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Year 5 (Alex) > Psych > Flashcards

Psych Flashcards

1
Q

What is Deprivation of Liberty Safeguards(DoLS)?

A

Procedure prescribed in law when it is necessary to deprive of their liberty a resident or patient who lacks capacity to consent to their care and treatment in order to keep them safe from harm.

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2
Q

What are the 3 core syx of depression

A
  • Low mood
  • Anhedonia
  • Anergia
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3
Q

Biological manifestastions of depression

A
  • Fatigue/sleep distrubance
  • Appetite/weight change
  • Low libido
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4
Q

Cognitive features depression

A
  • Memory impairment
  • Beck’s triad
    • Hoplessness
    • Worthlessness
    • Helplessness
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5
Q

Depression diagnosis criteria timeframe

A

Syx lasting at least 2 weeks

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6
Q

Depression levels of severity

A

Mild: 2 or 3 core syx + 2 others; can continue w most dialy activities

Moderate: 2 or 3 core syx + 3-4 others; difficulty with social acitivities and day to day functioning

Severe: 3 core syx + 4 or more others; major impact on daily function

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7
Q

Things to consider when diagnosing depression

A
  • Organic causes
    • FBC
    • TFT
  • Bipolar disorder
    • Previous mood elevation - (hypo)mania
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8
Q

High risk features of completing suicide attempt

A
  • Careful planning
  • Acts in anticipation
  • Precautions to prevent discovery
  • Suicide note
  • Violent method
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9
Q

Depression Ix

A
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10
Q

Depression mx

A

Bio

  • Antidepressants
    1. SSRI - sertraline, fluoxetine, citalopram, etc.
    2. SNRI - venlafaxine
    3. Augmentation therapy
      • Diff class antidepr // add lithium
    4. ECT

Psycho

  • Self help
  • CBT
  • Interpersonal therapy

Social

  • Finance
  • Relationships
  • Occupation

–

Mild- moderate

  • Low intensity psychological intervention
    • Guided self-help
    • Computerised CBT
    • Structured group physical activity programme
    • Group CBT
  • +/- medication
  • 2 week follow up

Moderate - severe

  • High intensity psychological intervention
    • Individualised CBT
    • Interpersonal therapy
  • Medication
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11
Q

Classes of antidepressants and examples of each

A

Selective serotoni receptor inhibitors (SSRIs)

  • Sertraline
  • Fluoxetine
  • Citalopram
  • Escitalopram

Serotonin and noradrenaline receptor inhibitors (SNRIs)

  • Venlafaxine
  • Deloxetine

Tricyclic anti-depressants (TCAs)

  • Amitriptyline
  • Notriptyline

Monoamine oxidase inhibitors (MAOis)

  • Phenelzine

Noradrenergic and specific serotonergic antidepressants (NaSSA)

  • Mirtazapine

Reversible inhibitors of monoamine oxidase type A (RIMAs)

  • Moclobemide
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12
Q

How long should pts continue antidepressants post-recovery for optimum prognosis?

A

6 months

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13
Q

SSRI side effects

A
  • GI syx
  • GI bleeding (+PPI)
  • Hyponatraemia
    • ​confusion, dizziness and weakness
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14
Q

How long does it take to stop an SSRI?

A

Withdraw gradually over 4 weeks

*Except fluoxetine due to its longer half life

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15
Q

SSRI discontinuation syndrome

A
  • Anxiety
  • GI symptoms
  • Electric shock sensations
  • Dizziness
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16
Q

SSRIs and pregnancy

A

Avoid unless benefits outweigh risks

  • 1st trimester - small increased risk of congenital heart defects
  • 3rd trimester - can result in persistent pulmonary hypertension of the newborn
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17
Q

Indications for Sertraline

A

Unstable angina or recent MI

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18
Q

How to swap from Fluoxetine to different SSRI?

A

Stop fluoxetine then 1 week wash out period (due to long half life) then start gradually

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19
Q

Citalopram and Escitalopram SEs

A

ventricular arrhythmias including torsade de pointes

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20
Q

Serotonin syndrome

A
  • confusion
  • agitation
  • muscle twitching
  • sweating
  • shivering
  • diarrhoea
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21
Q

SNRI SEs

A
  • Hypertension
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22
Q

TCA side effects

A
  • Overflow urinary incontinence
  • Prolonged QT on ECG
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23
Q

MAO-I Precaution

A

Avoid cheese (tyramine) –> hypertensive crisis

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24
Q

What (non-psych) drug can cause low mood?

A

Beta blockers

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25
Q

Seasonal affective disorder

A

depression which occurs predominately around the winter months

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26
Q

SAD Mx

A

Treated the same way as depression

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27
Q

CBT explanation

A

CBT is a form of talking therapy based on the concept that our thoughts, emotions, and actions are interrelted, and that negative thoughts and feelings can trap you in a negative cycle.

