Psychiatry + Geriatrics Flashcards
(103 cards)
A 23-year-old man presents to his GP surgery asking to be referred to a plastic surgeon. He is concerned that his ears are too big in proportion to his face. He now seldom leaves the house because of this and has lost his job. On examination his ears appear to be within normal limits. What is the most appropriate description of this behaviour?
Body dysmorphic disorder (sometimes referred to as dysmorphophobia) is a mental disorder where patients have a significantly distorted body image
What is the first line tx for a 14 year old girl with anorexia?
Family based therapy
Name two common features of sleep paralysis?
1) Paralysis - this occurs after waking up or shortly before falling asleep
2) Hallucinations - images or speaking that appear during the paralysis
What is sleep paralysis and what treatment can be used?
Sleep paralysis is a common condition characterized by transient paralysis of skeletal muscles which occurs when awakening from sleep or less often while falling asleep.
Tx: If needed clonazepam
What is the cut off for clozapine with regards to missed doses and needing to restart?
If clozapine doses are missed for more than 48 hours the dose will need to be restarted again slowly
What is the general summary of investigation results for patients with anorexia?
Most blood results are low
Anything beginning with GorC is high (Growth hormone, cortisol, glucose etc)
What is the minimum length of symptoms that ICD-10 criteria can be used to diagnose depression?
2 weeks
A 64-year-old woman presents as she is feeling down and sleeping poorly. After speaking to the patient and using a validated symptom measure you decide she has moderate depression. She has a past history of ischaemic heart disease and currently takes aspirin, ramipril and simvastatin. What is the most appropriate course of action?
Start sertraline (first line SSRI if heart disease) \+ lanzoprozole
As she is already taking aspirin, any NSAID + SSRI can give risk of GI bleed so needs cover with PPI
What are the main risks of using an SSRI (a) in the 1st trimester and (b) in the 3rd trimester
Use during the first trimester gives a small increased risk of congenital heart defects
Use during the third trimester can result in persistent pulmonary hypertension of the newborn
A 30-year-old female patient with previously diagnosed depression managed with fluoxetine presents to her GP having had terrifying hallucinations at night occurring most nights in the past week. These have been mainly auditory and woken her from sleep. They comprise of aggressive male voices which last for around 10 minutes after she is fully awake. What is the most likely diagnosis?
Hypnogogic (occurring from wakefulness to sleeping) and hypnopompic (occurring from sleeping to waking) hallucinations can occur as a normal physiological phenomenon, however there is a recognised association with depression and anxiety. They can also be associated with sleep paralysis. As these hallucinations have only been occurring at night over a one week period they are not a manifestation of psychosis associated with schizoaffective disorder or schizophrenia.
In what year was the Mental Health Act written and what year was it ammended?
Written 1983
Amended 2007
In what year did the mental capacity act come into place?
2005
When would a section 2 be used? How long does it last for?
Who approves it?
Detained in hospital for ASSESSMENT of mental health
Up-to 28 days
Approved by two doctors, one specialist?
Can a patient appeal a section 2, can it be renewed?
Can appeal in first 14 days
Can’t be renewed, but can be moved to a section 3
What is a section 3 used for?
How long does it last? Can it be renewed?
Detained in hospital for TREATMENT
- Up to 6 months
Renewed for periods of up to 1 year at a time
What is a section 4 used for and how long does it last? Who approves it?
Detained for emergency assessment
Up-to 72 hours
(needs only one doctor, but must have seen in last 24 hours)
When is a section 5 used? What are the subsections and how long does it last?
Stopped from leaving hospital for up to 72 hours
Done by doctor = Section 5 (2) - 72hrs
Done by nurse = Section 5 (4) - 6 hours
Of MHA sections 2/3/4/5, which can a patient be treated without consent, when can’t a patient be treated without consent?
Section 2 + 3 = Can treat without consent
Section 4+5 = Can’t treat without consent
What is a section 135 used for?
Warrant to gain access to premesis to remove patient to place of safety
One doctor + one police
- Assessment only, no tx
- Can only be used once
What is a section 136 used for?
Allow police to remove a person from public place to safety
- Police power only
- Assessment not tx
Name 3 risk factors for depression?
Female Past Hx Significant physical illness Other mental health conditions Afro-Caribbean or Asian
What are the depressive symptoms which should be covered in a hx?
Sad (mood) Apathy (loss of enjoyment) Guilty Concentration Loss of appetite Agitation or slow movements Sleep changes + fatigue Suicide
BAP (Bipolar, alcohol/ drugs, psychosis)
How should mild/moderate depression be treated?
1) Watchful waiting (assess every 2 weeks)
2) Low intensity psychological i.e. online CBT, relaxation therapy
3) Only offer medication if persists after this
How should moderate to severe depression be treated?
Medication + high intensity psychological tx
