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Meddygaeth B > Iechyd Meddwl > Flashcards

Iechyd Meddwl Flashcards

1
Q

What is the treatment for mild depression?

A

Offer low-intensity psychosocial intervention e.g. Guided self-help bases on principles of CBT, structured group physical activity programme

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2
Q

What is the treatment for moderate or severe depression?

A

Combination of antidepressants and a high-intensity psychological intervention e.g. CBT

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3
Q

What are higher risk factors for suicide?

A

> 45yrs, male, unemployed, psychiatric/ physical illness, previous attempt, single, FH of mental health issues

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4
Q

What are lower risk factors for suicide

A

Female, <45yrs, employed and in a couple

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5
Q

What type of anti-depressant is most commonly first line treatment for depression?

A

Selective serotonin reuptake inhibitor (SSRIs)

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6
Q

What is the most common side effect of lithium?

A

Tremor

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7
Q

What is the most common side effect of clozapine?

A

Postural hypotension

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8
Q

What SSRI can cause QT prolongation?

A

Citalopram. It is therefore contraindicated with other medications that can also cause a prolonged QT. e.g. antipsychotics

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9
Q

How long does it take for the SSRIs to begin to work?

A 
4 weeks (6weeks in elderly) 
They except some effect immediately however this is cancelled out by side effects
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10
Q

What are the side effects of SSRIs?

A

Nausea, dry mouth, drowsiness, anxiety, agitation (short term)
Sexual dysfunction
Increased risk of G.I. bleeding
Increased risk of hyponatraemia in the elderly

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11
Q

When are SNRIs commonly used?

A

After two SSRIs have failed.

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12
Q

What is a contraindication for use of the SNRI Venlafaxine?

A

Hypertension

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13
Q

What needs to be done when starting a patient on lithium?

A

Monitor renal and thyroid function before treatment and every 6 months after (more often if there is evidence of renal impairment)
ECG monitoring if at high risk of CVD
monitor serum lithium 1 week after treatment starts, at every dose change, and every 3 months.

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14
Q

What is mirtazapine?

A

A presynaptic alpha2 adrenoreceptor antagonist

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15
Q

What other antidepressants have similar MOA to SNRIs?

A

Tricyclics e.g. amitriptyline, nortriptyline

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16
Q

What foods can’t you eat when taking monoamine oxidase inhibitors?

A

Cheese and wine. They cause a hypertensive crisis as you are unable to breakdown tyrosine

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17
Q

What makes tricyclics antidepressants particularly dangerous?

A

Overdose. They increase risk levels of noradrenaline activating beta receptors and increase HR whilst simultaneously blocking the effects of muscarinic receptors which are cardiotoxic

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18
Q

What needs to be taken into account when stopping antipsychotics?

A

Must be stopped slowly. They are not addictive but taking them away can cause anxiety, sleep disturbances and headaches.
Monitor for signs of relapse

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19
Q

For how long are antidepressants prescribed?

A

Fist episode is 9 months

Several episodes / severe / risk of relapse is 2 years

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20
Q

What are the side effects of typical antipsychotics?

A

Extra pyramidal (Parkinsonism, dyskinesia), sedation, raised prolactin and QT prolongation

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21
Q

How do you manage the extra pyramidal side effects of antipsychotics?

A

Give them an anti-muscarinic drug

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22
Q

Name some atypical antipsychotics

A

Risperidone, clozapine, olanzopine, quatriapine, aripirizol

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23
Q

What is first line antipsychotic and what is second line?

A

First line is whichever antipsychotic the patient can handle best
Second line is clozapine

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24
Q

What are the side effects of clozapine?

A

Weight gain, sedation, increased risk of diabetes, postural hypotension and cardiovascular collapse, neutropenia, constipation (can be fatal), drooling, seizures and myocarditis

25
Q

What is lithium used for?

A

Mood stabilizer and augmenting antidepressants

26
Q

What are the side effects of benzodiazepines?

A

Addiction and dependance (weaning off can take years , 1-2mg per week) over-sedation and respiratory depression

27
Q

How does one calculate number of units in a drink?

A

(Volume of drink(mL) x %alcohol by volume (ABV%)) / 1000

28
Q

What are the safe drinking limits proposed by the chief medical officers?

A

Not regularly drinking more than 14units per week

Have alcohol free days

29
Q

What screening tool may be used to help make a diagnosis of depression and quantify severity?

A

Patient health questionnaire 9

PHQ-9

30
Q

What questions are the diagnostic criteria for depressive disorder?

A

Over a two week period any 5 of:
Must have depressed mood and/or markedly diminished interest or pleasure in activities.
Appetite change, sleep disturbance, psychomotor agitation or retardation, fatigue, feeling worthless or inappropriately guilty, diminished ability to think or concentrate, recurrent thoughts of death/ suicide

31
Q

What presentations require immediate referral to psychiatrist?

