Rapid Psychiatry

Clare Oakley, Amit Malik, Clare Oakley

• Publisher: Wiley-Blackwell
• Year: 2011
• Print ISBN: 9781405195577
• eBook ISBN: 9781118294185
• Edition: 2
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

This pocket guide is a must for all clinical medical students and junior doctors and provides an excellent revision tool in the run-up to exams. It is also perfect for when working on the psychiatric attachment, as it covers many of the conditions encountered on the wards, in clinics, and in general practice. Now thoroughly updated, it includes new sections on Neuropsychiatry, the Psychiatry of Learning Disability, Forensic Psychiatry, and Psychotherapy, as well as common disorders, their assessment and their treatment. Featuring the key points of the Mental Health Act, along with a glossary of terms, Rapid Psychiatry is the ideal refresher, covering just the basic relevant facts.

General Adult Psychiatry

Anxiety disorders – agoraphobia

DEFINITION Anxiety associated with places or situations from which escape may be difficult, e.g. crowds and public places.

AETIOLOGY Family and twin studies suggest that genetic factors are relevant. Onset of agoraphobia often follows a precipitating event, which may be a panic attack, which leads to avoidance. It can occur following a major life event in someone with dependent personality traits.

ASSOCIATIONS/RISK FACTORS It is strongly associated with panic and ICD-10 classifies the disorder into agoraphobia either with or without panic disorder.

EPIDEMIOLOGY F > M. Average age of onset is late twenties.

HISTORY Consistent and marked fear of:

• crowds
• public places
• travelling alone
• being away from home

Anxiety symptoms occur in the feared environment or in anticipation of it:

• Palpitations
• Sweating
• Shaking
• Dry mouth
• Difficulty breathing
• Chest pain
• Nausea
• Dizziness
• Hot flushes
• Fear of losing control
• Fear of dying

Avoidance of these situations is the prominent feature. The patient may feel better if accompanied by someone else.

EXAMINATION Normal unless in that situation. May have a panic attack if exposed.

INVESTIGATIONS FBC, U + Es, LFTs, Ca, TFTs.

MANAGEMENT Exposure therapy, gradually increasing, e.g. walking increasing distances from home each day. CBT.

COMPLICATIONS Isolation. Secondary depression. May misuse alcohol or illicit substances to cope with feared environment.

PROGNOSIS Fluctuating course. Condition may be severe and the person housebound.

Anxiety disorders – generalised anxiety disorder

DEFINITION Generalised and persistent anxiety, not restricted to, or predominating in, any particular circumstances (free-floating).

AETIOLOGY

• Genetic predisposition
• Current stress
• Life events

ASSOCIATIONS/RISK FACTORS Childhood experiences characterised by separations, demands for high achievement and excessive conformity.

EPIDEMIOLOGY Lifetime prevalence is 5%. F > M. Onset is in adolescence to early adulthood.

HISTORY The symptoms should be present most days for at least several weeks at a time. These symptoms should involve elements of:

• apprehension (worries about future misfortunes, feeling on edge, difficulty concentrating)
• motor tension (restlessness, fidgeting, tension headaches, trembling)
• autonomic overactivity (lightheadedness, sweating, tachycardia or tachypnoea, dizziness, dry mouth, epigastric discomfort).

EXAMINATION Tachycardia and tachypnoea.

INVESTIGATIONS FBC, U + Es, LFTs, Ca, TFTs.

MANAGEMENT

• Anxiety management:
  • psychoeducation
  • distraction techniques
  • cognitive control
  • breathing/relaxation techniques
• Benzodiazepines may be useful in the short term.
• SSRIs or venlafaxine are useful.

COMPLICATIONS Half will develop a depressive illness. May misuse alcohol or illicit substances to cope with anxiety.

PROGNOSIS Course may be chronic, worse at times of stress. Poor prognosis is associated with longer duration of illness, co-morbid psychiatric disorder and poor premorbid personality.

Anxiety disorders – social phobia

DEFINITION Persistent fear of social situations that may lead to scrutiny, criticism or embarrassment (e.g. eating, drinking, speaking in public).

AETIOLOGY There is evidence from family studies of a genetic component.

ASSOCIATIONS/RISK FACTORS More likely in those with lifelong sensitivity to critiscism and avoidant personality disorder.

EPIDEMIOLOGY F > M. Onset gradual from late adolescence.

HISTORY Situational anxiety in social groups: parties, meetings, classrooms. There is marked avoidance of these situations. There will be anxiety symptoms and blushing, trembling, fear of vomiting and urgency/fear of micturition.

EXAMINATION Normal unless exposed to social situation. Then blushing, shaking, restless, avoids eye contact. Fear of scrutiny/humiliation. Fear of vomiting/fainting.

MANAGEMENT Graded exposure and desensitisation. CBT. SSRIs.

COMPLICATIONS Social phobia may be secondary to a depressive illness when social performance declines. Secondary alcohol and substance misuse is common.

PROGNOSIS Generally present for life.

Anxiety disorders – specific phobia

DEFINITION Persistent fear of a specific object or situation, out of proportion to the threat of the situation. The fear is recognised as excessive, but cannot be reasoned away.

AETIOLOGY There is evidence for a familial pattern of phobias. Classical conditioni...

Table of contents

• Cover
• Title
• Copyright
• Preface
• Acknowledgements
• List of Abbreviations
• Introduction to Psychiatry
• Differential Diagnosis
• General Adult Psychiatry
• Neuropsychiatry
• Child and Adolescent Psychiatry
• Old Age Psychiatry
• Psychiatry of Learning Disability
• Forensic Psychiatry
• Psychotherapy
• PsychopharmacoIogy
• Appendices
• Glossary