Alzheimer's disease MRCPsych course

MRCPsych course

Alzheimer's disease (Neuropathology)

 

Think about Nagasaki Hiroshima

• Neurofibrillary tangles
• Neuronal cell loss
• Glial proliferation
• Granulovascular proliferation
• Senile/neuritic plaques
• Hirano inclusion bodies
• Reactive astrocytosis (also present in Pick's disease)

 MRCPsych course

Hallucination (MRCPsych course)

MRCPsych course

Hallucination = false perception without stimulus

Mnemonics C3-O-I3

• Clear as normal perception
• Constant
• Conscious
• Objective space
• Independent of will
• Insight absent
• Impaired reality testing

MRCPsych course

Mood disorders MRCPsych course

MRCPsych course

Major Depressive Disorder (DSM-IV-TR)
(5 symptoms or more including at least 1 core symptom)


MI SAG SPECS

1. Mood low (core symptom)
2. Interest/Pleasure loss (core symptom)
3. Sleep decreased/increased
4. Appetite decreased/increased
5. Guilt - excessive/inappropriate
6. Suicidal thoughts
7. Psychomotor retardation/agitation
8. Energy low
9. Concentration low/indecisiveness

Dysthymia

HE'S 2 SAD

• Hopelessness
• Energy low
• Sleep decreased/increased

• 2 years minimum of depressed mood, most of the day for more days than not  + 2 symptoms at least + not symptom-free period > 2 months

• Self-esteem low
• Appetite reduced/increased
• Decision/Concentration reduced 

Suicidal risk

SADPERSON SD

Sex - male
Age - <19, >45
Depression*
Past suicide attempt
Ethanol/drug abuse
Rational thinking loss (e.g. psychosis)*
Separated/Divorced/Widowed
Organised plan/serious attempt*
No social support
Sickness (chronic e.g. Cancer, HIV)
Determined to repeat/ Ambivalent*

*2 score (others 1 score)

Suicidal risk score:
1 -2 : low risk
3 - 5: moderate risk
7 or more : high risk 

MRCPsych course

Lithium (MRCPsych course)

 MRCPsych course

Adverse Effects Of Lithium

Early lithium adverse effects:

4 T’s:

• Thirsty
• Tired
• Tremor (fine)
• Taste (metallic)

Long term lithium adverse effects:

•  Diabetic insipidus
•  Hypothyroidism
•  Hyperparathyroidism
•  Weight gain
•  Coarsening & Hair loss
•  Leucocytosis
•  Hypokalaemia ( maybe associated with arrhythmias & T wave flattening (ECG)

Toxic ( >1.5 mmol/l)

CAT Got your tongue, ears & eyes

• Cerebellar syndrome *(refer below)
• Anorexia
• Tremor (Coarse)
• Gut/ GIT symptoms (diarrhoea, vomiting)
• Tongue – dysarthria
• Ears – tinnitus
• Eyes – Blurred vision

         Hyperreflexia

*Cerebellar syndrome

VANISHED

• Vertigo
• Ataxia
• Nystagmus
• Intentional tremor
• Speech staccato
• H
• Exaggerated broad-based gait
• Dysdiadokinesia

Extreme toxicity (>2.5 mmol/l)

6 C’s:

• Confusion
• Convulsion
• Circulatory failure
• Collapse
• Coma
• Corpse (death)

Teratogenicity : (especially use during 1^st trimester)- Ebstein’s anomaly

Factors that can lead to Dangerous toxicity:

4D’s

• Diuretics
• Dietary Deficiency of Na+
• Dehydration
• Drugs :

o   NSAIDs,

o   Acetazolamide

o    Metronidazole (high risk of Li+ toxicity during co-administration & for up to 3 weeks afterwards)

o   High doses haloperidol (>20mg/day)

 MRCPsych course

Benzodiazepines (MRCPsych course)

 MRCPsych course

Adverse Effects Of Benzodiazepines

5 D’s

• Dependence
• Drowsiness (daytime)
• Dysarthria
• Diplopia
• Disorientation: ‘paradoxical reaction’ leading to hyperexcitability or Delirium (esp. In elderly)

Benzodiazepines withdrawal symptoms (Abrupt cessation after development of dependence):

10 S’s

•   Stress
•   Skinny
•   Strange experiences (hypersensitivity derealisation/depersonalization, transient psychosis/perceptual distortions)
•   Sadness
•   Sleep disturbance
•   Salivation
•   Sweating
•   Sexual disinterest
•   Shaking  (tremor)
•   Seizures

 MRCPsych course

Hypothalamus MRCPsych course

MRCPsych course

Functions of Hypothalamus

 

ANTERIOR part of Hypothalamus

Anterior nucleus – to cool down body. Parasympathetic

Supraoptic nucleus – ADH release- regulates water intake

Preoptic nucleus – sexual & reproductive function 

Suprachiasmatic nucleus – circadian rhythm (biological clock)- sleep-wake cycle

CENTRAL part of Hypothalamus

Paraventricular nucleus – oxytocin – milk ejection, contraction of uterus at birth

Ventromedial nucleus – satiety centre. (lesion causes hyperphagia)

Dorsomedial nucleus -

Lateral nucleus -  hunger centre (lesion causes anorexia)

Arcuate nucleus – 

POSTERIOR part  of HYPOTHALAMUS

Posterior nucleus – to keep body warm. Sympathetic

Mammillary nucleus – part of limbic - emotion e.g. fear, rage

 

Functions of Hypothalamus (mnemonics SEAFEAST):

• Sexual & reproductive function
• Endocrine – control release of hormones from adenohypophysis & neurohypophysis
  
• Autonomic nervous system regulation
• Fluids - maintenance of body fluids
• Emotional regulation
• Appetite/food intake contol
• Sleep-wake cycle
• Temperature control of body

MRCPsych course

Psychopharmacology MAOIs MRCPsych course

 MRCPsych course

 

Food/Substances that need to be avoided when taking MAOIs (Monoamine oxidase inhibitors):

ABCDEFG

Alcohol – chianti, red wines, beer

Broad bean pods

Cheeses (except Cream and Cottage cheeses)

Drugs (please refer below*)

Extracts of mea and yeast (Marmite, Bovril)

Fish, especially smoked or pickled (fresh fish is relatively safe)

Game

*Drugs

ABCDEFGHI

Antidepressants (TCA)

Barbiturates

Coccaine, pethidine and other narcotics

L-Dopa

Epherine

Fenfluramine

General anaesthetics

Anti-Hypertensives

Insulin

 MRCPsych course