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Flashcards in General Adult Deck (41)
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1

Genetic risk of schizophrenia

Population risk - 1%
Grandchildren - 5%
Half-sibling - 6%
Full sibling - 9%
Child - 13%
Fraternal twin - 17%
Child (dual mating) - 46%
Identical twin - 48%

2

Risk of pueperal psychosis

Baseline risk - 1-2/1000
BPAD - 50%
Subsequent pregnancies 50-80%

3

OCD (history)

- HPC (onset and duration)
- Elicit core Sx (origin, nature, obsessions, compulsions)
- Impact on functioning
- Risk assessment (self, others, children)
- Comorbidity (mood, enjoyment, sleep, appetite, hallucinations, delusions, passivity)
- Substance use

4

Psychosis (MSE)

- Core delusional belief (evidence, challenge)
- Other delusions (persecution, grandiose, reference)
- Hallucinations (auditory and other modalities)
- Thought interference
- Passivity experiences
- Impact on mood
- Substances
- Risk

5

Questions about auditory hallucinations

- Do you hear sounds or voices that others cannot?
- How many voices?
- Are they as clear as me speaking to you now?
- What do they say?
- Do they speak to you or about you or both?
- Do they give you instructions or commands?
- Do they comment on your actions?
- How do you feel about them?
- Could there be any alternative explanation?

6

Questions about non-auditory hallucinations

- Has there been anything wrong with your sense of smell recently?
- Have you noticed that food or drink tastes differently to normal? Strange taste in your mouth at other times?
- Have you had any strange feelings in your body?
- Have you been able to see things that others cannot? What kinds of things do you see?

7

Questions about thought interference

- Do you feel that somebody is interfering with your thoughts? Who?
- Do you ever feel that you have thoughts in your head that are not your own? Where do you think these come from?
- Do you ever feel that other people can know what you are thinking?
- Do you ever feel as though thoughts are being removed from your head?

8

Mania (history)

- HPC (onset, duration)
- Core mania symptoms (elation, irritability, energy, sleep, appetite, racing thoughts)
- Grandiose delusions
- Hallucinations (all modalities)
- Thought interference and passivity
- Risk (Police, spending, substances, promiscuity, self, others)

9

Delirium Tremens (history)

- HPC (onset, duration)
- Visual hallucinations (content, clarity, alternative explanation)
- Hallucinations in other modalities
- Orientation (time, place, person)
- Alcohol history (quantity, duration, last drink, withdrawal, prev abstinence)
- Risk (self, others)

10

Panic disorder (history)

- HPC (onset, duration, first episode, frequency, triggers)
- Physical symptoms
- Psychological symptoms
- DDx (generalised anxiety, social anxiety, phobia, OCD, PTSD, depression)
- Impact on life and coping strategies
- PPHx, FHx, brief PHx, PMHx, medications

11

Pass review (MSE)

- Reason for admission and change since then
- Auditory hallucinations
- Delusional beliefs
- Thought interference and passivity experiences
- Mood (sleep, appetite, enjoyment)
- Insight (understanding, medication)
- Risk (plans at home, self, others, plan to return)

12

Psychotic depression (history)

- HPC (onset, duration)
- Nihilistic delusions (challenge these)
- "How were things for you before you died"
- Mood (sleep, appetite, enjoyment, energy, future)
- Other psychotic symptoms
- Risk

13

Adult ADHD (history)

- Core features (hyperactivity, inattention, impulsiveness)
- Impact on functioning (work, leisure, relationships, Police)
- Childhood history (childhood symptoms, academic attainment, previous treatments, comorbid disorders)
- Mood and substances
- Risk (violence, impulsivity, driving)
- Address other concerns

14

Panic disorder (explanation)

- Clarify diagnosis and explain symptoms
- Explain aetiology (stressors, FHx, personality)
- Pharmalogical treatment
- Psychological treatment (CBT)
- Other concerns and leaflets

15

Hyperprolactinaemia (explanation)

- Explain result and cause
- Elicit symptoms (abnormal periods, breast changes, sexual dysfunction, fractures)
- Screen for pituitory tumor (headaches, blurred vision, weakness, numbness)
- Explain long-term side-effects (osteoporosis, risk of breast cancer)
- Options for management (change antipsychotic, add aripiprazole)

