Mental Health Flashcards

Question

When asking about Forensic Hx in the psych Hx what are the key Q's?

Answer 1

* Any contact with the police? * Have you ever been to prison? * How do you think the contact with police has impacted you/others?

Answer 2

* How do you see yourself? * How do you think others see you?

Answer 3

* GAD * Panic disorder * Phobia * PTSD * OCD * Depression * ACS * Arrythmia * Hyperthyroidism

Answer 4

* Schizophrenia * Bipolar disorder * Depression * Shizoaffective disorder * Depression with psychosis * Delirium * Dementia * Drugs/Alcohol * Epilepsy (Temporal lobe) * SoL * SLE

Answer 5

* Depression * Seasonal Affective disorder * Bipolar disorder * Post natal depression * Hypothyroidism * Anaemia * Drug side effects * SoL

Answer 6

* Dementia - Alzheimers/Vascular/FTD/LBD/Mixed * Depression * Delirium * Degenerative CNS cause - Huntingdons/MS * Vitamin deficiency - B12/Folate/Thiamine * Electrolyte imbalance * Encephalitis

Answer 7

* Anorexia nervosa * Bulimia Nervosa * Depression

Answer 8

[Causes] * Stressful events + personality + female gender * Low levels of neurotransmitters in brain (Dopamine/NA/5-HT) [Diagnostic criteria] * **\>2wk** Hx causing significant impairment in function * Core symptoms: * **Persistent sadness/low mood nearly every day** * **Anhedonia** * **Fatigue** * Other symptoms: * Nihlism/Guilt * Suicidal ideation * Decreased concentration/apetite/mood/weight * Increased sleep * Psychomotor retardation * Psychosis -\> Depression w/psychosis [Investigations] * TFTs - Normal * FBC - Normal * U&E - Normal * PHQ9 - Positive screen * Vitamin B12 - Normal * ECG - Normal, for antidepressants * BP + Pulse + BMI [Management] * Mild to moderate: * CBT - self help * Moderate to severe: * SSRI - Sertraline * Children - Fluoxetine * High intensity CBT * Severe: * Mental health assesment * ECT

Answer 9

[Indication] * 1st line treatment for moderate to severe depression * Panic disorder * OCD [How it works] * Alters balance of some of the chemicals in your brain - NT * Affects the uptake of 5-HT from the synaptic cleft, so increases amount of 5-HT available. * Improves mood and physical symptoms of depression [How to take it] * Tablet - OD orally * Best taken on a full stomach * Can take up to 6 weeks for effects to start * Take for at least 6 months after symptoms stop, then taper it down slowly before stopping * If due to recurrent depression - wait 2 years after symptoms stop to withdraw [Side effects] * GI Upset * Change to apetite * Weight Loss/Gain * Skin rash - due to hypersensitivity * If elderly - can lead to confusion (Due to low Na+) * Can cause increased suicidal thoughts [Contraindications] * Epilepsy * Peptic ulcer disease * Hepatic impairment [Withdrawal] * Stomach upset * Flu like symptoms * Insomnia [Overdose] * Serotonin syndrome (Excess 5-HT) * Autonomic hyperactivity - HTN + Tachycardia + Hyperthermia * Tremor + Agitation + Irritability * Sweating + Diarrhoea * Delirium * Hyper-reflexia [Monitoring] * Before starting - ECG (QTc) + U&E * Review symptoms after 2-6 weeks

Answer 10

[Introduction] * Introduce self & Wash hands * Patient name & DOB & Age * I am here to speak to you about your current experiences in addition to your past experiences, and how they are impacting on your symptoms. The questions could be very personal, is that ok? * Anything that you say will be kept b/w myself and your medical team. [Presenting complaint] * Why did you come in today? * When did it start? * When did you last feel better/Different to this? * What triggered this episode? * Is it getting any better over time? Worse? Same? * Does anything make it worse or better? [Systems review] * Depression * Anxiety * Psychosis * Mania * Self harm - Risk assesment [Past psychiatric review] * When were you last well? * Have you ever had a mental health diagnosis? * Did you have any treatment? * Have you had any contact with mental health services? * Do you have a care coordinator? * Have you ever previously been admitted for a psychiatric condition? - Informal/Detained? * Have you ever been detained by the police for a psychiatric condtion? [PMHx] * Thyroid dysfunction? * Epilepsy? * Head injury - details & recovery * Any LoC with the head injury * Any post traumatic amnesia - How long for? * Any post traumatic epilepsy? * Any heart problems? * Any high Cholesterol? * Do you have DM? [DHx] * What medications are you currently taking? * Adherence? * Any recent changes to your medications? * Any drug allergies? * Any Non-prescribed medications? (OTC/Herbal) * Any ilicit drug use? * Do you drink alcohol? [Social Hx] * What are your current living arrangements? * What is your current occupation? * What are your relationships at work like? Performance? * Are you financially stable? * Are your friends and family supportive? * ADLs [If any time] * FHx - Assessing attachment * Personal & Psychosocial Hx * Forensic Hx

Answer 11

[Introduction] * Introduce self & Wash hands * Patient name & DOB & Age * What I am going to be doing is asking you questions to assess your state of mind, is that ok? * I just want to let you know that anything that you say will be kept b/w myself and your medical team [Presenting complaint] * Why did you come in today? * When did it start? * When did you last feel better/Different to this? * What triggered this episode? * Is it getting any better over time? Worse? Same? * Does anything make it worse or better? [Past psychiatric review] * When were you last well? * Have you ever had a mental health diagnosis? * Did you have any treatment? * Have you had any contact with mental health services? * Do you have a care coordinator? * Have you ever previously been admitted for a psychiatric condition? - Informal/Detained? * Have you ever been detained by the police for a psychiatric condtion? [PMHx] * Thyroid dysfunction? * Epilepsy? * Head injury - details & recovery * Any LoC with the head injury * Any post traumatic amnesia - How long for? * Any post traumatic epilepsy? * Any heart problems? * Any high Cholesterol? * Do you have DM? [DHx] * What medications are you currently taking? * Adherence? * Any recent changes to your medications? * Any drug allergies? * Any Non-prescribed medications? (OTC/Herbal) * Any ilicit drug use? * Do you drink alcohol? [Social Hx] * What are your current living arrangements? * What is your current occupation? * What are your relationships at work like? Performance? * Are you financially stable? * Are your friends and family supportive? * ADLs **MSE** [General Inspection] * Patients appearance & behaviour * Kempt/Unkempt * Any abnormal movements * Appropriate behaviour * Level of anxiety/restlessness/agitation * Assess rapport * Distractibility * Eye contact * Facial expressions [Speech] * Assess the speech of the patient - As it is an external presentation of the internal thought process * Rate * Rhythm * Volume * Quantity * Fluency * Abnormal associations * Any evidence of formal thought disorder? - opinion based on speech [Mood & Affect] * Objective based on what you see - how do they appear (Affect) * Low * High * Euthymic - Normal * Subjective based on a scale of 1-10 -\> Ask patient to describe their mood * Enjoyment -\> None/Increased * Energy -\> Increased/Decreased * Biological symptoms - Sleep -\> Increased/Decreased * Biological symptoms - Appetite -\> Increased/Decreased * Concentration & memory -\> Increased/Decreased * Libido -\> Increased/Decreased [Suicide risk] * Ask about thoughts of the future * Any Hopelessness? * Thoughts of suicide? or self harm? * Suicide * Any thoughts of life not worth living? Hopelessness? * Harming yourself? * Wanting to kill yourself? * Any plans to kill yourself? * Any protective factors? * Any hope for the future? * Risky behaviour [Thought] * Depression * Poverty of thought * Thinking is v slow & laboured (Takes patient a long time to answer) * Mania * Pressured thought * Spuriously connecting words/rhyming/flight of ideas (going on lots of tangents, but there is a process)/often funny * Psychosis * Loss of association * Derailment/Difficult to follow train of thought * Cognitive impairment * Circumstantiality - Patient talking around the point, going off topic * Meandering speech covering up for impairment Content of the thoughts * Normal thoughts * Triggered by internal/external stimulus * Obsessions * Any recurrent intrusive thoughts (Unpleasant) * Recognise as their own - they don’t want them * Generates anxiety * Try to resist = compulsive actions to reduce impact of the thoughts (Compulsion) * Delusions * Fixed false belief out of keeping with Social/Cultural/Education/Religious norms or background * Challenge the belief to ensure it is fixed - If I told you it was due to your mood what would you say? Specific content delusions * Persecutory * Ask if they want to harm anyone else?/Do you feel anyone wants to harm you? * Do you feel the need to carry a weapon? * Mood congruent - Delusions related to mood disorders * Depressive -\> Nihilistic/Guilt (Negative) * Manic -\> Most common in grandiose * Classic schizophrenia - Thought insertion/Thought extraction/Control/Reference [Perception] * Any unusual experience? * Have you heard or seen something you cant explain? * Normal * Any sensory experience with external stimulation * Illusion * Misinterpretation of an external stimulation * Hallucination * Perception w/o any external stimulation * Look for distractibility * Challenge - Continues to believe it * Auditory -\> Common in psychosis * Mood disorder - talking to YOU * Schizophrenia - one or two talking ABOUT you * Visual -\> Organic/drugs cause but can also happen in mental illness * Olfactory/Gustatory (Taste) -\> Epileptic activity but can happen with mental health * Somatic/Tactile -\> Rare/Drug use (Amphetamines or alcohol withdrawal) [Cognition] * Orientation * Time * Place * Person - What is your name & DOB * If not oriented -\> Full cognitive assessment with Mini-ACE or MOCA [Insight] * Do you think you are ill? * Do you think it is a physical or mental illness? * Also question insight into the severity of the illness? * What treatment do you think you need? * Are you willing to engage in treatment/services?

