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Cross reference - year 5 > PACES psych > Flashcards

PACES psych Flashcards

1
Q

depression counselling

A
  • persistently low mood that impacts on day to day functioning
  • very common, every year 1/4 suffer from MH problem
  • address social needs
  • explain role of psych therapy (CBT = talking therapy based on principle that thoughts, mood and behaviour are intertwined)
  • role of medication (takes a number of weeks to work, can make feel worse first, F/U in 1 week, warn about side effects)
  • advise about crisis resolution and home treatment team
  • support: mind.co.uk, Samaritans
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2
Q

BPAD counselling

A
  • consider admission and section if risky
  • explain is a condition where people experience extremes of emotion for variable lengths of time
  • important to control
  • both extremes can lead to making certain decisions and taking risks that you would otherwise regret
  • medications available that help balance the chemicals in the brain
  • advice about crisis resolution team and samaritans
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3
Q

alcohol misuse counselling

A
  • establish risks (driving, suicide, dependents)
  • assess social issues (SAFEGUARDING)
  • establish goals (elimination or moderation)
  • symptoms of withdrawal worse in 48 hours, should pass after 3-7 days
  • advise against stopping drinking abruptly
  • referral to drugs and alcohol service
  • assisted withdrawal uses benzodiazapines, psych treatment, relapse prevention and social support
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4
Q

opiate withdrawal counselling

A
  • explain worth getting tests done for blood-borne diseases, offer vaccinations
  • features of withdrawal (restlessness, anxiety, sweating, diarrhoea, abdo cramps, N/V, palpitations)
  • begin within 24 hours, peaks after 2-3 days, should be better by 1 week
  • detox involved giving a subsititue that should lessen symptoms of withdrawal
  • symptomatic treatment given to reduce nausea, diarrhoea
  • psych therapies to prevent relapse and address underlying MH issues
  • role of a key worker to support patient through detox
  • support: narcotic anonymous, SMART recovery
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5
Q

Benzo misuse counselling

A
  • explain harmful effects of benzos (in long term can cause worsening of psych symptoms and cognitive impairment)
  • can be reduced very gradually
  • role of CBT to address underlying MH and provide help on sleep hygiene
  • advice against driving if feeling drowsey
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6
Q

main psych in Dementia

A

group cognitive stimulation

group reminiscence therapy

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7
Q

drugs to avoid in forms of dementia

A

no Ach inhibitors in frontotemproral

no anti-psychotic in LBD

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8
Q

panic disorder management ladder

A
  1. recognition and diagnosis
  2. treatment in primary care (self help)
  3. review, consideration of alternative treatments (CBT + SSRI)
  4. review and referral to specialist mental health services
  5. care in specialist mental health services
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9
Q

PTSD counselling

A
  • condition that occurs after trauma
  • characterised by flashbacks, hyperarousal, avoidance
  • impact on patients life
  • trauma focused CBT for 8-12 sessions: explores how trauma has affected belief systems and outlook
  • medications e.g. sertraline and mirtazapine
  • consider group therpay
  • follow up
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10
Q

SSCM, MANTRA

A

specialist supportive clinical management

Maudsley Anorexia Nervosa treatment for adults

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11
Q

anorexia counselling

A
  • explain characterised by morbid fear of fatness, reduced calorie intake and a low BMI
  • risks of anorexia = osteoporosis, infertility and cardiac problems (arrythmias)
  • psychological therapy options (CBT-ED, SSCM, MANTRA, family therapy)
  • involves exploring through processes driving these behaviours
  • set an eating plan and feasible weight gain targets
  • medical therapy if depressed e.g. fluoxetine
  • support: BEAT
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12
Q

management of bulimia nervosa

A
  1. referral for specialist care
  2. BN-focused guided self help
  3. if ineffective after 4 weeks = ED-focused CBT
  4. trial of high dose fluoxetine
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13
Q

postnatal depression counselling

A
  • consider admission to mother and baby unit if severe
  • involve HTT and health visitor
  • likely due to hormonal changes
  • occurs in 1/10 women
  • address any concerns and provide support at home if needed
  • explain psych treatment (CBT)
  • medical treatment = sertraline which is safe in breastfeeding
  • prognosis = most recover in moneth
  • postnatal community mental health team will be involved
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14
Q

puerperal psychosis counselling

A
  • ADMIT
  • explain that may be linked to hormonal changes causing chemical imbalances in brain
  • treatment is anti-psychotics
  • admission to mother and baby unit is needed to keep both safe
  • recovery usually takes 6-12 weeks
  • 30% risk of recurrence
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15
Q