16

Clozapine (explanation)

- Clarify rationale and response rate (60%)
- Explain side-effects
- Explain monitoring (bloods - initially weekly, obs, ECG)
- Missed doses (as soon as remembers, unless 4hours until next dose, retitrate if >48hrs)
- Smoking and alcohol
- Other concerns and leaflet

17

Lithium augmentation (explanation)

- Clarify rationale
- Explain side-effects
- Baseline investigations (ECG, TFTs, U&Es, calcium)
- Explain titration and monitoring
- Signs of toxicity and risk of pregnancy

18

ECT (explanation)

- Clarify rationale
- Explain procedure (baseline tests, anaesthetic)
- Explain side-effects (headache, muscle pains, amnesia, confusion)
- Questions and leaflet

19

Schizophrenia (explanation)

- Clarify diagnosis and common symptoms (voices, delusional beliefs, passivity exp, low mood, apathy and lack of interest)
- Cause (genetic and environmental components)
- Pharmacological treatment (type, side effects, 6m)
- Alternative treatment (CBT, CPN)
- Questions and leaflets

20

Schizophrenia (Hx from CPN)

- History of last admission (HPC, medications, MSE on discharge)
- PPHx (previous admissions, MHA, past meds, risk)
- Current MSE (mood, sleep, appetite, activities, psychosis)
- Risk assessment (self, others, substances)
- Current concerns (med compliance, support needs)

21

Bipolar disorder (explanation)

- Clarify diagnosis and common symptoms
- Causes (genetic and environmental)
- Explain medications (mood stabiliser, side-effects)
- Alternative treatments (CPN support, CBT)
- Concerns and leaflets

22

Lithium in pregnancy (explanation)

- Clarify concerns and understanding
- Risks of lithium (heart defects - 0.1%, stillbirth, changes in Li level)
- Option to stop meds gradually (risk of relapse)
- Option to switch to antipsychotic
- Option to continue (increased monitoring - pt and baby)
- Breastfeeding
- Concerns and leaflets

23

Treatment-resistant Depression (treatment)

- Explore reasons for poor response (PMHx, substances, compliance, other stressors)
- Medication options (previous medications, reasons for stopping, increase dose, augmentation)
- Combine meds and therapy
- ECT
- Questions and leaflets

24

OCD (explain medications)

- Clarify diagnosis and understanding of meds
- SSRIs: mechanism, effectiveness (50-80%), side-effects, onset of action, duration (12m)
- Address other concerns (addictive, withdrawal, missed doses)
- Questions and leaflets

25

PTSD (history)

- Clarify HPC (onset, duration, trigger, others involved, survivor guilt, initial response)
- Intrusive thoughts (flashbacks, nightmares)
- Hyper-arousal (easily startled, irritability)
- Avoidance
- Emotional numbing (derealization, depersonalization , response to news, talking to others)
- Comorbidity (mood, sleep, appetite, concentration, memory, enjoyment, psychosis substance use)

26

Parasuicide assessment

- HPC (act, intent, planning, trigger)
- Circumstances (location, avoiding discovery, alcohol, final acts)
- Events following (presentation to A&E, regret, ongoing intent)
- Risk and protective factors (previous attempts, PPHx, PMHx, FHx, future planning)
- Underlying mental illness (mood, sleep, appetite, enjoyment, concentration, hallucinations, delusions, substances)

27

Grief reaction (history)

- HPC (timing and circumstances of bereavement, relationship with deceased, funeral)
- Comorbid depression (enjoyment, sleep, appetite, concentration, motivation)
- Stages of grief (anger/blame, bargaining)
- Atypical grief Sx (Avoiding dealing with possessions, hallucinations, guilt, suicidal thoughts)

28

Body dysmorphic disorder (history)

- HPC and explain psych input (onset, others' comments, trigger, other body parts)
- Challenging beliefs (inc. plans if refused surgery)
- Impact on functioning (work, relationships, avoidance, use of mirrors, camoflage)
- Risk (suicide, self-harm, self-surgery)
- Mood, enjoyment, sleep, appetite, concentration, psychosis, FHx, PPHx

29

Insomnia (history)

