Memory (stages of processing)
ESR (as in the blood test)
·
Encoding
(registration) – information placed into memory
·
Storage
(retention) – short term memory (7+2) and working memory*
·
Retrieval
(recollection) – recall information from memory. People remember first and last
info best, primacy and recency effects
*Working memory – manipulation of
information and includes the phonological loop and visuospatial
sketchpad
Freud’s stages of psycho
sexual development
Old Age Psychiatrists Love
Geriatrics
Or
Old Age Pensioners Love Grapes
·
Oral
·
Anal
·
Phallic
·
Latent
·
Genital
Hypo mania/mania features
MESSIAH’S DOG (or GOD)
·
Mood
elevated
·
Energy
increased
·
Sleep
– decreased need for
·
Speech
(more talkative, possible pressure of speech) / Sociability
·
Irritability
·
Attention
reduced
·
Horny
– sexual promiscuity and increased sexual energy
·
Social/occupational
functioning affected*
·
When
asking about risky behaviours, a lead on from sexual risk is:
·
Driving
– wreckless, too fast
·
Overspending
perhaps pointless, irrelevant items
·
Gambling
Messiah referring to
over-importance, increased self-worth.
*If delusions or hallucinations
present (i.e. psychosis) or severe effect on social or occupational functioning
then a diagnosis of mania may be made
Mania features
DIG FAST, Pal!
·
Distractibility
and easily frustrated
·
Inhibition
loss e.g. sexual disinhibition
·
Grandiosity
·
Flight
of ideas
·
Activity
increased, perhaps with weight loss
·
Sleep
decreased
·
Talkativeness
·
Psychosis
e.g. hallucinations/delusions
Depression features
DEAD SWAMP
·
Depressed
mood
·
Energy
loss
·
Anhedonia
·
Death
thoughts – suicide
·
Sleep
disturbance
·
Worthlessness,
guilty / Weight gain
·
Appetite
loss
·
Memory
/ Mental decrease (concentration and thinking)
·
Psychomotor
agitation / retardation
OR
IDEA SWAMP
·
Insomnia
·
Depressed
mood
·
Energy
loss
·
Appetite
disturbance
·
Suicidal
thoughts
·
Worthlessness
·
Anhedonia
·
Memory
/ Mental decrease (concentration and thinking)
·
Psychomotor
agitation / retardation
Psychiatric functional enquiry
MOAPS
·
Mood
– depression, elation
·
Organic
– alcohol/drug abuse, physically unwell, dementia
·
Anxiety
– worries, obsessions, phobia
·
Psychosis
– hallucinations, delusions, thought disorder
·
Suicide/homicidal
thoughts
MMSE
OO RAR LV (Ooh, RAR!, love)
·
Orientation
to place
·
Orientation
to time
·
Registration
·
Attention
and concentration
·
Recall
·
Language
·
Visual
construction
Factors in determining risk
Patients at risk of relapse, pay
attention to
following to SAVE them and others:
SAVE
·
Stress
·
Alcohol
and other substance abuse
·
Violence
in past
·
Empathy-lacking
Then go on to do a formal risk
assessment.
Mental State Examination
ASEPTIC
·
Appearance
/ Behaviour
·
Speech
·
Emotion
(mood and affect)
·
Perception
(hallucinations, illusions)
·
Though
(content, form)
·
Insight
·
Cognition
(AMT, MMSE)
Suicide risk assessment
SAD PERSONS
·
Sex
– male
·
Age
– older
·
Depression
·
Previous
suicide attempt
·
Ethanol
abuse
·
Rational
thinking loss e.g. hallucinations, delusions, hopelessness
·
Suicide
in family
·
Organised
plan
·
No
spouse
·
Sickness
e.g. chronic disability
One point for each. Score
calculated and suicide risk graded:
·
0-4
– low risk
·
5-6
– medium risk
·
7-10
– high risk
Attention Deficit Hyperactivity
Disorder (ADHD) symptoms
ADHD
· Attention
impaired – short attention span
· Distractibility
· Hyperactive
– over activity
· Devil-may-care
attitude – impulsivity
Or,
in keeping with the 3 core
symptoms:
1.
