Psych3 Flashcards
(16 cards)
Clinical features of BPD
Needs 5 out of the following:
- Uses extreme measures to avoid abandonment
- Intense, unstable relationships
- Identity issues with unstable self esteem
- extreme anger/can’t control temper
- persistent feelings of emptiness
- recurrent suicidal thoughts/ideation
- Emotional lability
- Irresponsible behaviour (two areas) eg sex, spending, substance abuse
Long term management of BPD
- Clinical psychologist referral for structured psycholgical intervention eg Cognitive behavioural therapy.
- Psychoeducation in multiple formats
- In order to set boundaries and facilitate a long term therapeutic relationship - clear, written plan of how the patient can access care - agreed by the patient - can be communicated with multidisciplinary team and administrative staff.
- Manage other comorbidities
- Ongoing suicide risk assessment and regular follow up
A patient presents as acutely suicidal with high risk - whats your approach?
Contact the local acute mental health crisis team (CAT) in the patients presence - explain the situation and work with the team and the patient to formulate a plan.
Advise patient of 24/7 crisis management hotline ‘Lifeline’ or the Mental health Access Line
Organise a mental health plan - obtain consent to gather collateral history from others
What scales can be used for assessing psychological distress and depression?
Kessler psychological distress score K10
Depression Anxiety Scale Score (DASS)
For Aboriginal patients K5
For postnatal Edinburgh post natal depression score
How would you distinguish Bipolar 1 and Bipolar 2
Bipolar 1 - At least one MANIC or mixed episode
Bipolar 2 - At least one major depressive episode and one hypomanic episode. No history of Mania.
Hypomanic - 4 days episode and does not significantly impair social functioning or necessitate hospitalisation, No psychotic symptoms (Although there’s an unequivocal change in function)
Manic - 7 days epsiode
Bipolar criteria
What are the side effects of lithium
What monitoring of lithium should be performed for a patient with bipolar
TICKL - 3-6 monthly
Li and Kidneys (UEC) every 3-6 months
Thyroid and Ca initially 6 monthly for first year and then yearly
ECG at the beginning
Lithium can cause hyperparathyroid, hyper and hypothyroid and renal impairment
What happens if lithium therapy is withdrawn
MUST be done SLOWLY over TWO months at least - otherwise rebound mania
What can trigger lithium toxicity?
Anything that affects kidneys can increase half life of lithium and thereby trigger toxicity
so dehydration, AKI, CKD, drugs which can impair renal function eg NSAID, diuretics, ARB, ACE
How would you treat lithium toxicity?
Withdrawl of lithium
IV fluid recusitation
Electrolyte replacement
treatment of underlying medical problem
Sometimes requires haemodyalisis
What therapeutic level of lithium should be aimed for
0.6-0.8mmol/L
What drug therapy would a patient with bipolar depression be commenced on
Antidepressant + Mood Stabiliser
Lithium 125mg bd for 5-7 days then check levels and titrate accordingly.
AND
Sertraline 50mg orally mane
For acute mania - Olanzapine 5mg orally nocte
How do most patients with Bipolar present to GPs?
With depressive symptoms
Distinguising features:
- Hyperphagia
- Hyper Somnia
Psychomotor retardation
WORSE or WEIRD when taking antidepressants
Irritability
FHx of Bipolar
When should serum lithium level be measured
8-12 HOURS after last dose
Lithium and Sodium Valp in pregnancy
Lithium - can cause Ebsteins anomaly (tricuspid valve doesnt develop)
Valproate - teratogenic