Answer 12

Poverty of thought (slow, decreased speech) * depression Pressure of thought (lots of words but makes sense) * Mania Total loss of association (completely disjointed, lapsed concentration) * Schizophrenia Circumstantiality (meandering around the point, covering up memory impairment) * Cognitive impairment

Answer 13

* Enjoyment -\> None + Anhedonia * Energy -\> Decreased * Sleep -\> Early morning wakening + Diurnal variation in mood * Biological symptoms - Appetite -\> Classically reduced/Can be increased in SAD * Concentration & memory -\> Decreased * Libido -\> Decreased

Answer 14

* Enjoyment -\> Excess * Energy -\> Increased * Biological symptoms - Sleep -\> Decreased * Biological symptoms - Appetite -\> Often decreased “Dont have time to eat” * Concentration & memory -\> Decreased (But they think its great) * Libido -\> Increased

Answer 15

[Introduction] * Introduce self & Wash hands * Patient name & DOB & Age * I am here to speak to you about your current experiences in addition to your past experiences, and how they are impacting on any symptoms you are currently having. * I just want to let you know that anything that you say will be kept b/w myself and your medical team * How are you feeling today? * Im really sorry that things got so bad for you that you had to do this, but I will need to ask some questions about the suicide attempt [Before] * Prior events/Mood -- What happened before that made you feel like you had to harm yourself? * Had you been feeling this way for some time now? * Plan -- Did you plan to harm yourself? * What plans did you make? * How long did you plan this? * Precautions -- Did you try to make sure you wouldnt be found? * Did you want to be found? * Preparation -- Did you make a note or make a will in preparation? * Did you tell anyone before you did it or did you seek help afterwards? * Did you regret it after you had harmed yourself? [During] * Can you talk me through exactly what happened? I know this might be difficult: * How * Where * When * DId you expect to die? * Were you under the influence of drugs? * Were you under the influence of alcohol? [After] * How were you discovered? * Did you tell anyone? * Did you want to be found? * How do you feel now after what has happened? Do you feel anger/regret? * Do you still have thoughts of wanting to harm yourself/suicide? * What are your thoughts of the future? [ICE] * How has your mood affected your day to day life? * Why do you think you feel the way you do? * Is there anything in particular you are scared/worried about? * Is there anything in particular you feel you need help with? [Background] PMHx/Psych Hx: * Do you have any medical illness * Do you have a diagnosis of any psychiatric illness? * Have you ever tried to commit suicide or self harm before this? DHx: * Are you currently taking any medication? * Do you have stores of medication at home? FHx: * Has anyone in your family ever tried to harm themselves? SHx: * Are you currently working? What do you do? * How are things at work? Any problems? * Who is at home with you? * Do you have support from family/friends? * Any children or dependents at home? * Do you drink alcohol? How much in a week? * Do you take any recreational drugs? * Do you think you need help? Would you be prepared to accept help? [Follow up] * If high risk: * In light of what you have told me today, I dont think it would be safe to let you go home, however I would need to discuss this with my seniors to come up with a plan with yourself on how we can move forward * If low risk: * I would like to see you again next week. Can we arrange a time to meet? * Is there anything you would like to talk about? If not now then think about it and we can discuss it next time we meet. [Conclusion] * Summary * Thank you, I hope we can work together to get you feeling better. [Management] * Full Hx + MSE * Collaborative Hx from family/friend * Plan if in patient admission required * Provide contact details for crisis team/mental health team * Formulation

Answer 16

* Violent method used * Planning in place * Ongoing suicidal intent * Previous suicide/self harm * Access to means * Recent adverse life event

Answer 17

[Causes] * Stressful events + personality + female gender * Bullying/Family disruption/Abuse * Low levels of neurotransmitters in brain (Dopamine/NA/5-HT) [Diagnostic criteria] * \>2wk Hx causing significant impairment in function * Core symptoms: * Persistent sadness/low mood nearly every day * Anhedonia * Fatigue * Other symptoms: * Nihlism/Guilt * Suicidal ideation * Decreased concentration/apetite/mood/weight * Increased sleep * Bad behaviour at school/home * Psychomotor retardation * Psychosis -\> Depression w/psychosis [Investigations] * Clinical diagnosis * TFTs - Normal * FBC - Normal * U&E - Normal * PHQ9 - Positive screen * Vitamin B12 - Normal * ECG - Normal, for antidepressants * BP + Pulse + BMI * Pregnancy test is female [Management] * CAMHS referral * Address sources of distress * Remove opportunities for self harm * CBT/Interpersonal therapy * Family therapy If moderate to severe: * Fluoxetine

Answer 18

* Depression * Bipolar disorder * Anxiety disorder * Bereavement * ADHD * Substance abuse * PTSD

Answer 19

* Depression * Bipolar disorder * Anxiety disorder * Bereavement * ADHD * Substance abuse * PTSD

Answer 20

[Layout] * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indication & Action of the drug] * Indications: * 2nd line treatment for moderate to severe depression, after SSRI * Treatment for neuropathic pain Actions: * Inhibit the re-uptake of Serotonin (5-HT) + Noradrenaline (NA) from the synaptic cleft * increase the availability for neurotransmission * Improve mood & physical symptoms of moderate to severe depression * Also help with neuropathic pain * Block receptors - Muscarinic + Histamine (H1) + Adrenergic (Alpha) + Dopamine (D2) * Causes the side effects [Side effects] Blockage of antimuscarinic receptors: * Dry mouth * Constipation * Urinary retention * Blurred vision Blockage of H1 and Alpha receptors * Sedation * Hypotension * Blockage of Dopamine receptors * Breast changes * Sexual dysfunction Cardiac adverse events * Arrythmias * ECG changes -\> Prolonged QT interval & QRS duration * Risk of Torsades des Pointes Neurological SE: * Convulsions * Hallucinations * Mania Sudden withdrawal can cause: * GI Upset * Neurological & flu like symptoms * Sleep disturbance [Overdose effects] Very dangerous, they cause Serotonin syndrome: * Severe hypotension * Arrythmias * Convulsions * Coma * Respiratory failure [Complications/Contraindications] * Caution for patients with: * Elderly - risk of fall * Epilepsy * Cardiovascular disease * Prostatic hypertrophy * Glaucoma * C/I: * Must not be given with MOAI -\> Can lead to HTN/Hyperthermia/Serotonin syndrome [How to take it] * Tablet/Oral solution * Take dose once a day * Dose can be adjusted after at least 6-8wks treatment * 2 weeks supply to reduce risk of serious overdose * Carry on for at least 6 months after they feel better * If recurrent depression -\> 2yrs * Effect time * Few weeks * Improves sleep and appetite [Monitoring Requirements] * Review symptoms 1-2 wks after starting treatment * ECG - assess for any QT interval changes before starting treatment * Risk of Torsades des Pointes

