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Week 2 paces cases > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

Eating disorder management

A

Biopsychosocial approach

Consider admission
Family therapy
CBT (eating disorder focussed)
MANTRA therapy

Can give fluoxetine for bulimia

Talk to eachother with group therapy as well as watched meals, sit and wait for food to settle

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2
Q

Core Sx of depression

A

Low mood
Anergia
Anhedonia

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3
Q

RF for depression

A 
Poor coping strategies
Female>male 
Stressful life events
Poor support network 
Chronic health problems 
Poor insight 
FAPS 
Female/FH
Alcohol/adverse events
Past depression, physical illness
Social support lacking/low socioeconomic status
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4
Q

What is De-Clerembaut’s syndrome?

A

Pt believes someone is in love with them

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5
Q

Symptoms of depression

A

DEADSWAMP

Depressed mood
Energy loss
Anhedonia
Death (Suicidal thoughts)
Sleep disturbance 
Worthlesness 
Appetite or weight change 
Mental (concentration loss)
Penis (libido) and psychosis (severe depression)
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6
Q

Difference between mild, moderate and severe depression

A

Presence and severity of symptoms
Mild = 2 core
Severe = all 3 core Sx

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7
Q

Questions to help Ix depression

A

How has your mood been recently?
Do you still enjoy the things you used to enjoy?
Do you find you don’t have much energy at the moment?
How do you feel about the future?

RISK
Have you had any thoughts about harming yourself or taking your own life?

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8
Q

DDx for depression

A

Organic causes such as dementia, bipolar disorder, thyroid dysfunction, anaemia, hypercalcaemia, chronic disease!

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9
Q

Components of MSE

A 
ASEPTIC 
Appearance
Speech 
Emotion
Perception
Thought 
Insight 
Cognition
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10
Q

Ix for depression

A 
PHQ9 questionnaire
Blood tests (anaemia, calcium, thyroid, CRP)
Imaging if personality change and headache for example

Check that they dont have episodes of feeling ecstatic! (same goes for the other way around)

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11
Q

Mx of depression

A

BIOPSYCHOSOCIAL

Bio = antidepressants
Psycho = CBT, self help, physical activity, counselling (getting them to explore their problems)
Social = support groups
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12
Q

Features of bipolar

A

At least one episode of mania and a further episode of mania or depression

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13
Q

Types of bipolar

A

Bipolar 1 = big highs and big lows

Bipolar 2 = milder highs and lows

Rapid cycling = fast changes

Also hypomania and mania with psychosis (severe)
The overarching disease can change aswell as the severity of the swings within it

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14
Q

Symptoms of bipolar disorder

A 
DIG FASTER 
Disinhibition
Insight impaired and irritable (80%)
Grandiose delusions 
Flight of ideas
Activity increased 
Sleep decreased 
Talkative
Elevated mood
Reckless behaviour and reduced attention span
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15
Q

RF of bipolar

A

Young adult
Family Hx
Substance abuse
Anxiety disorders

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16
Q

Questions for bipolar disorder

A

How would you describe your mood?

Have you felt on top of the world?

Have you been able to concentrate on your normal activities?

Do you have anything that is unique to you?

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17
Q

DDx for bipolar

A

Depression with psychosis
Organic (tumour, stroke, hyperthyroidism)
Personality disorder
Schizophrenia

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18
Q

Mx of bipolar

A

BIOPSYCHOSOCIAL

Bio = mood stabilisers like lithium

Psycho = CBT and psychoeducation

Social = suport groups, self help

Consider hospitilization if unable to look after themselves

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19
Q

Drug used in severe mania acutely?

