Yr 4 Psych notes

Pick’s Disease

• Greater relaitve atrophy of frontal and temporal lobes

• Knife-blade atrophic gyri

Alzheimer’s

• Generalised atrophy

• Widened sulci

• Dilated ventricles

Vascular Dementia

• Single/multile areas of infarcts

• Dilated ventricles

22 year old man has presents at A and E 2am on Saturday night.

He has mydriasis, tremor, BP 160/90 HR 110 and is

complaining that insects are crawling on him. What is the

likely diagnosis?

Cocaine Abuse

• Could be any stimulant (amphetamine, ecstasy) but formication most common in cocaine.

Mood SymptomsA. Grandiose delusionsB. Diurnal variation of moodC. Blunted affectD. Physchomotor agitationE. Circumstantial speechF. Manic stuporG. Pressure of speechH. AnhedoniaI. Meixed affective disorderJ. Tangential speech

1. 35yr old mother of three says she is not enjoying anything anymore, even horse riding which she always had been a great source of pleasure

2. A depressed man, who has stopped eating, shows little facial expression or emotion and speaks with a monotonous tone.

3. A woman with longstanding bi-polar affective disorder alternates, over the course of 2 days between tearfulness with psychomotor retardation and elated mood with pressure of speech

4. A young man with an amphetamine-induced manic episode is unable to stay focused in his initial trail of thought , and jumps from one topic to the next without ever returning to the original point.

5. A man who has severe depression with psychotic features is unable to sit still for longer than a few minutes without standing up and pacing around the room, al the time hand wringing and fidgeting with his clothes.

Answers

1. H - Anhedonia – loss of abilty to derive pleasure. Core somatic feature of depression.

2. C - Blunted affect3. I – mixed affective episode4. J Tangential speech. The speaker diverts

away from the initial trail of thoughts never returning. Nights move thinking. Opposite of circumstantial speech which is delayed reaching its final goal from the over-inclusion of details unnecessary.

5. D – Psychomotor agitation.

Psychotic symptomsA. Reflex haluccinationB. EcholaliaC. Liliputain halluciantionsD. FormicationE. Hypnagogic hallucinationsF. Word saladG. Mood-incongruent delusionsH. Hihilistic delusionsI. Hypnopompic hallucinationJ. Running commentary, third person

auditory hallucinations

1. A 22 year old man descirbes 2 females voices that incessantly remark on everything he goes e.g he is getting up now, he has just turned on ht elight. He is angry and wants to punch a wall

2. A heavy drinker presents to his GP in a confused drowsy state saying that he can see tiny people jumping up and down

3. An otherwise asymtomatic 33 year old woman is concerned because she regularly hears someone calling out her name when lying in bed at night

4. A man with schizoaffective disorder, depressive type, is convinced that he does not exist

5. A patient with a relapse of schizophrenia presents with speech which is completely incomprehensible as it is a mixture of strange, idiosyncratic words and phrases.

Answers

1. J running commentary, 3rd person

2. C Lilliputian

3. E hypnagogic

4. H Nihilistic

5. F Word Salad

Substance misuseA. NaltrexoneB. Lysergic acid diethylamineC. DisulfiramD. ThiamineE. MethadoneF. AcamprosateG. KetamineH. BuprenorphineI. FlumazenilJ. Chlorodiazepoxide

1. Two drugs used in the acute treatment of alcohol withdrawal

2. Two drugs strongly associated with hallucination

3. Two drugs used to help prevent relapse in the treatment of alcohol dependence

4. Two drugs used as substitutes drugs in the maintenance treatment of opiate dependence

5. Two receptor antagonists that can precipitate severe withdrawal in patients with substance dependence

Answers

• D, J Thiamine chlorodiazepoxide

• B,G LSD and ketamine

• C, F disulfiram, acamprosate

• E, H Methadone, buprenorphine

• A,I Naltrexone, flumazenil

Neuroleptic

Histamine and serotonin receptor blockade

D2-dopamine receptor blockade

Cortex and limbic Systems

Tuberoinfundibular

Dry mouthBlurred visionsUrinary retentionNasal congestionConstipation

MOVEMENT

Parkinsonism, DystoniasAkathiasTardative dyskinesia

Muscarinic receptor

blockade

Postural hypotensionHypothermia

Alpha-adrenoreceptors

Pituitary Gland ↑ Prolactin

HORMONALGalactorrhoea, Gynaecomastia, Menstrual disturbances, Decreased libido Impotence

Basal ganglia (striatum)Nigro-straitum

Mesolimbic

PSYCHOLOGICAL

AntipsychoticImpaired performanceSedation

May be irreversible