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AKT Prep > Mental Health, neurodevelopmental and disability > Flashcards

Mental Health, neurodevelopmental and disability Flashcards

1
Q

What is the best initial management of grief with bereavement hallucinations?

A

Reassure, normal part of grief process

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2
Q

What pyschological treatment should all individuals with newly diagnosed schizophrenia be offered?

A

CBT
- Family intervention should be offered to families of those living with schizophrenia (or close contact)

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3
Q

Name 3 medications where an SSRI would not be your first line choice in mod-severe depression.
What alternative?

A

Warfarin, heparin or non-steroidal anti-inflammatory drugs
- Don’t px SSRI due to bleed risk

Mirtazapine instead

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4
Q

What is the single most common form of self-harm?

A

Cutting

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5
Q

What are the most common precipitants of lithium toxicity in stable patients?

A

Dehydration (i.e. D+V illness)
Sodium imbalance

(Caution with diuretics)

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6
Q

How do you distinguish between bullaemia and binge eating disorder?

A

Bullaemia - Purge after binge (could be vomiting but could also be extreme exercise or laxatives)

BED - No purginging

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7
Q

How do you distinguish between anorexia and Bulimia?

A

Anorexia - Low BMI and often ammenorrhoea. Avoid food, calorie tracking

Bulimia - May have normal BMI. Vomiting (and dental problems from this). Binge eating and then purging

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8
Q

What is the name of the questionnaire which can be useful in screening for anorexia and Bulimia?

A

Sick control one fat food (SCOFF) questionnaire

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9
Q

What are the 5 questions of the SCOFF questionnaire?

A

Do you make yourself sick because you feel uncomfortably full?
Do you worry you have lost control over how much you eat?
Have you recently lost more than one stone in a three month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say that Food dominates your life?

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10
Q

What SCOFF questionnaire score indicates possible anorexia or Bulimia?

A

5 questions, 1 point each

2 or more points = Likely anorexia or Bulimia

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11
Q

What is the MINIMUM recommended duration of treatment for patients where drug therapy has been found to be effective?
a) In generalised anxiety (GAD)
b) In panic disorder

A

a) 12 months
b) 6 months

From the time was at the dose that worked for them

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12
Q

Social anxiety is MOST LIKELY to be associated with which mental health disorder?

A

Drug and alcohol misuse

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13
Q

You see a 28-year-old patient who takes escitalopram for severe depression. She reports that she has recently stopped smoking and is asking for advice regarding her anti-depressants. What do you need to consider?

A

Dose reduction by 25%

Smoking increases metabolism of many psychotropic medications and upon smoking cessation, doses may require immediate dose reduction to prevent medication toxicity. If smoking is resumed, original doses need to be reinstated. For escitalopram, monitor closely and consider 25% dose reduction.

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14
Q

What blood test needs checking on initiation of clozapine?
How often?

A

FBC
- Before
- Weekly for 18 weeks
- Bi-weekly after
- After 1 year, check 4 weekly

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15
Q

What is the evidence to decide on which treatment in depression of children and preventing further relapse - medicine/ pyschotherapy/ combination - which is best?

A

Limited evidence about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these in the prevention of relapse or recurrence of depression in children and adolescents.

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16
Q

When should lithium be initiated for bipolar disorder?

A

Start immediately after 1st severe mania episode

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17
Q

When may lamotrigiene be considered as a treatment for bipolar?

A

Consider lamotrigine in patients who have severe recurrent depression but only mild manic episodes (Bipolar II).

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18
Q

Which is the antidepressant of choice for patients with bipolar disorder who develop severe depression?

A

Fluoxetine
(often in combination with olanzapine and done in secondary care)

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19
Q

What is the minimum monitoring requirements for lithium (what and how often)?

A

BMI
U+E
Calcium
TFT’s
Lithium levels

Every 6 months min, if deterorating then do 3 monthly

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20
Q

When should lithium levels be monitored at initiation?

A

One week after initiation/ dose change
Then weekly til stable

Once stable 3 monthly for first year and 6 monthly thereafter

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21
Q

How would you characterise the symptoms of PTSD?

A

PTSD usually involves overarousal states including dysregulation of emotions (hyperacute emotions which are difficult to control), nightmares and sleep disturbance.

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22
Q

OCD, what is the first line therapy? If medication is used which one?

A

a) CBT
b) Sertraline

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23
Q

Name 3 features of abnormal grief?

A

Delayed – when more than two weeks have elapsed before grieving begins
Inhibited

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24
Q

How long after death is it considered delayed for someone to develop grief symptoms?

A

2 weeks

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25
Q

What group of medicines are linked to cognitive and functional decline in dementia?

A

Anticholinergics
(i.e. amitryptiline)

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26
Q

What characterises social anxiety disorder?

A

The hallmark of social anxiety disorder is excessive fear and anxiety when facing the possibility of humiliation or embarrassment.

Autonomic symptoms and avoidance

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27
Q

When is the peak incidence of:
a) baby blues
b) Postnatal depression

A

a) First few days, peak at one week, tapers by two weeks
b) 0-5 weeks

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28
Q

Which therapy has the strongest evidence for treating gambling addiction?

