General Adult Flashcards

Question

PTSD (history)

Answer 1

Trauma - single or multiple/repeated Re-experiencing: flashbacks, recorring memories/nightmares, intrusive thoughts, phsyical sensations. Avoidance: staying away from reminders, keep busy all time, use of substances, emotionally numb, detached from body, amnesia of trauma details Alertness: jumpy, tense, on edge, panic attacks, self-distructive, hypervigilance to sounds C-PTSD - dfficult to connect, difficult relationships, worthlessness, emotional dysregulaiton - associated multiple trauma

Answer 2

Pre, during, post Thoughts feelings actions. Planning Feelings of the event Attempt not to be found. How found? Geeting affairs in order Suicide note? Substance misuse? Method? Did patient believe method fatal? Continued access to method? Hopelessness? Hx of DSH/prev attempts? FHx suicide Physical illness? Protective factors

Answer 3

Take history surrounding bereavement - time, events around it, expected, what kind of support received Reaction - Denial, Anger, Bargaining, Depression, Acceptance Screen for Depressive illness - including hopelessness and suicidal ideation Perceptual disturbances - differentiate from psychotic - eg: patient has insight, brief, related to sense of person being 'present' Normal - Mourning, sadness, missing and yearning, hallucinations near to the death, should not persist for months / years Abnormal - pathological (depression, excessive guilt, psychosis, functional loss)

Answer 4

Definition - Intrusive thoughts about perceived physical defects that cause a degree of distress and psychosocial impairment. Thoughts are responded to by repetitive behaviors, checking, concealing / use of makeup /camflage. Risks - as per usual Differential diagnosis - OCD, psychosis, anxiety, eating disorders Explore the impact that these beliefs are having on the patients life. Show empathy, avoid stating the perceived defect is true. Management: Surgery is usually contraindicated - explain lack of success of this approach Treat depression if present Reassurance and practical support SSRI may be helpful - high doses, long periods of time - especially in context of depressive symptoms NICE Guidelines - CBT or SSRIs

Answer 5

Sleep History: Sleep and waking function Precipitating factors Comorbid medical or psychiatric illness Sleep: Time of bedtime and waking Awakening - frequency, cause eg: full bladder, anxiety, SOB, Heartburn Pre Sleep - bedroom, good sleep hygiene, caffeine intake, medications, recent life events, naps during the day Impact: Refreshing sleep Headache, dry mouth Daytime somnolence Screening for OSA Screening for depression Restless leg syndrome Parasomnias Investigations: Sleep diary Physical health exam - exclude physical health causes Sleep study - Polysomnography Management: z-drugs for short term insomnia expected to resolve, not for chronic use as efficacy wanes with use Treating physical health conditions Addressing psychiatric conditions CBT-I

Answer 6

Time and decision specific Capacity is present until proven otherwise 1) Take in and retain information 2) Understand the information 3) Weigh up the information 4) Communicate the decision - If patient has capacity but chooses the 'wrong' decision, express your concerns and explain that the best possible decision has not been made. - - Patient is free to make the decision, but it is contrary to the advice of professionals. - Encourage them to speak with other professionals, agree to see them again. - Be aware that refusal may be due to misunderstanding treatment/illness and spend as much time understanding patients concerns as possible. Avoid jargon, offer multiple forms of information. - Has the patient been influenced by others - is refusal due to coercion? (If lacking capacity - Best interest decision to be covered elsewhere)

Answer 7

The legal position for where a patient should live is the same as for medical decisions Usual context is patient wishing to live alone at home, but physical and cognitive difficulties pose risk Assessment of capacity in keeping with MCA Consult with the family - ensure patients best interests are being met Apply for court of protection - supervise welfare decisions via court appointed deputy Document thoroughly decisions being made Has capacity: Accomodate patients wishes Express concern that this is not the best possible decision Explain this being contrary to professional advice Removal of dangerous items / set up alarm systems, wear pendant alarm, carer visits - facilitate wishes MDT conference - patient, carers, professionals Come back a second time to assess capacity Does not have capacity: Duty of care not to discharge dangerously Consult NOK As per usual - best interest decision making IMCA (Independent mental capacity advocate) - if no NOK or relatives suitable Second medical opinion if disagreement between medical team and relatives

Answer 8

Rare, potentially life threatening reaction to antipsychotics Fever, rigidity, altered mental stated, autonomic disturbance. Related to D2 blocade or dopamine depletion in brain. Causes abnormal homeostasis - EPSEs, temp control, diarrhoea, confusion, tachycardia, hyper or hypotension, Cannot predict it. 0.01-0.02% incidence Higher: under 40, males, high dose, catatonia or agitation, high ambient temp. IV benzo's, IV fluids, discontinue drug, external cooling, bromocriptine - ECT has been used.