Attention
Deficit
2.
Hyperactivity
3.
Devil-may-care
attitude – impulsivity
Male sexual response stages
DEOR
·
Desire
·
Excitement
·
Orgasm
·
Resolution
Substantia nigra functions
niGRA
·
Gestures
(movement)
·
Reward
·
Addiction
Cingulate gyrus functions
Two main functions are dealing
with pain and regulating aggression.
To remember, think of some awful
contestant singing on that awful show, X-factor. Criticism from the
judges for her singing (CINGulate) causes pain initially
which leads on to aggression (usually towards the judges).
Dopamine pathways
MiLC TINS
·
MesoLimbic
·
MesoCortical
·
TuberoInfundibular
·
NigroStriatal
Limbic system functions
A DEMON (or MOANED)
·
Autonomic
control
·
Drives
·
Emotion
·
Memory
·
Olfaction
·
Neuroendocrine
control
Main regions of the limbic system –
hippocampus, amygdala
Neurotransmitter types
GOD SANG
·
GABA
·
Opiate
·
Dopamine
·
Serotonin
·
Acetylcholine
·
Noradrenaline
·
Glutamate
Obsessive-compulsive disorder
diagnosis
TORE (for obsessional symptoms)
·
Thought
or act resisted unsuccessfully
·
Own
thoughts in the patient’s mind (i.e. not psychotic)
·
Repetitive
and unpleasant obsessions (thoughts, images or impulses)
·
Ego-dystonic
– the patient does not enjoy these thoughts and finds them distressing
ICD-10 criteria. Obsessional
symptoms or compulsive acts (or both) present on most days of the week for
longer than 2 weeks. There needs to be associated distress or interference with
activities as a result.
Neurotransmitter types
FEAR
· Fear
of a specific object or situation
· Evasion
of said fear
· Anticipation
anxiety e.g. if knows will be exposed to phobia
· Restlessness and
anxiety when exposed
Obsessive compulsive
disorder symptoms
Having OCD is MURDER
·
Mind
– patient aware symptoms arise in the mind
·
Unpleasant
thoughts
·
Resist
– patient must want and try to resist obsessive thoughts
·
Displeasure
of feeling the obsession
·
Ego-dystonic
·
Repetitive
thoughts
Five stages of grief
DABDA
·
Denial
·
Anger
·
Bargaining
·
Depression
·
Acceptance
Post Traumatic Stress Disorder
(PTSD) diagnosis
TRAUMA
·
Traumatic
event that would cause stress in any individual
·
Reliving/re-experiencing
event e.g. flashbacks, nightmares, intrusive thoughts
·
Avoidance
of things similar to event
·
Unable
to function e.g. socially, work
·
Memory
affected – inability to recall (partial or complete) important aspects of the
event
·
Arousal
symptoms e.g. hyper-vigilance, startle reaction, irritability, poor
concentration, poor sleep
Symptoms arise within 6
months (ICD-10) or 1 month (DSM-V)
Post Traumatic Stress Disorder
(PTSD) features
IF AHEAD
·
Insomnia
– usually with nightmares (nocturnal flashbacks).
·
Flashbacks
– vivid reliving of trauma.
·
Avoidance
– of activities or events that resemble the traumatic event.
·
Hypervigilance
– autonomic hyperarousal and enhanced startle reaction.
·
Emotional
blunting – emptiness or numbness alternates with…
·
Anxiety
(intense) – experienced at similar events to trauma or anniversary of event.
·
Detachment
(emotionally) – from other people.