CBT aims to help us deal with problems by approaching them from a bird’s eye view and breaking them down into smaller parts to change the way we think and behave

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28
Q

Normal grief reaction presentation

A
  • Low mood
  • Psuedohallucinations
    • false sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating

Last up to 6months post loss

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29
Q

What is CBT used for?

A
  • Depression
  • Anxiety
  • OCD
  • Eating disorders
  • PSTD
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30
Q

Anxiety differentials

A
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31
Q

What can be mistaken for anxiety?

A

Hyperthyroidism

  • Abdo pain
  • Palpitations
  • Agitated and fidgety
  • Difficultly sleeping
  • Affected concentration
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32
Q

Anxiety Ix

A

MSE

GAD7

TFTs

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33
Q

Generalised anxiety disorder

A

Regular and uncontrolled (can be triggered by anything/ have no trigger) anxiety for >= 6 months.

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34
Q

GAD Psychological presentation

A
  • Anxiety
  • Fear
  • Impaired concentration
  • Irritability
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35
Q

GAD Physical presentation

A
  • Tremors
  • Palpitations
  • Loose stools
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36
Q

GAD Mx

A

Bio

  • SSRI - sertraline specifically
    • higher dose than for depression
    • Try a 2nd SSRI or SNRI as 2nd line
  • Benzodiazepines
    • Acute use for mx bad bouts of GAD
  • Beta blockers
    • Reduce physical syx, e.g., tremor
      • CI in asthma/diabetes

Psycho

  • CBT
  • Mindfullness
  • Psychoeducation

Social

  • Advice on stress mx
  • Advice on coping mechanisms
    • e.g., drug & alcohol
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37
Q

Acute anxiety (situation) Mx

A

Short prescription of Benzodiazepines

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38
Q

Panic disorder (panic attacks) features

A
  • Rapid-onset severe anxiety
  • Impending sense of doom
  • Resolves rapidly
  • Palpitations + tachypnoea
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39
Q

Panic disorder Mx

A

Bio

  • SSRIs

Psycho

  • CBT

Social

  • Psychoeducation
  • Breathing exercises
  • Support groups
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40
Q

Acute stress disorder

A

Acute stress reaction that occurs in the 4 weeks after a traumatic event

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41
Q

Post traumatic stress disorder

A

Stress reaction that develops 4 weeks following traumatic event. Symptoms present for >1 month.

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42
Q

PTSD features

A
  • re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
  • avoidance: avoiding people, situations or circumstances resembling or associated with the event
  • hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
  • emotional numbing - lack of ability to experience feelings, feeling detached
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43
Q

PTSD Mx

A

Bio

  • Venlafaxine (SNRI)
    • or SSRI
    • Risperidone in severe cases

Medication is not 1st line

Psycho

  • Trauma-focussed CBT
  • Eye movement desensitisation and reprocessing (EMDR)
    • More severe cases

Social

*

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44
Q

Obsessive compulsive disorder

A

Recurrent obsessional thoughts or compulsive acts are developed

Obsessions: thoughts/images that are distressing, unwanted and intrusive that are recognised as own thoughts

Compulsions: repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession

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45
Q

OCD Mx

A

Psycho

  1. CBT including exposure and response prevention

Bio
2. SSRI

  • Quickly increased to high dose
  • To continue for 12 months after pt goes into remission
  1. Clomipramine or alt SSRI (if first SSRI ineffective after 12 weeks)
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46
Q

Agoraphobia

A
  • Fear of being unable to escape to a safe place
  • Often end up housebound
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47
Q

Social phobia features

A
  • Fear of being scrutinised/judged
  • People noticing you blush
  • Can tolerate large, anonymous crowds
  • Dislike intimate gathering
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48
Q

Type 1 vs Type 2 Bipolar disoder

A

Type 1

Mania + depressive episodes

Type 2

Hypomania + depressive episodes

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49
Q

Manic episode presentation

A

Mania lasts for at least 7 days

  • Feelings of euphoria
  • Hallucinations and/or delusions
  • Predisposition to risky or reckless behaviour
  • Mutism
    • Severely manic pts
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50
Q

Mania Mx

A

From primary care

  • Urgent referral to community mental health team

Psych

  • Olanzapine
    • Useful in acute mania
    • Long term prophylaxis for bipolar affective disorder
  • Clonazepam &/or Lorazepam
    • Fast onset of action
    • Tranquilising effect

*Psychological therapy not usually offered to manic pts in the acute phase

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51
Q

Manic patients risk of depressive episode in future

A

>90%

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52
Q

Auditory hallucinations in Schizophrenia (3)

