Psych Flashcards
(22 cards)
Management of PTSD
BIO
- SSRI - Sertaline or SNRI
- Atypicall antipsychotics
PSYCHO
- Trauma-based CBT (will need to touch on trauma briefly)
- EMDR
SOCIAL
support groups, help with work/sick leave
Diagnosis of PTSD
> 1 month after event, within 6m
- rexperiencing
- avoidance of trigger
- hyperarousal
Other
Sleeping difficultly, emotional numbing, anxiety symptoms, depressive symptoms
Definition of alcoholism/dependence
3+ in the last month of:
- tolerance
- craving
- withdrawal symptoms
- out of control use
contiune despite harm - neglecting other aspects of life addiction
- returning to the saame place
- same substance/drink
Outline the process of community based alcohol withdrawal
Used when pt drinks 15+ units/day or scores 20+ on AUDIT
ACUTE:
Oral chlordiazapoxide +/- IV pabrinex on a reducing dose
2-4 meetings per week for 3w
CHRONIC:
1. acamprostate/naltrexone
2. Difulsuram
Individualised intervention plan
How would you manage a learning disability?
MDT
Psychiatrist, OT, SALT, specialaist nurse, educational support, social worker involvement
BIO:
Treat co-morbid medical/psych problems
Melatonin for sleep
Antipsychotics if challenging behaviour (rispiridone)
PSYCHO:
CBT, family therapy, psychodynamic therapy, art therapy if talking is difficult
SOCIAL:
Education
Finanial support/benefits/carer
SCOPE disability charity
Outline the process of inpatient alcohol withdrawal
Used when pt drinks 30+ units/day or 30+ on SADQ score, PMHx of epilepsy, DT,
ACUTE:
Oral lorazepam +/- pabrinex rapid reducing dose
CHRONIC:
1. acamprostate/naltrexone
2. Difulsuram
Individualised intervention plan
How would you investigate/diagnose autism?
ADI-R = autism diagnostic inventory ADOS = autism diagnostic observatory schedule
WISC-V cognitive assessment
SALT and hearing assessment
Management of Autism
- psychosocial play-based therapy with play specialist
Challenging behviours:
- psychosocial assessment - also investigate for co-existing mental health or physical disorders
- Pharm: APs, melatonin, methylphenidate, SSRI
Diagnostic Criteria for schizophrenia
1m+ of:
1+ schneiders 1st rank sx
OR
2+ paranoia/hebephrenic (disorganised mood and speech)/catatonic/negative sx (simple - these are also the subtypes) AND present most of the time AND not caused by substance/organic source
Describe the progression of schizophrenia
- prodrome/at risk mental state - negative sx dominant
- acute pphase - positive sx dominant
- chronic phase - negative dominant
What are the risk factors for schizophrenia
1st degree relative, 50% concordance in MC twins substance abuse ethnic miniority low premorbid IQ adverse life experiences
How would you manage schizophrenia?
URGENT:
crisis resolution team and home treatment time
NON-URGENT but still an EMERGENCY: Early intervention in psychosis team (psychosis is dangerous, esp if untreated for >3m)
Rapid Tranquilisation = Oral –> IM Lorazepam, Haliperidol/lorazepam
BIO
1. 6w atypical AP - aripip/quietapine (weaker, fewer SE), olanzapine/rispiridone (stronger, weight gain, SE)
augment with BDZ or mood stabaliser is ?schzoaffective
2. 2w Typical AP
3. clozapine
PSYCHO
- CBT - 16 sessions, testing reality
- Family therapy
SOCIAL
Risk aassessment
housing, benefits, work, education
Define Schizoaffective disorder
affective + psychotic sx equally prpesent
Manic:
Mania + schiz
Depressive:
depression + schiz
1 episode of psychosis lasting >2w without mood disorder
AND
1 episode psychosis with obvious mood overlap
Risk factors for Panic Disorder?
Aged 20-30m Female White Positive family history Major life stressors/ history of recent trauma Comorbid disorders Asthma/ respiratory variability Cigarette smoking/caffeine use
What are some organic causes of Panic disorder?
Hyperthyroidism → TFTs Too much caffeine → history Alcohol → LFTs/gGT/MCV Drugs → UDS Arrhythmia → ECG/ 24 hour ECG Hypoglycemia → glucose (while anxious) Pheochromocytoma → 24 hour urine VMA
How would you manage an acute panic attack?
Reassurance that the symptoms are not dangerous and attack will subside (never really more than 30 mins)
Advise on slowing breathing
Quiet side room and support from significant other
MAY use benzodiazepines in ED to terminate attack
Management of a panic attack
BIO
- SSRI - fluoxetine
- TCAs
PSYCHO
low intensity CBT and self-help
SOCIAL
Management of triggers e.g. recent family something,
Management of a panic attack
BIO
1. SSRI - fluoxetine
2. TCAs
NO Benzos, APs or sedating anti-histamines
PSYCHO
low intensity CBT and self-help
SOCIAL
Management of triggers e.g. recent family something,
Management of a panic attack
Reassure and self help first of all
BIO
1. SSRI - citalopram
2. TCAs after 12w
NO Benzos, APs or sedating anti-histamines
PSYCHO
- low intensity self-help
- high intensity CBT
SOCIAL
Management of triggers e.g. recent family something,
What is the diagnostic criteria of a panic disorder?
Recurrent episodes of severe panic lasting <30mins
Several episodes within a month
Minimal anxiety between episodes, no concurrent mood disorder
Diagnosic criteria for GAD
3+ of the following sx for >6m:
Restlessness/nervousness Being easily fatigued Poor concentration Irritability Muscle tension Sleep disturbance
What are the cut of values for the GAD-7 and PHQ-9 questionairres for anxiety and depression?
Mild = >5 Moderate = >10 Severe = >15