Lewy body dementia features
SHACK
·
Stiffness,
rigidity and movement difficulties e.g. in bed
·
Hallucinations
– visual or auditory
·
Antipsychotic
sensitivity e.g. to sedation and EPSE
·
Cognitive
impairment which fluctuates (think delirium-like picture)
·
Klumsiness
– falls
VIP
·
Visual
hallucinations
·
Inattention,
fluctuating course
·
Parkinsonism
Kluver-Bucy syndrome
Damage to bilateral medial temporal
lobes (amygdala and hippocampus)
Oral Sex DVD
·
hyperOrality
·
hyperSexuality
·
Docility
·
Visual
agnosia
·
Dietary
changes – hyperphagia, carbohydrate craving
Narcolepsy features
Sleepy People Can Have
Hallucinations
·
Sleepiness
(excessive during the day)
·
Paralysis
(sleep)
·
Cataplexy
·
Hypnagogic
Hallucinations
Extrapyramidal side
effects (EPSE)
ADaPT
·
Akathisia
·
acute
Dystonia
·
Parkinsonism
·
Tardive
dyskinesia
Balint syndrome features
Damage to bilateral
parietooccipital lobes
SOOT
·
Simulatnagnosia
– inability to simultaneously perceive different aspects of a picture to
appreciate it as a whole
·
Ocular
apraxia – difficulty keeping the eyes still
·
Optic
ataxia – difficulty moving the eyes to a specific position
·
Tunnel
vision
Simultaneous Operatic Occupation
·
Simulatnagnosia
·
Optic
ataxia
·
Oculomotor
apraxia
Subcortical dementia features
LAPSED
·
Language
sparing/preservation
·
Anamnesis
(memory retrieval) impaired
·
Personality
change
·
Slowing
of psychomotor activities
·
Executive
dysfunction
·
Depression
Delirium causes
PINCH ME
·
Pain
·
INfection
·
Constipation
·
Hydration
·
Medication
·
Electrolyte
imbalance e.g. low calcium / Environment
I WATCH DEATH
·
Infection
– UTI, pneumonia, encephalitis, meningitis
·
Withdrawal
– alcohol, benzodiazepines, barbituates
·
Acute
metabolic disorder – derranged electrolytes, hepatic, renal failure
·
Trauma
– head injury, post-op
·
CNS
pathology – stroke, haemorrhage, tumour, seizure
·
Hypoxia
– anaemia, cardiac failure, PE
·
Deficiency
– vitamin B12, folate, thiamine (B1)
·
Endocrine
disorder – thyroid, glucose, parathyroid, adrenal
·
Acute
vascular – shock, vasculitis
·
Toxins,
substance abuse
·
Heavy
metals – mercury, lead
Dementia reversible causes
DEMENTIA
·
Drugs
and alcohol esp. anticholinergics
·
Emotions
e.g. depression
·
Metabolic
derangement e.g. hypothyroid, electrolyte abnormalities
·
Eyes
and ears in decline
·
Normal
pressure hydrocephalus
·
Tumor
·
Infection
e.g. encephalitis, HIV, syphilis
·
Anemia
e.g. vit B12, folate deficiency
Parkinson’s disease features
TRAP
·
Tremor
– usually hands (pill-rolling, 3-6Hz), present at rest, worsened by anxiety,
improves on action
·
Rigidity
– lead-pipe rigidity. Cogwheeling = tremor + rigidity
·
Akinesia
– reduced facial expression, monotonous speech, abnormal gait/stance, ‘slowed
down’
·
Postural
instability
Anxious (avoidant) personality
disorder features
ANxIOUS
·
Avoidance
of social interaction – fear of criticism/rejection
·
Need
for physical security which places restrictions in life
·
Insecure
– belief that one is socially inept/unappealing
·
Ostracised,
worried about
·
Unwilling
to be involved unless certain of being liked
·
Socially
inept (beliefs of such)
Dissocial (antisocial) personality
disorder features
CORRUPT Blame
·
Callous
unconcern for the feelings of other
·
Obligations
(social) and rules ignored
·
Remorse
lacking (no empathy)
·
Relationships
unable to be maintained (although can often be started)
·
Underhanded
– deceitful, lying and manipulative although can have superficial charm
·
Punishment
does not yield benefit – unable to profit from punishment
·
Temper
– low tolerance to frustration and low threshold for anger
·
Blames
others or attempts to offer rational explanations for behaviour
Histrionic personality
disorder features
PRAISE ME (source)
·
Provocative
or seductive behaviour
·
Relationships
considered more intimate than they are
·
Attention
required (need to be the centre)
·
Influenced
easily
·
Style
of speech (impressionistic, lacking detail)
·
Emotions
shallow, rapidly shifting, dramatic
·
Manipulative
/ Make up (physical appearance used to draw attention to self)
·
Ego-centric
Schizoid personality
disorder features
DISTANT Fantasy (source)
·
Detached
or flattened affect
·
Indifferent
to criticism or praise
·
Sexual
experiences of little interest
·
Tasks
done alone (solitary)
·
Absence
of close friends
·
Neither
desires nor enjoys close relationships
·
Takes
pleasure in few activities
·
Fantasy
and introspection, preoccupation with such
Paranoid personality
disorder features
SUSPECT (source)
·
Sensitive
(excessively) to setbacks and rebuffs
·
Unforgiving
and bears grudges persistently
·
Spousal
infidelity suspicions
·
Perceives
friendly/neutral acts as hostile/contemptuous
·
Excessive
self-worth/importance
·
Conspiratorial
beliefs
·
Tenacious
sense of self rights
SCOFF eating disorder
screening tool
SCOFF
·
Do
you make yourself Sick because you feel uncomfortably full?