A
  1. Thought echo
    • Hears own thoughts as if spoken aloud to them
  2. 3rd person voices
    • People talking about them from 3rd person
  3. Running commentary
    • Voice narrating what they are saying
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53
Q

Hypomania presentation

A

Typically lasting 3-4 days

  • Does not interefere majorly with day to day
  • Euphoric
  • Impulsive behaviour
  • Feels doesn’t need sleep/far less sleep
  • Irritability
  • Flight of ideas
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54
Q

Hypomania mx

A

Low risk

  • Routine referral to CMHT

High risk

  • Urgent referral to CMHT
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55
Q

Bipolar disorder Mx

A
  • Mood stabilisers
    • Lithium
    • Alt Sodium Valproate
  • Address co-morbidities
    • 2-3x incr risk diabetes, CVD, COPD
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56
Q

Lithium monitoring

A

Lithium levels should be checked 12 hours post-dose

  • One week after starting treatment/after dose change
  • Weekly until the levels are stable
  • Once levels are stable, measure every 3 months

+ every 6/12:

  • U&Es
  • TFTs
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57
Q

Lithium SEs

A
  • Hypothyroidism
  • Renal impairment
  • Preceipitation of a relapse if suddenly discontinued
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58
Q

Lithium overdose presentation

A
  • Coarse tremors
  • GI disturbance
  • Ataxia
  • (white pills)
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59
Q

Lithium and pregnancy

A

First trimester exposure associated with Ebstein’s anomaly (a serious cardiac anomaly)

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60
Q

Lithium and NSAIDs

A

NSAIDs can increase lithium levels in the blood resulting in an increased risk for serious adverse effects like confusion, tremor, slurred speech, and vomiting

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61
Q

Sodium Valproate SEs

A
  • N+V
  • Diarrhoea
  • Movement disorder
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62
Q

Sodium valproate congenital risks

A
  • cleft palate
  • spina bifida
  • Neural tube defects
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63
Q

Mx of manic/hypomanic pts on antidepressants

A

Consider stopping the antidepressant and start antipsychotic therapy

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64
Q

Psychosis differentials

A
  • Acute (episode)
    • Transient, resolves
  • Organic
    • Drugs
    • Delirium
    • Medication
      • Steroids
  • Affective
    • Severe depression
    • Mania
  • Personality disorders
    • Schizoaffective
    • Schizotypal
  • Delusional disorder
    • Only have delusions
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65
Q

First episode psychosis Ix and Mx

A

Ix

  • Take a detailed history
    • Drug use
    • FHx
  • Perform exam and ix
    • Urine drug screen
  • Obtain collateral hx

Mx

  • Consider section 5(2)
  • Refer to psych team
  • Commence medication
    • For acute agitation: Lorazepam
    • Antipsychotic: Atypical but NOT Clozapine
      • Aripiprazole 10mgOD, or Olanzapine 10mg nocte
  • Education & support
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66
Q

Baby blues

A

Tearful & emotionally labile after giving birth

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67
Q

Post natal depression screen

A

Ask 2 depression identification Qs (low mood & anhedonia), if +ve to one ->

Edinburgh postnatal depression scale

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68
Q

PND Mx

A
  • CBT
  • SSRI
  • F/U w GP
  • Home visits from community midwives
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69
Q

Puerperal psychosis onset

A

Occurs in first 3 weeks post natal with acute onset

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70
Q

Puerperal psychosis presentation

A
  • Elevated mood
  • Sleeping less/not sleeping
  • Delusions
    • Often grandiose
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71
Q

Schizophrenia explanation

A

Characterised by break down of thought process, contact with reality, and emotional responsiveness

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72
Q

Schizophrenia classification (4)

A
  1. Paranoid (most common)
    • Prominent delusions & hallucinations
    • Dominated by sense of anxiety that something bad will happen
  2. Hebephrenic
    • Disorganised
    • Chaotic mood
    • ‘child-like’ shallow & inappropriate affect
  3. Catatonic
    • Psychomotor disturbance
  4. Simple
    • Only negative features, e.g., social withdrawal and blunted affect
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73
Q

Schneider’s first rank syx

A
  • Auditory hallucinations
  • Abnormal thoughts
  • Delusions
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74
Q

Abnormal thoughts in Schizophrenia (3)

A
  • Thought insertion
    • Thoughts have been inserted into their brain
  • Thought withdrawal
    • Thoughts are being stolen from them
  • Thought broadcasting
    • Other people can see/hear what they are thinking
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75
Q

Definition of delusion

A

False, fixed belief held despite conflicting evidence.