Answer 9

Emotional instability Unstable relationships, Impuslive Disturbed self-image. Feelings of abandonment Recurrent self-harm Feelings of emptiness. Anger outbursts Transient psychotic/dissociative symptoms Risks to self and others

Answer 10

How much oral intake Thoughts around food/weight Any sensory issues when eating Purging behaviours Guilt associated with eating Pattern of eating Rapid weight loss Weakness Palpitations/Chest pain Reduced libido Amenorrhea Fractures

Answer 11

Risk factos: Young age Genetics Female FHx ED or other MH disorder Social pressures Adverse life events Personality traits - perfectionise. Co-morbid mental health High mortality. BMI, sit-up-squat-stand (SUSS), blood abnormalities (low electrolytes, immunocompromised), ECG Changes - brady, prolonged QTc,

Answer 12

Low body weight caused by abnormal eating behaviours outside of social or cultural norms. BMI under 18.5kg Deliberate weight loss induced by patient (e.g. not healht related or scarcity) Weight gain prevented by various means (vommiting, purging, diarrhoea, exercise, retricting. Preoccupation with weight and shape or overestimation of weight. 50% make a full recovery Community or hosptial dependent on need (particularly if risk of refeed). Dietician support, psychological therapy (modified CBT), medication for co-morbid psychiatric - some offlicense such as olanzapine have been used VERY cautious.

Answer 13

Occurs when food reintroduced after period of abstinence. Depletion of bodily stores of electrolytes Insulin released in response to food (and rising blood glucose) Body begins to synthesis glycogen, fat, protein Shifts serum levels down. (mag, phos, potass) Low serum levels can lead to heart arrhythmias which can be fatal. Food reintroduced by dietician gradually. Thiamine, vit B co-strong, multivitamin prescribed If not detained for ED - nurse will need to request formal capacity assessment if deemed incapacitous to refuse treatment.

Answer 14

History re: Birth - Date, Complications Timeline of symptoms Past psychiatric history Family history of perinatal psychiatric concerns Social isolation Domestic abuse Differentials: Baby Blues - few days post childbirth - mild depressive symptoms, irritability, emotional lability - Usually resolve within 2 weeks - is very common - Post Partum Depression - Depressive symptoms lasting longer than 2 weeks post delivery - Risks of neglect / lack of drive to feed (formula vs breastfeeding) - Post-partum psychosis - within days / weeks, can develop suddenly. Risks with FH and personal Hx of BPAD, extreme mood disturbance and psychosis - potentially life-threatening - Urgent treatment - RISKS: screen about harm to baby / harm from baby / other babies - Perinatal OCD - intrusive thoughts, compulsive behaviours, time spent performing these Management: Depression - SSRI (not fluoxetine)- Standard depression management (biopsychosocial)- Paroxetine drug of choice, sertraline, citalopram or SNRI / Mirtazapine - Mother and Baby unit / ECT / TMS - Breastfeeding or not influences options available - social groups (mother and baby groups, early years worker, OT) Psychosis - Standard psychosis (biopsychosocial) - Antipsychotic Quetiapine/Olanzapine, consider urgent MBU OCD - Standard OCD treatment - SSRI/CBT with ERP or combination, clomipramine

Answer 15

Begin with explain psychosis - more predisposed than others, characterised by loss of touch with reality - hallucinations, behaviour, delusions, thought disorder, functional loss Pregnancy and perinatal period bodily changes can lead to vulnerabilities Increased risk from past history of Post partum psychosis, FH of psychosis, BPAD Treatment response rate is good Recurrence may occur in future pregnancies Acknowledge patient-specific details Discuss the risks that you would be concerned about - Risks to mother, risks to baby Discuss management - Antipsychotics, mood stabilisers, inpatient admission to MBU, close monitoring Perinatal referral Provide leaflet / additional information

Answer 16

Type of medication that is injected into a large muscle of the leg or buttock. Slow releasing medication, designed to maintain the level in your body until your next injection. Typically 2-4 weekly. In community setting/clinic by trained nurse. Helpful for: compliance, difficulty taking tablets, prefer not to think about medicaiton daily. Risks: Abscess, bleeding, bruising, irritation, lumps, numbness, pain, redness, soreness, swelling. Note - as continue to act for e.g 2 weeks, if unpleasant side effect, cannot just stop giving tablet, so may experience for that period until medication washes out. Reduce risks by cycling injection sites.

