Phase 3a Rupy and Alex The Peer Teaching Society is not liable for false or misleading information

Phase 3a

Rupy and Alex

Psychiatry 1

The Peer Teaching Society is not liable for false or misleading information…

• Schizophrenia• Psychotic disorders • Psychiatric treatments (pharmacological and non-

pharmacological)• Psychiatric emergencies;– Lithium toxicity– Acute dystonic reaction– Neuroleptic malignant syndrome– Serotonin syndrome

• Personality disorders


Aims

• Mix of +ve and –ve symptoms • Affects 1% of the population • For diagnosis have to have the symptoms for a

month

• What are positive symptoms?• What are negative symptoms?


Schizophrenia

1. 3rd person Auditory hallucinations 2. Delusions of thought referencing 3. Delusions of control 4. Delusions of perception

ICD- 10 = 1 of the symptoms for >1 month for diagnosis


First rank symptoms

• ICD – 10 at least 2 of…

• Persistent hallucination• Break in thoughts• Catatonic behaviour • -ve symptoms


Or……

• What are the different categories of schizophrenia?


Categories

1. Paranoid2. Hebephrenic 3. Catatonic 4. Undifferentiated 5. Residual 6. Simple 7. Post schizophrenic depression

• Typical / 1st generation– Block D2 – Haloperidol, chlorpromazine

• Atypical – Olanzapine, ziprasidone, clozapine


Treatment - antipsychotics

• Atypical

• Last resort – if nothing works, chronic schizophrenia

• Need to monitor blood levels when on it- how often?

• Doses need to be titrated carefully- initiation is

inpatient

• What advise should you give patients?The Peer Teaching Society is not liable for false or misleading information…

Clozapine

• Can you name some side effects?

• Name some contraindications of clozapine


• Non selective dopamine channels

• Leads to side effects

• Name the 4 extrapyramidal side effects

• Name some non extrapyramidal side effects


1st generation antipsychotics


Extrapyramidal side effectsTx- procyclidine (anticholinergic)

Tx- procyclidine

Tx- propranolol Tx- Hard to treat, change the meds

• When does this occur? • Rare but fatal • Name biochemical markers• Name some clinical features • Name the complications

• Stop the drug, provide cardio and resp support, bromocriptine and dantrolene


Neuroleptic malignant syndrome


Atypical side effectsAnticholinergic

Dry mouth, Urine retention, Blurred vision, Constipation

Antihistamine Sedation

weight gain

Antiadrenergic Postural hypertension,

tachycardia

• This ↑ prolactin sexual dysfunction


All antipsychotics block dopamine

• 2 out of 3 core symptoms for >2 weeks• Name some risk factors

• What are the core symptoms?• Minor symptoms:– Cognitive – Functional / somatic Name some minor symptoms


Depressive disorders

1. CBT2. SSRI – Citalopam, fluoxetine, sertraline – Can worsen symptoms in 1st 2 weeks- warn

patient– Side effects? – Relatively safe in overdose – Less sedating than tricyclics


Depression Tx

• Name the symptoms

• Tx – Benzo– Cyproheptadine – Iv fluids


Serotonin syndrome

• Phenelzine, rasagiline

• Prevents breakdown of monoamine • ↓ breakdown of serotonin, dopamine and

norepinephrine


Monoamine oxidase inhibitors

• ↑ tyramine with MAOI

• Avoid tyramine containing foods- Examples?

• Release of noradrenaline– Tachycardia– Hypertension– vasocontriction


Hypertensive crisis

A- AlcoholB- Broad beansC- CheeseD- Drugs (antihypertensives)E- Extracts (marmite)F- FishG- Game


Tyramine foods

• How do they work?

• At risk of agranulocytosis and thrombocytopenia


Tricyclics

• Symptoms for 1 week

• Impair occupational and social functioning

• 2 episodes of mood disturbance.

• Symptoms of mania? Act them out if you so wish


Mania

• Elevated mood• Increased activity• Increase self esteem• Decreased attention/increased distractabilty• Irritable• Aggressive • Suspicious • Sexual disinhibition


Need 3 or more for Dx

• Delusion which are mood congruent or grandiose

• Auditory hallucinations

• Loss of insight


Psychotic symptoms

• Lithium – reduces suicide risk • How long does it take to work?• What is the therapeutic window?• When is it CI?• Name the features of lithium toxicity• What is the treatment for lithium tox? • What Tx for acute mania?