Answer 21

Syndrome caused by excess serotonin, from SSRI + TCA + SNRI + MOAI * Autonomic hyperactivity - HTN + Tachycardia + Hyperthermia * Tremor + Agitation + Irritability * Adbominal pain * Sweating + Diarrhoea * Delirium/Altered Mental state * Hyper-reflexia [Management of Serotonin syndrome] * Discontinue medication * Benzodiazepines for agitation * Severe -\> Cyproheptadine - Serotonin antagonist * Active cooling

Answer 22

[Introduction] * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indication & Action of the drug] Indications * Major depression where SSRI’s are ineffective or not tolerated * Generalised anxiety disorder Action: * Serotonin (5HT) and Noradrenaline (NA) re-uptake inhibitor (SNRI) * Interferes with these NT at the synaptic cleft * Increases bioavailability of monoamines for NT - improve mood and physical symptoms in moderate to severe depression * \*Weaker antagonist of muscarinic & histamine receptors than TCA’s * Fewer anti-muscarinic SE than TCAs [How to take it] * Orally * Take tablet every day - orally * Treatment started at low dose and titrated up according to response * Continue taking it for 6 months after they stop feeling better to stop the depression from coming back * If recurrent depression -\> 2 years * Refer them for psychological therapy - long term benefits * Effect time -\> Should improve symptoms over a few weeks, particularly sleep and appetite [Important Side Effects] * GI upset * Dry mouth/nausea * Change in weight * Diarrhoea/constipation * Neurological effects -- Headache * abnormal dreams * Insomnia * Confusion * Convulsions Sudden withdrawal can cause: * GI Upset * Neurological & flu like symptoms * Sleep disturbance Serious SE: * Hyponatraemia * Serotonin syndrome * May increase suicidal thought and behaviour * Prolongs QT interval + Increased risk of ventricular arrhythmia * Risk of Torsades des Pointes [Complications/Contraindications] * Use with caution in: * Elderly * Patients with pre-existing arrhythmia * Dose reduction may be required in Hepatic/Renal impairment [Monitoring requirements] * Review symptoms 1-2 weeks after treatment and regularly there-after * Dose should not be adjusted after 6-8 weeks of therapy

Answer 23

[Introduction] * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indication & Action] Indications * Major depression where SSRI’s are ineffective or not tolerated Actions * Antagonist of inhibitory pre-synaptic alpha 2 adrenoreceptors * Increases bioavailability of monoamines for NT - improve mood and physical symptoms in moderate to severe depression [How to take it] * Orally * Take at night to minimise sedative effects * Treatment started at low dose and titrated up according to response * Continue taking it for 6 months after they stop feeling better to stop the depression from coming back * If recurrent depression -\> 2 years * Refer them for psychological therapy - long term benefits * Effect time -- Should improve symptoms over a few weeks, particularly sleep and appetite [Important SE] * GI upset * Dry mouth/nausea * Change in weight * Diarrhoea/constipation * Neurological effects -- Headache * abnormal dreams/Insomnia * Confusion * Convulsions Serious SE: * Hyponatraemia * Serotonin syndrome * May increase suicidal thought and behaviour [Complications/Contraindications] * Use with caution in: * Elderly * Patients with pre-existing arrhythmia * Dose reduction may be required in Hepatic/Renal impairment [Monitoring requirements] * Review symptoms 1-2 weeks after treatment and regularly there-after * Dose should not be adjusted after 6-8 weeks of therapy

Answer 24

[Introduction] * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indication/Action] * Bind to monoamine oxidase (Irreversible) preventing inactivation of biogenic amines such as NA, D and 5HT leading to increased synaptic levels * Very effective [Important side effects] * Orthostatic hypotension * Weight gain * Drug mouth * Sedation * Sexual dysfunction * Sleep disturbance * Hypertensive crisis if MAOIs - taken with tyramine-rich foods - mature cheddar/broad bean pods/pickled herrings or sympathomimetics [Important information] * Risk of Serotonin syndrome if MAOI is combined with serotonergic medication or sympathomimetic actions - decongestants * 2 week wait to start MAOI after stopping SSRI * 5 week wait if Fluoxetine due to longer half life

Answer 25

[Introduction] * Brief Hx * What is CBT * Why its being used * How does it work * What does it involve * How effective is it? * How long does it take? * What if symptoms come back? [Brief Hx] * Can you bring me up to speed with the symptoms you were having? * How do you feel today? How is your mood? * How is it affecting your life? [What is CBT] * Do you know what CBT is? Have you heard of it before? * It is a way of talking about how you think about yourself, the world and others. * Aim is to help you think about your thoughts and feelings, and change how you think and what you do * Cognitive = What you think, Behaviour = What you do * Focus is on the here and now, not necessarily past events [What is it used for] * Used for Anxiety/Depression/Phobias/OCD/PTSD [How does it help?] * Breaks down problems into smaller parts -- Into Situation/Thoughts/Emotions/Physical feelings/Actions as this is the way we deal with scenarios * Aim is to break the vicious circle - to stop you making yourself feel worse unconsciously [What does it involve?] * Either individually or with group of people, or self help * Meet with therapist for between 5-20 weekly sessions lasting up to 1hr * May be asked about your past life and background to understand you and what may be impacting on your actions now. * But doesnt delve deeply into this, and it isnt the main focus * Work with the therapist to break down each problem * Homework -- Keep diary + Practice the techniques learned on changing unhelpful thoughts & behaviours * You decide the pace of the treatment and what you will/wont try [Effectiveness] * As effective as antidepressants * May be used alongside antidepressants [How long does it take?] * From 6 weeks to 6 months * Depends on the problem, and your engagement [Recurrence of symptoms] * Always a risk of return * CBT should help to control the symptoms

Answer 26

[Cause] * Episodic illness with behavioural disturbances * Episodes of mania/hypomania + Depression * Different types: * Bipolar 1 -- Mania + Depression * Bipolar 2 -- Hypomania + Depression * Rapid cycling -- \>4 episodes of MDE/Mania/Hypomania in \<1yr * Cyclothymic -- Chronic + Less severe mania & moderate depression for \>2yrs [Epidemiology] * Males - Bipolar 1 * Females - Bipolar 2 * FHx of bipolar [Diagnostic criteria] At least 2 episodes of: * Depression * Mania/Hypomania Mania: * Elevated mood * Excessively happy/irritable/easily angered * Gradiose ideas * Pressured speech * Flight of ideas * May have psychosis Hypomania: * Persistent mild elevation of mood * Increased activity & Energy * No hallucinations/Delusions Depressive episode: * Low mood * Reduced mood * Anhedonia * Negative thoughts [Investigations] * Clinical diagnosis * FBC -- Normal * TFTs -- Normal * Urine drug screen -- Normal. * ECG -- QTc interval [Management] * Patient education * CBT Acute episode: * Mania -- Lithium/Valproate (Mood stabiliser) * Depression -- Olanzapine/Fluoxetine * Refractory/Life threatening -- ECT Long term management: * Lithium ± Valproate * Olanzapine * CBT

Answer 27

* **Bipolar disorder** * Isolated Manic episode * Hyperthyroidism/Hypothyroidism * Psychosis * Anorexia nervosa * Cerebrovascular event * Dementia * Steroid use

Answer 28

* **Bipolar disorder** * Isolated Manic episode * Hyperthyroidism/Hypothyroidism * Psychosis * Anorexia nervosa * Cerebrovascular event * Dementia * Steroid use

Answer 29

* **Bipolar 1** -- Mania + Depression * **Bipolar 2** -- Hypomania + Depression * **Rapid cycling** -- \>4 episodes of MDE/Mania/Hypomania in \<1yr * **Cyclothymic** -- Chronic + Less severe mania & moderate depression for \>2yrs

Answer 30

If they have ever had any manic episdoes * Why -- Because prescribing antidepressants in a patient with bipolar disorder can lead to manic episodes

