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Phase 3a Rupy and Alex

Psychiatry 1. Phase 3a Rupy and Alex. The Peer Teaching Society is not liable for false or misleading information…. A ims. Schizophrenia Psychotic disorders Psychiatric treatments (pharmacological and non-pharmacological) Psychiatric emergencies; Lithium toxicity

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Phase 3a Rupy and Alex

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  1. Psychiatry 1 Phase 3a Rupy and Alex The Peer Teaching Society is not liable for false or misleading information…

  2. Aims • Schizophrenia • Psychotic disorders • Psychiatric treatments (pharmacological and non-pharmacological) • Psychiatric emergencies; • Lithium toxicity • Acute dystonic reaction • Neuroleptic malignant syndrome • Serotonin syndrome • Personality disorders The Peer Teaching Society is not liable for false or misleading information…

  3. Schizophrenia • 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? The Peer Teaching Society is not liable for false or misleading information…

  4. First rank symptoms • 3rd person Auditory hallucinations • Delusions of thought referencing • Delusions of control • Delusions of perception ICD- 10 = 1 of the symptoms for >1 month for diagnosis The Peer Teaching Society is not liable for false or misleading information…

  5. Or…… • ICD – 10 at least 2 of… • Persistent hallucination • Break in thoughts • Catatonic behaviour • -ve symptoms The Peer Teaching Society is not liable for false or misleading information…

  6. Categories • What are the different categories of schizophrenia? • Paranoid • Hebephrenic • Catatonic • Undifferentiated • Residual • Simple • Post schizophrenic depression The Peer Teaching Society is not liable for false or misleading information…

  7. Treatment - antipsychotics • Typical / 1st generation • Block D2 • Haloperidol, chlorpromazine • Atypical • Olanzapine, ziprasidone, clozapine The Peer Teaching Society is not liable for false or misleading information…

  8. Clozapine • 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…

  9. Can you name some side effects? • Name some contraindications of clozapine The Peer Teaching Society is not liable for false or misleading information…

  10. 1st generation antipsychotics • Non selective dopamine channels • Leads to side effects • Name the 4 extrapyramidal side effects • Name some non extrapyramidal side effects The Peer Teaching Society is not liable for false or misleading information…

  11. Extrapyramidal side effects Tx- procyclidine Tx- procyclidine (anticholinergic) Tx- propranolol Tx- Hard to treat, change the meds The Peer Teaching Society is not liable for false or misleading information…

  12. Neuroleptic malignant syndrome • 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 The Peer Teaching Society is not liable for false or misleading information…

  13. Atypical side effects Anticholinergic Dry mouth, Urine retention, Blurred vision, Constipation Antiadrenergic Postural hypertension, tachycardia Antihistamine Sedation weight gain The Peer Teaching Society is not liable for false or misleading information…

  14. All antipsychotics block dopamine • This ↑ prolactin  sexual dysfunction The Peer Teaching Society is not liable for false or misleading information…

  15. Depressive disorders • 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 The Peer Teaching Society is not liable for false or misleading information…

  16. Depression Tx • CBT • SSRI • Citalopam, fluoxetine, sertraline • Can worsen symptoms in 1st 2 weeks- warn patient • Side effects? • Relatively safe in overdose • Less sedating than tricyclics The Peer Teaching Society is not liable for false or misleading information…

  17. Serotonin syndrome • Name the symptoms • Tx • Benzo • Cyproheptadine • Iv fluids The Peer Teaching Society is not liable for false or misleading information…

  18. Monoamine oxidase inhibitors • Phenelzine, rasagiline • Prevents breakdown of monoamine •  ↓ breakdown of serotonin, dopamine and norepinephrine The Peer Teaching Society is not liable for false or misleading information…

  19. Hypertensive crisis • ↑ tyramine with MAOI • Avoid tyramine containing foods- Examples? • Release of noradrenaline • Tachycardia • Hypertension • vasocontriction The Peer Teaching Society is not liable for false or misleading information…

  20. Tyramine foods A- Alcohol B- Broad beans C- Cheese D- Drugs (antihypertensives) E- Extracts (marmite) F- Fish G- Game The Peer Teaching Society is not liable for false or misleading information…

  21. Tricyclics • How do they work? • At risk of agranulocytosis and thrombocytopenia The Peer Teaching Society is not liable for false or misleading information…

  22. Mania • Symptoms for 1 week • Impair occupational and social functioning • 2 episodes of mood disturbance. • Symptoms of mania? Act them out if you so wish The Peer Teaching Society is not liable for false or misleading information…

  23. Need 3 or more for Dx • Elevated mood • Increased activity • Increase self esteem • Decreased attention/increased distractabilty • Irritable • Aggressive • Suspicious • Sexual disinhibition The Peer Teaching Society is not liable for false or misleading information…

  24. Psychotic symptoms • Delusion which are mood congruent or grandiose • Auditory hallucinations • Loss of insight The Peer Teaching Society is not liable for false or misleading information…

  25. Treatment • 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? The Peer Teaching Society is not liable for false or misleading information…

  26. Positive psychotic symptoms • 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 The Peer Teaching Society is not liable for false or misleading information…

  27. Negative psychotic symptoms • Lack of interest in other people • Few gestures • Monotone • Apathy – definition? • Lack of emotional response • Social withdrawal/depression The Peer Teaching Society is not liable for false or misleading information…

  28. Schizoaffective disorder • Overlap between bipolar and schizophrenia in the same episode • Tx- mood disorder and schizophrenia • Lithium and antipsychotics The Peer Teaching Society is not liable for false or misleading information…

  29. Personality disorder definition • 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 The Peer Teaching Society is not liable for false or misleading information…

  30. Personality Disorder Bingo • Narcissistic • Paranoid • Schizoid • Schizotypal • Anankastic • Avoidant • Dependent • Dissocial (antisocial) • 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) The Peer Teaching Society is not liable for false or misleading information…

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

  32. Jordan, 20 • Self harm • Often runs away from home • Unpredictable mood- constantly arguing with parents and best friends • Multiple short term relationships The Peer Teaching Society is not liable for false or misleading information…

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

  34. Helps person change unhelpful behaviours • Accepting themselves as they are (distress tolerance) • Skills on interpersonal response • Close relationship with therapist The Peer Teaching Society is not liable for false or misleading information…

  35. Family history of personality disorder or mental illness The Peer Teaching Society is not liable for false or misleading information…

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

  37. Regina, 18 https://www.youtube.com/watch?v=9lxk5IRLysI#t=365 The Peer Teaching Society is not liable for false or misleading information…

  38. Harry, 24 • Been in and out of prison • Says he “doesn’t give a f*** about anyone” The Peer Teaching Society is not liable for false or misleading information…

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

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

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

  42. Abuse or neglect during childhood The Peer Teaching Society is not liable for false or misleading information…

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

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

  45. Terry, 41 • Asks you for help with anger management • Unemployed • Mood swings • Always arguing with wife and friends down the pub • Attempted suicide before The Peer Teaching Society is not liable for false or misleading information…

  46. Explores why things have gone wrong in past • Thinking about themselves differently • Coping strategies The Peer Teaching Society is not liable for false or misleading information…

  47. Any questions? The Peer Teaching Society is not liable for false or misleading information…

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