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Year 4 PT > Psychiatry + Ethics > Flashcards

Psychiatry + Ethics Flashcards

1
Q

What is lithium used to treat and how do you take it? What blood tests are checked?

A

Bipolar

tablet and liquid form: take same time every day usually at night with lots of water

lithium levels checked 12 hours post dose, weekly and then every 3 months

Since lithium has thyroid and renal affects
thyroid, renal and calcium status should also be checked every 6 months

patient will receive a lithium dose record book

no pregnancy or breastfeeding

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2
Q

What is fluoxetine used for and how does it work?

A

SSRI

depression: first line treatment is sertraline SSRI, however if it is a teenager then give fluoxetine

panic attacks, OCD, bulimia

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3
Q

What are the age rules for gender dysphoria relating to MEDICAL treatment (e.g. hormone blockers)?

A

If your child is under 18 and may have gender dysphoria, they’ll usually be referred to the Gender Identity Development Service (GIDS) –> usually psychological rather than medical treatment

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4
Q

What drug is used to treat sertatonin syndrome?

A

Cyphrohepatidine

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5
Q

What is St John’s Wort? And can it be used with contraception?

A

(Hypericum perforatum) is a herbal remedy for treating mild depression

cannot be used with the COCP

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6
Q

When people are started on antidepressants for the first time, what must be done?

A

reviewed every 1–2 weeks at the start of antidepressant treatment.

Treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering whether to switch antidepressant

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7
Q

What do the different mental health acts mean?
17, 37, 135, 136, 5 (4), 5 (2), 4, 3, 2

A

-17: patients detained under sections 2 and 3 of the Act to be granted leave of absence
-37: should be in hospital instead of prison after committing a crime
-135 up your drive: police can enter your home to take you to a place of safety
-136: police detain in a public place
-5 (4): nurse holding power for 6hrs
-5 (2): doctor 72hr holding power
-4: 72 hr assessment used in emergency
-3: 6 months admission for treatment with a section 12 doctor
-2: admission for 28 days for treatment against patients wishes with a section 12 doctor

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8
Q

What is the age of consent for medical treatment in WALES?

A

16 or over

Children under the age of 16 can consent to their own treatment if they’re believed to have Gillick competent.

Otherwise, someone with parental responsibility can consent for them.

If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent.

The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health.

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9
Q

What is the difference between PTSD and acute stress disorder? What is the treatment for PTSD?

A

Acute stress disorder occurs in the 4 weeks after a traumatic event, as opposed to PTSD which is diagnosed after 4 weeks.

PTSD –> CBT, eye movement desensitisation and reprocessing (EMDR)
if these fail –> venlafaxine or SSRI

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10
Q

How is the “cheese crisis” treated?

A

Reversible MAOI e.g. Moclobemide

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11
Q

What is clonus?

A

neurological condition that creates involuntary muscle contractions. This results in uncontrollable, rhythmic, shaking movements.

Clonus primarily occurs in muscles that control the knees and ankles. It’s usually brought on by excessive stretching of these muscles

caused by lots of things but in overdoses only seen in SEROTONIN drug overdoses (SSRIs)

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12
Q

What is the definition and treatment for OCD?

A

Spends more than 3hrs a day on OCD- THIS IS A SEVERE case not a mild one

mild: CBT or ERP (exposure therapy)
moderate: SSRI or intensive CBT
severe: mental health team refer, SSRI and CBT

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13
Q

What is electroconvulsive therapy (ECT)?

A

first-line treatment in some patients with severe depression, including those with life-threatening features, psychotic symptoms, suicidality, or catatonia (thinks they’re dead).

It is also indicated later in treatment for people with refractory depression or intolerance to antidepressants

side effects:
arrhythmias
headaches
short term memory impairment

can be used in pregnancy

CANNOT be used if:
raised ICP, brain tumour/aneurysm
recent MI
Any acute medical conditions

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14
Q

What is the HADS score?

A

Scoring system for hospital anxiety and depression

0-21 (21 being worst)

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15
Q

What is the treatment for anorexia nervosa in adults and children?

