General Adult Flashcards
(41 cards)
1
Q
Genetic risk of schizophrenia
A
Population risk - 1% Grandchildren - 5% Half-sibling - 6% Full sibling - 9% Child - 13% Fraternal twin - 17% Child (dual mating) - 46% Identical twin - 48%
2
Q
Risk of pueperal psychosis
A
Baseline risk - 1-2/1000
BPAD - 50%
Subsequent pregnancies 50-80%
3
Q
OCD (history)
A
- 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
Q
Psychosis (MSE)
A
- 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
Q
Questions about auditory hallucinations
A
- 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
Q
Questions about non-auditory hallucinations
A
- 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
Q
Questions about thought interference
A
- 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
Q
Mania (history)
A
- 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
Q
Delirium Tremens (history)
A
- 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
Q
Panic disorder (history)
A
- 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
Q
Pass review (MSE)
A
- 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
Q
Psychotic depression (history)
A
- 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
Q
Adult ADHD (history)
A
- 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
Q
Panic disorder (explanation)
A
- Clarify diagnosis and explain symptoms
- Explain aetiology (stressors, FHx, personality)
- Pharmalogical treatment
- Psychological treatment (CBT)
- Other concerns and leaflets
15
Q
Hyperprolactinaemia (explanation)
A
- 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
Q
Clozapine (explanation)
A
- 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
Q
Lithium augmentation (explanation)
A
- Clarify rationale
- Explain side-effects
- Baseline investigations (ECG, TFTs, U&Es, calcium)
- Explain titration and monitoring
- Signs of toxicity and risk of pregnancy
18
Q
ECT (explanation)
A
- Clarify rationale
- Explain procedure (baseline tests, anaesthetic)
- Explain side-effects (headache, muscle pains, amnesia, confusion)
- Questions and leaflet
19
Q
Schizophrenia (explanation)
A
- 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
Q
Schizophrenia (Hx from CPN)
A
- 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
Q
Bipolar disorder (explanation)
A
- Clarify diagnosis and common symptoms
- Causes (genetic and environmental)
- Explain medications (mood stabiliser, side-effects)
- Alternative treatments (CPN support, CBT)
- Concerns and leaflets
22
Q
Lithium in pregnancy (explanation)
A
- 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
Q
Treatment-resistant Depression (treatment)
A
- 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
Q
OCD (explain medications)
A
- 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
