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P-PALS PSYCHIA TRY LECTURE FRITHN MCGRUGAN & LIVWHATWEWILL COVERTODA Y… Personality Schizophrenia Bipolar Disorders ASD (Autism ADHD (Attention Spectrum Deficit Questions! Disorder) Hyperactivity Disorder)SCHIZOPHRENIARISK FACORSCLINICAL FEATURES (+/-) PositiveSx Negative Sx ¡ Thought: ¡ BluntedAffect ¡ Insertion/Withdrawal ¡ Apathy ¡ Broadcasting ¡ Social Isolation ¡ Auditory Hallucinations ¡ Poverty of Speech ¡ Delusional Perceptions ¡ Poor Self Care ¡ PassivityINVESTIGA TIONS & DIAGNOSIS - BASELINE BLOODS -> USUALS LIKE FBC,TFTS,UE,LFTS,CRPAND FASTING GLUCOSE - URINE CULTURE -> IF COULD BE ?UTITHEREFORE,DELIRIUM - URINE DRUG SCREEN - SYPHILIS SEROLOGY IF INDICATED - SERUM LIPIDS -> BEFORE STARTINGANTIPSYCHOTICS - IMAGING -> CT HEADTO R/O ORGANIC NEURO CAUSEMANAGEMENT (BIO-PSYCHO-SOCIALAPPROACH) Biological Psycho-social ¡ Antipsychotics (Typical vsAtypical) ¡ MDTs ¡ TYPICAL ¡ CBT ¡ Haloperidol,Chlorpromazine,Flupentixol Decan¡atFamilyTherapy ¡ ATYPICAL ¡ Olanzapine,Risperidone,ClozapineMENT AL ST ATE EXAM:PSYCHOSIS A – SELF HARM SCARS,WEIGHT CHANGE,POOR PERSONAL HYGIENE,UNKEMPT CLOTHING S – PRESSURED,MONOTONE, DIFFICULTTO FOLLOW FLUENCY E –ANXIOUS/ MOOD SWINGS. BLUNTED DISTRESSEDAFFECT. P –AUDITORY HALLUCINATIONS,SHADOW ILLUSIONS T – LOTS I – NO INSIGHT,POOR JUDGMENT C – ORIENTATED BUT PROBLEMSW/ UNDERSTANDING COMMON PROVERBSBIPOLAR ICD-10 definition Two or more episodes in which the patient's mood and activity levels are significantly disturbed consisting of episodes of: ¡ Elevation of mood and increased BIPOLAR energy and activity (hypomania or mania) ¡ Lowering of mood and decreased energy and activity (depression). ¡ Hypomania q <4 days q Symptoms not usually severe enough to disrupt work or result in social rejection MANIA q No psychotic features VERSUS ¡ Mania HYPOMANIA ¡ Can be with or without psychotic features ¡ >4 days ¡ Psychotic features:Delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the patient) ¡ Mood-congruent or mood-incongruentMANAGEMENT Classes of Mood Stabilisers 1. Lithium – gold standard for mood stabilising both mania and depression 2. Anticonvulsants – e.g SodiumValproate,Lamotrigine Management of mania – discontinuing antidepressants - Antipsychotics Management of depression – 1 st choice fluoxetineLITHIUM COUNSELLING –ATHLETICS SE:increased polydipsia Mood stabiliser Lithium levels TFT’s & U&E’s and polyuria,metallic taste,fine tremor, weight gain,tiredness C/I:pregnancy!!! – Complications – Renal increase of birth Supplementary advise LithiumToxicity toxicity,nephrogenic defects especially 1t – leaflet, diabetes, trimester,breast www.bipolaruk.org.uk hypothyroidism feeding,NSAIDS - Emotionally unstable personality disorder (EUPD) - Schizoid personality disorder PERSONALITY DISORDERS - Paranoid personality disorderAUTISM SPECTRUM DISORDERASD ¡ Deficit in: ¡ Social Interaction ¡ Communication ¡ Behaviour ¡ Observable before 3 y/o ¡ Management dependent on severity ¡ Is not curable ¡ Requires MDT inputADHD