FFP Mental Health Flashcards

Question

Treatment of tardive dyskinesia

Answer 1

Tetrabenazine may be used to treat moderate/severe tardive dyskinesia

Answer 2

I.v. 2mg lorazepam -> if improvement 4-12mg/day if not ECT

Answer 3

Schizoaffective disorder - equal negative and schizo sx at the same time Psychotic depression - initial depression with psychosis Delusional disorder - 3 months of delusions (non bizarre grandiose, persecutory) but not thought control and no other sx

Answer 4

Delirium - infection Medication - steroids, dopamine agonists Endocrine - Cushings, thyroid Neuro - huntingtons, temporal lobe epilepsy SLE, porphyria Pyschoactive substances - cocaine, amphetamines Alcohol withdrawal

Answer 5

Life threatening reaction to antipsychotics Insidious onset (4-14 days) Altered consciousness Severe lead pipe rigidity Autonomic dysfunction - hyperthermia, sweating, labile BP Hyporeflexia Increased WCC, CK, Liver transaminases Stop antipsychotics Benzos if needed Cool the pt +- fluids i.v. bromocriptine/dantrolene

Answer 6

1-2 days onset Altered consciousness Severe lead pipe rigidity Autonomic dysfunction - hyperthermia, sweating, labile BP Hyperreflexia, tremor, clonus Increased CK Stop serotonergic drugs Benzos if needed Cool the pt +- fluids I.v. Cyproheptadine (antihistamine)

Answer 7

2 weeks< Low mood, anhedonia, low energy Early awakening, diurnal variation in mood, decreased appetite, psychomotor agitation Decreased conc, decreased self esteem, guilt, hopelessness If v severe, delusions/hallucinations e.g. cotord's syndrome

Answer 8

Pt believes they are already dead, nilhistic, grandiose

Answer 9

hypothyroid, hypoadrenalism, anaemia

Answer 10

CBT, lifestyle, social support SSRIs - Citalopram, Fluoxetine (U18s), Sertraline SNRIs - Duloxetine, Venlafaxine NaSSAs - Mirtazapine TCAs - Amitriptyline 1st line in pregnancy MAOIs - phenelzine, isocarboxacid ECT

Answer 11

0-4: No depression 5-9: Mild depression 10-14: Moderate depression 15-19: Moderately severe depression - active therapy 20-27: Severe depression

Answer 12

U18s - Fluoxetine Pregnancy - Amitriptyline Teratogenic - Paroxetine in 1st trimester QT prolongation - TCAs (CI in CVD, Liver disease) and Citalopram Atypical depression (insomnia/overeating) - MAOIs - phenelzine, isocarboxacid

Answer 13

SSRIs - Citalopram, Fluoxetine, Sertraline: GI, inital anxiety/suicidality decreased appetite, akathisia, insomnia, sweating, ED SNRIs - venlafaxine, duloxitine As above but more severe NaSSAs - Mirtazapine Increased appetite and sedation TCAs - amitriptyline, lofepramine Anticholinergic, antihistamine; wt gain, sedation, anti-a; postural hypotension. QT prolongation MAOIs - phenelzine, isocarboxacid Hypertensive crisis: cheese affect Serotonin syndrome

Answer 14

Type I: Manic episodes + Major depression Type II: Hypomania + Major depression

Answer 15

Elevated self esteem, accelerated thinking, impaired judgement, poor concentration Decreased need for sleep, increased energy Disorder thought form, abnormal beliefs, perceptual disturbances Hypomania - milder form less delusions

Answer 16

Admission Stop antidepressants Antimanic drugs = antipsychotics: risperidone, olanzapine, quetiapine

Answer 17

Check level of mood stabiliser (lithium/valproate/olanzapine) and increase if possible Add SSRI/Olanzapine/Lamotrigine CBT

Answer 18

Lithium GI, dry mouth, metallic taste Not suitable in renal impairment Cardiotoxic, Thyrotoxic Toxicity => tremor, seizures, coma. AKI, Nephrotic syndrome, diabetes insipidus. QT, sinus node dysfunction. Teratogenic 3 monthly plasma levels, TFTs every 6 months Valproate wt gain, hair loss, sedation, tremor, blood dyscrasias, liver failure teratogen Olanzapine As per antipsychotics

Answer 19

6 months, impairs day to day functioning Heart racing, sweating, hyperventilation, etc. Persistent worrisome thoughts, poor conc. irritability, avoids socialisation CBT Beta blockers PRN SSRIs

