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Year 1 SBA revision > 104 - Suicide > Flashcards

104 - Suicide Flashcards

1
Q

Antidote to heroin

A

Naloxone

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2
Q

How common are psychiatric disorders in the general population

A

21% prevenlance

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3
Q

Definition of prevelance

A

How much disease is present in the population

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4
Q

Definition of Incidence

A

How many new cases of disease occur over a given time

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5
Q

Most common psychiatric disorders

A

Anxiety disorders

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6
Q

Hierarchy of psychiatric disorders

A 
Organic
Bipolar
Schizophrenic
Depression
Anxiety disorder
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7
Q

Why is the order of the hierarchy of psychiatric disorders important?

A

Disorders higher on the list may include symptoms of disorders further down

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8
Q

4s ‘D’s’ of organic disorders

A

Dementia - global cognitive deficit
Delirium - acute disorientation
Drugs - Impact/withdrawal - prescribed/recreational
Disease - Psych symptoms of physical disease

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9
Q

What is bipolar disorder?

A

Periods of hyper and hypomania as well as depression

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10
Q

Symptoms of bipolar disorder

A

Elated mood, irritability, overspending, pressure of speech, flight of ideas, increased energy, lack of sleep, delusions of grandeur, mood convergent hallucinations

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11
Q

What is pressure of speech

A

Thinking faster than can talk

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12
Q

What is mood convergent hallucinations

A

Mood appropriate hallucinations

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13
Q

Treatment for bipolar disorder

A

Acute - Antipsychotics/Benzodiazepines

Maintenance - Mood stabilisers and anticonvulsants

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14
Q

Genetic contributions to major psychiatric disorders

A

Strong genetic component to schizophrenia
Some genetic component to bipolar disorder
Less genetic component to depression

Environmental factors also important

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15
Q

Bipolar disorder - Aetiology

A

1% prevalence, M/F equally affected, onset gradually in 20’s

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16
Q

Risk in patients who attempt suicide

A

15% repeat in 1yr

1% die - 100x increase in risk of suicide.

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17
Q

Risk assessment for suicide after self harm. Need to consider

A

Characteristics of self harm
Characteristics of person
Characteristics of situation

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18
Q

What is Anorexia?

A

Pts restrict food intake and compulsively overexercise. BMI

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19
Q

Psych disorder with highest death rate

A

Anorexia

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20
Q

Symptoms of anorexia

A

Depression, Weight loss, amenorrhoea, fear of weight gain, distorted body image.

Affects 10x F than M, onset in adolescence.

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21
Q

Treatment of anorexia

A

Depends on age. Controlled weight gain + CBT (adults) or family therapy (adolescents)

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22
Q

Impact of anorexia on depression

A

Patients may be depressed as anorexia affects serotonin levels. As gains weight, depressions should improve.

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23
Q

What is bulimia?

A

Intense cravings for food - overeat and then purge to prevent weight gain. Preoccupation with weight.

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24
Q

Treatment for Bulimia

A

High dose SSRIs and CBT

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25
Q

3 core symptoms of depression

A

Low mood
Anhedonia
Decreased energy

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26
Q

Clinical depression if

A

Low mood and anhedonia present for >2 weeks

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27
Q

Becks Cognitive triad is

A

Pessimistic thoughts about
Self
World
Future

28
Q

Depressions associated with

A

Socioeconomic deprivation and genetic component. 2x F as M affected.

29
Q

How is severity of depression determined

A

Number of symptoms, severity of symptoms and impact on patients day to day life.

30
Q

Treatment depends on

A

Severity of depression

Can be managed in primary care

31
Q

Treatment of mild depression

A

Lifestyle changes, exercise, counselling, monitoring

32
Q

Treatment of moderate-severe depression

A

CBT, antidepressants, Electroconvulsive therapy

33
Q

Reoccurrence of depression

A

50% (higher if severe depression) - will be more severe if reoccurs

34
Q

What do drug treatments for depression try to do and why?

A

Aim to increase serotonin production as levels of serotonin and noradrenaline are low in depression

35
Q

What is a first rank symptom of schizophrenia

A

A symptom that suggests schizophrenia if it is present in the absence of a disorder higher up the hierarchy of psychiatric disorders. Patients may not have any of these symptoms but can still have depression.

