Psychiatry and Addiction Medicine Flashcards

Question

Clozapine myocarditis - onset, symptoms, investigations and management

Answer 1

1:1000 at initiation of therapy Onset within 2 months (~3/52) S+S: - Chest pain, SOB, heart failure - Fever, tachy, hypotensive Ix: Trop >2x ULN CRP >100 (in 70%) - Both together, highly specific ECG - prolonged QTc, non-specific ST changes TTE Mx: Cease clozapine if CRP >100 + trop 2x ULN Supportive

Answer 2

Somatisation - Lack of insight Factitious - Intentional but no secondary gain beyond sick role Malingering - Intentional with secondary gain e.g. avoiding work, financial compensation, drug-seeking etc.

Answer 3

>5 presentations/year (most common; many others) EtOH/substance avuse Mental illness esp. personality disorders Males Exposure to violence Unemployment Homelessness

Answer 4

Immediate - Senior staff to manage - Avoid unnecessary investigations - Manage underlying disease Long term - Notification of state drug and poisons if drug-seeking - Issue an ED alert - Management plan development - Guardianship boards/police in extreme cases - Restraining orders in cases of repeated threatening behaviours *A designated mental health team ineffective in reducing attendance rate*

Answer 5

Medical - HR <40 - BP <90/60 - Symptomatic hypoglycaemia - Temp <36.0 degC - Dehydration - K <3.0 mmol/L - Na < 130 mmol/L - Phos <0.5 mmol/L - Prolonged QTc Weight related - Weight <75% expected - Weight loss >1kg in 1 week - Unable to eat independently - Requiring NG feeding Psychological - Failure of outpatient management - Severe coexisting psychiatric disease

Answer 6

Weekly CBT - 20 weeks bulimia - 40 weeks anorexia Family-based therapy in adolescents and children SSRI + CBT more effective than either alone Recovery rate by 9 years of treatment: - Bulimia 65% - Anorexia 50% Highest mortality of all psychiatric disordres - 0.5% per annum - More frequently suicide than starvation

Answer 7

- Delusions - Hallucinations - Disorganised speech - Grossly disorganised or catatonic behaviour - Negative symptoms incl.: - Lack of motivation - Poor self-care - Blunted affect - Reduced speech output - Social withdrawal

Answer 8

Osteoporosis Short stature Stress fractures Abnormalities in cognitive function - loss of grey matter during starvation may persist Higher miscarriage rate Lower infant birth weight Renal calculi

Answer 9

1. BMI <17.5 or BW <85% expected 2. Weight loss self-induced 3. One of more of: - Body image distortion - Self-induced vomiting or purging - Excessive exercise - Associated endocrine disorders (e.g. amenorrhoea for >3 consecutive months post-menarche)

Answer 10

Past history of psychiatric disorder Current presentation similar to previous psych presentations Normal vitals No acute drug intoxication / normal physical examination Auditory hallucinations Collateral history suggestive of slow onset deterioration No medical symptoms / complaints

Answer 11

Age - No absolute rules - >18 years, considered competent - 14-17 variable - <14 usually considered not competent Cognitive capacity to understand - Medical condition - Options for treatment - What is recommended - Potential adverse outcomes - Likelihood of these Should be able to: - Accept information as reality - Retain information provided - Paraphrase information - Explain the possible consequences - Indicate the major facts in the their decision OR Understands: - Current condition - Treatment options - Possible outcomes of each option Can retain, repeat back and paraphrase information

Answer 12

- History of depression - Prior post-partum depression - History of other mental illness – bipolar - Recent stressors – pregnancy complications, job issues, health problems - Baby has health problems or special needs - Feeding difficulties - Relationship issues/DV - Lack of supports - Unwanted pregnancy

Answer 13

1. Psychosis 2. Admission of thoughts of infanticide/harm 3. Thoughts of self-harm 4. Any suicidality (any other SADPERSONS type stuff) 5. Poor social supports

Answer 14

Hypophosphataemia Hypokalaemia CCF Peripheral Oedema Rhabdomyolysis Seizures Haemolysis

Answer 15

ABS MAT PCI Appearance and behaviour Speech Mood Affect Thoughts Perception Cognition Insight and judgment

Answer 16

Mix of SADPERSONS + past history and means - High intent/ continual or specific thoughts - Definite plan - Hopelessness - Severe depression - Psychosis/ command hallucinations/ delusions about dying - Past attempts/ high lethality attempts - Impulsivity/ changeability/ lack of rapport - Intoxication/ substance abuse/ dependence - Male gender - Recent psychiatric hospitalisation - Access to means - Lack of supportive relationships/ social isolation - Conflicting information/ unable to verify information

Answer 17

- Age 16-65 years - No acute physical health problems (including trauma, ingestion or drug side-effects) - No altered level of consciousness - No evidence of physical cause for the acute presentation /normal vitals and examination - Not the first or significantly different psychiatric presentation

Answer 18

Widespread ST depression with TWI and U waves Significantly prolonged QU interval Consistent with severe hypoK Risk of VT, VF, Torsades de Pointes

Answer 19

1. Security to search premises 2. Attempt to contact patient by his listed mobile phone. 3. Notify police that patient has absconded & request welfare check at listed address 4. Notify NOK that patient has absconded & ask them to bring him back to ED if they have contact with him. 5. Notify psychiatric unit that patient on involuntary order has absconded 6. Document attempts to locate patient in chart

Answer 20

1. Medical stabilization of medical complications eg cardiac failure 2. Prevent or manage refeeding syndrome 3. Weight restoration 4. Reversal of cognitive deficit due to starvation 5. Inpatient psychotherapy

Psychiatry and Addiction Medicine Flashcards

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