Day: April 13, 2024

Overview Wernicke-Korsakoff syndrome refers to two distinct neurological syndromes resulting from thiamine (Vitamin B1) deficiency. Wernicke-Korsakoff syndrome (WKS) refers to a disease spectrum causing two classical neurological syndromes as a result of thiamine (vitamin B1) deficiency: Wernicke’s encephalopathy (WE): an acute encephalopathy characterised by a triad of confusion, ataxia, and oculomotor dysfunction Korsakoff syndrome (KS): a chronic amnesic syndrome characterised by defects in both anterograde and retrograde memory The syndromes are most commonly observed in chronic alcoholism because of poor dietary intake, although other factors are involved including a possible genetic element. WKS is not restricted to chronic alcoholism and may be observed in other conditions

Introduction Substance abuse or misuse is a repetitive harmful pattern of substance use that leads to negative consequences Substance abuse is a major problem both in the UK and more broadly across the world. Common substances of abuse, which can lead to dependence, include alcohol, opioids, cocaine, and a variety of legal substances such as nicotine and caffeine. In this article, we go over the general principles for substance misuse. For more specific information regarding a single substance, please see the relevant notes in our Psychiatry section. Substance abuse or misuse Substance abuse or misuse is a repetitive harmful pattern of substance use

Introduction In phobias, the fear response is excessive, irrational, and can have debilitating consequences for individuals. Fear is an uncomfortable emotion that occurs in response to threatening situations. The purpose of fear is to motivate an individual to protect themselves and avoid harm. Fear is therefore a rational reaction to a real threat or danger. In phobias, the fear response is excessive, irrational, and can have debilitating consequences for the individual. There is an exaggerated or unrealistic sense of danger about the phobic situation or object, which persists despite evidence to the contrary. In some cases, even thinking about the phobic object

Introduction In social anxiety disorder, the fear of social situations is overwhelming and disproportionate. It is normal to feel nervous in some social situations, such as attending a job interview or going on a date. However, in social anxiety disorder, the fear of social situations is overwhelming and disproportionate. The individual is fearful of being negatively judged by others in a variety of social settings including everyday social interactions, being observed by others, and performing in front of others. There may be a fear of humiliation, embarrassment, or social rejection. Individuals with social anxiety disorder therefore strive to avoid these social

Overview Serotonin syndrome can be a life-threatening neurological disorder due to increased serotonergic activity in the central nervous system. Serotonin syndrome (SS) is a potentially life-threatening disorder that is characterised by altered mental status (i.e. confusion), autonomic hyperactivity, and neuromuscular abnormalities (e.g. rigidity, clonus, hyperreflexia). It is due to increased serotonergic activity in the central nervous system (CNS) that can be induced by a range of medications that increase serotonergic transmission by altering the neurotransmitter serotonin. There is a wide clinical spectrum and the prognosis is generally favourable although severe cases may require treatment in intensive care. Epidemiology The incidence of SS has been increasing due to

Overview Schizophrenia, a form of psychosis, is characterised by distortion to thinking and perception and inappropriate or blunted affect. Schizophrenia is the most common form of psychosis with an onset that is typically early in life (15 to 35). It is a chronic condition with a course characterised by episodes of acute psychosis. Features that are common to psychoses are: Hallucinations: hallucinations can be defined as perceptions in the absence of stimuli. Most commonly auditory but may be visual or affect smell, taste, or tactile senses. Delusions: a fixed, false belief not in keeping with cultural and educational background. Thought and speech disorder:

Introduction Post-traumatic stress disorder (PTSD) describes a constellation of symptoms and experiences that an individual develops after exposure to a traumatic event or multiple events Many people who experience a traumatic event will struggle with negative emotions, thoughts, and unpleasant memories of the event. These symptoms are often transient and ease over time but for some, symptoms will persist and intensify. Post-traumatic stress disorder (PTSD) describes a constellation of symptoms and experiences that an individual develops after exposure to a traumatic event or multiple events. These include: Re-experiencing the traumatic event (e.g. memories, flashbacks, nightmares). Avoiding thoughts and memories: individuals typically try to

