Psych V Flashcards
(24 cards)
Describe a patient with histrionic personality disorder [1]
Patients with histrionic personality disorder tend to be excessively attention-seeking.
How does depression change in OA populations? [2]
Episodes are more severe and longer lasting
Prognosis worse
Depression in OA is broadly similar to young people, but what are some key presentations need to consider? [4]
- Psychomotor agitation (agitated depression) and slowing much more common
- Psychotic depressive syndromes much more present, think Cotard’s, nihilistic delusions regarding poverty, status
- Hallucinations and paranoia can be a more prominent component
- Somatic and anxious symptoms usually more marked than mood component
How long should you prescribe antidepressant medications in OA? [1]
Px for two years post remission as relapses are more common and intense
What is aka paraphrenia? [1]
Late onset schizophrenia
How does late onset schizophrenia present [2]
Persecutory delusions the more marked symptom relating to commonplace themes e.g., spying neighbours, people entering their homes, theft, nihilism
Negative symptoms and thought form disorder are much less common
Can be very difficult to achieve symptom remission. Often highly debilitating.
How can you differentiate delirum and psychosis in older adult? [1]
Delirium - have inattention. Ask them to say the months of the years backwards (can’t)
This MRI shows changes in keeping with which type of dementia? [1]
Vascular changes
This MRI shows changes in keeping with which type of dementia? [1]
AD
- Bilateral hippocampal atrophy
Which anti-psychotic is the only drug you should give in a patient with PD and LBD to reduce risk of EPSE? [1]
Quetiapine
- is still a dopamine antagonist, but has least impact
When does post-natal depression most likely occur? [1]
0-6 weeks after birth
What questions in about risk do you need to ask in a clinical assessment of perinatal mental health patient? [3]
Significant changes in mental state
New thoughts or acts of violent self harm
Expressions of incompetency
Estrangement from child
From history taking sessions:
What are three key questions need to ask about in a post-partum depression patient? [2]
2 cardinal features of post-partum depression need to address;
- Feelings of guilt and shame
- Ilccit these when look at others - e.g. how do you feel when you see other mothers?
- Feelings of detachment from the baby
- Do you feel love for your child? Do you feel disconnected?
Need to ask about risk
- do you ever feel like it would better that baby is without you?
- AND
- have you ever had feelings (fleeting) of not having baby
Which drugs are contraindicated in pregnancy? [2]
Carbamazapine
Valproate
What are the physiological changes in pregnancy that affect PK of lithium, methadone and escitalopram.
How would you adjust the doses for this? [3]
What defines BN? [4]
Recurrent binge eating
* Clearly excessive amounts, defined period, loss of control, negative affect
AND
Inappropriate compensatory behaviours
* E.g. purging, excessive exercise, fasting
NELFT
at least weekly over last 3 months
AND
Not just during AN
What is meant by other specified feeding or eating disorder (OSFED)? [1]
Any presentation that doesn’t fit neatly into other categories - could be a mixed picture
- e.g. symptoms haven’t gone on long enough for 3 months
- Or anorexic like behaviour, but started on large weight so aren’t at low weight yet
What is meant by avoidant restrictive food intake disorder? [1]
Marked dietary restriction WITHOUT weight and shape concern
What is important to note about how people transition between eating disorders? [1]
Often transition away from AN to other eating disorders
- Move is away from low weight presentations, but often will continue purging etc.
If taking a Hx from ?ED patient, what do you speficially need to ask? [+]
Exploring ED symptoms:
Diet history
- Meals & snacks, fluid intake, foods avoided, calorie restriction, rules
Binges
Compensatory behaviours
- Purging
- Exercise
- Restriction
- Medication (e.g. appetite suppression)
Weight concerns
- Comfort at current weight
- Body dissatisfaction
- Salience in self-evalation
Weighing and checking behaviours
Current weight, recent and longer term trends
- Ask about max/min weight
- If women - has if periods have ever stopped
- Ask if ever had treatment
Motivation for change
Which electrolyte imbalance is key in AN? [1]
Hypokalaemia can cause cardiac arrest
What are the key features of refeeding syndrome and why do they occur? [2]
Refeeding syndrome:
- falls in phosphate and magnesium (used to make ATP)
Causes:
- Peripheral oedema - potentially fatal
Which foods should you encourage with refeeding? [1]
Diary - full of phosphates
Describe how you would perform a physical risk assessment in a malnourished patient [5+]
Appearance:
- Often look well
BMI
- < 13kg/m2 / 70% WH or rapid weight loss (>1 kg per week) high risk
Physical examination:
- Vital signs, muscle power and SUSS (Sit-Up Squat-Stand)
Blood tests:
- FBC, U&Es, glu, PO4, Mg, LFTs,
ECG