Answer 31

* Self harm + Suicide risk * Financial risk * Sexual risk * Risk to self/others * Drugs/Alcohol use * Vulnerability -- Neglect/Debts

Answer 32

[Section 2] * Can be used up to 28 days * Used to admit patient for assessment * Treatment can be given for the mental disorder itself or conditions directly resulting from the disorder Requires Application by: * AMHP/Nearest relative Recommendation required by: * 1 section 12 approved Dr + 1 other Dr Discharge/Renewal if: * Pt appeals to tribunal/Discharge by responsible clinician, Hospital manager, or Nearest relative * If further treatment required - Section 3 application [Section 3] * Can be used for 6 mo * Used to admit patient for treatment Treatment can be: * Given for 3 mo THEN * Consent required/2nd Opinion Requires Application by: * AMHP/Nearest relative Recommendation required by: * 1 section 12 approved Dr + 1 other Dr Discharge/Renewal if: * Patient appeal to tribunal/Responsible clinician/Hospital manager/Nearest relative [Section 4] * Can be used for 72hrs * Used for emergency admission for assessment * Treatment can only be given under common law Requires Application by: * AMHP/Nearest relative Recommendation by: * Any Dr Discharge/Renewal if: * Cannot appeal * Discharge by responsible clinician

Answer 33

[Section 5(2)] * Can be used for 72hrs * Used for emergency holding order - for pt already admitted to hospital informally * Treatment can only be given under common law Requires Recommendation by: * Dr/Approved clinician in charge of pt care/Nominated deputy of responsible clinician Discharge/Renewal if: * Cannot appeal * Discharge by responsible clinician [Section 5(4)] * Can be used for 6hrs * Used for emergency holding order - for pt already admitted to hospital informally * Treatment can only be given under common law Requires Recommendation by: * Registered nurse Discharge/Renewal if: * Cannot appeal * Discharge by responsible clinician

Answer 34

[Section 135] * Can be used once * Warrant to gain access to premises to remove patient to a place of safety * Does NOT allow for treatment Requires: * 1 doctor * AMHP * Police Can be renewed if further assessment required [Section 136] * Can be used once * Allows police to remove person from public place to place of safety * Does NOT allow for treatment Requires * Police - remain in attendance until further assessment arranged

Answer 35

[Cause] * Extreme impairment in cognitive ability -- Intereferes with ability to function. There are many different causes * Mental illness -- Primary v Secondary * Organic causes * Drugs + Alcohol [Diagnostic criteria] * Delusions * Hallucinations -- Auditory/Visual/Tactile [Investigations] * Referral to mental health services * Hx + MSE * Delirium screen: * FBC + U&E + LFTs * STD Screen * Urine drug screen * CT brain if focal signs * CXR if indicated * Urine dipstick ± Culture * B12 + Folate * Blood glucose [Management] * Treat cause of the psychosis * May require admission under MHA

Answer 36

Primary psychosis: * Schizophrenia * Depression w/psychosis * Bipolar disorder * Peurpural psychosis * Delirium Secondary psychosis: * Drugs -- OTC/Anticholinergics/Corticosteroids/Thyroid hormones/Dopamine agonists * Recreational drugs -- Cocaine/Cannabis/Amphetamines/Alcohol * Drug/Alcohol withdrawal Organic causes: * Epilepsy * MS * Dementia * ABI * Encephalitis * SoL * Vitamin deficiency -- B12/Folate/B3/Thiamine

Answer 37

[Cause] * Vulnerability to psychotic episodes * Caused by genetic/environmental/social reasons * Imbalance of NT in the brain, and decreased brain volume. * Increased risk of developing with cannabis use Types: * Paranoid * Catatonic [Who gets it?] * Typically in younger ages (Adolescence/20's) * Men \> Women * FHx [Diagnostic criteria] \>2 of the following for a significant period in 1 month, and continous overall for \>6months: Positive symptoms * Delusions * Hallucinations -- Usually auditory * Disorganised speech/catatonic behaviour * Formal thought disorder -- Echo/Withdrawal/Insertion/Broadcase/Control Negative symptoms: * Emotional flattening * Avolition -- Reduced ability to do goal directed behaviour * Blunted mood * Self neglect * Social withdrawal * Improverished speech & language [Investigations] * Full Hx + MSE * Clinical diagnosis * if 1st episode - Delirium screen: * FBC -- Normal * LFTs -- Normal * STD screen -- Normal * Urine drug screen -- Normal * If focal neurological signs -- CT Head [Management] * MDT support/CAMHS if young * Health promotion -- Stop smoking/drugs/diet control * Manage social factors * Patient education Medical management: * Antipsychotics -- Risperidone/Olanzapine/Quetiapine * I/M Depot injections if non-compliant * If treatment resistant (Used \>2 antipsychotics) -- Clozapine If Acute agitation: * Lorazepam Resistant to drugs: * ECT [Prognosis] * Suicide risk is higher than general population * Increased risk of death from violence * Relapse is common

Answer 38

**Schizoaffective disorder** * Shizophrenia + Major affective disorder (Depression/Bipolar) **Schizophreniform disorder** * Symptoms that are similar to schizophrenia but do not meet the threshold for schizophrenia

Answer 39

* **Schizophrenia** * Drug induced psychosis -- Amphetamine/LSD/Cannabis * Temporal lobe epilepsy * Alcoholic hallucinations * Delirium * Encephalitis * Mania * Depression with psychosis * Anxiety

Answer 40

* **Schizophrenia** * Schizoaffective disorder * Drug induced psychosis -- Amphetamine/LSD/Cannabis * Temporal lobe epilepsy * Alcoholic hallucinations * Delirium * Encephalitis * Mania * Depression with psychosis * Anxiety

Answer 41

* **Schizoaffective disorder** * Drug induced psychosis -- Amphetamine/LSD/Cannabis * Temporal lobe epilepsy * Alcoholic hallucinations * Delirium * Encephalitis * Mania * Depression with psychosis * Anxiety

Answer 42

Deterioration of higher levels of functioning - Progressive Causes: * Memory loss - Short term memory * Decline in cognition * Difficulties with ADLs Types: * Alzheimers dementia (Most common) -- Degeneration of brain matter * Vascular dementia -- Brain damage due to strokes * Dementia with Lewy Bodies -- Dementia with parkinsons symptoms * Frontotemporal dementia -- Specific atrophy of the frontal + temporal lobes * Mixed dementia -- Mixture of dementia types

Answer 43

Where there is: * Mild cognitive impairment * Decline in cognitive function - greater than expected for age/education level * No Intereference with ADLs

Answer 44

[Introduction] I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Most common cause of dementia * Due to progressive degeneration of the cerebral cortex - impairs cognitive function * Deposition of Amyloid plaques + neurofibrillary tangles (Deposition of material in the brain) * Leads to inflammatory reaction that damages the brain matter * Insidious onset + Slow progression [Who gets it?] * Most common form of dementia * Genetic - FHx * Can also be idiopathic - Due to ageing + environment * Women \> Men * Can be initiated by head injury [Symptoms/Signs] * Insidious * Short term memory lapses * Decline in ADLs + IADLs * Confusion * Apathy * May develop Depression/Hallucinations/Delusions * May become aggressive/Disinhibited/Agitated [Diagnostic criteria] * Progressive short term memory impairment * Deficits in \>2 areas of cognition * Insidious onset over months/years - Progressive worsening * No disturbance of consciousness [Investigations] * Clinical diagnosis - Hx + Examination * Cognitive assesment - MMSE + ACE * Delerium screen: * FBC -- Normal * U&Es -- Normal * TSH -- Normal * Serum B12/Folate -- Normal * MRI -- Generalised atrophy. Rule out cerebral pathology. [Management] * Advanced care planning - LPA/Advanced statement * Assess capacity to consent * Patient education * Inform DVLA for assesment * Mild to moderate: * Structured group cognitive stimulation * Memory enhancement strategies * Moderate to severe: * Donepezil/Rivastigmine/Galantamine

Answer 45

* **Alzheimers dementia** * Vascular dementia/Lewy body dementia/Fronto-temporal dementia * Normal pressure hydrocephalus * Delirium - Hypothyroidism/B12 deficiency