·
Do
you worry you have lost Control over how much you eat?
·
Have
you recently lost more than One stone over a three month
period?
·
Do
you believe yourself to be Fat whilst others say you are thin?
·
Would
you sy that Food dominates your life?
One point for each positive answer.
A score of > =2 suggests she has anorexia nervosa or
bulimia.
84.6% sensitivity and 98.6%
specificity with a negative predictive value of 99.3%.
Anorexia nervosa features
Low FAT
·
Low
weight (BMI < 17.5 kg/m2)
·
Fear
of weight gain/increasing
·
Amenorrhoea
·
Thin aspirations
(desire to be thin)
Anankastic Personality
Disorder features
PERFECT List
·
Perfectionism
which interferes with task completion
·
Excessive
doubt and caution
·
Relationships/social
life affected by excessive preoccupation
·
Flexibility
poor (rigid and stubborn) and forces others to their ways
·
Egoistic
·
Conventions
(social) not commonly adhered to
·
Thoughts/images
are persistent and welcome (the opposite of OCD)
·
Lists,
rules and details very much a preoccupation
Emotionally Unstable Personality
Disorder (EUPD) features – borderline
AM SUICIDE (source)
·
Abandonment
·
Mood
instability
·
Suicidal
behaviour
·
Unstable
and intense relationships
·
Impulsivity
·
Control
of anger difficult
·
Identity
disturbance
·
Dissociated
and paranoid symptoms that are stress-related and transient
·
Emptiness,
chronic feelings of
RAISED
·
Relationships
often unstable
·
Abandonment,
fear of (and efforts to avoid abandonment)
·
Image
of self is disturbed/unclear
·
Suicidal
/ Self-harm thoughts and actions
·
Emptiness
feelings (chronic) / Emotionally labile
·
Dissociated
feelings
IMPULSIVE
·
Impulsiveness
·
Mood
labile, often low
·
Paranoia
or dissociation under stress
·
Unstable
self-image
·
Labile,
intense relationships
·
Suicidal
gestures
·
Inappropriate
anger
·
Vulnerable
to abandonment
·
Emptiness
(feelings of)
Valproate side effects
VALPROATE
·
Vomiting
and nausea
·
Appetite
increase, so weight gain
·
Lethargy
/ Liver failure (monitor LFTs during 1st 6 months)
·
Pancreatitis
·
Reversible
hair loss (grows back curly, apparently)
·
Oedema
·
Ataxia
·
Teratogenicity,
Tremor, Thrombocytopaenia
·
Encephalopathy
(due to hyperammonaemia) / Enzyme inducer
Main effects: Valproate
Take Lots Of Hair AWay
·
Vomiting
and nausea (also any kind of gastric disturbance e.g. diarrhoea)
·
Thrombocytopaenia
/ Tremor
·
Lethargy
·
Oedema
·
Hair
loss / Hyperammonaemia (confusion)
·
Appetite
increased / Weight gain
Lithium side effects
LITHIUM
·
Lethargy
/ Leukocytosis
·
Intension
(or fine) tremor
·
Teratogenic
·
Hypothyroidism
– need to check TFTs
·
Insipidus
(diabetes) – need to check U&Es
·
Urinary
frequency/excess
·
Metallic
taste
Source here
Clozapine side-effects (common)
Some Say Clozapine Has Too Many
Nasty Adverse Effects
·
Sedation
·
Seizures
·
Constipation
·
Hypotension/Hypertension/Hypersalivation
(sialorrhoea in 30%)
·
Tachycardia
·
Mass
increase (weight gain)
·
Nausea
·
Agranulocytosis
·
Enuresis
(nocturnal)
Carbamazepine side effects
HARD SAND
·
Headache
·
Ataxia
·
Rash
– itchy, erythematous in 1/10 patients
·
Dizziness
·
Sexual
dysfunction
·
Anaemia
(aplastic), agaranulocytosis
·
Nausea
·
Diplopia
Clozapine – receptors affected
by it
Clozapine Has Such Affinity for Dopamine
·
Cholinergic
·
Histaminergic
·
Serotonergic
·
Adrenergic
·
Dopaminergic
Greater affinity to D4 than D2
receptors. D4 receptors are highest in the frontal cortex and amygdala and
low in the basal ganglia. D2 receptors are higher in the basal ganglia so this
may explain why there are reduced extra-pyramidal side effects (EPSE) with
clozapine compared to other atypical antipsychotics.