Answer 20

CBT SSRIs if agora/social phobia

Answer 21

2 weeks< affecting functioning: Obsessions: involuntary thoughts, against own resistance and good insight Compulsions: repetitive mental operations e.g. handwashing, compelled to perform them CBT with exposure and response prevention (ERP SSRIs if moderate-severe social input

Answer 22

After significant trauma; >3 days, but <4 weeks (PTSD if longer) Dissociative sx - emotionally numb, physical dissociation, amnesia of event details Vivid recollection Avoidance of stimuli State of hyperarousal

Answer 23

After significant trauma; >4 weeks (Acute stress reaction if shorter) Dissociative sx - emotionally numb, physical dissociation, amnesia of event details Vivid recollection Avoidance of stimuli State of hyperarousal

Answer 24

Eye movement desensitisation and reprocessing CBT SSRIs, venlafaxine, antipsychotics

Answer 25

if more than 1 year (5 if child) CBT, guided mourning

Answer 26

"S for symptom concern" For 2 years Multiple, recurrent, frequently changing sx e.g. GI, sexual, urinary, neuro With no belief it is psychological Seeking sx relief

Answer 27

Similar to Somatization disorder (Briquet's), but severe and persistent pain is the overriding presenting complaint

Answer 28

C (chondrial) cancer Irrational fear for own health; asks for many many investigations despite normal results

Answer 29

Psychotherapy Regular arranged GP appts to support pt.

Answer 30

Faking sx to gain access to "sick role"

Answer 31

Faking sx in a child to gain sick role

Answer 32

Faking sx for own gain e.g. avoid prosecution, obtaining drugs

Answer 33

self induced Low body weight (15% below normal), overvalued ideas about body image, endocrine disturbance (amenorrhea, impotency) Lanugo (fine hair over body), bradycardia, constipation, cardiomyopathy, oesophageal tears, scarring over knuckles, dental defects Deranged LFTs, increased urea cortisol GH, decreased T3, hypoglycaemia, decreased FSH/LH, normocytic anaemia Weekly visits to boost weight Hospitalisation if BMI <13.5, rapid wt loss, syncope, electrolytes; risk of refeeding syndrome (hypophosphatemia hallmark sign) CBT - 40 sessions Maudsley anorexia nervosa treatment for adults - 20 sessions

Answer 34

Hospitalisation if BMI <13.5, rapid wt loss, syncope, electrolytes; risk of refeeding syndrome (hypophosphatemia hallmark sign)

Answer 35

Binge eating, strong food cravings -> methods to counteract wt gain; vomiting, diuretics, excessive exercise, fasting normal or increased weight CBT-ED self help guidance SSRIs

Answer 36

"SUSPECT" Sensitive Unforgiving Suspicious Possessive & jealous Excessive self importance Conspiracy theories Tenacious sense of rights

Answer 37

"ALL ALONE" Anhedonia Limited emotion Little sexual interest Apparent indifference to praise Lacks relationships One player activities Normal social conventions ignored Excessive fantasy world

Answer 38

"UFO AIDER" Unusual perceptions Friendless Odd beliefs Affect is inappropriate Ideas of reference Doubtful Eccentric Reluctant to socialise

Answer 39

AEIOU Affective instability Explosive behaviours Impulsive Outbursts of anger Unable to plan ahead Borderline type: SCARS Self image unclear Chronic emptiness Abandonment fears Relationships unstable Self harm and suicidal Impulsive type: LOSE IT Lack control Outbursts Sensitivity to criticism Emotional instability Inability to plan Thoughtless of consequences

Answer 40

"FIGHTS" Forms but cannot maintain relationships Irresponsible Guiltless Heartless Temper Someone else's fault

Answer 41

"ACTORS" Attention seeking Concerned with appearance Theatrical Open to suggestion Racy Shallow affect

Answer 42

A FAME GAME Admiration required Fantasises about success Arrogant Manipulative Envious Grandiose sense of importance Associates with special people Me first attitude Empathy lacking

Answer 43

DETAILED Doubtful Excessive detail taken Tasks not completed Adheres to rules Inflexible Likes own way Excludes pleasure Dominated by intrusive thoughts

Answer 44

AFRAID Avoids social contact Fears criticism Restricted lifestyle Apprehensive Inferiority Doesnt get involved without acceptance

Answer 45

SUFFER Subordinate Undemanding Feels helpless when alone Fears abandonment Encourages others to make decisions Reassurance needed