A

Adults:
-eating-disorder-focused cognitive behavioural therapy (CBT-ED)
-Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
-specialist supportive clinical management (SSCM)

In children and young people:
-anorexia focused family therapy’ as the first-line treatment
-cognitive behavioural therapy

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16
Q

What is the difference between and type 1 and 2 error?

A

type 1:H0 is true but we reject it - FALSE POSITIVE

type 2:H0 is false but we fail to reject it -FALSE NEGATIVE

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17
Q

What are the side effects of TCA’s e.g. amitriptyline?

A

can’t pee (overflow incontinence), can’t see, can’t spit, can’t shit

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18
Q

What is Cotard syndrome?

A

patient thinks a part of their body or themselves is dead or non-existent

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19
Q

What are the postpartum mental health problems that could occur?

A

baby blues: 60-70% of women: reassurance

postnatal depression: 10%: seen within a month and peaks at 3months: CBT or SSRIs

puerperal psychosis: linked to bipolar, seen in the first 2-3 weeks: admission to mother & baby unit

sheehan’s syndrome
postpartum thyroiditis

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20
Q

What is the difference between the thought disorders: Knight’s move, Flight of ideas, circumstantiality?

A

Knight’s = where the patient jumps from topic to topic without any clear or logical link between each sentence

Flight = small links between topics, seen in mania

circumstantiality = inability to answer a question without giving excessive, unnecessary detail

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21
Q

What is the difference between paranoid, schizoid and schizotypal personality disorders?

A

paranoid = hypersensitive and unforgiving

schizoid = prefers solitary activites, lack of interest in sexual interactions, emotional coldness

schizotypal = lack of close friends, odd beliefs, odd speech

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22
Q

What is tangentiality?

A

wandering from a topic without returning to it

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23
Q

What is generalised anxiety disorder (GAD) and panic disorder and how do you treat them?

A

GAD: excessive worry plus muscle tension, autonomic arousal, sleep disturbance all for 6 months—-> education, self-help, CBT, sertraline

Panic disorder:recurring panic attacks, catastrophizing, fear of dying—>CBT or SSRIs

AVOID benzos

RULE OUT HYPERTHYROIDISM

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24
Q

What is the difference between bipolar type I and II?

A

type I: MANIA (for 7 days or more and has psychotic symptoms like auditory hallucinations) and DEPRESSION

type II: hypomania (for 4 days or more), still able to function e.g. attending work, still self-caring

lithium is used to treat

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25
Q

What is Russell’s sign? And what electrolyte imbalance is seen with this condition?

A

calluses on the knuckles or back of the hand due to repeated self-induced vomiting

seen in Bulimia nervosa - intentional vomiting or using laxatives/exercising to lose weight

hypokalaemia can be seen with bulimia nervosa

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26
Q

When can you not give zopiclone and what are the risks?

A

seasonal affective disorder

increases risk of falls in elderly

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27
Q

What’s the definition of delayed and prolonged grief?

A

delayed: more than 2 weeks

prolonged: up to or more than 12 months

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28
Q

What is ADHD (attention deficit hyperactivity disorder)?

A

talk all the time, easily distracted, cannot follow instructions, cannot play quietly, run and climb in inappropriate situations etc.

More common in boys

10 weeks watch and wait
refer to paediatrician

drug therapy only for 5 years old or older and who do not respond to therapeutic ways:
methylphenidate in adults and children- 6 week trial (weight and height monitored)

cardiotoxic drugs so ECG before treatment

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29
Q

What is De Clerambault’s syndrome (erotomania)?

A

delusion with an amorous quality e.g. woman thinks a famous person is in love with her

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30
Q

What should you do if you are switching from fluoxetine to another SSRI?

A

withdraw (gradually reduce then stop) then leave a gap of 4-7 days before starting a low-dose alternative SSRI

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31
Q

Can you just stop taking antidepressants?

A

no, keep going for at least 6 months after remission to stop relapse

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32
Q

What are the common adverse effects of atypical antipsychotics e.g. clozapine, olanzapine, RISPERIDONE?

