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Flashcards in pot pourri Deck (18)
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1

capgras syndrome

delusions that familiar people have been replaced by imposters

2

Fregoli's syndrome

delusion that strangers have taken on the psychological identity of a familiar person

3

Cotard's syndrome

nihilistic delusion in which posits that a person's possessions, friends, or parts of their own body does not exist or are about to not exist; most common in psychotic depression

4

sleep changes in depression

-disturbed REM sleep
-longer sleep latency, but, shortened REM latency
-Increased percentage of REM sleep
-REM sleep in 1st half of the night
(SSRI are super selective REM inhibitors)

5

neurobiology of OCD

changes in orbitofrontal cortex, anterior cingulate cortex and striatum
cortico-striato-thalamo-cortical pathway

6

catatonia associated with another mental disorder (specifier)

Clinical picture is dominated by 3 or more of the following:
1. stupor (ie no psychomotor activity; not relating to environment)
2. catalepsy (ie passive induction of a posture held against gravity)
3. waxy flexibility (eg slight, even resistance to positioning)
4. mutism (ie no/very little verbal response; exclude if known aphasia)
5. negativism (ie opposition/no response to instructions or external stimuli)
6. posturing (ie spontaneous and active maintenance of a posture against gravity)
7. mannerisms (ie odd, circumstantial caricature of normal actions)
8. stereotypy (ie repetitive abnormally frequent, non-goal-directed movements)
9. agitation, not influenced by external stimuli
10. grimacing
11. echolalia (ie mimicking another's speech)
12 Echopraxia (ie mimicking another's movements
note: disorder X, catatonia associated with disorder X

7

Schneiderian First Rank Symptoms

Kurt Schneider (1887-1967)
Concerned with making diagnosis of schizophrenia more reliable
*First Rank Symptoms (not sufficient or necessary)
-Audible thoughts/hallucinations
-Voices arguing/discussing
-Voices commenting on actions
- Somatic passivity-tactile/visceral/somatic hallucinations imposed by an external agent
- Thought withdrawal
-Thought insertion
-Thought broadcasting
- Made feelings– feelings imposed by an external agent
-Made impulses/drive- impulse for action imposed by external agent
-Made volitional acts- actions are from and controlled by external agent
-Delusional perception- perception has an unique/idiosycractic meaning leading to delusional interpretation

8

NMS criteria

Symptoms/Signs
(Tetrad of symptoms-­‐ FARM,
Symptoms+ Signs-­‐FAALTER M)
§ Fever
§ Autonomic Instability
§ Rigidity
§ Mental status change (agitated delirium)
§ Leukocytosis
§ Tremor
§ Elevated CK
§ Altered LOC

9

NMS treatment

Treatment
§ Stop causative agent (as
well as other psychotropics, lithium, serotonergic agents, anticholinergics)
§ Supportive care (ICU, cardio/resp stabilization,IV fluids, cooling blankets, BP control, heparin, benzos for agitation)
§ Medications (use is controversial and unsupported;
case reports only)
• Dantrolene (muscle relaxant)
• Bromocriptine (dopamine agonist -­‐2.5mg q8-­‐12h Max 45 mg/day)
§ ECT (controversial; only useif no response in 1-­‐3)
o You can re-­‐challenge patients who have had NMS. Have to wait 2 weeks. Lean toward low potency, oral formulation, no Li, low dose, slow increase, monitor and avoid dehydration

10

NMS risk factors

Risk factors:
§ History of NMS (strongest)
§ Meds that block dopamine transmission
(typical > atypicals, antiemetics)
§ Recent dose change or aggressive dosing
§ Parenteral administration
§ Depots
§ Concomitant lithium
§ Comorbid substance use
§ Acute illness
§ Dehydration
§ Neurological disease
§ Age and sex are NOT risk factors. More young males affected because they are more frequently exposed to medications.

11

Delusional d/o Risk factors

Advanced age
Sensory impairment or isolation
Family history
Social isolation
Personality features (e.g., unusual interpersonal sensitivity)
Recent immigration

12

CT head changes in schizophrenia

**Indicated with focal neurological findings**
Findings:
• Increase in volume of ventricles (third and lateral)
• Decrease in volume of
hippocampus (results in decreased glutamate transmission), amygdala, thalamus, cortical grey matter
• Decrease in brain symmetry and volume of temporal, frontal, & occipital lobes
• Uncertain changes in cerebellum and basal ganglia
• These findings are present before onset of full syndrome
and before intiation of
medications
• Progression throughout the first few yearsof illness
Degree of grey matter atrophy
correlates with disease severity
(EXAM) (ie increased ventricles, sulci)
o Related to cannabis use,
medication use, and psychotic relapses

13

Good prognostic factors for schizophrenia

Late Onset
Obvious precipitating factors
Acute onset
Good premorbid social, sexual, and work histories
Mood disorder symptoms (especially depressive disorders)
Married
Family History of mood disorders
Good support systems
Positive Symptoms

14

Bad Prognostic Factors for Schizophrenia

Young onset
No precipitating factors
Insidious onset
Poor premorbid social, sexual, and work histories
Withdrawn, autistic behavior
Single, divorced or widowed
Family history of scz
Poor support systems
Negative symptoms
Neurological signs and symptoms
History of perinatal trauma
No remissions in 3 years
Many relapses
History of assaultiveness

15

Anorexia/Bulimia Labs

Increased: Cr/BUN (Dehydration), amylase (vomiting), cholesterol (starvation), LFTs (starvation), T3 (high or low)
Decreased: RBCs (starvation), WBC (starvation), Na, K, Cl (vomiting, laxatives), LH, FSH, estrogen (starvation), T3/4 (sick euthyroid syndrome), testosterone (males), Mg, Zinc, PO4 (starvation), bone mineral density (assess if amenorrhic x 6/12)

16

MAiD criteria

MAiD criteria:
1. Canadian.
2. 18 yo and capable of making decisions.
3. Grievious and irremediable condition—serious illness, advanced state of irreversible decline, unbearable suffering , natural death is reasonable foreable (does not have to be a single terminal condition but global picture)
4. Give informed consent, be competent at time of request and of death (usually a 10 day waiting period after request)

17

Refeeding Syndrome

Refeeding syndrome: fluid and electrolyte imbalance (hypophosphatemia)—in fasted state intracellular ions are depleted, with normal serum levels, insulin is suppressed with increased glucagon
Refeeding—increased insulin secretion due to increased glucose increased glycogen, fat and protein synthesis which uses up phosphates, Mg and K  which are already depleted; blood glucose increase, thiamine falls
Tx: replace electrolytes, daily doses of thiamine, vit B complex, multivitamin and mineral strongly recommended, regular labs

18

Bipolar disorder brain changes

-hyperintensities in white matter
-increase ventricular size
-decreased grey matter in anterior cingulate