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RACGP Exams Complete Deck > Psych2 > Flashcards

Psych2 Flashcards

(52 cards)

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1
Q

What non pharm management approach would one take for a child or adult with ADHD

A

Non pharm

Structure (routines/schedules/predictable)

Social (supervised socialisation/acknowledgement and reward for appropriate socialisation)

Self esteem (aknowledge and affirm positive behaviour)

Verbal Communication (Clear/brief instructions)

Written communication (use cues like highlighters/astericks/bold format to assist)

Communication between school and home (consider a formal communication portal such as a communication book between parents and school)

Community supports

Pharmacological - Methylphenidate/Dexamphetamine are stimulants - dont use under 4 years of age.

-Atomoxetine (NARI) (lag of 2-4 weeks before it starts working) and Clonidine (For agression or sleep disturbance) are also used

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2
Q

What are the criteria for adjustment disorder with anxious mood? What is the management

A
  1. Time limited (persist for less than 6 months once stressor is eleminated)
  2. Are in excess of normal expectations related to the stressor
  3. Not due to another identifiable mental disorder
  4. Not part of a continuing pattern of over-reaction to stress
  5. IMpair social or occupational function

Symptoms can include: sadness, worry, anxiety, insomnia, poor concentration, anger, hopelessness, feeling trapped

FIRST - Psychological management - counselling/CBT/Relaxation/ Mindfullness mediation/

Treatment is Diazepam 2 to 5 mg as a single dose PRN up to twice daily for no longer than 2 weeks

Review

Safety net

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3
Q

Which symptoms indicate depression/anxiety/which are common to both?

A

Depression: Distinct depressed quality to mood; diurnal variation of mood, psychomotor retardation; negative cognitions (guilt/worthlessness); Suicidal thoughts; change in appetite or weight

Anxiety: Irrational, excessive worry, feeling wound up

Both : Anxiety, insomnia, Irritability, Restlessness, Poor concentration, Fatigue

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4
Q

Features and associated sx of GAD

A

Associated: SKIM (BEF)

Sleep disturbance

Keyed up/on edge

Irritable

Muscle tension

Being Easily Fatigued

Excessive anxiety and pervasive and uncontrollable worry for 6 months of symptoms

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5
Q
A
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6
Q

Management of Generalised anxiety disorder?

A

First line - psychological management - Counselling/CBT/Relaxation/Mindfulness

2nd line - SSRI eg Sertraline 25mg mane orally (meds take one month for action)

consider short term benzo during crisis - no longer than 2 weeks

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7
Q

Which anxiety conditions should you exclude in history?

A

G4PO BASH

GAD
Specific Phobia

Social Phobia

PTSD

Panic

Obssessive compulsive

Body dysmorphia

Anorexia Nervosa

Somatisation disorder

Hypochondriasis

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8
Q

Starting dose of sertraline for Anxiety vs Depression?

A

Anx - 25g

Dep - 100mg

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9
Q

Symptoms of panic attack?

A

Discrete period of intense fear or discomfort with 4 or more of the following in 10 minutes

Palpitations

sweating

Trembling/shaking

Shortness of breath

choking

Chest pain

Nausea

Dizzy

derealisation (unreality) depersonalisation (detached from oneself)

Fear of losing control

Fear of dying

Paraesthesiae

Chills or hot flushes

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10
Q

What is panic disorder?

A

Recurrent panic attacks

Onset is not associated with situational trigger and not caused by substances or another medical or psychiatric disorder

Associated symptoms:

Anticipatory anxiety

Elevated levels of general anxiety or tension

Somatic preoccupation

Phobic avoidance (agorophobia 80%/social phobia 10%)

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11
Q

What is treatment for panic disorder

A

Psychological - CBT is first line

Mindfulness/Relaxation techniques

Second line sertraline 25mg orally daily

or Venlafaxine 75mg orally daily

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12
Q

Diagnostic criteria for schizophrenia

A
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13
Q

What are sideeffects of SSRI’s?

A

And GI and Bleeding

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14
Q

When is clozapine used in schizophrenia? What is the monitoring required?

A

Treatment resistant and/or schizo PLUS suicidation/self harm

Side effect profile includes AGRANULOCYTOSIS in 1%

National distribution system requires registration of practitioners

Needs:

At outset: ECG,ECHO, Trop, CRP, FBE, UEC, LFT, Fasting lipids, Fasting glucose

Then - WEEKLY FBE for 18 weeks

WEEKLY CRP and TROPONIN for one month

Regular BP, RR, HR and TEMP

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15
Q

How do we monitor antipsychotics with bloods?

A

3 monthly Fasting lipids and Glucose for 1 year

then yearly

Regular BMI, BP and Smoking Cessation advice

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16
Q

Management of Schizophrenia

A

Screen for Comorbid Substance Use

Screen for comorbid Depression or anxiety or suicidality

Psychosocial interventions - Clinical psychologist referral
Commence oral olanzapine 5mg nocte

Arrange review for one week

Safety net re: numbers of mental health CAT team, 000, emergency department if he feels unsafe at any time.