36
Q

What are the first rank symptoms of schizophrenia

A

A - Auditory hallucinations in 3rd person
B - Broadcasting - think others can hear thoughts
C - Control, delusions of - think someone else is controlling their actions
D - Delusional perception - perceives things have a special meaning for just them
E - Echo - Think thought spoken aloud just after they say them

37
Q

Diagnostic criterial for schizophrenia -

A

1st rank symptom or persistant delusion present for >1 month in absence of drug intoxication/withdrawal, brain disease or prominent affective symptoms

38
Q

Treatment of schizophrenia

A

Antipsychotics (dopamine blockers), modified CBT, rehab family interventions

39
Q

Effect of increase in [dopamine]

A

Parkinsons medications act to increase dopamine and an overdose of these medications can cause schizophrenia like symptoms. Likely induced by the increased dopamine levels.

40
Q

Suicide attempt risk factors

A 
Social isolation
Social class 
Spring peak - no known reason
Prison or involvement with police
25% known to mental health services
2/3 expressed suicidal ideas
1/3 left note
41
Q

Assessment of patients after self harm - consider

A

Immediate risk of suicide
Subsequent risk of suicide
Current medical/social problems

42
Q

Suicide attempts with high risk of death if:

A 
Premeditated
Precautions to avoid detection
Attempted in isolation
Timed to minimise discovery
Final acts in anticipation
Suicide note
Violent methods
Patient thought irreversible/lethal methods used
Patient wanted to kill themselves
Regrets survival
No attempt to seek help
Multiple previous attempts with intent to die
Stated they wanted to die prior to attempt
43
Q

What is self harm?

A

Intentionally self poisoning or self injury, irrespective of motivation or suicidal intent

44
Q

Why is cutting more associated with suicide than overdose as self harm?

A

Developing capacity for self harm - getting past instincts not to hurt self

45
Q

Antibiotics not suitable for use when taking Warfarin

A

Erythromycin - do not give. Inhibits warfarin metabolism and can lead to overdose.
Avoid macrolides.

46
Q

Problems with morphine/codeine use in elderly

A

Can overdose more easily - need to be cautious - cardiac arrest - check for pinpoint pupils/change in BP

47
Q

First thing to do in suspected poisoning

A

Poison promotes vomiting - PROTECT AIRWAY

48
Q

Poisoning - Need to consider

A 
Contamination - protect staff
Injuries - self inflicted/accidental
Actually unconscious? risk to staff
Mixed drug injection
Other causes of problem - head injury?
49
Q

Investigations for poisonings

A 
Serum/urine for forensics
Toxicology screen - not used clinically
Venous blood gas - check acid/base balance, anion gap. osmole gap.
ABG
Cardiac monitoring
50
Q

Antidote to opioids

A

Naloxone

51
Q

Antidotes to paracetamol

A

Acetylcysteine/Parvolax

Methionine

52
Q

Use of stomach pumps in poisoning

A

Not used - cause harm

53
Q

Use of activated charcoal in poisoning

A

Single dose within 1hr of poisoning in PROTECTED AIRWAY

Not all drugs.

54
Q

Tricyclic overdose signs/symptoms

A

‘Red as a beet, dry as a bone, blind as a bat, hot as a hare and mad as a wet hen’

55
Q

How do tricyclics act

A

Acts on parasympathetic nervous system - antimuscarinic

56
Q

If neurotoxicity has occurred in tricyclic poisoning then what has also occurred?

A

Cardiactoxicity

57
Q

Codeine effect on pupils

A

Constricts - pinpoint

58
Q

If overdose and low respiratory rate think

A

Opiods

59
Q

Symptoms of MDMA overdose

A

M - Mydriasis - dilated pupils
D - Delerium
M - Melting - hyperthermia
A - Agitation

60
Q

Antidote to Beta blockers

A

Glucagon

61
Q

Symptoms of paracetamol overdose

A

Jaundice - harmful to liver
Abdo pain
Nausea and vomiting

62
Q

Durkheim’s model of suicide

A

Anomic - Lost or alone
Altruistic - Would be better for others if they were gone
Egoistic - Detached from society

63
Q

SSRIs

A

Citalopram, Fluoxetine, Sertraline

64
Q

When use monoamine-oxidase inhibitors?

A

Severe depression only.

65
Q

Signs of benzodiazepine overdose

A

Drowsiness/Coma

66
Q

Signs of TCA overdose

A

Large pupils
Coma
Hypothermia
Arrythmias/hypotension

Year 1 SBA revision (37 decks)

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