ic instability

>6

#reat'ent of Alcohol


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#reat'ent of AlcoholWithdrawal

"reFuent vital sign checks vs2tele&etry

,aper doses o% ben/odia/epines

Chlordia/epoxide 5Libriu&7

Lora/epa& 5Ativan7

Dia/epa& 50aliu&7

Sei/ure precautions

Multivita&in# thia&ine# %olate

>

Wernic6e7s


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Wernic6e s%ncephalopathy

,hree key characteristics

Ataxia

Con%usion

Ocular proble&s

An acute proble& that can bereversed (ith thia&ine

Al(ays give thia&ine be%ore glucose

>!


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5orsa6o7s Syndro'e

Chronic and o%ten irreversible

+&paired recent &e&ory

Anterograde a&nesia

Con%abulation o%ten present

>)


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2piates

Sti&ulate opiate 5&u# kappa# delta7receptors +nvolved in analgesia# sedation# dependence

.xa&ples 'eroin

Codeine

Morphine

Methadone Meperidine

Dextro&ethorphan

>3


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2piate .nto3ication

Dro(siness1altered &ental status

-espiratory depression

Constipation

Constricted pupils

Can progress to co&a or death inoverdose

,reat&ent .nsure A4Cs

Can use naloxone or naltrexone i% there isrespiratory co&pro&ise

>9


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2piate Withdrawal

Craving1Anxiety

Lacri&ation

-hinorrhea

Diaphoresis Abdo&inal disco&%ort

Mydriasis

Myalgias +rritability

>>

#reat'ent of 2piate


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#reat'ent of 2piateWithdrawal

Sy&pto&atic relie% %or nausea#vo&iting# &yalgias# anxiety# andinso&nia

Clonidine -educes catechola&ine release %ro&

sy&pathetic nervous syste&

Methadone or buprenorphine &ay beconsidered %or (ithdra(al and1or&aintenance treat&ent

>

S d i i


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Sedative-Hypnotics

4en/odia/epines

Potentiate GA4A by increasing%reFuency o% chloride channel opening

4arbiturates Potentiate GA4A by increasing duration

o% chloride channel opening

>


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E

Sedative-Hypnotic


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Sedative Hypnotic.nto3ication

Dro(siness1altered &ental status

Lack o% coordination1ataxia

-espiratory depression

?ystag&us

Death or co&a in overdose#

especially in co&bination (ithalcohol

6

Sedative-Hypnotic


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Sedative HypnoticWithdrawal

Maintain A4Cs

"lu&a/enil

Short8acting ben/odia/epine antagonist

that can be used in overdose treat&ent May precipitate sei/ures

4asic principle is sa&e as alcohol

,aper ben/odia/epines# &aintain sei/ureprecautions# (atch %or autono&icinstability

2th S , t


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2ther Su,stances

*e see patients (ho abuse or &eetdependence criteria %or a host o% othersubstances

+n a test situation# ust recogni/e i% thesubstance is an


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Agenda

Cognitive Disorders

)

What is a cognitive


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What is a cognitivedisorder?

Proble& (ith &e&ory# orientation#attention# and1or udg&ent

,hree &aor categories

De&entia

Deliriu&

A&nestic disorder

3

D ti D li i


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De'entia vs" Deliriu'

De'entia Deliriu'

Me&ory i&pair&ent Sensoriu& i&pair&ent

Slo( onset 5generally7 Acute onset

Sy&pto&s are stable throughoutthe day

*axing and (aning course

Usually not reversible Usually reversible i% identi%y cause

9

D ti


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De'entia

Me&ory i&pair&ent (ithout change in level o%consciousness

May have behavioral disturbance and1orpsychosis

*atch out %or pseudode&entia# i2e2# depressed&ood that &asFuerades as de&entia ?eed to rule out reversible causes o% de&entia

461%olate de$ciency 0D-L1-P-

,hyroid abnor&alities .lectrolyte abnor&alities

>

Al h i 7 Di


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Alhei'er7s Disease

Most co&&on type o% de&entia

Progressive and linear course

O%ten have personality and &oodchanges

Pathology

?euro$brillary tangles 5,au protein7

Senile plaFues 5A&yloid protein7

Alhei'er7s Disease/


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/cont"