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76
Q

Development of Schizophrenia

A

Prodrome -> Acute phase -> Chronic phase

Prodrome

  • Social withdrawal
  • Loss of interest in work and relationships

Acute phase

  • Delusions
  • Hallucinations
  • Thought interference

Chronic phase

  • Apathy
  • Blunted affect
  • Social withdrawal
  • Anhedonia
  • Poverty of thought
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77
Q

Prevalence of schizophrenia in general population

A

1%

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78
Q

Risk of schizophrenia in 1) child (if 1 parent has it), 2) twin

A

1) 10%
2) 50%

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79
Q

Schizophrenia RFs

A

FHx

  • monozygotic twin has schizophrenia = 50%
  • parent has schizophrenia = 10-15%
  • sibling has schizophrenia = 10%
  • no relatives with schizophrenia = 1%

Others

  • Black Caribbean ethnicity - RR 5.4
  • Migration - RR 2.9
  • Urban environment- RR 2.4
  • Cannabis use - RR 1.4
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80
Q

Schizophrenia Mx

A
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81
Q

Schizophrenia mx

A

Bio

  • Antipsychotics

Psycho

  • CBT
  • Family therapy

Social

  • Social skills training
  • Education
  • Benefits
  • Housing
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82
Q

Treatment resistant Schizophrenia

A

Failure to respond to 2 or more antipsychotics, at least 1 of which is atypical. Each given at therapeutic dose for at least 6 weeks.

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83
Q

Treatment resistant Schizophrenia Mx

A

Clozapine

  • Weekly blood tests
    • Risk of agranulocytosis
      • ​Decreased leukocytes
    • Counsel about taking infyx syx seriously

*reduces seizure threshold

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84
Q

What is prodromal schizophrenia?

A

earliest stage of schizophrenia

(not experience by everyone)

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85
Q

Features of prodromal schizophrenia

A
  • Nervousness
  • Anxiety
  • Depression
  • Difficulty concentrating
  • Excessive worrying
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86
Q

Typical antipsychotic mechanism

A

Dopamine antagonist

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87
Q

Typical antipsychotic SEs

A

Extra pyrimidal side effects

(mimics parkinsons)

  • Acute dystonia
    • suddenly v painful contractions of parts of body
    • oculogyric crisis - deviation of eyes and repeated blinking
    • Procyclidine helps treat ^
  • Tardive dyskinesia
    • Often develops with long term use
    • Lip smacking, sticking tongue out, difficulty swallowing, excessive blinking
  • Parkinsonism
  • Akathisia
    • restlessness
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88
Q

Typical antipsychotics examples

A
  • Haloperidol
  • Chlorpromazine
  • Zuclopenthixol decanoate
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89
Q

Atypical antipsychotics examples

A
  • Olanzapine
  • Quetiapine
  • Clozapine
  • Risperidone
  • Aripiprazole
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90
Q

Atypical antipsychotics mechanism

A

Affect dopamine, serotonin, histamine and adrenergic receptors

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91
Q

Atypical antipsychotic SEs

A

Metabolic

  • Weight gain
  • Dyslipidaemia
  • Hypercholesterolaemia
  • Hyperprolactinaemia
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92
Q

Missed Clozapine

A

If missed for >48 hours, dose will need to be retitrated again slowly

Starting Clozapine after a break of >48 hours,can make side effects worse, such as blood pressure changes, drowsiness and dizziness

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93
Q

Adjusting Clozapine dosage

A

Reduces levels

  • Starting smoking, or smoking more
  • Stopping drinking

Increases levels

  • Alcohol binges
94
Q

Clozapine ECG arrhythmia

A

ST elevation due to myocarditis

95
Q

Agranulocytosis mx

A
96
Q

Poor compliance antipsychotic Mx

A

considered for once monthly IM antipsychotic depot injections

97
Q

Neuroleptic malignant syndrome

A

Complication of taking antipsychotics

98
Q

Neuroleptic malignant syndrome presentation (4)

A
  • Hyperthermia
  • Altered mental status - agitation, cofnusion
  • Muscle rigidity
  • Urinary incontinence
99
Q

NMS Ix

A
  • Creatine kinase
    • Raised
    • Degree of muscle breakdown due excessive contractions
  • U&E
  • WCC
  • LFTs
100
Q

NMS Mx

A
  • Stop antipsychotic
    • Psych input if MH concern
  • Cooling blankets
    • For hyperthermia
  • Dantrolene
    • Rigidity
    • Also ± Bromocroptine
  • Benzodiazepines
    • Agitation
  • Fluids
    • If AKI
101
Q

Potential ECG changes in clozapine/ antipsychotics

A

ST elevation due to cardiac failure secondary to myocarditis and cardiomyopathy

102
Q

Personality disorder

A

Deeply ingrained and maladaptive pattern of behaviour persisting over many years.