- HPC (onset, duration, falling asleep, staying asleep)
- PMHx (snoring, medications)
- Sleep hygiene (shift work, bedtime routine, screen use, caffeine, daytime exercise, lighting)
- Mental state (mood, appetite, enjoyment, concentration, stressors, psychosis, suicidality)
- Personal and FHx (PPHx, FHx, substances, personality)
- Management (sleep hygiene, relaxation, short course of meds)
- Questions and concerns

30

Capacity for medical procedure

- Clarify medical diagnosis
- MSE (PPHx, medications, mood, enjoyment, sleep, appetite, delusions, hallucinations, thought interference)
- Understanding (cause, investigations, purpose)
- Retain information (advantages and risks or procedure)
- Weigh information (decision and reasoning)
- Plan (discuss with medical team)

31

Capacity for social care

- MSE (PPHx, medications, mood, enjoyment, sleep, appetite, psychosis)
- Understanding (diagnosis)
- Retention (reasons for social care, risks of refusing)
- Weigh information (decision and reasoning)
- Summary and plan

32

Neuroleptic malignant syndrome (explanation)

- Explain rationale for treatment
- Explain NMS and Sx (1/100, high temperature, unstable HR/BP, rigidity)
- Management (transfer to acute, exclude other illness, stop antipsychotic)
- Longer term management (record allergy, alternative antipsychotic)
- Questions and concerns

33

Borderline PD (history)

- HPC (event, trigger, previous DSH, intent)
- Relationships (arguments, coping with endings, previous relationships)
- Identity disturbance (chronic emptiness, self-image, future planning)
- Impulsivity
- Affective instability
- Pseudohallucinations

34

Eating disorder (history)

- Core AN Sx (avoidance, exercise, obsession with food, calorie-counting, body image, current and ideal weight)
- Core bulimia Sx (binging, vomiting, laxatives)
- Complications (periods, dizziness, weakness, hospital admission)
- Aetiology (family relationships, FHx, reaction to illness, personality, childhood events)
- Co-morbidities (mood, enjoyment, sleep, concentration, psychosis, risk)

35

Anorexia (d/w student)

- Clarify diagnosis and understanding
- Explain symptoms (deliberate weight loss, weight <15% expected, distorted body image, physical complications)
- Aetiology (FHx, childhood illness, personality traits, family dynamics, cultural norms)
- Treatment (obs, bloods, admission if compromised, dietician, CBT/FBT)
- Good prognostic factors (onset <15y/o, higher weight at Dx, early Rx <3m, recovery <2y, supportive family, motivation to change)

36

Anorexia (explanation to relative)

- Clarify understanding and concerns
- Admission criteria (weight loss <1kg/wk, HR/BP abnormalities, hypothermia, electolyte imbalance, worsening co-morbid disorder, failure OP Rx)
- Treatment options (weight restoration 0.5-1kg/wk, vitamin supplements, dietician, psychotherapy)
- Questions

37

Re-feeding syndrome (explanation to nurse)

- Clarify concerns and history
- Explain diagnosis (electrolyte imbalance - K/phos/Mg)
- Signs and Sx (oedema, constipation, vomiting, diarrhoea, lethargy, arrhythmias, seizures)
- Management (admission, correction of electrolytes, dietician)

38

Postnatal depression or psychosis (history)

- HPC
- Risk factors (PPHx, FHx, pregnancy/delivery, relationship with partner, feeding, bonding, support)
- Depressive Sx (variation in mood, enjoyment, energy, sleep, appetite, guilt)
- Psychotic Sx (hallucinations, delusions, thought interference, passivity)
- Risk (self, baby - inc neglect)

39

Postnatal psychosis (explanation to relative)

- Clarify diagnosis and Sx
- Management (admission to MBU, medication, ECT)
- Potential complications (risk, affect bond)
- Questions and concerns

40

Depot (explanation)

- Clarify diagnosis and understanding
- Explain rationale for depot (non-compliance, risk of relapse, injection - med released over weeks)
- Administration (test dose, CPN, injection into deltoid/buttock)
- Potential risks (EPSEs, pain, sedation)
- Questions and leaflet

41

MHA (explanation to relative)

- Clarify diagnosis and understanding
- Explain use of MHA (mental disorder, SIDMA, risk, admission is necessary, no alternative)
- Explain type of section, duration, appeal, advocacy, named person etc