?eed &e&ory proble&s plus one o%the %ollo(ing

Aphasia Language di@culty

Apraxia Purpose%ul &ove&ent5


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/cont"

Assess cognition at regular intervals

Use antidepressants i% patient has truedepression

Consider lo(8dose antipsychotics to treatassociated behavioral disturbance

So&e &edications &ay slo( rate o% decline

?MDA receptor antagonists 5Me&antine7

Cholinesterase inhibitors 5Donepe/il#-ivastig&ine7

E

8ascular De'entia


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8ascular De'entia

Cognitive de$cit secondary to in%arctburden

Clinical criteria are identical to that o%Al/hei&erJs disease .tiology and progression are di;erent

Step8(ise course

?eurological de$cits are co&&on

Sa&e li&ited treat&ents as (ithAl/hei&erJs disease# but &ust alsocontrol vascular risk %actors

6

Deliriu'


92/101

Deliriu'

"luctuating clinical course


93/101

Deliriu'/ cont"

"irst and %ore&ost# try to identi%y theunderlying cause o% deliriu&

Until the etiology is identi$ed# can

only provide sy&pto&atic treat&ent "reFuent re8orientation

Lo(8dose antipsychotic to treat agitation

Avoid ben/odia/epines andanticholinergic agents# as these cancause paradoxical disinhibition

!

A'nestic Disorders


94/101

A'nestic Disorders

Me&ory i&pair&ent (ithout other cognitiveproble&s associated (ith de&entia

?o alteration in consciousness

Al(ays occur secondary to &edicalcondition Sei/ures

'ypoxia

'ead trau&a

Substance use

Many &oreK

)

Agenda


95/101

Agenda

Other Disorders

3

&ental Retardation


96/101

&ental Retardation

Signi$cant de$cits in intellectual %unctioningand age8appropriate adaptive skills

+H is >E or belo(

Onset in childhood# be%ore age 6 years Most &ental retardation has no clear cause

So&e genetic syndro&es are i&plicated# e2g2#Do(nJs Syndro&e# "ragile # Prader *illi#

Angel&anJs Prenatal and perinatal exposures can play

signi$cant roles

9

Pervasive Develop'ental


97/101

pDisorders

De$cits in social skills# language# behavior +&pair&ent is apparent in early childhood

Autis& Di@culties (ith social interaction

Co&&unication i&pair&ent 5non8verbal ordelayed speech7

-epetitive and stereotyped behavior

AspergerJs Disorder Si&ilar to autis but higher %unctioning

because cognitive develop&ent and languageskills are nor&al

>

Disruptive Behavioral


98/101

pDisorders

Conduct disorder Pattern o% behavior that violates rights o%

others and de$es social nor&s

Aggression to(ard people# ani&als# property

Serious rule violation,hink precursor to antisocial personality

disorder

Oppositional de$ant disorder 5ODD7 'ostile and de$ant behavior 4ig di;erence %ro& conduct disorder is that

ODD patients do not violate the rights o% others

Attention De9cit


99/101

Hyperactivity Disorder

Onset be%ore age seven years

4ehavior is inconsistent (ith age anddevelop&ent

Sy&pto&s involve inattentiveness#hyperactivity# or both %or 9 &onths

Mainstay o% treat&ent is C?S sti&ulants#

e2g2# &ethylphenadate#dextroa&phata&ine

So&e role %or behavioral &odi$cation

%ating Disorders


100/101

%ating Disorders

Anorexia nervosa 4ody (eight is 63B belo( nor&al +ntense and distorted body i&age preoccupation A&enorrhea

4uli&ia nervosa -ecurrent binge eating and atte&pts to

co&pensate 5vo&iting# laxatives# diuretics#and1or excess exercise7

+ntense and distorted body i&age preoccupation

4ehavioral therapy and individualpsychotherapy is &ainstay# as (ell ascontrol o% &edical co&orbidities

6EE

#he %nd


101/101

#he %nd

GOOD LUCIT

psychiatry - shelf review

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