A

-weight gain
-agranulocytosis
-hyperprolactinaemia (gynaecomastia, loss of libido and erectile dysfunction) –> switching to aripiprazole helps with this

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33
Q

How would a patient present if they had alcohol withdrawal and how would you treat this?

A

Calculate CIWA score

6-12 hours: tremor, sweating, tachy, anxiety
36 hours: seizures
48-72 hours: delirium tremens –> coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachy

treat with TAPERING chloradiazepoxide or diazepam
pabrinex

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34
Q

What is LSD intoxication E.g. acid?

A

causes colourful, visual hallucinations, depersonalisation and paranoia

give –> lorazepam

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35
Q

What are clang associations?

A

ideas related only by rhyme or similar sounding

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36
Q

Antipsychotics can cause acute dystonia (involuntary movements of muscles), what can be given to help this?

A

Procyclidine

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37
Q

What is Mirtazapine?

A

an antidepressant but it is useful to use to help people with fatigue as it makes them sleepy but also can increase their appetite

38
Q

What mental health drug can cause hyperparathyroidism?

A

lithium

39
Q

What drugs can you not give with SSRIs e.g. citalopram?

A

NSAIDs
aspirin
triptans

40
Q

What is lithium toxicity, what causes it and how do you treat it?

A

Toxic level is 1.2mmol/l

causes:
dehydration
renal failure
drugs: ACE-inhib/ARB, NSAIDs, diuretics (thiazide), metronidazole

GI problems: nausea, diarrhoea, vomiting
Motor: tremor, slurred speech
Cerebral: drowsy, fits

Treatment: haemodialysis, fluids

41
Q

What drugs can cause sudden onset psychosis?

A

steroids

42
Q

What antipsychotic can make seizures more likely?

A

Clozapine

43
Q

What is mania/hypomania and how do you treat it?

A

Elevated mood
excitement
irritability
inappropriate
reduced sleep
increased energy

-crisis team referal
-MDT approach
-STOP antidepressant and START antipsychotic/lithium

44
Q

What risk factor is the strongest for developing psychotic disorders?

A

family history of the psychotic disorder

45
Q

What is vaginismus?

A

body’s automatic reaction to the fear of some or all types of vaginal penetration.

Whenever penetration is attempted, your vaginal muscles tighten up on their owntreatment –> psychosexual therapy, mindfulness, pelvic floor exercises, vaginal trainers

46
Q

What is Charles-Bonnet syndrome (CBS)?

A

hallucinations (usually visual or auditory) occurring in clear consciousness

USUALLY have a history of visual impairment

CBS must occur in the absence of any other significant neuropsychiatric disturbance e.g. they must psychologically normal compared to schizophrenia where they are not

** associated with AGE-RELATED MACULAR DEGENERATION **

47
Q

What are the core symptoms of depression and how do you diagnose?

A

-Low mood
-Anhedonia: low interest or pleasure in most activities of the day
-Lack of energy (anergia)

^at least for 2 weeks

must ask about suicide/self harm

-HADS scale
-patient health questionnaire (PHQ-9)
-DSM-5 criteria

48
Q

If someone presents as feeling tired, lack of energy, low mood, what could the differentials be?

A

depression
hypothyroidism
anaemia
vitamin B12 deficiency

49
Q

What is Treatment Resistance Depression?

A

Lack of response to 2 anti-depressants

Strategies to overcome resistance:
-Combination of antidepressants
-Potentiation with Lithium and other mood stabilisers
-Monoamine Oxidase Inhibitors (MAOI)
-ECT

50
Q

What are the three main delusions about in psychotic depression?

A

health, wealth, self-esteem

51
Q

What is pysychosis and what is the diagnostic criteria for schizophrenia and how is it treated?

A

DSM-5 and the ICD-11

At least two or more of the following for 1 month or a significant period of time during this:
-hallucinations (e.g. auditory)
-delusions
-thought disorganisation e.g. world salad-catatonic behaviour (awake but not responding to people)
-also could have depression and self-harm

A ‘brief psychotic disorder is where symptoms last less than a month

crisis team involved
CBT
lifestyle measures
haloperidol (typical)
olanzapine (aytypical)
risperidone
aripiprazole
benzos

52
Q

What is agoraphobia?