In mental health, the word ‘personality’ refers to traits that we developed as we grow up which make each of us an individual. These include the ways that we: think, feel and behave.

Personality disorders manifest as experiencing significant difficulties in how you relate to yourself and others and having problems coping day to day stemming from your personality.

103
Q

Categorisation of personality disorders - ICD-11 v cluster

A

ICD-11

  1. Severity: Mild –> Moderate –> Severe
  2. Trait domain

Clusters

  • A- ‘odd cluster’
  • B - ‘dramatic cluster’
  • C - ‘anxious cluser’
104
Q

ICD-11 traits (5)

A
  • Negative affectivity: tendency to experience broad range of negative emotions with a frequency and intensity out of proportion with the situation
  • Dissocial: disregard for others’ rights and feelings - encompassing both self-centredness and lack of empathy
  • Disinhibition: tendency to act rashly based on immediate external or internal stimuli without consideration of potential negative consequences
  • Anankastic: narrow focus on one’s rigid standard of perfection/right and wrong - controlling one’s own and other’s behaviours and situations to ensure conformity to these standards
  • Detachment: tendency to maintain interpersonal distance and emotional distance
105
Q

Personality disorder clusters

A

A- ‘odd cluster’

  • Paranoid
  • Schizoid
  • Schizotypal

B - ‘dramatic cluster’

  • EUPD
  • Histrionic
  • Antisocial

C - ‘anxious cluser’

  • Avoidant
  • Anankastic
  • Dependent
106
Q

3 Ps of personality disorders

A
  • Pervasive
  • Persistent
  • Pathological
107
Q

Personality disorder Mx

A

Bio

  • SSRI
  • Antipsychotics

Psycho

  • CBT
  • DBT
    • EUPD
  • MBT
  • Arts therapy

Social

  • Therapeutic communities
108
Q

Avoidant personality disorder

A

Often solitary existence due to feelings of inadequacy and fear of rejection and judgement from others.

109
Q

Obsessive-compulsive personality disorder

A
  • Occupied with details, rules, organization
  • Dedicated to work and efficiency to the elimination of spare time activities
  • Rigid about etiquettes of morality, ethics, or values
  • Unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
110
Q

Schizoid personality disorder presentation

A
  • Disinterest in social relationships
  • Emotional coldness
  • Preference for solitary activities
  • Few interests
  • Indifference to praise/criticism
111
Q

Schizotypal personality disorder

A
  • Cognitive or perceptual distortions
  • Eccentricities of behaviours
  • Paranoia
    • Resulting in lack of relationships
112
Q

Adjustment disorder

A

an emotional or behavioral reaction to a stressful event or change in a person’s life

113
Q

Charles-Bonnet syndrome

A

visual hallucinations associated with eye disease - most common hallucinations are faces, children and wild animals.

114
Q

Delusional parasitosis

A

delusion that they are infested by ‘bugs’

115
Q

Depersonalisation-derealisation disorder

A

Depersonalisation: persistently or repeatedly have the feeling that you’re observing yourself from outside your body

Derealisation: you have a sense that things around you aren’t real

116
Q

Erotomania

A
  • a.k.a De Clérambault’s syndrome
  • Delusion that a famous person is in love with them, with the absence of other psychotic symptoms
117
Q

Formication

A

Feeling of insects crawling under your skin

118
Q

Illusion

A

sensory stimulus is present but incorrectly perceived and misinterpreted

119
Q

Microspia

A

Things are perceived to be smaller than they are

120
Q

Othello’s syndrome

A

paranoid delusional jealousy, characterized by the false absolute certainty of the infidelity of a partner, leading to preoccupation with a partner’s sexual unfaithfulness based on unfounded evidence

121
Q

Signs of dependence

A
  • Increased tolerance
  • Prioritising over other things
  • Continuing despite negative consequence
122
Q

Going sober Mx

A

Bio

Acute

  • Outpt or inpt reducing dose of Chlordiazepoxide (alcohol withdrawal syx mx)
  • Thiamine

Longer term

  • Acamprosate
    • Reduces cravings

Psycho

  • Motivational interviewing

Social

  • Alcoholics anonymous
  • OT help
    • Work, finance, housing, etc

! To stop gradually

123
Q

Alcohol withdrawal presentation

A
  • anxiety after waking
  • sweating and tremors
  • nausea or retching in the morning
  • vomiting
  • hallucinations
  • seizures or fits
124
Q

Alcohol withdrawal timeline

A

Symptoms: 6-12 hours

Seizures: 36 hours

Delirium tremens: 72 hours

125
Q

Delirium tremens presentation

A
  • agitation
  • confusion
  • autonomic dysfunction (e.g. high blood pressure, sweating and pyrexia, raised heart rate)
  • hallucinations
  • tremors
126
Q