Discuss potential side effects of medication and the blood monitoring - eg fasting chol/gluc 3 monthly for first year

Advice re: Smoking cessation and cardiovascular risk factor management

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17
Q

Symptoms of schizophrenia

A

Positive

Hallucinations

Delusions

Impaired insight

Disorganised thinking/speech

Negative

Lack of motivation

poor self care

blunted affect

Reduced speech output

Cognitive

Impaired planning, memory, social cognition

Excitement

hostility, agression,

Mood

Depression, anxiety

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18
Q

Diagnostic criteria for schizophrenia

A
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19
Q

What is the treatment of choice for PTSD

A

TRAUMA FOCUSSED PSYCHOLOGICAL THERAPY

  • this could include cognitive process therapies(CPT) and EMDR (prolonged exposure, eye movement desensitisation and reprocessing)

2nd line

Sertraline 50mg orally daily

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20
Q

What are 4 C’s for interpreter use

A

In a Crisis

Assessing Cognitivie competence

Giving Complex instructions

obtaining Consent

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21
Q

What are key features of working with children who’ve expereinced trauma?

Study These Flashcards
A

Family engagement

Address current safety issues and Risks

Understand the Perspective of the child

Create a management plan

Review regularly

Refer appropriately

22
Q

What are the three main clusters of PTSD symptoms?

Study These Flashcards
A
  1. RE-experiencing symptoms
  2. Hyper-arousal
  3. Avoidance and Numbing

Screen for comorbid depression and substance abuse

24
Q

How might children at different developmental stages respond to trauma?

Study These Flashcards
A
  1. Infants/preschool

Developmental regression

Enuresis, sleep, appetite, speech issues.