A

fear of going to open or crowded places, leaving home, panic attacks at these outdoor places etc

Treatment—> graded exposure

53
Q

What is PANDAS?

A

OCD (obsessive compulsive disorder), tics or both suddenly appear after a strep infection (E.g. scarlet fever, strep throat) in children

54
Q

What SSRI is best for people post myocardial infarction?

A

Sertraline

55
Q

What is the difference between OCD and OCPD?

A

OCD is an anxiety disorder in which you have frequent unwanted and intrusive thoughts (obsessions) that cause you to perform repetitive behaviors (compulsions)

OCPD: occupied with details, rules, lists, order, organization, or agenda

56
Q

What are the extrapyramidal side-effects (EPSEs) of taking typical antipsychotics for a long time e.g. haloperidol, chlorpromazine and what can you give to help?

A

-Tardive Dyskinesia: involuntary lip smacking, pouting of jaw, chewing —> give tetrabenazine
-Akathisia: inner restlessness and inability to keep still
-Acute Dystonia: muscle contraction e.g. oculogyric crisis–> give procyclidine

57
Q

What is conversion disorder?

A

loss of motor or sensory function due to no cause

Hoover’s sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis

58
Q

What are the factors that would suggest an INCREASED risk of suicide?

A

-male
-history of self-harm
-alcohol or drug misuse
-history of mental illness
-unemployment
-unmarried/divorced/widowed
-planning
-avoid discovery
-writing a note
-final acts: sorting out finances

59
Q

How do you stop a SSRI completely?

A

Should be withdrawn gradually over 4 weeks

60
Q

What are the main side effects of SSRIs?

A

GI symptoms incl. bleeding

hyponatraemia

citalopram is associated with a prolonged QT interval (normal = less than 430m/450f)

61
Q

What are the physiological abnormalities seen in anorexia nervosa?

A

everything is usually LOW apart from raised G’s and C’s (glucose, growth hormones, cortisol, cholesterol, carotinaemia)

62
Q

When do you decide to start clozapine?

A

Only used in patients who are resistant to 2 or more antipsychotics

this is because clozapine needs constant blood count monitoring and can cause seizures

63
Q

What is Korsakoff’s syndrome?

A

Memory disorder seen in alcoholics

can lead to Wernicke’s encephalopathy

-anterograde amnesia
-retrograde amnesia
-confabulation: gaps in memory are filled with things they have imagined

Treatmeant:
Pabrinex (IV B/C vitamins)

64
Q

What screening tool is used for postnatal depression?

A

Edinburgh scale

65
Q

What is Münchausen’s syndrome?

A

Purposefully causing symptoms, for example a diabetic taking too much insulin to cause hypos

66
Q

How can you tell the difference between Alzheimer’s and depression in a history?

A

Symptoms pointing towards depression:
Recent loss of a spouse
Loss of appetite
Early morning wakening
Poor concentration

67
Q

What are delusions of persecution?

A

They are convinced someone is mistreating, conspiring against, or planning to harm you or your loved one

68
Q

What is delusions of reference?

A

Patient believes that unsuspicious occurrences refer to them e.g. news is directed at them, music playing is for them

69
Q

What happens if you miss a lithium dose?

A

DO NOT take a double dose
instead take next dose as normal

A sudden TOTAL stoppage of lithium can cause mania

70
Q

Can you take lithium whilst pregnant/breastfeeding?

A

discuss risks and benefits of medication

birth defects and fetal heart problems
NO breastfeeding

71
Q

What can cause a rise in clozapine levels in the blood?

A

if patients STOP smoking

72
Q

What monitoring is needed for antipsychotics?

A

baseline and yearly:
BMI
FBC, U+Es, LFTs, eGFR, lipids, glucose, prolactin
ECG
pulse and BP

6 months and then yearly:
prolactin

73
Q

Can you give SSRIs with MAOIs (selegiline)?

A

No, as can cause serotonin syndrome

74
Q

What is othello syndrome?