Wernicke’s encephalopathy presentation

A
  • Disorientated
  • Horizontal nystagmus
  • Difficulties in heel-toe walking
127
Q

Korsakoff’s syndrome

A
  • Able to give consistent account of long term memory
  • Recent history inconsistent
  • Horizontal nystagmus
128
Q

Alcohol withdrawal Mx

A
  • Admit for medical observation
  • Descending regime of long-acting benzodiazepine, e.g., Chlordiazepoxide or Diazepam
  • +Pabrinex (Thiamine)
129
Q

Drug (sub) used for opioid dependence

A

Methadone hydrochloride or buprenorphine

130
Q

Benzodiazepines use

A

Acute bouts of anxiety

  • sedation
  • hypnotic
  • anxiolytic
  • anticonvulsant
  • muscle relaxant

Use for 2-4 weeks only - development of psych and physical dependence

131
Q

Benzodiazepines mechanism of action

A

enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channel

132
Q

Benzodiazepines examples

A
  • Lorazepam
  • Diazepam
  • Temazepam
133
Q

Benzodiazepines overdose presentation

A

Sedation

134
Q

Which benzodiazepine causes the largest problem re withdrawal?

A

Lorazepam

Shortest half-life -> levels in body decrease rapidly

135
Q

Benzodiazepines withdrawal presentation

A
  • Confusion
  • Slurred speech
  • Unsteady gait
136
Q

Benzodiazepine withdrawal Mx

A

IV Flumazenil

137
Q

Stopping benzodiazepines

A

Reduce dose in steps of 1/8th of daily dose every fortnight

138
Q

Benzodiazepine overdose

A

IV Flumenazil

139
Q

Benzodiazepines and pregnancy

A

First trimester exposure associated with increased risk of cleft lip

140
Q

Cocaine overdose presentation

A
  • Central chest pain
  • Agitation
  • Hyperthermia
  • Hallucinations
141
Q

Opioid/heroin withdrawal presentation

A
  • Runny nose
  • Dilated pupils
  • Goodsebumps/piloerection
  • Sweating/fever
142
Q

Types of opioids

A
  • Morphine (Heroin is formulated from morphine)
  • Codeine
  • Fentanyl
  • Tramadol
143
Q

Opioid overdose presentation

A
  • Drowsiness/ coma,
  • Respiratory depression
  • Pinpoint pupils
144
Q

Opioid overdose treatment

A

Naloxone

145
Q

Paracetamol overdose

A

Urticarial rash/anaphylactoid reaction not uncommon to NAC

stop and restart slow down infusion and observe for 1 hour whilst closely moniroring

146
Q

Eating disorder Qs

A
147
Q

ED Ix

A

Bedside

  • Full physical exam
  • 12 lead ECG
  • Body weight and height
  • SCOFF questionaire

Bloods

  • FBC
    • may show anaemia from malnutrition or GI losses
  • U&Es
    • hypokalaemia is suggestive of vomiting or laxative abuse
  • LFT
    • may be slightly elevated from malnutrition
148
Q

What are the question in the SCOFF questionaire?

A
  • ‘Do you ever make yourself sick because you feel uncomfortably full?’
  • ‘Do you worry that you have lost control over how much you eat?’
  • ‘Have you recently lost more than one stone in a 3-month period?’
  • ‘Do you believe yourself to be fat when others say you are too thin?’
  • ‘Would you say that food dominates your life?’
149
Q

Anorexia nervosa criteria

A
  1. Restriction of intake relative to requirements leading to a significantly low body weight
  2. Intense fear of gaining weight or becoming fat
  3. Disturbance in the way in which one’s body weight or shape is experienced

+Lanugo hair, reduced BMI, brady, hypten

150
Q

AN Ix

A
  • U&Es
    • Low K+
    • High phosphate
  • Low FSH, LH, oestrogens and testosterone
  • Raised cortisol and GH
  • Impaired glucose tolerance
  • ECG
    • T wave inversion due to hypokalaemia
151
Q

AN Mx

A

Refer to specialist ED clinic - combo of

  • Nutritional advice
  • Anorexia-focused family therapy
  • Individual CBT

Use of MHA for admission if BMI dangerously low at <13

152
Q

AN Complx

A
  • Hypothyroidism
153
Q

! Refeeding syndrome

A

Metabolic abnormalities which occur on feeding a person following a period of starvation

154
Q

Refeeding syndrome Ix

A
  • U&Es!
    • Low Ca
    • Low K
    • Low Mg
155
Q

What scoring system is used in Refeeding syndrome?