EUPD counselling

A
  • explain is characterized by increased sensitivity to emotions
  • likely to be linked to stressful life circumstances and experiences
  • personality disorders are often underdiagnosed (10% have personality disorder)
  • dialectical beahvioral therapy helps (helps you understand your thought processes and teaches you not to view things as black and white, teaches skills to cope with difficult emotions)
  • use of therapeutic communities (meet other people with similar issues and support each other in recovering)
  • crisis management: numbers for crisis team, community mental health nurse, out-of-hours social worker, Samaritans
  • support: mind.co.uk
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16
Q

depression history

A

ask all core symptoms
biological symptoms
cognitive symptoms
forensic history

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17
Q

depression investigation important details

A

PHQ9
physical exam
blood (FBC, TFT, Ca)

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18
Q

depression management

A
  • CBT + SSRI
    4-6 weeks to work, 2 week follow up, SEs (nausea, appetite change, anxiety)
  • advice: sleep hygiene, exercise, self-help, IAPT
19
Q

somatisation DDx

A
  • delusional disorder

- adjustment disorder

20
Q

important thing to check in psych history

A

insight

21
Q

Lewy body dementia management

A
  • patient adaptions with OT (reality orientation, environmental modifications)
  • social support
  • optimise physical health
  • pysch therapies e.g. reminiscence
  • Parksinons symptoms can treat with Parkinsons drugs but make hallcuinations worse
  • Ach inhibitors
22
Q

DLB on CT

A

mild atrophy

23
Q

if child psych history

A

some aspects of paeds history

24
Q

counsellin in anorexia

A
  • condition characterised by restriction of energy intake
  • leads to low body weight, intense fear of gaining weight and disturbance in way individual perceives body
  • can lead to physical health problems so we would like to treat her to help her achieve healthy weight
  • anorexia focused family therapy = show how you can support your daughter
25
Q

schizophrenia counsel

A
  • voices you have been hearing and feeling are due to imbalance in chemicals in your brain
  • when these chemicals are unbalanced, can cause you to see and hear things that other people don’t
  • we can give you medications to help balance these chemicals and make symptoms go away
26
Q

what to check in psychosis?

A

are taking steroids

27
Q

main important management in delirium

A

admit as it fluctauates

28
Q

important question to assess insight

A

“are the thoughts your own”

29
Q

counsel in OCD

A

it is a condition where you have recurrent intrusive thoughts to do something and it can really affect your life
this can be managed by CBT (explain CBT)

30
Q

what to do when start SSRI?

A

1 week F/U

31
Q

important lifestyle question in anxiety?

A

caffeine intake

32
Q

what is agoraphobia?

A

fear of being unable to easily escape to safe place

33
Q

counsel about trauma-focused CBT

A

trauma can shatter previous belief systems
these beliefs can be examined and tested
doesn’t require patient to vividly recall trauma
helps patient understand link between current feelings and trauma

34
Q

counsel about PTSD

A

condition that occurs when someone has gone through major traumatic event
characterised by episodes where you may feel anxious and on high alert
can affect your behaviour and cause you to avoid things that trigger these memories

35
Q

important question to ask in child with fever/unwell

A

are they tugging at their ear

36
Q

investigations in febrile seizure

A

FBC, ESR, CRP for sign of infection
U&E for electrolyte imbalance
GLUCOSE exclude hypoglycaemia

37
Q

management of seizure

A 
ABCDE approach
give oxygen, gain IV access
check blood glucose 
give buccal midazolam
IV lorazepam
phenytoin infection
38
Q

assess what in a manic patient

A

capacity

39
Q

Pysch and social management of BPAD

A

Psychological (CBT – identify relapse indicators, relapse prevention strategies), Social (family support, aiding return to work, deal with financial issues resulting from overspending)

40
Q

mania counselling

A

o We believe you’re experiencing something called mania – this is when a chemical change in your brain can lead to a very increased mood
o This may not sound like a bad thing and I know you’ve told us that you feel great right now, but it can actually be very damaging in the long run
o It can lead you to make risky decisions that you wouldn’t otherwise make and this can cause you serious harm (financial, physical, emotional)
o We would like to keep you in the hospital to give you some treatment that can normalise the chemicals in your brain and help you think clearer
o When you’re feeling back to normal, we can also discuss how we can help you get back to regular work and perhaps discuss any financial issues that you may have

41
Q

if patient presented in depressive phase of BPAD

A

Antidepressant (e.g. SSRI) with an atypical antipsychotic (e.g. aripiprazole, quetiapine) to prevent triggering mania
1st line = quietapine/olanzapine/fluoxetine + olanzapine/lamotrigine

42
Q

what drug does clozapine interact with?

A

lithium

43
Q

PHQ 9 score meanings

A

0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.

44
Q

medically unexplained symptoms

A

conversion disorder
chronic fatigue
fibromyalgia

Cross reference - year 5 (22 decks)

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