A

Delusional jealousy, usually believing their partner is unfaithful

75
Q

What is a poor, prognostic indicator of schizophrenia?

A

Gradual onset

76
Q

What do you do if someone is on antidepressants and they are going to have ECT treatment?

A

Reduce their dose

77
Q

What symptoms does SSRI discontinuation syndrome cause?

A

Dizziness
Electric shock sensations
Anxiety

78
Q

A patient presents with polyuria and polydipsia and has been taking lithium for bipolar, what do you need to consider?

A

nephrogenic diabetes insipidus

79
Q

What types of drug can cause glucose dysregulation and diabetes e.g. polyuria and polydipsia?

A

Long term atypical antipsychotics and lithium

80
Q

How do you asses the mental capacity act?

A

Understand
Retain
Weigh
Communicate Decision

-why they are here and why they need treatment
-benefits vs risk and what will happen if don’t have treatment
-tell me your decision

81
Q

What help is there available for alcoholics?

A

-groups
-charities
-detox: chlordiazepoxide
-reduce relapses: acamprosate (reduce cravings)
-vitamin B supplements

82
Q

What monitoring is required for clozapine specifically?

A

FBC’s weekly for 18 weeks, then fortnightly for up to one year, and then monthly

Lipids and weight should be measured at baseline, at 3 months for the first year and then yearly.

Fasting blood glucose at baseline, one month
and then every 4–6 months.

83
Q

What are the ACUTE differential diagnoses in psych to consider?

A

-acute stress reaction
-emotionally unstable personality disorder
-bipolar
-drug induced psychosis
-serotonin syndrome

84
Q

How do you treat bulimia nervosa and what could the differentials be?

A

-Eating disorder focused CBT
-in children: anorexia focused family therapy groups
-refer to CAHMS (in children)
-ECG monitoring (hypokalaemia)
-weight and height monitoring (BMI)
-IV fluids
-NG tube
-sectioning

Differentials:
Bulimia
Anorexia
Depression

85
Q

How do you sedate an agitated patient who is at risk to self or others?

A

-Try to camp patient down and moved to a safe place
-Call security
-Turn on the lights and explain where they are and the time and ask if a relative is near to come in to the room

LORAZEPAM 1-2mg PO/IM
OR HALOPERIDOL 2-5mg PO/IM

Repeat at 30-60mins up to 3 times
If this fails call anaesthetist

-half doses in elderly or renal failure
-haloperidol is contraindicated in Parkinson’s, Lewy body dementia, alcohol withdrawal, heart problems
-ensure procyclidine is available if using haloperidol to counteract

-REMEMBER TO DOCUMENT WHY

86
Q

How do you structure the conversation when you are information sharing to a patient e.g. Explaining a disease, procedure, and new drug?

A

BUCES

-Brief history from them
-Understanding
-Concerns
-Explain
—> normal anatomy/physiology, what the disease is, cause, complications, management
-Summarise: any Qs

87
Q

How do you assess risk?

A

1) risk to self:
-self harm (if so then take a history on this)
-look after themselves (hygiene, substances, physical health)

2) risk from others:
-do they feel safe at home?
-has anyone hurt you?

3) risk to others:
-sometimes when people are going through difficult things, they might have thoughts to harm other people. Have you ever thought about this?
-is anyone telling you to harm other people

88
Q

What is the difference between the mental capacity and the mental health act?

A

Someone who has a mental health history e.g. Schizophrenia, might come in with a chest infection but refusing antibiotics.
You would use the mental CAPACITY ACT

Someone who has a mental health history e.g. bipolar, depression, eating disorders, Schizophrenia, who is refusing to take their antipsychotics and going to harm themselves.
You would use the mental HEALTH act

89
Q

What PHQ-9 score indicates a more severe case of depression?

A

16 or over

90
Q

What adverse effects can using antipsychotics cause in the elderly?

A

Increased risk of stroke and VTE

91
Q

How do you reverse haloperidol?

A

Procyclidine

92
Q

What antipsychotic is linked to constipation and intestinal obstruction?

A

Clozapine

Year 4 PT (14 decks)

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