Sean hood lectures pt 2.

Question 1

predisposing factors

Answer 1

are areas of vulnerability that increase the risk for the presenting problem. Examples include genetic (i.e. -family history) predisposition for mental illness or prenatal exposure to alcohol.

Question 2

precipitating factors

Answer 2

are typically thought of as stressors or other events (they could be positive or negative) that may be precipitants of the symptoms. Examples include conflicts about identity, relationship conflicts, or transitions.

Question 3

perpetuating factors

Answer 3

are any conditions in the patient, family, community, or larger systems that exacerbate rather than solve the problem. Examples include unaddressed relationship conflicts, lack of education, financial stresses, and occupation stress (or lack of employment)

Question 4

protective factors

Answer 4

include the patient’s own areas of competency, skill, talents, interest and supportive elements. Protective factors counteract the predisposing, precipitating, and perpetuating factors.

Question 5

5 key areas of management

Answer 5

0. context/disposal - where, who
1. acute risk management
2. diagnostic clarification
3. management of the acute symptoms - for each Ddx, using B/P/S approach
4. psychosocial and other contributory factors (treating secondary / axis IV conditions)
5. long term rehabilitation

Question 6

acute risk management

Answer 6

risk to themselves, to relationships, others (violence), reputation, employment, finance, property, medical professionals

Question 7

what defines potential suicide risk

Answer 7

deliberate self harm (DSH)
suicidal ideation plans/attempts/access to means
homicidal ideation/ history of violence or aaggression
protective factos

Question 8

immediate risk management measures

Answer 8

safety - eg. check for syringes
seperate from others - seclusion
listen to the patient
consider short term benzodiazepines or physical restraints

Question 9

medium term risk management measures

Answer 9

antidepressants
one on one special observations
OT
clinical psychologist
deal with social crisis

Question 10

diagnostic clarification

Answer 10

history
bloods
urine - MCS for UTI in older people or for toxicology eg. opites
imaging for patients with first episode of psychosis or delirium
ECG - for possible drug side effects
ECG - temporal lobe encephalopathy (wernicke’s encephalopathy), CJD, seizures (temporal lobe epilepsy)

Question 11

some things you might consider in management

Answer 11

pharmacological management
ECT
psychological therapies
social aspects
substance use
discharge meeting eg. GP, case managers, carers, non-government organisations, family

Question 12

treating secondary conditions

Answer 12

educating family members, social supports, carers
compliance/adherance

Question 13

long term rehabilitation

Answer 13

construct plans post discharge

Question 14

what diagnostic help would bloods provide?

Answer 14

FBC - anaemia
UEC - hyponatraemia can mimic depression, drugs metabolised by kidneys
LFTs - drags metabolised by liver, alcoholism/carrhosis
TFTs - changes in levels can Mimis depression/anxiety/mania/irritability
drug levels
bHCG - pregnancy
fasting BSL - metabolic syndrome can be caused by drugs
Fasting lipids - metabolic syndrome can be caused by drugs
B12, folate - deficiency mimics psychiatric syndromes e.g. depression, dementia, delirium
Ca, Mg - parathyroid problems can mimic psychiatric syndromes e.g. depression, delirium anxiety, psychosis
HSV, syphilis, hepatitis, HIV, chlamydia/gonorrhoea PCR - test these in certain patient groups e.g. IVDU, with specific consent

Question 15

what are Erikson’s stages

Answer 15

age appropriate stages of psychosocial development; challenges of stages not necessarily completed arise as problems in the future

Question 16

Erickson’s stage of infants

Answer 16

hope (trust vs. mistrust, infants birth to 1 year)
Childs understanding of society depends on whether infants needs met by parents
secure environment

Question 17

Erickson’s stages of toddlers

Answer 17

will (autonomy vs sham and doubt, toddlers 2-4 years)
child begins to explore surroundings, develop interests and capability to satisfy some of own needs, caregivers foster development of child’s through encouragement vs restriction

Question 18

Erickson’s stage of preschoolers

Answer 18

purpose (initiative vss guilt, preschool 4-6 years)
child develops initiative in planning and undertaking activities, if their plans are dismissed by. adults, develop guilt about needs and desires

Question 19

Erickson’s stage of childhood

Answer 19

competence (industry vs inferiorly, childhood 7-13 years)
abstract thinking and complex skills developed, learning to be productive and complete tasks at school, recognise and develop special talents gives sense of self confidence vs lack of motivation, low self esteem and lethargy

Question 20

Erickson’s stage of adolescents

Answer 20

fidelity (identity vs role confusion, adelesents 14-24 years)
developing sense of who they are and where their lives are heading, sexual identity, role they will play in society

Question 21

Erickson’s stage of young adults

Answer 21

love (intimacy vs isolation, young adults 25-40 years)
forming long term intimate relationships

Question 22

Erickson’s stage of middle adulthood

Answer 22

care (generavity vs stagnation, middle adulthood 45-65 years)
making a valuable contribution to society, achieving a sense of productivity and accomplishment

Question 23

Erickson’s stage of seniors

Answer 23

wisdom (ego integrity vs despair, seniors 65+)
retirement, contemplate accomplishments and develop integrity if consider to have lead a successful life and reached life goals

Question 24

appropriate follow up using bio/psycho/social model

Answer 24

bio
- pharmacological management
- GP discharge
psycho
- psychologist
- community mental health clinic
- other members of multidisciplinary teams SW / OT
social
- occupation
- housing
- financial situation