A

CBT

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29
Q

If antidepressant medication is used in pregancy which medication is preferable?

A

SSRI

Or TCA

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30
Q

What, if any, is the MINIMUM duration of unexplained, appropriately investigated symptoms before a formal diagnosis of medically unexplained physical symptoms (MUPS) should be considered?

A

3 months

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31
Q

What is the Care Programme Approach (CPA)?

A

The care programme approach (CPA) is a framework for providing care to those aged 16 years and over with mental health problems (with or without learning disabilities). It involves creating a formal, written care plan agreed by all involved parties (the patient, any carers/family and health and social care professionals). This should include a discussion of the patient’s holistic care needs and the patient should be assigned a named care coordinator.

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32
Q

In mild depression in adolescents, how long is watchful waiting appropriate for?

A

Watchful waiting is appropriate for up to four weeks with a reassessment after two weeks to reconsider the need for referral.

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33
Q

A patient has hypermetropia and diabetes, which antidepressant should be avoided?

A

Mirtazapine (Can precipirate angle closure glaucoma)

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34
Q

After a first episode of depression, once symptoms are in remission how long should antidepressants be continued for?

A

6 months

35
Q

What is the usual period of withdrawal for antidepressant therapy if established for over a year?

A

Around 4 weeks

36
Q

Name 2 antidepressants with a short half life where you may consider longer than 4 weeks withdrawal when stopping?

A

Paroxetine and venlafaxine

37
Q

Which antidepressant has the longest half life and therefore would need a less slow withdrawal than the usual 4 weeks?

A

Fluoxetine

38
Q

Sodium valpropate - what monitoring bloods and when?

A

BMI + FBC + LFT’s
After 6 months and then annually

39
Q

What advice should be given to reduce adverse effects of vomiting in someone with bulimia nervosa?

A

Rinse mouth after
Avoid acidic food and drink

Anorexia advised multivitamin but not bullimia

40
Q

Neuroleptic maligant syndrome:
a) 3 characterising features
b) 3 most common precipitating drugs

A

a) fever, rigidity and mental status changes

b) haloperidol, olanzapine and risperidone

41
Q

What is the most common form of abuse?

A

Coercive control

42
Q

Risk of suicide is highest in what time frame following index episode of self harm?

A

After 1st episode risk of suicide highest in first 6 months

43
Q

What is the recommended treatment for self harm in adolescents?

A

Dialectical behavioural therapy (DBT)

Typically a 16-week programme with both the young person and their family to develop coping skills, manage emotions and develop relationships.

44
Q

What duration of hypomania/ mania symptoms is considered significant in bipolar?

A

Over 4 days or more

45
Q

What characterises avoidant personality disorder?

A

Feelings of social inadequacy and fear of rejection.

46
Q

If there is a history of recurrent depression or the risk of relapse is considered high, then treatment with medication should be for a minimum duration of what?

A

At least 2 years

47
Q

What are the criteria for diagnosis of bulimia?

A

Binge eating once a week for at least three months
WITH
- compensatory behaviour (vomiting and excessive exercise)
AND
- psychological features (a loss of control)

48
Q

Only antidepressant licenced for use in children?

A

Fluoxetine

49
Q

Name 4 drugs which may be used to treat bipolar disorder?

A

Lithium, olanzapine, lamotrigine and sodium valproate

50
Q

How often do NICE recommend eye tests in the elderly?

A

Every2 years

51
Q

When should lithium level samples be taken?
What is the target window?

A

Samples should be taken 12 hours after the dose to achieve a serum-lithium concentration of 0.4–1 mmol/l

52
Q

According to NICE what PTSD pyschological treatments are recommended and when in relation to the event?

A

Trauma focussed CBT - >1mth after event (can be done not F2F)

EMDR - consider 1-3 mths after event, routinely offer if >3 mths after event

53
Q

Annual physical health checks are carried out for those with mental illness, what group of complications are most common?

A

Cardiovascular

54
Q

According to current guidance, which is the SINGLE MOST appropriate initial psychological management of binge eating disorder in an adult?

A

Guided self help

If ineffective after 4 weeks refer for group CBT

55
Q

What is the peak age of onset of bipolar disorder?

A

15-19yrs

56
Q

A patient taking lithium should be advised to avoid which OTC medicines?

A

NSAID

NSAIDs reduce the excretion of lithium and increase the risk of toxicity

57
Q

Which is the SINGLE MOST appropriate non-drug intervention for managing social anxiety disorder in adults?

A

Individual CBT

58
Q

What is the recommended drug-free gap required when switching from fluoxetine to another selective serotonin reuptake inhibitor (SSRI)?

A

7 days

Particular caution when switching from fluoxetine to other antidepressants, because fluoxetine has a long half-life (approximately 1 week). When switching from fluoxetine to another SSRI, either to stop fluoxetine (or taper if dose >40 mg/day), wait 7 days for a washout period,then start the new SSRI at low dose.

