Contents
1. ADHD
2. Alcohol misuse
3. ASD
4. Bipolar Affective Disorder
5. BPAD management
6. Childhood and Adolescent disorders
7. Delirium tremens
8. Delirium
9. Dementia
10. Depression
11. Eating disorders
12. GAD
13. Intellectual disability
14. OCD
15. Panic disorder
16. Perinatal psychiatry
17. Personality disorders
18. Phobias
19. Psychosexual disorders
20. PTSD
21. Schizophrenia
22. Sleep disorders
23. Stress
24. Substance abuse
25. Suicide and self harm
26. Unexplained symptoms
27. Antidepressants
28. Antipsychotics
29. Benzodiazepines and Z-drugs
30. Drugs for dementia
31. ECT
32. Mood stabilisers
33. Drugs for substance abuse
34. Psychotherapy
35.
,ADHD
CLINICAL SIGNS EPIDEMIOLOGY
Triad of - 5% in children
1. Impaired attention - 2.5% in adults
2. Impulsivity - M>F
3. Hyperactivity
Causing significant functional impairment in AETIOLOGY
at least 2 domains (e.g. home and school) for a One of the highest heritabilities of all psychiatric
period of > 6 months illnesses
Symptoms should be present by early-mid - Maternal smoking, alcohol, or heroin during
childhood pregnancy
- Impaired attention - Very low BW, fetal hypoxia, perinatal brain
o Poor or limited concentration on injury
tasks - Prolonged emotional deprivation
o Highly distractible
DIFFERENTIALS
o Difficulty listening
o Loses things often Children
- Impulsivity - Normal for age
o Inability to suppress impulses - Secondary to: sensory impairment (myopia),
o Not thinking about consequences psychosocial adversity (hunger),
o Difficulty waiting turn mental/physical health problem (pain,
- Hyperactivity thyrotoxicosis, diarrhoea, anxiety)
o Restlessness - Neurodevelopmental disorder (ID, ADHD,
o Noisiness, talkative Tourette syndrome or dyskinesia, specific
- Sensory processing abnormalities are also learning disability)
common but not diagnostic - Conduct disorder
- Reactive attachment disorder
Often comorbid with other mental disorders
Adults
Presentation in adults
- Normal range
- Losing keys - Secondary to substance abuse or other
- Struggle with administration psychiatric disorder (GAD, BPAD, depression)
- Reckless decisions - Personality disorder (EUPD, dissocial)
- Finishes others sentences - Neurodevelopmental disorder
- Avoids queuing - Brain injury
- Movement less of a problem but may avoid - Neurodegeneration
activities where sitting still required
- Overtalkativeness on irrelevant topics
MANAGEMENT AND PROGNOSIS
Psychosocial
1st line for children with mild-moderate ADHD.
Can include parental education, CBT, and social skills training. Less evidence of benefit in adult ADHD
Pharmacological = methylphenidate
- For school-age children with severe ADHD and adults with moderate-severe ADHD
- 2nd line in children with moderate ADHD who have failed psychosocial intervention
- Monitoring; HP, BP, weight, height – ensure reduced appetite doesn’t lead to growth suppression
- 2nd line: atomoxetine, dexamfetamine
Prognosis
Tends to improve in adolescence, particularly hyperactivity, however 2/3 will have symptoms that persist
into adulthood
Worse prognosis associated with unstable family dynamics and coexisting conduct disorder
Individuals with ADHD are at increased risk of substance abuse and incarceration in adulthood
,ALCOHOL MISUSE
DEPENDENCE CLASSIFICATION
3 or more criteria present together at some time
during the previous year
1. Strong desire or compulsion to take
substance
2. Difficulties in controlling substance-
taking behaviour (onset, termination, levels
of use)
3. Physiological withdrawal state when
substance use has reduced or ceased; or
continued use of the substance to relieve
or avoid symptoms
4. Tolerance – increased quantities required
to produce the same effect
5. Priority given to substance with
subsequent neglect of interests and INTOXICATION
activities due to time spent acquiring
substance and recovering from effects Initial enhanced sense of well-being, greater
6. Persistence despite harm – use of confidence, relief of anxiety
substance continued despite awareness of Inappropriate sexual/aggressive behaviour, sullen +
harmful consequences withdrawn, labile mood, possible self-injurious
behaviour
PATHOPHYSIOLOGY Incoordination, slurred speech, ataxia, amnesia,
impaired reaction times
Uncomplicated alcohol withdrawal
syndrome: 4-12 hours after cessation Low GCS, respiratory depression, coma
- Tremor, sweating, nausea, vomiting
- Mood disturbance (anxiety, depression, EPIDEMIOLOGY
feeling ‘edgy’) - 57% drank alcohol within last week (M>F)
- Hyperacusis - 15% binge drank within last week (M = F)
- Autonomic hyperactivity (tachycardia, HTN, - 1.4% alcohol dependence (M>F)