Answer 46

* **Alzheimers dementia** * Vascular dementia/Lewy body dementia/Fronto-temporal dementia * Normal pressure hydrocephalus * Delirium - Hypothyroidism/B12 deficiency

Answer 47

Depression * Avoid TCAs due to effect on cognition * SSR -- Sertraline/Citalopram Psychotic features * Risperidone Agitation/Aggression * Lorazepam/Haloperidol/Olanzapine

Answer 48

Due to the progressive nature of the condition, they will eventually require palliative care: * Oral nutrition * Consider DNAR * Most common cause of death is infection Vascular dementia -- Prognosis worse than AZD

Answer 49

* Patient experiences dementia like symptoms temporarily due to severe depression * can also appear with mania, schizophrenia, dissociative disorders or psychoactive drug use [Diagnostic features] * Meet all the core symptoms for depression * Concurrent loss of short term memory +/- long term memory * Rapid decline of cognitive function * Temporary [Management] * SSR - Sertraline/Citalopram * CBT

Answer 50

[Introduction] I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Chronic progressive disease of brain leading to cognitive impairment secondary to cerebrovascular disease (ischaemia/haemorrhage) * Due to stroke/small vessel disease * Leads to loss of axons, and damage to brain matter [Who gets it?] * 2nd most common type of dementia * Increased incidence with age - \>65yrs * Men \> Women * CADASIL in younger patients * Risk in patients with Hx of stroke/TIA or HTN or DM * All risk factors for CVD [Symptoms/Signs] * Progressive short term memory loss - Sudden/Gradual after a distinct decline * Stepwise progression [Diagnostic criteria] * Memory loss + \>2 impairments of cognition * Intereference of ADLs due to deficits * Concurrent cerebrovascular disease - O/E + brain imaging * Symptoms within 3 months of stroke [Investigations] * Clinical diagnosis + Imaging for CVE * CT/MRI brain -- Signs of cerebrovascular lesions * ECG -- Identify if patient has AF * Delirium screen: * FBC -- Normal * ESR -- Normal * Blood glucose -- Normal * U&Es -- Normal * LFTs -- Normal * Vitamin B12/Folate -- Normal * TFTs -- Normal [Management] * Patient education * Reduce CVD risk factors: * Antiplatelet -- Aspirin/Clopidogrel * Statin * Increase physical activity * Antihypertensives * Smoking cessation * Cognitive stimulation therapy

Answer 51

* **Vascular dementia** * Alzheimers dementia/Frontotemporal dementia * Depression/Pseudodementia * Mild cognitive impairment * Normal pressure hydrocephalus

Answer 52

* Behavioural problems -- Wandering/Delusions/Hallucinations * Depression * Falls/Gait abnormalities * Aspiration pneumonia * Pressure ulcers * Caregiver burden/stress

Answer 53

[Introduction] I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Progressive widespread impairment of mental function interfering with ADLs * Proteins deposited into neurones within the area which causes Parkinsons disease [Who gets it?] * 3rd most common type of dementia * Sporadic/Genetic (AD inherited) * Older patients [Symptoms/Signs] * Memory loss * Cognitive decline * Visual hallucinations * Mild parkinsonisms -- Tremor/Rigidity/Falls * Sleep disorders -- REM sleep disorder * Autonomic dysfunction -- Fainting/Urinary incontinence/Constipation [Diagnostic criteria] * Fluctuating cognition + Prominent & persistent memory impairment * Recent visual hallucinations * REM sleep behaviour disorder * Parkinsonism symptoms -- Bradykinesia + Resting tremor + Rigidity [Investigations] * Clinical diagnosis * Delirium screen: * FBC -- Normal * ESR -- Normal * Blood glucose -- Normal * U&E -- Normal * LFTs -- Normal * Vitamin B12/Folate -- Normal * TFTs -- Normal * MIGB scintigraphy -- Diagnostic for LBD [Management] * Specialist referral * Patient education * Risk assesment - OT & Phsyio * Inform DVLA * Rivastigmine - manage cognitive decline * Lorazepam -- Manage behavioural disturbances/anxiety/agitation

Answer 54

* **Lewy body Dementia** * Alzheimers dementia * Vascular dementia * Idiopathic parkinsons disease * Intracranial tumour * Stroke/TIA

Answer 55

[Introduction] I will be explaining to you the following: Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Progressive dementia affecting the frontal lobe + temporal lobe * Due to atrophy of the frontal and temporal lobes, no plaque formation * "Holes" formed in these areas * Picks disease -- Pick bodies (Proteins in neurons) + Neurons balloon [Who gets it?] * Genetic component -- FHx * Typically patients \<65yrs old * Rare condition [Symptoms/Signs] * Gross change in social behaviour & language * Indifferent to self care & others needs * Loss of speech and comprehension * Impulsive + Loss of inhibitions [Diagnostic criteria] * Insidious onset * Behavioural changes * Non fluent aphasia * No neurological signs [Investigations] * Clinical diagnosis * Fulfils diagnostic features * MRI -- Frontal & Temporal atrophy * Delirium screen: * FBC -- Normal * ESR -- Normal * Blood glucose -- Normal * U&E -- Normal * LFTs -- Normal * Vitamin B12/Folate -- Normal * TFTs -- Normal * MIGB scintigraphy -- Diagnostic for LBD [Management] * No treatment to stop progression * Alleviate symptoms * Patient education * Future planning -- DNAR/Will * OT/SALT/Physio

Answer 56

* **Frontotemporal dementia** * Alzheimers dementia * Vascular dementia * Intracranial tumour * Stroke/TIA * Substance abuse

Answer 57

* **Frontotemporal dementia** * Alzheimers dementia * Vascular dementia * Intracranial tumour * Stroke/TIA * Substance abuse

Answer 58

[Introduction] I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Developmental condition where there is impairment in: * Social interaction * Reciprocal communication * Stereotyped repetitive/limited behavioural repertoire [Who gets it?] * Genetic + Environmental influences * Associated with Fragile X syndrome/Downs syndrome/Tuberous sclerosis * Boys \> Girls [Symptoms/Signs] * Hx of language delay * Language regression * Lack of pretend play * Impaired verbal communication * Unusual/repetitive movements * Communication impairment * Social impairment [Diagnostic criteria] * Abnormal or impaired development manifests \<3yrs * Abnormal functionin in ALL areas: * Reciprocal social interaction * Communication * Restricted/stereotyped/repetitive behaviour [Investigations] * Diagnosis after age 2/3 * Specialist diagnosis via ASD team * Assessment by SLT + OT + Social workers + Special educators * Screening tests, including play - ADOS2/DISCO [Management] * Patient mediated intervention to aid families to interact w/child * Intensive behaviour intervention programme * CBT * SLT - aid with speech problems * If challenging/aggressive behaviour -- Risperidone

Answer 59

* **Autism spectrum disorder** * Deafness * Hellers disease * General learning disability

Answer 60

* **Autism spectrum disorder** * Deafness * Hellers disease * General learning disability

Answer 61

[Introduction] I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Patients maintain low body weight due to pre-occupation with weight * Fear of fatness/pursuit of thinness - pts believe they are fat and terrified of normal weight/shape [Who gets it?] * Females \> Males * Early/mid adolescents * FHx of eating disorder/depression * Pre-morbid experiences -- Sexual abuse/Dieting behaviour in family [Symptoms/Signs] * Low body weight - BMI \<18.5kg/m2 or \<5th centile in child * Rapid weight loss * Weight loss measures -- Extreme dieting * Amenorrhea \>3 months * Purging behaviour -- Over-exercise/Laxative use/diuretics * Lanugo hair [Diagnostic criteria] * Restriction of energy intake to significantly lower weight below minimum for age/height * Intense fear of gaining weight/persistent behaviour interfering with weight gain * Disturbance of body image * Restricting sub-type -- Weight loss by dieting/fasting/excessive exercise * Binge eating sub-type -- Recurrent episodes of Binge eating in preceeding 3 months * Purging sub-type -- Recurrent episodes of purging in preceeding 3 months [Investigations] * Clinical diagnosis * FBC -- Normal. May have normocytic normochronic anaemia + Mild leukopenia + thrombocytopenia * TFTs -- Normal * U&Es -- Normal. May have electrolyte imbalance from purging behaviour * LFTs -- Normal. May have elevated ALT/AST/Cholesterol * Urine dipstick -- Normal. May have ketonuria (Starvation) * DEXA -- If 1 yr underweight due to risk of osteopenia/osteoporosis * ECG -- Assess for Bradycardia/Prolonged QTc interval [Management] * Assess physical risk with MARSIPAN (Determine if severe anorexia) * Refer to eating disorder service -- Further assesment/treatment * If child -- Anorexia focused family therapy (Control to parents, then independence, then maintenance) * Dentist assesment if purging * If severe -- Refeeding under MHA sectioning