Treatment

• Hallucinations – types?– Perceptions without the corresponding external

object.• False beliefs or delusions – types?– Abnormal beliefs held with absolute certainty

• Thought disorder – types?– Abnormality in the form of thought


Positive psychotic symptoms

• Lack of interest in other people • Few gestures• Monotone • Apathy – definition?• Lack of emotional response• Social withdrawal/depression


Negative psychotic symptoms

• Overlap between bipolar and schizophrenia in the same episode

• Tx- mood disorder and schizophrenia – Lithium and antipsychotics


Schizoaffective disorder

• Enduring, persistent and pervasive disorders of inner experience and behaviour

• Distress or significant impairment in social impairment

– Problems in cognition, affect, behaviour

• Not due to other conditions

• Out of keeping with social and cultural norms


Personality disorder definition

• Narcissistic • Paranoid• Schizoid• Schizotypal• Anankastic • Avoidant • Dependent• Dissocial

(antisocial)The Peer Teaching Society is not liable for false or misleading information…

Personality Disorder Bingo• Borderline emotionally unstable• Impulsive emotionally unstable• Histrionic• A risk factor• A risk factor• Dialectical Behaviour Therapy (DBT)• Cognitive Behaviour Therapy (CBT)• Cognitive Analytical Therapy (CAT)

• John, 46• Says his wife made him come see you • He doesn’t trust her “they got to her too, she used to

be on my side”• Asks if you are associated with the government or his

ex-employer• Hasn’t met with friends for 4 years as “they ask too

many questions, you never know when it could be used against you”


• Jordan, 20

• Self harm

• Often runs away from home

• Unpredictable mood- constantly arguing with parents

and best friends

• Multiple short term relationships


• Mark, 35• No relationships with other people• Doesn’t seem to mind• Works as a programmer from home• Seems uninterested during consultation• Daydreams often and shrugs when you ask what he’s

been thinking about


• Helps person change unhelpful behaviours

• Accepting themselves as they are (distress tolerance)

• Skills on interpersonal response

• Close relationship with therapist


Family history of personality disorder or mental illness


• El-Or (real name George), 28• Changed his name at the age of 19 after an alien

abduction• Says he developed psychic abilities• Every day paints a red square on his forehead to

“renew my covenant with the alien captors”• He paints a blue circle under this to open portal to

alien world from his mind• Few friends


Regina, 18https://www.youtube.com/watch?v=9lxk5IRLysI#t=365


https://www.youtube.com/watch?v=9lxk5IRLysI%23t=365



• Harry, 24

• Been in and out of prison

• Says he “doesn’t give a f*** about anyone”


• Peter, 50

• Company director

• Doesn’t care about how much his employees get paid, fires them often

• “I deserve more money and more power”

• 4 divorces as wives were not good enough, wants to marry a model next


• Focus on underlying beliefs about self and others

• Thoughts, feelings and physical sensation are linked

• Changes cognitive errors e.g. my partner seems

stressed, they must be about to leave me

• Deals with current problemsThe Peer Teaching Society is not liable for false or misleading information…

• Sandra, 38

• Convinced she is ugly and stupid

• Hates going to office parties

• Very shy, says she is “invisible” to others

• Hates taking risks

• Constantly worrying


Abuse or neglect during childhood


• Helen, 42

• Feels helpless and unabel to cope

• Never had a job

• Recently divorced from abusive, nasty husband

• Says she is very weak and needs a husband

• Admits she was very, very clingy with husband


• Jonathan, 30

• Perfectionist, works as figurine painter

• Crippled with indecision and doubt about every decision

• Asks to re-arrange the items on your desk

• Never had a relationship, avoids intimacy


• Terry, 41

• Asks you for help with anger management

• Unemployed

• Mood swings

• Always arguing with wife and friends down the pub

• Attempted suicide before


• Explores why things have gone wrong in past

• Thinking about themselves differently

• Coping strategies


Any questions?


Documents

Phase 3a Rupy and Alex The Peer Teaching Society is not liable for false or misleading information