29.04 - the day of the Gnarklebark Flashcards

Question

3 core symptoms of PTSD

Answer 1

Hyperarousal: persistent anxiety, irritability, insomnia, poor concentration Re-experiencing: flashbacks Avoidance: numbness, loss of interest in activities, avoiding reminders These symptoms persist beyond 6 MONTHS after event Substance abuse and guilt common Can also occur years later, if reactivation

Answer 2

Psychoeducation Trauma focused CBT Eye movement desensitisation and Reprocessing (EMDR) Antidepressants (SSRIs) Social: family support/education Reintegration Avoid alcohol

Answer 3

``` Chronic empty feeling Abandonment fears Relationships are unstable and intense Suicide attempts and self-harm Occasional psychotic features (pseudohallucinations) ```

Answer 4

``` Lacks impusle control Outbursts of violence Sensitivity to being criticised Emotional instability Inability to plan ahead Thoughtless of consequence ```

Answer 5

Dialectical behavioral therapy Group therapies Admit if danger to self Help from seniors Mood stabilisers or antidepressants may be helpful. Antipsyhcotics for agitation

Answer 6

Acute intoxication Harmful use Dependence syndrome Withdrawal

Answer 7

Primacy (obtaining drug becomes most important) Continued use despite negative consequences (eg. loss of family, money) Loss of control of consumption (early morning start) Narrowing of repertoire (same drug in same setting with same people) Rapid reinstatement of dependent use after abstinence Tolerance and withdrawal

Answer 8

4-12 hours after last drink ``` Coarse tremor Sweating Tachycardia Nausea Vomiting Agitation Insomnia ``` Intense cravings Lasts 2-5 days Transient hallucinations are possible

Answer 9

Peaks at 4-6 days ``` Acute confusion Amnesia Psychomotor agitation Psychosis Delirium tremens ``` Seizures: 5-15% of cases Occur 6-48hrs after last drink

Answer 10

Medical emergency Occurs 1-7 days post drink in 5% Disoriented to time, place and person ``` Recent amnesia Hallucinations and delusions Severe psychomotor agitation Fever Autonomic disturbance and electrolyte imbalance ``` 40% mortality if left untreated

Answer 11

Benzodiazepines for symptomatic relief (Chlordiazepoxide) Nutritional and vitamin supplementation (Thiamine and B vitamins for WErnicke's) Close monitoring Admit if: past hx of complicated withdrawal, current psychiatric symptoms, severe malnutrition, severe biochemical abnormalities

Answer 12

Neuronal degeneration 2° to thiamine deficiency 1. acute confusional state 2. Ophthalmoplegia, nystagmus 3. Ataxic gait Complete triad only in 10%. Confusion in 80% Tx IV Pabrinex (B1 replacement) If left untreated, 80% progress to Korsakoff's

Answer 13

Usually due to thiamine deficiency Can be chronic anterograde amnesia with some retrograde amnesia Confabulation (describe false memories) Apathy KEEP ON THIAMINE and MULTIVITs for 2 yrs!

Answer 14

Disulfiram (alcohol deterrent. Irreversibly inhibits ADH. Build of ADH causes flushing, headache, tachycardia and vomiting) Motivational interviewing CBT Assertiveness training (learning to say no) AA Social support

Answer 15

Methadone (symptomatic tx) Lofexidine (reduces symptoms) Anti-emetics

Answer 16

First 48hrs Temporary excitement, mild overactive with insomnia Self-resolves

Answer 17

``` 50-80% Day 3-10 Tearfulness Emotional lability Anxiety Lasts 48hrs and self-resolves ```

Answer 18

Peak onset 2-4 weeks | 50% risk of recurrence if previous severe depression or postnatal depression

Answer 19

Edinburgh scale!

Answer 20

50% present by day 7 Almost all by day 90 50% risk with bipolar or previous psychosis

Answer 21

Clouding of consciousness Disturbed cognition 1 of: variable activity levels, increased reaction time, altered speecn of flow +1 of: insomnia, daytime drowsiness, nocturnal worsening of symptoms, disturbing dreams

Answer 22

Lorazepam (quick onset) Anti-psychotics: olanzapine or haloperidol

Answer 23

Reversible extrapyramidal side effects that occur due to anti-psychotics Muscle spasm occurring aywhere in the body. Can be lifethreatening if it affects laryngeal muscles!! IT is a psychiatric emergency Most common with haloperidol (in 10%) 30% Neck twisting 17% Tongue, 15% Jaw, 6% Oculogyric crisis (neck arched and eye rolled back)

Answer 24

Anticholinergics (Procyclidine 5-10mg)

Answer 25

It is only renally excreted Renal impairment Sodium depletion Can be with diuretics, NSAIDs and ACEI

Answer 26

``` Early: Tremor Anorexia N/V/D Dehydration and lethargy ``` ``` Late: Restlessness Muscle fasciculations Myoclonic jerk Hypertonicity ``` Ataxia, dysarthria, confusion, hypotension, arrhythmias

Answer 27

Stop lithium! Hydrate May require haemodialysis

Answer 28

Fever Diaphoresis Rigidity Confusion and fluctuating consciousness Autonomic instability: tachycardia, salivatin and incontinence SLOW onset! Days-weeks

Answer 29

withdraw antipsychotics!! Hydrate Consider benzos for sedation or bromocriptine

Answer 30

Usually when swithcing an antidepressant or combining Or when mixing with Triptans for migraines or illicit substances ``` Various symptoms come on within a few hours: Restlessness/Agitation/confusion Hyperthermia GI upset Mydriasis Myoclonus Rigidity Tremors/convulsions Ataxia ``` Can be fatal if left untreated

Answer 31

Stop serotonergic meds Rehydrate Benzos for severe agitation Consider gastric lavage if OD

29.04 - the day of the Gnarklebark Flashcards

(55 cards)