Psychiatry

• 10ml ethanol = 8g
• volume an adult can metabolise in 1 hour

Units = volume (ml) x %strength / 1000

• Men: 21 units
• Women: 14 units

less if: CLD, low weight, malnourished, extremes of age, metronidazole, MOAI, antihistamines, benzos, opiods

2

1.5

1

• ~12 hours after last drink
• anxiety
• insomnia
• sweating
• tachycardia
• tremor
• seizures after 48 hours
• 5% mortality

• reducing regular benzos - chlordiazepoxide
• IV or PO vitamin B

• 48 hours after last drink
• lasts 5 days
• tremor
• restlessness
• increased autonomic activity
• fluctuating consciousness with disorientation
• fearful affect
• hallucinations - often visual, sometimes Lilliputian
• delusions

• decreased sleep
• increased energy
• psychomotor agitation

• decreased concentration
• flight of ideas
• lack of insight
• circumstantiality
• tangentiality

• elevated or irritable mood
• decreased sleep
• high energy, agitation
• flight of ideas, poor concentration, thought disorder
• +/- psychotic features
• first rank symptoms (20%)
• manic stupor

• grandiose delusions
• persecutory delusions
• hyperacusis
• hyperaesthesia

• unresponsive
• akinetic
• mute
• conscious
• elevated facies

speaker digresses further and further away from the initial topic via loose associations

speaker eventually gets to the point in a very roundabout way

• circumstantiality
• tangentiality

• BMI <17.5 or <15% expected
• self-induced weight loss: dieting, exercising, vomiting
• morbid fear of fat
• endocrine disturbance: amenorrhoea, pubertal delay, lanugo hair

• anaemia
• interest in preparing or buying food
• tiredness
• coldness
• bradycardia
• hypotension

• CBT
• raising calorie intake
• admission with weight loss >35%

• Caucasian
• higher social class
• academic prowess
• interests in ballet, modelling

• 50% complete recovery
• 5% mortality - starvation or suicide

• binge eating
• self-induced weight loss or attempts: vomiting, purging, laxatives
• morbid fear of fat

AN: 4 in 100,000, peak age 18y, 10% male

BN: 12 in 100,000, 10:1 female

• hypokalaemia
• dehydration
• parotid swelling
• dental caries
• Mallory-Weiss tear
• osteoporosis
• Russell's sign (thickened dorsum of hand)

• 70% recovery within 5 years
• No increase in mortality

• CBT
• normalisation of calorie intake
• SSRIs may improve bingeing

• non-specific syndrome caused by several illnesses
• impaired cognition may include memory, attention, language, problem solving
• present for greater than 6 months

• multiple small cerebral infarcts in cortex and white matter
• clinically apparent when >100ml
• onset in 60s
• step-wise deterioration
• focal neurology, fits, nocturnal confusion
• death often within 5y due to IHD or CVA

• male
• smoking
• hypertension
• diabetes
• hypercholesterolaemia

• dementia (mainly memory)
• gait disturbance
• urinary incontinence

obstruction in subarachnoid space prevents reabsorption of CSF but flow is uninterrupted so ventricles dilate but opening pressure is only marginally raised

• Diagnosis: LP then CT/MRI
• Management: VP shunt

• frontotemporal dementia
• "knife blade" atrophy of frontal and temporal lobes (visible on MRI if advanced)
• cytoplasmic inclusion bodies of tau protein (Pick bodies) in substantia nigra

• disinhibition
• inattention
• antisocial behaviour
• personality changes
• later: apathy, akinesia, withdrawl, memory loss, disorientation

• fluctuating impairment of consciousness
• mood changes
• abnormal perceptions
• may be hypoactive
• acute onset
• average duration 7 days
• 40% die from underlying condition
• 5% progress to dementia

• infection
• hypoxia
• electrolyte disturbances
• constipation
• drugs
• CNS disease

• treat cause
• calm environment
• good lighting
• glasses, hearing aids
• continuity of staff
• family, friends, familiar objects
• PO or IM haloperidol or benzos IFF required

• psychosocial: marital difficulties, financial strain
• alcohol use
• drugs - beta-blockers, tricyclics, benzos, antihistamines, oestrogens, statins, anti-Parkinsonisms
• disease: neuropathy, ischaemic vascular disease, hypertension

• intracavernosal injection of papaverine
• prostaglandin E1
• vacuum device
• nitrate creams
• rod insertion

• severe depressive illness
• life-threatening behaviour
• puerperal depression
• mania
• catatonic schizophrenia

• absolute: raised ICP
• relative: high anaesthetic risk, cerebral aneurysm

• short term headaches
• short term muscles aches
• temporary confusion
• working memory loss
• possible long-term LT memory loss

extra-pyramidal side effects

• Parkinsonism (rigidity, bradykinesia, tremor)
• dystonia
• akasthisia (restlessness)
• Tardive Dyskinesia

• trismus
• tongue protrusion
• spasmodic torticollis
• opisthotonus
• oculogyric crisis
• grimacing

chewing, grimacing, sucking, darting tongue