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psychiatry

1.a) Delusive, schizoid and schizotyp personality disorders10 personality disorders: Persistent life-long problems.3 clusters:Cluster A: Odd and eccentric groupDelusive (paranoid): Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood.Suspects, without sufficient basis, that others are exploiting him or her.Is preoccupied with unjustified doubts about the loyalty of friends or associates.Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.Has recurrent suspicions, without justification, regarding fidelity of partner.Withdrawn from communication.Very cautious.Schizoid: Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood.Neither desires nor enjoys close relationships (Lack of social contact). Lack close friends.Has li – multi impulsive bulimia nervosa.Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (self-cutting).Affective instability due to a marked reactivity of moodChronic feelings of emptinessInappropriate, intense anger or lack of control of angerTransient, stress-related psychotic symptoms, “mini-psychosis”.More serious personality disorder.Identity problems.Border between psychosis and neurosis.Chaotic lifeMany relationships; cannot develop strong and long relationshipsTypically, females who were sexually abused during childhood: 60-70%!Histrionic: Pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood. Comes from the word hysteria.Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.Displays rapidly shifting and shallow expression of emotionsConsistently uses physical appearance to draw attention to self.Shows self-dramatization, theatrical behaviorIs suggestible, i.ood disorders:Bipolar disorderMajor depressive disorderCyclothymiaDysthymiaSeasonal affective disorder (SAD) e.g. winter depression.Adjustment disorders with depression:Psychologic response from an identifiable stressors that cause significant emotional or behavioral symptoms.General explanation before mentioned disorders:Bipolar disorder or manic-depressive disorder: A mood disorder defined by the presence of one or more episodes of abnormally elevated mood (mania). These manic periods may be interrupted by depressive episodes or mixed episodes (mania and depression present at the same time). Bipolar disorder has been subdivided into:Bipolar I: True mania + true depressionBipolar II: Hypomania (mild mania) + severe depressionBipolar III: Antidepressive-induced hypomaniaCyclothymia: Hypomania + mild depression (In some textbooks not classified under bipolar).Depression: Depressive phasesDysthymia: Depression >2years. Chronic and mild depression.SAD – Seasonal affective disorder: Lack oRIMA: Moclobemide5-HT reuptake inhibition + 5HT2 antagonism: Trazodone, NefazodoneSSRI’s: Paroxetine, Fluoxetine, Sertraline, Citalopram, Fluvoxamine, Escitalopram.SNRI’s, dual action: Venlafaxin, reboxetinSome extra information from seminar:Litium: 1940s – good for bipolar. Cade discovered: Anti-manic, anti-depressant and mood stabilizer. EEG, TSH, and Creatinine clearance has to be checked before introduction!! Check blood levels regularly – narrow therapeutic window 0,6-1,2 mmol/l. First toxic signs after 1,6 mmol/l. 1,6-2 mmol/l: tremor, dysarthria, diarrhea, ataxia. >2,2 mmol/l: delirium, confusion, serious ataxia, diarrhea. >3 mmol/l: coma. Good anti-suicidal effect!60-70% of bipolar patients are responding well to Lithium. The rest is resistant. Long term use has SE: hypothyroidism, tubular renal dysfunction: polyuria, polydipsia, isosthenuria.5.b) Cannabis and cocaine related mental disordersSymptoms of cannabis use:EuphoriaDrowsiness and relaxationHungerDepersonalization↑ HR↓ ationPsychomotor restlessnessVerbigeration: Meaningless repetition of words and phrases without stimulus.Jactitation: Involuntary spasm of limb (psychomotor restlessness)Perseveration: Repetition of a particular response despite cessation of stimulus. (Stand up, sit down)Stupor symptoms: ↓ psychomotor activityMutism: Don’t want to speak.Negativism: Not willing to cooperate or follow instructions.Active: Spit out the food.Passive: Eats when fed.Catalepsia: Muscular rigidity and fixity of posture regardless of external stimuli and ↓ sensitivity to pain. Bizarre posture.Waxy flexibilityCrystallization: Patient stays in weird position. As a statue.Appear in: Schizophrenia, Bipolarity, PTSD, Depression, and drug abuse.Therapy: ECT, Benzodiazepines (1-2 mg i.m. Lorazepam), antipsychotics.Severe anorexiaNeuroleptic malignant syndrome prevention (since cannot use neuroleptic, if still psychotic).(Can be done in pregnancy)Contraindications: AMI, epilepsy, brain tumor (brain edema), arrhythmiasEMI

의/약학| 2018.02.27| 48페이지| 2,000원| 조회(58)

성격장애, PSYCHIATRY, personality disorde

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