Bleuler’s four A’s
of schizophrenia
Am Aff Au Ass
·
Ambivalence
·
Affect
disturbed
·
Autism
·
Association,
loosening of
Schizophrenia types
Crazy People Hear Something
·
Catatonic
– unresponsive, fixed stupor
·
Paranoid
– often delusional, angry, jealous
·
Hebephrenic
– disintegration of personality, erratic speach
·
Simple
– disintegration of thinking process
Schizophrenia – Schneider’s first
rank symptoms
BADS Made VIA
Broadcasting, insertion and withdrawal of thought
Auditory hallucinations
·
Thought
echo – thoughts spoken aloud (echo de la pensee)
·
3rd
person arguing – 2 or more voices arguing about the patient: “He’s a
bad man.” “No, he’s good!”
·
Commentary
– “he is folding his arms now”
Delusional perception (i.e. taking a normal sensory
perception to mean a bizarre situation such as taking seeing an aeroplane as
indicating that the president has been shot)
Somatic passivity / delusions of control
Made:
·
Volition
– someone controlling the action, usually completed act
·
Impulses
– someone controlling the desire to act
·
Affect –
someone controlling mood/affect
Schizophrenia symptoms
Positive symptoms
THREAD
·
Thinking
disturbed, neologisms
·
Hallucinations,
typically auditory
·
Reduced
contact with reality
·
Emotional
control affected – incongruous affect
·
Arousal
may lead to worsening of symptoms
Negative symptoms
LESS
·
Loss
of volition, under-activity, social withdrawal
·
Emotionally
flat
·
Speech
reduced, monosyllabic
·
Slowness
in movement and thought, psychomotor retardation
Schizophrenia negative symptoms
The six A‘s
·
Affective
flattening – unchanging facial expression, reduced movement, poor eye contact
·
Alogia
– poverty of speech, thought block, delayed response
·
Anergia
– loss of energy
·
Anhedonia
– loss of interest in things/sex/relationships
·
Apathy
– poor hygiene, lack of interest
·
Asociality
– not engaging with peers, little interest in sex
Amisulpride – best evidence for
treatment (handily begins with A also).
Narcissistic personality
disorder features
SPECIAL
·
Special
treatment expected (grandiose), feelings of entitlement
·
Power,
success and high intelligence (fantasises over)
·
Envious
of others and beliefs others are equally jealous of them
·
Conceited
(vain)
·
Interpersonal
exploitation – exploits others to achieve personal gain
·
Admiration
of others needed
·
Lacking
empathy
Dependent personality
disorder features
RELIANT
·
Relies
on others to make important decisions (needing reassurance)
·
Encourages
others to make decisions
·
Limited
capacity themselves to make decisions (about life responsibilities)
·
Inability
to care for oneself (fears of such) so are uncomfortable alone
·
Abandonment
fears of caring for oneself
·
Needs
of others put first and unduly compliant with others’ requests
·
Tolerance
– inability to disagree with others
COMMENTS