  1. School age

Emotional lability/agression/hostility

lack of concentration

somatic symptoms -stomach or head ache

  1. Teenage

Risk taking behaviours

Behavioural changes

SOmatic complaints

REexperinecing, numbing/avoidance/hyperarousal

25
Baseline tests for new refugees
Should include B12, iron studies, TFT as food insecurity is common
26
Risk factors for the development of eating disorders?
Fhx of eating disorders Competitive family History of obesity History of anxiety disorders Type 1 Diabetes
27
DDx of an eating disorder
Gastrointestinal - IBD, IBS, Coeliac, GORD Endocrine - DM, hyperthyroid, Addisons Malignancy Psychiatric - OCD Infection - TB, HIV,
28
What are warning signs for eating disorders
**Behavioural** - Not eating in public, cooking for others but not eating, developing 'allergies' to food. **Psychogical** - anxiety - especially with regards to food, eating **Physical** - Dental caries, amenorrhea, Lanugo
29
What questions can be asked to screen for eating disorders?
**SCOFF** Do you make yourself **SICK** because you're uncomfortably full? Do you worry that you've lost **CONTROL** of how much you eat? Have you recently lost more than **ONE** stone (**6kg)** of weight Do you believe you are **FAT** when others say you are thin? Would you say food **DOMINATES** your life? **TWO or more YES answers - indicates need for more comprehensive assessment** Two more: Are you satisfied with your eating patterns? Do you ever eat in secret?
30
What are the diagnostic criteria for anorexia nervosa - restricting type?
1. **Restriction** of energy INTAKE 2. Either An **Intense fear** of gaining weight OR Persistent **behaviour** that **interferes** with weight gain 3. Disturbance in the way one's body is **Perceived**
31
How is a severe eating disorder classified?
Less than 70% of median body weight OR BMI Z score less than -3 OR \> 20% weight loss or \>10% weight loss in that last six months
32
Examination findings which would require admission in Anorexia
Bradycardia (HR \< 50) Cardiac arrhythmia **Prolonged QTc \> 450** Temp _\< 35.5_ _Hypokalaemia_ **Suicidality** **Weight loss** - **\< 75% of expected body weight**
33
What are the principles of management of anorexia nervosa?
1. Secure medical and psychiatric **safety** 2. Enage both patient and family in treatment process 3. **Family Based psychological therapy eg the Maudsley Method** 4. **Weight restoration** 5. Treat micronutrient and electrolyte disturbance 6. Treat psychiatric comorbidity
34
What is refeeding syndrome?
Acutely it is when electrolytes are taken up rapidly by cells and leaving little in the serum. Avoid by: **Gradually increasing caloric intake** from 1200/kcal a day Regular monitoring (DAILY in first week) of **potassium, phospate and magnesium (PPM)** **Supplements - thiamine, zinc, multivtiamins**
35
Examination in acute weight loss with anorexia nervosa
Vital signs - hypothermia or bradycardia, cardiac arrhythmia Assess **hydration state** clinically BMI and current weight **(BMI less than 14 is criteria for admission)** ECG - look for prolongation of **QTC** or an arrhythmia Pulse and Blood Pressure - lying and standing **(postural hypotension)** Bedside blood glucose Assess self harm risk Urgent check of UEC, CMP,
36
Chronic management of a patient with anorexia nervosa?
Multidisciplinary team: Psychologist - for family based therapy Dietician Psychiatrist Ongoing screening - dental, osteoporosis, electrolyte montoring, suicide risk, endocrine review - eg amenorrhea
37
38
What is the DSM definition of a major depressive episode?
5 out of 9 symptoms must be present for 2 weeks - and one must be either lowered mood most days OR anhedonia. 1. **Lowered mood** most days 2. **Anhedonia** 3. CHANGE in **appetite or weight** (up or down) 4. **Sleep** disturbance 5. **Psychomotor** retardation 6. Feelings of **hopelessness**/guilt 7. Loss of **ENERGY** 8. **Suicidal i**deation 9. Diminised ability to **CONCENTRATE** **Also must not be due to substances, grief or another medical problem and must INTERFERE WITH FUNCTION**
39
40
DDx of Depressive disorder?
1. Bipolar (Ask about manic/hypomanic episodes) 2. Adjustment disorder (acute stress in last three months) 3. Acute stress reaction 4. Dysthymic disorder (sad on most days of last 12 months) 5. Cyclothymia (daily fluctuation of mild depression and mania) 6. Hyperthymia (Chronic mood more towards mania - not relavent in depression 7. Schizophrenia 8. Personality disorder 9. Medical conditions - Anaemia, Hypothyroid, Malignancy, Dementia
41
Screening investigations to exclude organic causes of depression?
1. FBE (if anaemic check iron/B12/Folate) 2. UEC 3. LFT 4. Fasting glucose 5. TSH 6. ESR, CRP 7. Urine toxicology 8. Cerebral imaging
42
What is a suicide risk assessment approach?
**SADPERSONS scale** **S**ex (male) **A**ge (\<19 or \>45) **D**epression **P**revious suicide attempt **E**thanol abuse **Rational** thinking loss **Social Supports** lacking **O**rganised Plan **No Spouse** **Sickness** (chronic debilitating) One point for each 3-7 - think about hospitalisation or very close follow up Over 7 - hospitalisation
43
Treatment of depression in adults
1. Psychoeducation - using an empathic approach - provide resources in multiple formats (eg videos) 2. Refer to psychologist under a GP Mental health plan for structured psychotherapy 3. Encourage healthy eating, exercise and sleep hygiene 4. Commence oral antidepressant - eg Sertraline 50mg orally daily, and arrange follow up in one week. 5. Safety netting - numbers for CAT (Crisis assessment team) and 000 and advice on when to seek help. 6. Support cessation of alcohol and drugs
44
Treatment of depression in adolescents
Psychoeducation - using an empathic approach - provide resources in multiple formats (eg videos) Refer to psychologist under a GP Mental health plan for structured psychological intervention - eg CBT Encourage healthy eating, exercise and sleep hygiene Regular monitoring of mental state and risk assessment Obtain collateral history Monitor parents and siblings mental health status Safety netting - numbers for CAT (Crisis assessment team) and 000 and advice on when to seek help. Support cessation of alcohol and drugs
45
What are the principles of antidepressant withdrawl
Slow wean over 4 weeks
46
What are the symptoms of serotonin toxicity?
47
ADR of TCAs
Constipation Dry mouth Urinary retention (in BPH) Postural hypotension Blurred vision OVERDOSE sedation, seizures, hypotension, **broad complex dysrhythmias, anticholinergic syndrome** (blind as a bat (mydriasis), mad as a hatter (Delirum), dry as a bone (Dry mucous membranes/skin), Red as a beet (flushed)
48
Management of ATSI with depression
Referral to psychologist for CBT on GBMHP (can access 5 extra visits if has undergone 715 MBS health check - on top of usual 10) Include an ATSI health worker for ongoing culturally competent psychosocial support Follow up in one week to assess symptoms Safety netting - Advice re: numbers for Crisis assessment team and/or to go to Emergency department if feeling suicidal.
49
Cultural considerations to consider?
1. Impacts of systemic prejudice and/or overt prejudice on her mental health 2. Obligations to family, community and culture need to be appreciated - a patient centred approach which encourages her to share these with you is appropriate 3. Allow her to guide you about her own cultural preferences 4. Consider engaging an Aboriginal Health worker in providing broader support 5. Consider engaging the local Aboriginal Community Controlled Health Service to offer holistic support IN the event that she asks you 'how she can help suicide prevention in her community' - suggest that this is best led by the local Aboriginal community controlled health service and that you are willing to support those activities as a GP.
50
Which specific tools can be used to address mental health in Aboriginal populations?
Kessler 5 (Adapted from Kessler 10) for Indigenous Australians
51
What non pharmacological methods can be used to alleviate symptoms of depression
Mindfulness meditation Relaxation techniques SNAP Sleep hygiene Reduce time with electronic devices Encourage community connection
52
Examples of Australian evidence based online resources
headtohealth. gov.au thiswayup. gov.au

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