Answer 62

* **Anorexia nervosa** * Bulimia nervosa * Depression * Hyperthyroidism * T1DM * Crohns/UC * Systemic illness

Answer 63

* Osteoporosis * Hypokalaemia -- Fatal arrythmia * Hypotension * Anaemia + Thrombocytopenia * Hypoglycaemia * Infertility * Stunting of growth + Delayed puberty * AKI/CKD * Anxiety & Mood disorders

Answer 64

[Introduction] * I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Eating disorder with repeated uncontrolled excessive eating (Binges) * Compensatory weight loss behaviours [Who gets it?] * Genetic/Environmental * Women \> Men * All socio-economic groups * Adolescents & young adults [Symptoms/Signs] * Regular binge eating for at least 3 months - with loss of control * Compensatory weight loss - Vomitting/Fasting/Exercise/Medication use * Physical symptoms: * Bloating/Fullness * Abdominal pain * Sore throat * Dental problems due to vomiting * Swollen parotid glands * Calluses on back of hand due to teeth abrasions (Russels sign) [Diagnostic criteria] * Excessive preoccupation with body weight and shape * Regular binge eating for at least 3 months - with loss of control * Lack of control over eating * Compensatory weight loss - Vomitting/Fasting/Exercise/Medication use [Investigations] * Clinical diagnosis * U&E -- Normal * Urine pregnancy test -- Negative [Management] * Referral to eating disorder service * Focused family therapy * Individual CBT * Regular dental review & Dental hygeine * Fluoxetine -- to decrease purging behaviour

Answer 65

* **Bulimia Nervosa** * Binge eating * Depression * Anorexia nervosa with bulimic features

Answer 66

* **Bulimia Nervosa** * Binge eating * Depression * Anorexia nervosa with bulimic features

Answer 67

* Haematemesis * Metabolic complications (Hypokalaemia) * Dental erosions * Painless enlargement of salivary glands * Tetany * Seizures

Answer 68

[Introduction] * I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Recurrent persistent pattern of behaviour - violates rights of others and societal norms * May develop into antisocial personality disorder as adult [Who gets it?] * Late childhood/Early adolescence * Boys \> Girls * Parents may be involved with substance abuse or antisocial behaviour [Symptoms/Signs] * Lack sensitivity to feelings and well being of others/Little remorse * Mispercieve others behaviour as threatening * Act aggressively or bully * Use weapons/act against the rules * May harm animals/Destroy property [Diagnostic criteria] * Child/Adolescent with \>3 behaviours in past 12 mo + at least in last 6 mo * Aggression towards people/animals * Destruction of property * Deceitfulness/Lying/Stealing * Serious violations of parental rules * Impairs functioning in relationships at school/work [Investigations] * Clinical diagnosis [Management] * Psychotherapy - Improve self esteem + self control * Behviour modification * CBT * Risperidone (Short term - rarely used)

Answer 69

[Introduction] * I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Recurrent persistent pattern of negative/defiant/hostile behaviour directed at authority figures * Mild version of conduct disorder * Dont lack remorse/conscience [Who gets it?] * Common in children from argumentative families * Boys \> Girls [Symptoms/Signs] * Loses temper easily and repeatedly * Argue with adults * Refuse to obey rules * Blame others for own mistakes/misbehaviour * Spiteful/Vindictive [Diagnostic criteria] * Child with \>4 symptoms for at least 6/12 * Loses temper easily and repeatedly * Argue with adults * Refuse to obey rules * Blame others for own mistakes/misbehaviour * Spiteful/Vindictive * Severe + Disruptive * [Investigations] * Clincal diagnosis [Management] * Behvaiour modification therapy - reward based

Answer 70

What does it mean? * Therapy to try to balance contradictory positions - work with therapist to find a good balance b/w acceptance v change * Acceptance -- Accepting yourself * Change -- Making positive changes in your life * Aim is that by understanding yourself you can learn to deal with your feelings in a different way Who is it used for? * To treat Borderline personality disorder * Can also be used for people with drug/alcohol problems, eating disorders, offending behaviour What does it involve? * Talking with therapist to help patient gain control over their behaviour * Stop suicidal and self harming behaviour * Reduce behaviour that intereferes with therapy * Improve quality of life by addressing things that interefere with this

Answer 71

[Introduction] * I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Persistent pattern of inattention + Hyperactivity & Impulsivity * May be due to dysregulation of dopamine + Noradrenaline * Commonly occurs in children with low birth weight/Maternal smoking [Who gets it?] * Genetic + Environmental * One of the most common disorders in childhood * Boys \> Girls * FHx [Symptoms/Signs] * Inattention: * Fails to give close attention to details * Trouble holding attention * Does not listen when spoken to * Easily distracted * Hyperactivity & Impulsivity: * Figeting/Tapping * Unable to remain seated * Run about/climbs in inappropriate situations * Interrupts often [Diagnostic criteria] * Persistent pattern of inattention + Hyperactivity & Impulsivity * Inattention -- \>6 symptoms for at least 6/12 * Hyperactivity & Impulsivity -- \>6 symptoms for at least 6/12 * Symptoms start in childhood \<7yrs * Functional impairment across 2 domains at school + home [Investigations] * Clinical diagnosis: * Diagnostic symptoms * Conners assesment scale * Full clinical & Psychosocial assesment -- Observer/School reports [Management] * Specialist referall to CAMHS * If adult --\> Psychiatrist * Patient & Parent education * Balanced diet & good nutrition & Regular exercise * If severe -- Methylphenidate (Stimulants)

Answer 72

* **ADHD** * Thyroid disease * Depression * Anxiety * Substance abuse

Answer 73

* **ADHD** * Thyroid disease * Depression * Anxiety * Substance abuse

Answer 74

At least 3 in the last 12 months: 1. Increased tolerance 2. Loss of control of substance use 3. Narrowing of drinking repertoire 4. Reinstatement despire knowing its harmful 5. Difficulty/Failure of abstinence 6. Withdrawal leads to - Sweats/Nausea/Tremor 7. Often aware of compulsion to use drug

Answer 75

Repeated drinking that harms the persons work/social life Signs of dependence: * Increased tolerance * Loss of control of substance use * Narrowing of drinking repertoire * Reinstatement despire knowing its harmful * Difficulty/Failure of abstinence * Withdrawal leads to - Sweats/Nausea/Tremor * Often aware of compulsion to use drug [Screening tools] * CAGE * Have you felt the need to CUT down on your drinking? * Have people ANNOYED you by critisizing your drinking? * Have you ever felt bad/GUILTY about your drinking? * Have you ever had a drink 1st thing in the morning to steady your nerves/get over the hangover (EYE OPENER) * \>2 considered clinically significant

Answer 76

* Ask patient if they want to change * Treat coexisting depression if present * Self help/Group therapy

Answer 77

* Liver -- AFLD/Hepatitis/Liver failure * CNS -- Poor memory/cognition/Wernickes/Korsakoffs * Gut -- D&V/Peptic ulcer/Varices/Pancreatitis * Hear -- Arrythmia/HTN/Cardiomyopathy * MSK -- Osteoporosis risk due to disrupted Ca metabolism

Answer 78

Delirium tremens: * Increased pulse * Decreased BP * Tremor * Fits/Seizures * Visual/Tactile hallucinations [Management] * Monitor observations * Diazepam for 3 days then wean -- To prevent seziures * Pabrinex - Thiamine

