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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.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Mood Symptoms
Grandiose delusions
Diurnal variation of mood 1. 35yr old mother of three says she is not
enjoying anything anymore, even horse riding
Blunted affect
which she always had been a great source of
Physchomotor agitation
pleasure
Circumstantial speech
2. A depressed man, who has stopped eating,
Manic stupor
shows little facial expression or emotion and
Pressure of speech
speaks with a monotonous tone.
Anhedonia
3. A woman with longstanding bi-polar affective
Meixed affective disorder
disorder alternates, over the course of 2 days
Tangential speech
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 affect
3. I – mixed affective episode
4. 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.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Psychotic symptoms
Reflex haluccination
Echolalia
1. A 22 year old man descirbes 2 females voices
that incessantly remark on everything he goes
Liliputain halluciantions
e.g he is getting up now, he has just turned on
Formication
Hypnagogic hallucinations ht elight. He is angry and wants to punch a
wall
Word salad
2. A heavy drinker presents to his GP in a
Mood-incongruent delusions
confused drowsy state saying that he can see
Hihilistic delusions
tiny people jumping up and down
Hypnopompic hallucination3. An otherwise asymtomatic 33 year old woman
Running commentary, third person
is concerned because she regularly hears
auditory hallucinations
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.
2.
3.
4.
5.
J running commentary, 3rd person
C Lilliputian
E hypnagogic
H Nihilistic
F Word Salad
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Substance misuse
Naltrexone
Lysergic acid diethylamine 1.
Disulfiram
2.
Thiamine
Methadone
3.
Acamprosate
Ketamine
4.
Buprenorphine
Flumazenil
5.
Chlorodiazepoxide
Two drugs used in the acute treatment of
alcohol withdrawal
Two drugs strongly associated with
hallucination
Two drugs used to help prevent relapse in the
treatment of alcohol dependence
Two drugs used as substitutes drugs in the
maintenance treatment of opiate dependence
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
PSYCHOLOGICAL
Dry mouth
Blurred visions
Urinary retention
Nasal congestion
Constipation
Cortex and
limbic
Systems
Mesolimbic
Muscarinic
receptor
blockade
Nigrostraitum
Neuroleptic
Alphaadrenoreceptors
D2-dopamine
receptor blockade
Tuberoinfundibular
Pituitary Gland
↑ Prolactin
Postural
hypotension
Hypothermia
Antipsychotic
Impaired performance
Sedation
Histamine
and serotonin
receptor
blockade HORMONAL
Galactorrhoea, Gynaecomastia,
Menstrual disturbances, Decreased
libido
Impotence
Basal ganglia (striatum)
MOVEMENT
Parkinsonism,
Dystonias
Akathias
Tardative dyskinesia
May be irreversible