mydriasis, pyrexia) - 7% of all hospital admissions related to
- Sleep disturbance, psychomotor agitation alcohol (M > F)
With perceptual disturbance - 1.4% of all deaths (M > F)
Illusions or hallucinations – typically visual,
auditory, or tactile
AETIOLOGY
Lillipution hallucinations
- Genetic
With withdrawal seizures: 6-48 hours after - Biochemical (GABA, NMDA)
cessation - Psychological factors
5-15% of all alcohol-dependent drinkers o Positive reinforcement
Usually generalised tonic-clonic seizures o Modelling
o Psychiatric or physical illness
- Social and environmental factors
MANAGEMENT o Cultural attitudes
Outpatient or community based detox o Price
Inpatient if severe dependence, hx of withdrawal o Occupation
seizures/delirium tremens, unsupportive home
environment, significant comorbidity, advanced
age, pregnancy, failed community detox PROGNOSIS
- Benzodiazepine Variable course, often numerous relapses
- IM/IV thiamine (Pabrinex) 50-60% with alcohol dependence show abstinence or
- Avoid repeated detoxes in short period of significant functional improvement 1 year after
time treatment
Maintenance Risk of death
Psycho: motivational interviewing, CBT, mutual aid - X3 in men
organisations - X5 in women
Social: social/peer support, residential rehab - X12 completed suicide
communities
Bio: Disulfiram, acamprosate, naltrexone and
nalmefene
, ASD
CLINICAL SIGNS SUMMARY
Impaired social interaction Childhood autism – triad of: impaired social
- Poor use of non-verbal communication interaction, impaired communication, and
- Failure to develop peer relationships restricted/stereotyped interests and behaviours
presenting < 3 years
Impaired communication
ASD – concept of spectrum which includes full range
- Poor development of spoken language of intellectual functioning and language abilities. Can
- Extreme difficulty starting/making encompass individuals without difficulties in
conversation intellectual functioning
- Lack of make-believe play
There is becoming less emphasis on presentation by
Restricted/stereotypes interests and behaviours age 3 – symptoms are usually present but may not
- Intense preoccupations with specific manifest fully until later when social demands exceed
interests and repetitive, stereotyped capacities
movements
Not core: EPIDEMIOLOGY
- Behavioural problems – aggression towards - Prevalence 1%
others or themselves, poor impulse control - M>F
- Sensory difficulties – often - Increasing over time
hypersensitivities - Epilepsy is comorbid in 25-30% of cases
- 50% have significant ID
- 25-30% will have epilepsy
Presentation in adults – tends to be milder, highly AETIOLOGY
unlikely to be associated with ID or significant Genetics
language delay
- Highly heritable (~80%)
- Unable to make small talk - Siblings of autistic children have 10-15% risk
- Does not pick up on social cues of being affected
- Pedantic, overly formal use of language - Risk increased by some syndromic ID – e.g.
- Intense interest in objects or numbers, fragile X, tuberous sclerosis
often enjoyment gained from categorizing
or collecting Environmental – any environmental factor that can
- Inflexible adherence to routine have influence (perinatal, postnatal, prenatal)
- Repetitive movements less common Subtle structural brain imaging differences
MANAGEMENT DIFFERENTIALS
No pharmacological treatments recommended but Children
can be used for comorbid physical or mental - Normal for age
disorders - Secondary to: sensory impairment,
Psychosocial interventions psychosocial adversity, physical health
- Play-based social communication problems (e.g. absence seizures, cleft palate)
programmes for children - Secondary to other psychiatric disorder
- Social learning programmes in adults o Anxiety disorders, social anxiety, OCD
- Self-help or support groups for adults and o Social behaviour disorder – elective
older children mutism, reactive attachment disorder,
- Supported employment programme conduct disorder
- Structured supervised leisure activity - Neurodevelopmental disorder: ASD, ID, ADHD,
- Anger management specific language impairment, genetic
- Crisis planning syndrome
Prognosis – lifetime condition, no cure Adults
Impact fluctuates with stressors, change, and - Within normal range
physical illness - Neurodevelopmental disorder: ASD, ID
- Personality disorder: schizoid, schizotypal,
Good prognostic factors are: IQ > 70, anankastic, EUPD, dissocial
communicative language by age 5, absence of - Secondary to other psychiatric disorder: GAD,
epilepsy depression, social phobia
Those with comorbid ID are unlikely to live - Brain injury
independently by adulthood - Neurodegenerative