59
Q

Caution is recommended when prescribing antipsychotic drugs in elderly patients with dementia owing to an associated increased risk of?

A

Stroke or TIA

60
Q

You are starting antidepressant medication for a patient. When should they be reviewed?

A

Suicide risk OR man aged 18-25 - Within a week

No suicide risk - Within 2 weeks

61
Q

What IQ cut off’s are used for different categories of disability?

A

<20 Profound
20-35 Severe
35-50 Moderate
50-70 Mild
>70 - Normal

62
Q

What are the three characteristics of a learning disability?

A
  • A state of arrested or incomplete development of mind that occurs during child development
  • Impairment of intellectual functioning (usually measured by IQ)
  • Impairment of adaptive/social functioning
63
Q

What is the most common cause of non-inherited learning disability?

A

Foetal alcohol syndrome

64
Q

Name 3 physical features of fetal alcohol syndrome?

A

Small for age
Small widely-spaced eyes (hypertelorism)
Short palpebral fissures
Thin upper lip
Low nasal bridge
Often ASD/ VSD

65
Q

Name 3 physical features of Down’s syndrome?

A

Round face
Prominent epicanthic folds
Upsloping palpebral fissures
Oversized tongue
Single transverse palmar crease.

66
Q

Name 3 physical features of Turners syndrome?

A

short stature, low hairline, low set ears and webbing of the neck.

67
Q

An eight-year-old boy with ADHD has been brought to you for a repeat prescription of methylphenidate. The drug has improved his symptoms and you think it is appropriate to continue it. You wish to check for side-effects.

Which is the SINGLE MOST relevant examination?

A

Height/weight/blood pressure

Common side-effects include abdominal pain, nausea, dyspepsia, anorexia and reduced weight gain. It is, therefore, advisable to monitor growth during treatment.

68
Q

Dyslexia gives difficulty in which 3 key areas?

A

Phonological awareness
Verbal memory
Verbal processing speed.

69
Q

ADHD, 3 key characteristics?

A

Hyperactivity
Impulsivity
Inattention.

70
Q

A 15-year-old boy is taking atomoxetine to help control his attention deficit hyperactivity disorder (ADHD).

Which is the SINGLE MOST appropriate parameter to monitor?

A

Blood pressure

For people taking atomoxetine for ADHD, the heart rate and blood pressure should be monitored before and after each dose change and every six months.

71
Q

Name three medications which can be used in ADHD, which order should they be used in?

A

1) Methylphenidate
- If unsuccesful 6 week trial:
2) Lisdexamfetamine
If no improvement:
3) Atomoxetine or guanfacine

72
Q

You assess a patient with a learning disability needs a hospital admission but is refusing - you have assessed that they lack capacity. How do you proceed?

A

Make best interests decision

  • Needs to be balanced and with discussion with close family/ contacts - if no-one available discuss with IMCA

NOT mental health act as their is no mental health condition

73
Q

Developmental milestones:
vocalising one to six words with meaning is expected by what age?

A

18mths

74
Q

Developmental milestones:
building a tower of 4 bricks is expected by what age?

A

18 months

75
Q

Developmental milestones:
unsupported sitting is expected by what age?

A

Around 6 months but upper limit is 9 months

76
Q

What is Gowers sign? Which condition is it seen in?

A

Gower’s sign is seen in Duchenne muscular dystrophy. On rising the child will walk their hands up their legs to achieve an upright posture.

77
Q

Name 3 conditions associated with Down’s syndrome?

A

Hypothyroid
Cateracts
Deafness
Congenital heart disease
Congenital GIT abnormalities
Atlanto-axial instability
Alzheimer’s disease
Leukaemia

78
Q

What questionnaire can be used to screen for Autism, what score raises suspicion and need for further assessment?

A

AQ-10 test

Score over 6 needs further assessment

79
Q

When should medication to aid sleep be prescribed? Which medication is used?

A

Only after behavioural intervention
- After discussion with pysch
- Together with non=pharma interventions

Melatonin is first chocie

80
Q

What are the two most common complications of cerebral palsy?

A

Intellectual disability (60%)
Seizures (50%)

Then visual impairment, scloiosis (20%), drooling (30%)

81
Q

A 9 year old boy is on methylphenidate, what should be monitored every 3 months?

A

Weight

Weight should be monitored every three months in children under the age of 10 being treated with methylphenidate. Height, pulse rate and blood pressure need monitoring every six months.

82
Q

A mother reports her child’s ADHD symptoms are worse after he eats anything containing artificial colouring.

According to current guidance, which is the SINGLE MOST appropriate INITIAL recommendation?

A

Diet may have some effect on children’s hyperactivity but a formal dietetics opinion is recommended if a possible link is found between food/drink and behaviour.

83
Q

Which is the SINGLE MOST appropriate tool to use when SCREENING for social anxiety disorder?

A

Mini spin

84
Q

Name groups that may benefit from:
a) CBT
b) DBT
c) Bereavement counselling

A

a) Depression, anxiety disorders, OCD
b) Personality disorders
c) Bereavement/ adjustment disorder

AKT Prep (22 decks)

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