Answer 17

MHA Law: Section 136 - 24hrs - Police - Reason to suspect a patient is behaving in a way that is warranting assessment by mental health team - triggers MHA Section 2 - 28 days - Assessment, treatment can be initiated (only mental health conditions or consequences of MH condition) 3 independent clinicians, 2 doctors, at least one section 12 approved doctor which is usually a psychiatrist, Approved mental health professional (AMPH) typically social workers (offering a non-medical opinion, helping organize the process, knowledge of local services). Interviewed and decided if there is sufficient evidence of a mental health condition that cannot be safely managed in the community. Can be converted to Section 3 Can be rescinded prior to finishing For a treatable MH condition No least restrictive option available Do not consent / cant consent to admission voluntarily Nearest relative - can apply for mental health tribunal hearing should they disagree, which take place within 7 days of application. Can apply for nearest relative discharge then RC has 72 hours to respond, if in disagreement then goes to hospital managers meeting. Tribunal - can appeal against section - tribunal will be set up to make the decision - can get free legal representation Section 3 - 6 months - For Treatment - has been assessed under Section 2 -> section 3. Or has known mental health problem, presenting with same difficulty, section 3 can be initiated. Treatment can be given against the will of the patient (only for MH diagnosis). (6 months, 6 months, then 1 year). Can be rescinded prior to 6 months as per Section 2. Section 17 leave - the patient is detained under section to the hospital. Can be allowed specific leave whilst under this section, which will be written up as S17 leave. Right to access IMHA - advocate for you Right to having legal representation Second opinion appointed doctor (SOAD) - 3 months - independent review Section 5(2) - 72 hrs

Answer 18

All relevant cirumstances considered (diagnosis, care needs, etc) Persons own beliefes / values Persons past / present wishes and feelings Consult others who are involved in their care (NOK, family, relative, carers, attorneys) Any other factor the person would consider? Will they regain capacity? Can it wait? Is there a least restrictive option? Encourage patient to be involved as much as possible Decision not made solely based on age, condition, behaviour Life sustaining treatment - decision not motivated by wanting to bring about person's death - consider all of the above and have a reasonable belief about person's best interest

Answer 19

What is it: 'It also works in a similar way to ECT by simulating the brain, although with magnetic fields rather than electricity. This promotes the brain to mend and make new connections' Non invasive Does not require sedation How is it given: Centre specific but, usually 30 minute sessions given 5 days per week for 2-6 weeks. Length of treatment tends to depend on responce. Why do we give it: Depression or anxiety that has not responded to conventional antidepressant Risks: Absolute Contraindications - MRI - Metal in the head / Relative contraindications - pacemakers / medical devices / tumours or vascular events Discomfort around administration site - 'clicking' Headache, dizziness Twitching in the face Rare (1/60,000) risk of seizure Blood glucose if diabetic Benefits: Can see benefits within one week, but some people will take the full course to see the benefit. Extras: Able to drive between sessions provided side effects not too severe

Answer 20

What is it? The VNS procedure happens using anaesthetic. This will either be general anaesthetic, which sends you to sleep. Or local anaesthetic, where you are awake but a part of your body is made numb. Doctors will place a small electric device under the skin of your chest, just below your collar bone. This device is a bit like a pacemaker. They will attach this device with some wires to a nerve in the left side of your neck. This is called the vagus nerve, which naturally sends signals to your brain. The VNS device sends electrical pulses to your vagus nerve to stimulate this process. This stimulation will happen automatically for 30 seconds every 5 minutes. The VNS device will stay in until it runs out of battery. This can take 3 to 8 years. If you need to, you can have the device turned off or removed. How long does it take to work? VNS may help to improve your mood and reduce your symptoms of depression. Some people can feel a little better straight after surgery. Others may take 6 months or longer before noticing any improvements in their symptoms. Risks: Feeling hoarse or having other changes to your voice Coughing Headaches Neck pain Feeling prickles or tingles in your skin Sore throat Difficulty breathing Difficulty swallowing Feel the pulse Surgical complications Benefits: Improve mood and reduce symptoms of depression

General Adult Flashcards

(44 cards)