A

Risk of suicide, harm to others, self neglect
Psychotic symptoms
History is clinical suspicion of bipolar disorder
Cases where a child or adolescent is presenting with major depression

32
Q

What is treatment ladder for moderate or severe depression?

A
  1. SSRI e.g. sertraline or citalopram
  2. Venlafaxine, Mirtazapine or escitalopram
  3. Augmenting agent e.g. quetiapine (antipsychotic) and lithium
    4 tricyclics e.g. amitriptyline
  4. MAOI e.g. moclobomide
33
Q

What accompanying symptoms suggest that psychosis may be caused by underlying organic cause?

A

Disorientation, memory problems other neurological problems

34
Q

What are common organic causes for psychosis?

A

Brain tumor, high dose steroids, thyroid disease, encephalitis, temporal lobe epilepsy

35
Q

What do you do for a psychotic patient not at risk?

A

Urgent referral to a specialist mental health team

36
Q

What is first line treatment for first episode of psychosis?

A

Oral antipsychotic medication in conjunction with psychological intervention e.g. family intervention and individual CBT

37
Q

What needs to be done prior to starting antipsychotic medication?

A

Plot weight and waist circumference, pulse and BP, fasting glucose, HbA1c, blood lipid profile and prolactin levels, asses any movement disorders, asses nutritional status, diet and levels of activity, sometimes ECG.

38
Q

What is a section 2?

A

Detain patient for assesment for up to 28days, if patient is suffering from mental disorder AND it is in the interest of their own health and safety to be detained

39
Q

What is section 135?

A

A warrant for police to gain access to a premeditated to remove patient to a place of safety requires a doctor and police

40
Q

What is section 136?

A

Allows police to remove person from a public place to place of safety. Police remain in attendance until further assessment is arranged

41
Q

What is a section 3?

A

Allows admitting patient for treatment for up to 6months. Treatment can be given for 3 months then consent is required for second opinion. Requires 2 doctors, one that is section 12 approved.

42
Q

What is a section 4?

A

Emergency admission for assessment for 72 hours, treatment only. Given under common low, recommendation by doctor

43
Q

What is a section 5(2)?

A

Emergency 72 hour holding order for patient that is already admitted, treatment only given under common law, recommendation from Dr or approved clinician

44
Q

What is a section 5(4) ?

A

Emergency 6hour holding order for patient already admitted, treatment can only be given under common law, recommendation by nurse

45
Q

What are risk factors for developing schizophrenia?

A

Family history, smoking cannabis, birth complications

46
Q

What is the treatment for Alzheimer’s dementia?

A

Cholinesterase inhibitors- donepazil, galantamine
Butyrylcholinesterase and acetylcholinesterase inhibitors- rivastigmine
NMDA receptor blockers - memantine

47
Q

What are the cholinesterase inhibitors and what are their side effects ?

A

Donepezil and galantamine
Contraindicated in patients with bradykinesia, left bundle branch block and prolonged QT. Therefore do ECG! Cautioned in patients with gastric ulcer or seizures

48
Q

What is the NMDA receptor blocking drug called and what are side effects?

A

Memantine

Renal failure therefore do U&E

49
Q

What medication is licensed to treat lewy body dementia?

A

Rivastigmine

50
Q

Define personality disorder

A

A group of disorders marked by persistent, inflexible, maladaptive patterns of thought and behavior that develop in adolescence and persist into adulthood significantly impairing an individuals ability to function

51
Q

What type of therapy is used to treat patients with Emotionally Unstable Personality disorder?

A

Dialectical behavior therapy

52
Q

What is the purpose of the minimental state examination?

A

Commonly used test to assess complaints of memory or other mental abilities

53
Q

What are the components of the mini mental state exam?

A 
Orientation
Registration
Attention and calculation
Recall
Language 
Copying
54
Q

What is the orientation component of the mini mental state examination?

A

What year, month, day, date and tine

Country, town, district, hospital, ward

55
Q

What is the registration and attention/calculation portion of the mini mental state examination?

A

Registration: I name 3 objects: apple, table, penny ask patient to repeat/ then learn those 3 nouns
Attention and calculation: -7 from 100 then repeat 5 times, spell world backwards

56
Q

What is the language component of the mini mental state exam?

A

Name pencil and watch
Repeat ‘no ifs ands or buts’
Complete 3 stage command ‘place index finger of right hand on your nose and then on your left ear’
Read and obey written command ‘close eyes’
Ask patient to write a sentence, score if sensible and has a subject and verb

57
Q

What is the copying stage of the mini mental state exam?

A

Ask the patient to copy a pair of intersecting pentagons

58
Q

What is the recall component of the mini menral state exam?

A

Ask for the names of three objects stated earlier apple, table, penny

Meddygaeth B (9 decks)

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