Answer 79

[Wernickes] * Thiamine B1 deficiency - due to: * Deceased dietary intake of thiamine * Decreased absorption of thiamine from GIT + Utilisation in cells Symptoms: * Confusion * Wide based gait ataxia * Opthalmoplegia -- Nystagmus + Bilateral Lateral rectus palsy Management: * High dose Pabrinex for 1 week IV/IM * Followed by oral supplementation * Glucose [Korsakoffs syndrome] * Complication of untreated wernickes encephalopathy * Leads to Hypothalamus damage + Cerebral atrophy Symptoms: * Inability to acquire new memories * Confabulation - invented memory due to retrograde amnesia * Lack of insight + apathy Management: * May be reversible with supplemental thiamine * May be permanent requiring institutional care

Answer 80

[Introduction] * I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Syndrome of ongoing anxiety + worry about thoughts/events - No identifiable trigger * Patient recognises that the worry & anxiety is inappropriate * Can be chronic & disabling * Can be due to: * Increased minor stressors in life * Presence of physical/emotional trauma * Genetic factors * Bullying/peer victimisation [Who gets it?] * Women \> Men * May have onset in childhood/adolsecence * FHx of anxiety * Hx of physical/emotional trauma * Co-morbid depression [Diagnostic criteria] * At least 3 symptoms for 6/12: * Excess anxiety + worry more days than not - Concerns wide range of events/activities * Difficulty controlling worry * Poor concentration * Irritability * Sleep disturbance * Restless/Nervous * AND at least 4 of the following: * Autonomic arousal symptoms * Chest/abdominal symptoms * Symptoms involving mental state * General symptoms [Investigations] * Clinical diagnosis * TFTs -- Normal * Urine drug screen -- Negative * ECG -- Normal * BP -- Normal [Management] * Patient education * Low intensity psychological support * CBT * Drug treatment: * SSRI -- Escitalopram/Paroxetine * SNRI -- Venlafaxine * If immediate management -- Clonazapam/Diazepam * If complex/Treatment refractory: * Medication * Psychological treatment * Crisis intervention

Answer 81

* **Generalised Anxiety disorder** * Panic disorder * PTSD * OCD * Social phobia

Answer 82

[Introduction] * I will be explaining to you the following: * Causes * Who gets it? * Symptoms/Signs * Diagnostic criteria * Investigations * Management [Causes] * Develops folloing a stressful event/situation of exceptionally threatening/catastrophic naure * Likely to cause pervasive stress in anyone * Anterior cingulate area fails to inhibit the amygdala, so there is decreased amygdala threshold to fearful stimuli * Increased adrenaline produced in HPA axis [Who gets it?] * Increased in inner cities/disaster zones * Military personnel/Emergency services/Police * Can also occur in post natal period * Female \> Males [Symptoms/Signs] * Intrusions -- Flashbacks/dreams & nightmares/Intrusive images * Avoidance -- People/situations/circumstances that resemble the event * Negative alteration to mood & cognition -- Feeling alienated/diminished interest in activities * Altered arousal & reactivity -- Hypervigilance/Exaggerated startle response * Emotional detachment from others * Amnesia regarding important aspects of the trauma [Diagnostic criteria] 4 symptoms present for at least 4 weeks: * Intrusions -- Flashbacks/dreams & nightmares/Intrusive images * Avoidance -- People/situations/circumstances that resemble the event * Negative alteration to mood & cognition -- Feeling alienated/diminished interest in activities * Altered arousal & reactivity -- Hypervigilance/Exaggerated startle response * Emotional detachment from others * Amnesia regarding important aspects of the trauma [Investigations] * Clinical diagnosis [Management] * Manage anxiety * Beta blockers * Clonidine (Alpha antagonist) * Long term management: * CBT * EMDR (Eye movement desensitisation & reprocessing) * SSRI * TCA

Answer 83

* **PTSD** * Depression * Specific phobia * Acute stress reaction (Symptoms \<1month) * Psychosis * personality disorder

Answer 84

* **PTSD** * Depression * Specific phobia * Acute stress reaction (Symptoms \<1month) * Psychosis * personality disorder

Answer 85

Layout: * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indication & Action of the drug] * Indication * Bipolar affective disorder * Schizoaffective disorder * Cyclothymia * Impulse control & Intermittent explosive disorders * Action: * The precise mechanism of action of Li+ as a mood-stabilizing agent is currently unknown. * Lithium has been found to exert a dual effect on glutamate receptors, acting to keep the amount of glutamate active between cells at a stable, healthy level, neither too much nor too little. * It is postulated that too much glutamate in the space between neurons causes mania, and too little, depression * Effective in long term prophylaxis of both mania + depressive episodes [Side effects] * GI distress * Reduced appetite * Nausea & Vomiting * Diarrhoea * Fine tremor - intention tremor * Hair loss * Acne * Polydipsia * Polyuria -\> Secondary to ADH antagonism Long term effects: * Chronic renal failure * Clinical/subclinical hypothyroidism * Diabetes insipidus * Cardiac arrhythmia * Leukocytosis - elevated WCC count * Reduced seizure threshold * Cognitive slowing Toxicity * Moderate - Blurred vision/Clonic limb movements/Anorexia/Delirium.Syncope * Severe - Generalised convulsions/Oliguria/Renal failure [How to take it] * Tablet [Monitoring requirements] * Before starting * FBC - Increase WCC * U&E - gradual increase in creatinine (Kidney function affected) * TFTs * Weight + BMI * ECG * Check for pregnancy * Teratogenic in 1st trimester * Monitoring Lithium levels * Steady state achieved after 5 days * Blood sample taken 12hrs after last dose (Trough level) * Therapeutic range - 0.6-1.2 mmol/L * Once stable check: * Weekly for 1/12 * Monthly for 6/12 * 3 monthly * TSH and Creatinine levels every 6 months

Answer 86

Layout: * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indication & Action] Indications * Seizure prophylaxis in epilepsy * Status epilepticus not responding to benzodiazepines * Bipolar disorder - acute treatment of manic episodes and prophylaxis against recurrence Action * Weak inhibitor of neuronal Na channels - stabilising resting membrane potentials & reducing neuronal excitability * Increases brain content of GABA - inhibitory NT (Involved in regulation of neuronal excitability [How to take it] * Take in 1-3 divided doses * Comes as tablet/granules/oral solutions/IV infusion * Reduce GI upset by taking it with food [Important SE] * GI Upset * Nausea/Gastric irritation/diarrhoea * Neurological & psychiatric effects * Tremor/ataxia/behavioural disturbances * Thrombocytopenia + platelet dysfunction * Transient increase in liver enzymes Severe rare SE: * Severe liver injury - chemical hepatitis * Pancreatitis * Bone marrow failure * Anti-epileptic hypersensitivity syndrome Complications/Contraindications * Avoid in:Women of childbearing age - conception & 1st trimester * Increased risk of foetal abnormalities - NT defects/Craniofacial/Cardiac & limb abnormalities * Also risk of developmental disorders - ADHD/ASD * Note: If pregnancy can not be avoided - Folic acid 5mg daily * Hepatic impairment * Severe renal impairment Special info * Signpost to seek urgent medical advice, for unexpected symptoms * Lethargy/Loss of appetite/vomiting/abdominal pain - Signs of liver poisoning * Bruising/high temperature/mouth ulcers - Indicates blood abnormalities [Monitoring requirements] * Monitor by comparing seizure frequency before + after starting treatment * Monitor safety * Measure LFTs + PT time * Pregnancy test * Before starting * During first 6 mo of treatment * Measure Plasma valproate levels * Check for adherence/toxicity