A

Haloperidol or another anti-psychotic

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20
Q

Physiological Sx of anxiety

A 
Tremor 
Palpitations
Chest pain 
Breathlessness
Sweating 
Butterflies
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21
Q

Ways to categorise anxiety

A

Continuous = GAD
Situation dependent = phobic (diff types)
Situation independent = panic disorder

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22
Q

Organic causes of anxiety

A

Hyperthyroidism
Drugs
Caffeine

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23
Q

Features of generalised anxiety disorder

A

> 6mo duration, present most days
Ongoing, uncontrollable, widespread worry

The patient recognises these worries as inappropriate and excessive

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24
Q

RF for generalised anxiety disorder

A

Genetic predisposition
Stressful events
History of anxiety

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25
Features of autonomic arousal
``` Sweating Headache Tremor Restlessness Tension in muscless Concentration difficulty ```
26
Questions to try and determine type of anxiety
When do you get these episodes? Could you briefly walk me through a typical day and when you might get worried
27
Important conditions to screen for in GAD
Depression Substance misuse Thyroid disease These are strongly linked with GAD
28
Management of GAD
BIOPSYCHOSOCIAL SSRI (sertraline) Psychoeducatinal groups and CBT Relaxation and mindfulness Self help methods and support groups as well as exercise
29
Mx of anxiety disorders (agoraphobia, social phobia and specific phobia)
CBT SSRI Graduated exposure techniques (bit better each time) Exposure therapy for specific
30
Features of panic disorder
Generally OK then episodes of panic (autonomic arousal) Unpredictable (e.g. at an airport) Feeling of not being able to breathe
31
Mx of panic disorder
SSRI are first line Self help apps CBT
32
How long should you keep taking SSRI after your mood has improved?
6 months, reduces rate of recurrence
33
Things associated with poor schizophrenia prognosis
``` Gradual onset No clear trigger Hx of social withdrawal Strong FH Poor social support network Low socioeconomic status Low IQ ```
34
What key feature can help you determine between bullaemia and anorexia?
BMI is usually preserved in bullaemia
35
Personality change, brain autopsy shows TAU proteins, Dx?
Picks disease (fronto-temporal dementia)
36
Management of heroin/opiod withdrawal
Supportive measures only Onset can be quick (6hours) Peaks at 36-72hr
37
Anti-psychotic with reduced side effect profile
Aripiprazole
38
First line Mx of autoimmune encephalitis
Methylprednisolone
39
Mx of autoimmune encephalitis
Methylprednisolone Rituximab Plasma exchange
40
First line Mx for post-partum depression
CBT
41
Features of Alzheimers on CT
Widespread cortical atrophy
42
Blood results in anorexia
Hypokalaemia Low sex hormone levels (FSH, LH, oestrogen and testosterone) Raised growth hormone and cortisol levels Hypercholesterolaemia
43
Symptoms of anorexia
``` Low BMI Hypotension Bradycardia Enlarged salivary glands Lanugo hair (fine hair covering the skin) Amennorhea ```
44
Congenital RF for autism
Down's syndrome
45
What are delusional perceptions?
Pt sees something and makes an unreasonable leap I saw the Queen on TV and I knew I was destined to save the world
46
Side effects of SSRI
Sick Sexual dysfunction Serontonin dysfunction Sodium disregulation
47
RISK assessment components
HARMS Hope for the future Attempts at harming/suicide Risk factors = unemployed, mental health disorders, male, depression MSE Support network
48
Mx of suicidal patient
Consider admission and ensure they are safe Psychiatric treatment Risk assessment
49
Management of patients with repeated suicide attempts
Crisis team Detect and treat underlying disorders Urgent hospitilisation Building of support network
50
Management of baby blues
Reassurance, support network, repeat appointment to check up on them (also make sure they attend their midwife appointment!)
51
Management of post-partum depression
CBT | Consider admission
52
Management of pueperal psychosis
Alert the post-natal mental health crisis team | Admission
53
Management of dementia
BIOPSYCHOSOCIAL Bio = donepezil or memantine (severe) Psycho = memory clinic Social = good support, adapting the home and home life
54
DDx for dementia
``` Alzheimers Lewy Body Fronto-temporal Vascular dementia Delirium Hypothyroidism SOL Depression CJD ```
55