Introduction Pica is a mental health condition where a person compulsively swallows non-food items. Pica refers to the eating or craving of things that are not food and do not contain significant nutritional value. The term is derived from “pica-pica” the Latin word for the magpie; a bird with a tendency for gathering and eating an odd assortment of items. PICA is classified as an eating disorder but can also be the result of an existing mental disorder, or occur in the context of pregnancy or vitamin deficiencies. There are different types of pica, which can be characterised by the non-food

Introduction Personality is described as the “combination of characteristics or qualities that form an individual’s distinctive character“. Personality describes an individual’s enduring personal characteristics, including their unique patterns of thinking, feeling, and behaving. Personalities are thought to be formed from a combination of a person’s innate temperament, environmental factors, and life experiences. Personality disorders, commonly abbreviated to “PD”, occur when personality traits deviate significantly from the norm and manifest in harmful patterns of thinking, feeling, behaving, and interacting with others. Personality disorders tend to become evident during late adolescence or early adulthood but are not usually diagnosed under the age

Introduction Opioid is a broad term used to describe naturally occurring or synthetic substances that bind to opioid receptors. Opioids are naturally occurring or synthetic substances that bind to opioid receptors. They may have agonist, partial agonist, or mixed agonist and antagonist activity at opioid receptors. An opiate is a natural derivative of the flowering opium poppy plant that has activity at opioid receptors. All opiates are opioids but not all opioids are opiates. In these notes we will use the term opioids of which there are several types: Naturally occurring opioids (i.e. opiates): codeine, morphine, and heroin. Synthetic opioids: fentanyl, methadone,

Introduction Obsessive compulsive disorder is characterised by the presence of obsessions and/or compulsions. It is a relatively common disorder with a wide clinical spectrum. It may significantly impact an individual’s daily life and be a cause of profound functional impairment. NICE reports that anywhere between 1-3% of the UK population are affected. It is characterised by two features: Obsessions: intrusive thoughts, urges and images that cause anxiety and distress. Compulsions: repetitive behaviours that one feels compelled to perform, these may be observable or occur in the mind (e.g. repeating a phrase). Epidemiology OCD is a leading cause of global disease burden. It

Overview Neuroleptic malignant syndrome is a life-threatening neurological disorder characterised by confusion, fever, and rigidity. Neuroleptic malignant syndrome (NMS), is a rare, life-threatening disorder that is associated with the use of antipsychotic drugs (previously known as neuroleptic medications) but the exact cause is unknown. The condition is characterised by altered mental status (i.e. confusion), fever, muscular rigidity, and dysautonomia (i.e. autonomic instability). It is associated with high mortality (~10-20%) and requires a low index of suspicion in patients presenting with characteristic symptoms (i.e. fever or rigidity) whilst taking antipsychotics. Treatment is largely supportive and most episodes will resolve within two weeks

Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by persistent symptoms of inattention, hyperactivity and impulsivity. Attention deficit hyperactivity disorder (ADHD) is considered one the neurodevelopmental disorders such as Autism spectrum disorder. It is characterised by persistent symptoms of inattention, hyperactivity, and impulsivity. Inattention: may manifest as forgetfulness, being easily distracted, difficulty organising and prioritising tasks, seeming not to listen, and losing belongings. Hyperactivity: may present as excessive fidgeting, difficulty sitting still, restlessness, and being overly talkative. Impulsivity: may manifest as difficulty waiting their turn and interrupting others. These three hallmark symptoms are present across several settings (e.g.

Introduction ARFID is known as avoidant/restrictive food intake disorder, which is characteristed by a pattern of eating leading to avoidance and/or restriction of food. Avoidant/restrictive food intake disorder (ARFID) is characterised by a pattern of eating where there is avoidance and/or restriction of the food type or quantity of food eaten. This tends to have negative consequences for an individual’s physical health leading to weight loss, and nutritional deficiencies. The avoidance and/or restriction of foods in ARFID can occur for several reasons including: Sensory-based avoidance of food: the individual may dislike the smell, texture, taste, or look of certain foods.