Answer 87

Layout: * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indication & Action of the drug] Indication * Psychomotor agitation - causing dangerous/violent behaviour/calm patients to permit assessment * Schizophrenia * Bipolar disorder - Mania/Hypomania * Nausea & vomiting Actions: * Blocks post synaptic D2 (Dopamine) receptors * Note: Dopaminergic pathways:Mesolimbic (Positive symptoms) Midbrain -\> Limbic system * Where positive symptoms come from - Hallucinations/Delusions/Thought disorders * Too much dopamine * Mesocortical pathways (Negative symptoms)Midbrain -\> Frontal cortex * Where Negative symptoms & cognitive disorders come from * Too little dopamine * Nigrostriatal pathway * Substantia nigra -\> Corpus striatum of basal ganglia * Involved in movement regulation * Dopamine hyperactivity -\> Parkinsonian movements * Tuberohypophysial pathway Hypothalamus -\> Pituitary gland * Dopamine inhibits/regulates Prolactin release * Blocking dopamine here -\> Predisposed to hyperprolactinemia (Gynecomastia/galactorrhoea/decreased libido/menstrual dysfunction) [Side effects] * Extrapyramidal SE Movement abnormalities from D2 blockage of Nigrostriatal pathway * Acute dystonic reactions - involuntary parkinsonisms/muscle spasms * Akathisia - state of inner restlessness * Neuroleptic malignant syndrome\* (Rare but life threatening) * Muscle Rigidity * Confusion * Autonomic dysregulation * Hypethermia * HTN + Tachycardia * Hyper-reflexia * Tremor * Agitation & irritability * Sweating * Pyrexia * Confusion * Elevated FBC & LFTs * Tardive dyskinesia (Late effect) * Pointless movements * Involuntary & repetitive movements (Lip smacking) * Drowsiness * Hypotension * Prolonged QT interval - Risk of Torsades des Pointes * Erectile dysfunction * Weight gain * Hyperprolactinemia * Menstrual disturbance * Galactorrhoea * Breast pain Complications/Contraindications * Neuroleptic malignant syndrome * C/I: * Dementia - increased risk of stroke & death * Parkinsons disease - EP effects [How to take it] * Tablet or Depot injection (Every 2-4wks) * Oral (Tablet/Liquid) * Slow release IM depot injection * Long term treatment - to stop symptoms from returning * If aggression (Psychomotor agitation) - Single dose to manage patient * Takes several days/weeks for the effects to take place [Monitoring requirements] * Regular review of symptoms & signs * ECG - before starting, assess QT interval

Answer 88

Neuroleptic malignant syndrome\* (Rare but life threatening S/E of antipsychotics) * Muscle Rigidity * Confusion * Autonomic dysregulation * Hypethermia * HTN + Tachycardia * Hyper-reflexia * Tremor * Agitation & irritability * Sweating * Pyrexia * Confusion * Elevated FBC & LFTs Complications: * Rhabdomyolysis * Hyperkalaemia * Kidney failure * Seizures * Potentially fatal Management * Discontinue medication * ICU - may require circulatory/ventilator support * Active cooling * Dantrolene/Bromicriptine/Amantadine for rigidity * Benzodiazepines for agitation * May require aggressive IV hydration with Diuresis

Answer 89

Layout: * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indication & Action of the drug] * Urgent management of psychomotor agitation * Schizophrenia * When EP symptoms are a problem on 1st generation medications * If negative symptoms are prominent * Bipolar disorder - Mania & Hypomania Actions: * Blocks post synaptic D2 receptors * Main effects are on the mesolithic & mesocortiyal pathways * Note: Dopaminergic pathways:Mesolimbic + Mesocortical pathways * Midbrain -\> Limbic system/frontal cortex * Antipsychotics block the D2 pathway here * Nigrostriatal pathway * Substantia nigra -\> Corpus striatum of basal ganglia * Tuberohypophysial pathway Hypothalamus -\> Pituitary gland * activity in these pathways cause the SE of the antipsychotics * Also Serotonin antagonists * More effective in treating treatment resistant schizophrenia & against the negative symptoms * Decreased risk of EP symptoms - Due to higher affinity for other receptors [Side effects] * Extrapyramidal SE (Lesser degree than typical) Movement abnormalities from D2 blockage of Nigrostriatal pathway * Acute dystonic reactions - involuntary parkinsonisms/muscle spasms * Akathisia - state of inner restlessness * Neuroleptic malignant syndrome\* (Rare but life threatening) * Muscle Rigidity * Confusion * Autonomic dysregulation * Hypethermia * HTN + Tachycardia * Hyper-reflexia * Tremor * Agitation & irritability * Sweating * Pyrexia * Confusion * Elevated FBC & LFTs * Tardive dyskinesia (Late effect) * Pointless movements * Involuntary & repetitive movements (Lip smacking) * Sedation * Metabolic disturbance * Increased weight - BMI/Waist circumference * Increased lipids * DM * Prolonged QTc interval * Risk of Torsades des Pointes [Complications/Contraindications] Use with caution in patients with: * Cardiovascular disease * Severe heart disease Avoid Clozapine in patients with: * Severe heart disease * Neutropenia - Agranulocytosis [How to take it] * Tablet daily * Depot injections every 2-4 weeks, slow release * Best taken at bed time * Start with small doses - titrate up over 1-2wks depending on response * Long term treatment to stop symptoms from returning * Effects take several days/weeks to manifest [Monitoring requirements] * Assessment of symptoms & signs * Testing at start of treatment & Periodically after * FBC * U&E * LFTs * Serum Prolactin * Note if patient is on Clozapine:Monitoring is weekly * Due to risk of Agranulocytosis (Decreased WCC - neutrophils) * Risk of Myocarditis Monitor for metabolic and Cardiovascular SE: * Fasting blood glucose & HbA1c * Lipid profile * Weight & BMI * ECG - assess QT interval * Risk of Torsades des Pointes

Answer 90

Layout: * Check what the patient knows * Brief history * Do they know what the drug is? * Indication & Action of the drug * Side effects * How to take it * Monitoring requirements [Indications & Action] Indications: * Mild to moderate Alzheimers disease * Mild to moderate dementia with PD (RIVASTIGMINE) Actions: * Acetylcholine is important NT in the CNS - essential for learning & memory * Decrease in activity of the brains cholinergic system seen in AZD and Dementia associated with PD * Drugs inhibit the cholinesterase enzymes (Enzyme that breaks down ACh) in the CNS * Increased availability of ACh for neurotransmission - improves cognitive function & reduces rate of cognitive decline * Recovery of function is not guaranteed however - aim is to improve memory and brain function, but may only slow decline [How to take it] * Available as tablet/capsule/liquid * Rivastigmine available as a patch - if swallowing difficulties * Donepezil - to be taken at night before bed * If patient experiences vivid dreams - best taken in the morning [Important SE] * Nausea & Diarrhoea * vomiting * Due to increased cholinergic activity in PNS * Patients with asthma or COPD - may have exacerbation of symptoms Serious SE: * Peptic ulcers & bleeding * Bradycardia & Heart block * Central cholinergic effects * Hallucinations * Altered/aggressive behaviour * Extrapyramidal symptoms & Neuroleptic malignant syndrome [Complications/Contraindications] Use with caution in: * Asthma & COPD * Risk of developing peptic ulcers Avoid in: * Heart block * Sick sinus syndrome * Rivastigmine can worsen tremor in PD [Monitoring requirements] * Reviewed for adverse effects 2-4 weeks after starting treatment * 3 months later - repeat cognitive assessment to assess efficacy * Continue treatment only where there is improvement in symptoms (Cognitive/functional/behavioural Special info * Signpost to see doctor if: * Abnormal movements * Agitated or aggressive behaviour * Reversible SE by reducing dose or stopping treatment * Rivastigmine is best for patients with poly pharmacy as it has no drug interactions

Answer 91

[Indication & Action of the drug] * Moderate to severe dementia in alzheimers disease Action * In AD there is increased Glutaminergic neurotransmission * Causing hyper excitation of neurons - leading to toxicity * Memantine acts as an antagonist to the glutamate receptors * Binds to the receptors and inhibits excessive neuronal excitation * Therefore stopping the excitotoxicity [Side effects] Anticholinergic drugs decrease the effect of the AChE-Inhibitors e.g. Benzodiazepines/Antipsychotics/Warfarin/TCAs SE are due to increased cholinergic activity * Nausea/vomiting/diarrhoea * Insomnia/Dizziness * Urinary incontinence * Can cause bradycardia Note: Donepezil is thought to have lower SE frequency * In patients with CVD/Polypharmacy -\> Rivastigmine

Mental Health Flashcards

(115 cards)