ADHD management
Family therapy Methylphenidate and regular growth measurements as well as dietician involvement
56
Features of ADHD
Inattentive Lots of energy Easily distractable Impulsive (crossing roads without looking)
57
Categories of ADHD
Inattention Hyperactive Mixed
58
Features of anorexia
``` Weight loss Low BMI Pt doesnt like their body image (body dysmorphia) Lanuga hair Amenhorrea Anaemia Enlarged salivary glands Russel's sign (calused knuckles) Poor dentition (repeated vomiting) ```
59
Management of eating disorders
Bullaemia -> SSRI to reduce binging, CBT Anorexia -> consider admission if severe (low weight, lost lots of weight recently), refeeding slowly (maybe with some phosphate), CBT, GROUP THERAPY, family therapy
60
Criteria to diagnose anorexia
FEED Fear of weight gain Endocrine disturbance Emaciated Deliberate weight loss
61
Ix for anorexia
``` FBC (anaemia and leukopaenia) U&E LFTs Cortisol GH Amylase (pancreatitis is a complication of AN) ```
62
DDx for anorexia
Bulimia Depression OCD Organic causes of weight loss
63
Typical Hx of bulimia
Binge eating Fear of fatness Purging behaviour Sense of compulsion to eat = cyclical
64
Features of post-traumatic stress disorder
Intense, prolonged, delayed reaction following exposure to a traumatic event Reliving the situation Avoidance Hyperarousal Emotional numbing
65
When must PTSD occur to be PTSD
Within 6mo of the traumatic event
66
Cut off for normal berheavement response
6mo
67
What is acute stress reaction?
Exposure to an exceptional event or stressor, response in the immediate aftermath = disorientation, excessive grief, hopelessness
68
Management of acute stress reaction
Watchful waiting Trauma focussed CBT Short term drug treatment for things like sleep disturbance (e.g. zopiclone) Risk assesment
69
Features of OCD
Recurrent obsessional thoughts or compulsive acts
70
What are obsessions? (in the context of OCD)
Unwanted, intrusive thoughts | Urges
71
What are compulsions
Repetitive, sterotyped behaviours that the patient feels driven to perfrom to reduce the obsessive thoughts
72
Key features of OCD thoughts/compulsions
Failure to resist Originate in the patients mind Repetitive and distressing Carrying out is not pleasureable but reduces anxiety levels
73
Example obsessive thought and corresponding compulsion
"I am covered in germs" | "I must clean my hands 10 times"
74
Questionnaire for OCD
Yale Brown
75
DDx for OCD
Anxiety disorders | Depressive disorder
76
Mx of OCD
``` CBT SSRI (fluoxetine and paroxetine) Clomipramine can be added if severe Psychoeducation Self-help books ```
77
What is psychosis? CRUCIAL
Distortion of reality Unsure what is real and what is not!
78
What is a delusion?
Falsely held belief | Firmly held despite everything and background of patient
79
What is a hallucination?
A perception in the absence of a stimulus
80
What is a thought disorder?
An impairment in the ability to form thoughts logically
81
RF for schizophrenia
``` Black and other ethnic minorities Urban upbringing Family history Substance misuse Smoking cannabis ```
82
How long do you have to have Sx of psychosis for it to be Schizophrenia?
>1mo
83
What are some features of schizophrenia?
Delusional perception Third person auditory hallucinations Thought interferanec (broadcast, insertion, withdrawal) Passivity phenomenen
84
Great question to ask if worried about Schizophrenia?
Do you ever struggle to determine whats real and what is not?
85
Negative symptoms of schizophrenia
Anhedonia Attention deficits Alogia (poverty of speech)
86
Characteristics of hebephrenic schizophrenia
Child-like state
87
Characteristics of simple schizophrenia
Just the negative symptoms
88
How do you diagnose someone with schizophrenia often?
Palpable 'loss of person' Can be terrifying for the patient! They dont know what is real and can have hallucinations aswell, scary
89
Ix for schizophrenia
Check for organic cause = anaemia and thyroid aswell as delirium Toxicology screen ECG because need to check before using anti-psychotics
90
Mx of schizophrenia
``` RISK assessment Admit the patient Antipsychotics Support groups Catatonic schizophrenia -> ECT CBT (reduces residual symptoms) Art therapy (reduce negative symptoms) ```
91
Last line medication after trying 2 different antipsychotics?
Clozapine
92
Categories of personality disorders
``` ABC Mad Bad Sad (MBS) Schizoid and Schizotypal Borderline Avoidant and dependent ```

Week 2 paces cases (3 decks)

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