A

MUST score

High risk: little nutritional intake >10 days, unintentional weight loss >15% over 3-6months, BMI<16

156
Q

Bulimia nervosa presentation

A
  • Overeating/binging
  • Purging
  • Calluses on knuckles
157
Q

BN Ix

A
  • ECG
    • T wave inversion due to hypokalaemia
158
Q

BN Mx

A

Refer to specialist ED clinic - combo of:

  • Nutritional advice
  • Anorexia-focused family therapy
  • Individual CBT
159
Q

memory loss ddx

A
160
Q

MMSE Qs (name 3) and scoring

A

Scoring:

24-30 No cognitive impairment

18 - 23 Mild cognitive impairment

0-17 severe cognitive impairment

161
Q

AMTS Qs (10)

A
162
Q

Memory loss Ix

A

Bedside

  • MMSE
    • or AMTS
  • Urinalysis

Bloods

  • FBC
  • U&E
  • B12/folate
  • TFTs
  • CRP

Scan

  • CT/MRI head
163
Q

Alzheimers v depression

A

Alzheimers has longer period of onset - often others notice syx as opposed to patient themselves

Depression has biological syx e.g. weight loss, sleep disturb

164
Q

Memory loss specific Qs

A

How are they when left alone? Doing anything unsafe? Self-neglect? Aggression?

165
Q

Alzheimer’s presentation

A
  • Usually older person
  • Gradually worsening memory
  • Pays less attention
  • Problems w spatial orientation (getting loss in familiar places)
  • Behaviour changes as Alzheimer’s progresses but not prominent at start
166
Q

What increases risk of developing Alzheimer’s?

A

Down’s syndrome

167
Q

Lewy Body dementia presentation

A
  • Progressive memory loss (fluctuating)
  • Parkinsonism
  • Visual hallucinations
168
Q

What type of hallucinations would you get with Lewy Body dementia?

A
  • Small animals and people
  • Things are going slower
169
Q

What drugs should be avoided in Lewy Body Dementia pts?

A

First generation/typical antipsychotics

(cause severe confusion, severe Parkinsonism, sedation and sometimes even death)

170
Q

Vascular dementia presentation

A
  • Hx CVD
  • Cerebrovascular disease hx
171
Q

Vascular dementia vascular RF Mx

A

Aspirin

172
Q

Frontotemporal lobar degeneration

A

3rd most common type of dementia after alz and lew body’s

173
Q

Frontal temporal lobar degeneration presentation

A

Personality change and impaired social conduct

174
Q

What MMSE score would fall under mild cognitive impairment?

A

20-25

175
Q

What MMSE score would fall under moderate cognitive impairment?

A

15-19

176
Q

What MMSE score would fall under severe cognitive impairment?

A

9-14

177
Q

MRI findings

1) Alzheimer’s dementia
2) Frontotemporal dementia

A

1) Hippocampal atrophy - part of temporal lobe (early feature)
2) Frontotemporal atrophy

178
Q

Alzheimers mx

A

Bio

  • ACH-esterase inhibitor
    • e.g., donepezil, rivastigmine, galantamine
  • 2nd line: Memantine

Psycho

  • Refer to memory clinic - old age psychiatrist (1)
  • Group cognitive simulation therapy

Social

  • Occupational therapy assessment
    • Home safety, transport, care needs
179
Q

ECT SEs

A

Short term

  • Cardiac arrhythmias

Long term

  • Memory impairment - retrograde amnesia
180
Q

Relative CIs for ECT

A
  • raised intracranial pressure
  • recent cerebrovascular accident
  • untreated cerebral aneurysm
  • myocardial ischaemia or uncontrolled cardiac failure
  • unstable major fracture
  • severe osteoporosis
181
Q

Circumstantiality

A

Circuitous and non-direct thinking or speech that digresses from the main point of a conversation, however the final goal of the conversation will be reached.

Common in anxiety disorders and hypomania.

182
Q

Clang associations

A

when someone uses words that rhyme with each other or sound similar

183
Q

Delusion of passitivity/ passitivity phenomena/ delusion of control

A

Delusion that their actions are being controlled

184
Q

Echolalia

A

repetition of someone’s speech

185
Q

Flight of ideas

A

patient speaks very quickly and rapidly jumps between different topics

Common in mania

186
Q

Knight’s move thinking/Loosening of association

A

No clear links between successive thoughts

Common in psychosis

187
Q

Neologism

A

formation of new words

188
Q

Perseveration

A

ideas or words are repeated several times

189
Q

Tangentiality

A

Wandering from topic without returning to it

190
Q

Thought withdrawal

A

Belief of having the removal of a thought by an external force

Common in Schizophrenia

191
Q

Conversion disorder

A

loss of motor or sensory function. May be caused by stress

192
Q

Factitious disorder

A

a person, without a malingering motive, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain (for themselves or for another) a patient’s role.

193
Q

Hypochondira/Illness anxiety disorder

A

persistent belief in the presence of an underlying serious disease, e.g. cancer

194
Q

Malingering

A

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

195
Q

Sleep paralysis

A

transient paralysis of skeletal muscles which occurs when awakening from sleep or less often while falling asleep

±hallucinations during the paralysis

***Clonazepam may be considered

196
Q

Somatisation disorder

A

multiple physical SYMPTOMS present for at least 2 years with no organic cause found

197
Q

Suicide hx

A
198
Q

Suicide risk assessment

A
199
Q

Counseling - explanation

A
200
Q

COmmon drug explanation

A
201
Q

IQ - Extremely low/ learning disability

A

Under 70

202
Q

ADHD Mx

A

Bio

  • Methylphenidate
    • 5 and above

​Psycho​

  • Family therapy <1st line>

Social

  • Parental training
203
Q

Conduct disorder presentation

A
  • Violence
  • Enjoy causing harm, lying
  • Ignoring rights/feelings of others
204
Q

Conduct disorder Mx

A

Multisystemic (family) therapy

205
Q

Steps for de-escalating situation

A
  1. Verbal de-escalation
  2. IM Lorazepam
206
Q

Psych PACES gen tips

A

+ICE

207
Q

Who is able to section under the MHA?

A

Requires two doctors and an Approved Mental Health Professional. At least one doctor must be “approved” under s12 MHA, and ideally the other doctor would know the patient (usually a GP). The AMHP is often a social worker.

208
Q

Section 2

A

Assessment - 28 days

209
Q

Section 3

A

Assessment and treatment - 6 months

210
Q

Section 5(2)

A

Dr’s holding power - 72hours

211
Q

Section 5(4)

A

Nurse’s holding power- 6 hours

212
Q

Section 135

A

Police can enter your property

213
Q

Section 136

A

Police can bring someone from public place to a safe space

214
Q

What pathophysiology would you expect for

1) Alzheimer’s
2) Lewy body dementia
3) Vascular dementia

A

1) Amyloid plaques and neurofibrillary tangles (tau protein)
2) Lewy bodies (eosinophilic) deposits
3) Thromboembolic or hypertensive infarction

215
Q

Schizoaffective disorder

A

Symptoms of schizophrenia and mood disorder are equally prominent

216
Q

Persistent delusional disorder

A

Most pervasive symptom is delusion

217
Q

Schizophrenia dx criteria

A

Over period of one month patient must have 1 first rank syx or at least 2 other syx

218
Q

Delirium mx

A
  • Re-orientate (glasses/hearing aids, clock/orientation reminders/familiar objects/adequate lighting)
  • Identify and treat underlying causes (infection/pain/constipation…)
  • Medication – halorperidol, benzodiaepines
219
Q

Onset of Alzheimers

A

Gradual, progressive

220
Q

Onset of Lewy body dementia

A

Insidious onset, progressive with fluctuations

221
Q

Onset of vascular dementia

A

Abrupt or stepwise

222
Q

Onset of frontotemporal dementia

A

Insidious onset, rapid progression

223
Q

Puerperal psychosis RFs

A
  • Previous episodes of psychosis
  • History of bipolar disorder
  • First time mothers
  • After instrumental delivery
  • FH of affective disorder
224
Q

Puerperal psychosis mx

A

Admit to mother and baby unit

±antipsychotics
± ECT

225
Q

Extracampine hallucination

A

Perceived hallucination is beyond limits of normal sensory perception, e.g., hearing an alien speaking from Mars

226
Q

Pareidolic illusion

A

Seeing things, .e.g, faces and animals, in things

227
Q

Elemental hallucination

A

Flashes of lights/sound etc

228
Q

Drugs which can cause psychosis

A
  • Cannabis
  • Steroids
  • Cocaine
229
Q

How long does it take to recover from puerperal psychosis?

A

6-12 weeks

230
Q

Puerperal psychosis RFs

A
  • Previous puerperal psychosis
  • FHx PP
  • Underlying MH dx esp BPAD
  • Obstetric complx
231
Q

What is DBT/how does it work?

A

Focuses on factors contributing to emotional instability which lead to a vicious cycle where you experience intense and upsetting emotions, which make you feel guilty and worthless and leads to actions that can make you feel upset again

  • DBT aims to introduce two important concepts:
    • Validation: accepting that your emotions are acceptable
    • Dialectics: showing you that things in life are rarely black or white, and helping you be open to ideas and opinions that contradict your own

Year 5 (Alex) (4 decks)

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