Answer 46

Psychotherapy - Dialectal behavioural therapy

Answer 47

3< of the following: Strong desire, difficulty controlling substance use, withdrawal sx, tolerance, neglect of other interest

Answer 48

Narrowing of repertoire, prioritising drinking, tolerance, withdrawal, awareness of compulsions to drink, rapid dependence after abstinence

Answer 49

4-12 hours after stopping tremors, sweats, GI upset, autonomic hyperactivity, mood disturbance "Complicated" if perceptual disturbances

Answer 50

respiratory depression, aspiration, hypoglycaemia, hypothermia, trauma

Answer 51

6-48 hours after alcohol cessation GTC treat as per normal seizures - 4mg iv lorazepam

Answer 52

1-7 days after cessation alcohol - most common 48 hours Delirium with cognitive impairment vivid hallucinations Paranoid delusions Extreme autonomic hyperarousal: HTN, fever, tachycardia, sweats, marked tremor High dose benzodiazepines (+ antipsychotics if severe) High dose IV thiamine (pabrinex) Fluids and electrolytes

Answer 53

None if low risk If higher risk, titrated Chlordiazepoxide over 24 hours (as per CIWA score) Thiamine supplementation

Answer 54

Chronic vitamin B1 (thiamine) deficiency: Delirium Ocular palsy: nystagmus, CNVI palsy or gaze palsy Ataxia High dose benzodiazepines (+ antipsychotics if severe) Very high dose IV thiamine (2 pairs pabrinex TDS) Fluids and electrolytes If untreated => Korsakoff's psychosis

Answer 55

Untreated B1 deficiency and Wernicke's encephalopathy Anterograde amnesia Frontal lobe dysfunction Psychosis

Answer 56

cortical atrophy and ventricular enlargement

Answer 57

Disulfiram: aldehyde dehydrogenase blocker Unpleasant after effect after alcohol consumption Acamprosate: Enhances GABA to decrease cravings Naltrexone: opioidR blocker Reduces cravings and nice effects. CBT, motivational interviewing, social support

Answer 58

Effects: Euphoria, intense relaxation, miosis, drowsiness, nausea, itching Withdrawal: Not life threatening; insomnia, tachycardia, muscle pains (helped with lofexadine), dilated pupils, sweating, GI Overdose: Respiratory depression, bradycardia, coma Pinpoint pupils unreactive Management: i.v. Naloxone Substitution therapy for controlled withdrawal: Methadone - long acting agonist Buprenorphine - long acting partial agonist Naltrexone - blocks future opioid use euphoria

Answer 59

Overdose management: i.v. Naloxone Substitution therapy for controlled withdrawal: Methadone - long acting agonist Buprenorphine - long acting partial agonist Naltrexone - blocks future opioid use euphoria

Answer 60

Effects: Increased energy, alertness, mydriasis, increased impulsivity, decreased need for sleep Anxiety, htn, arrhythmias, cocaine bugs (hallucination) Overdose: Tremor, confusion, seizures, panic and agitation Tachycardia, HTN, hyperthermic

Answer 61

Euphoria, sociability, intimacy Increased BP, HR, Temp jaw clenching, appetite

Answer 62

Euphoria, detachment, synaesthesia behavioural toxicity

Answer 63

Effects: Anxiolytic Withdrawal: Anxiety, tremor, seizures Overdose: Respiratory depression, coma, death

Answer 64

Euphoria, disinhibition, visual illusions Headache, MI Cognition, renal, hepatic injury long term

Answer 65

Impaired attention and hyperactivity for 6 months in multiple environments Parental, CBT, Social skills Methylphenidate, Atomoxetine

Answer 66

Impaired social interaction Impaired communication Restricted, stereotyped interests Aggressiveness, impulsivity, self injurious 75% intellectual disability, 25% epilepsy Social skills and support plans Asperger's is the same but language and cognitive development is normal; monotonous but good quality speech

Answer 67

6 months, persistent and repetitive: Aggression, destruction, deceitfulness, violation of age related social expectations Psychosocial Risperidone if very severe

Answer 68

Mild: IQ 50-69 Deficits may be subtle, children require increased academic support but are generally able to live independently in adulthood. Moderate: IQ 35-49 Limited language / comprehension skills, rarely able to live independently in adulthood. Severe: IQ 20-34 Marked motor impairment, may learn to speak only at school age, capable of elementary self-care only. Profound IQ <20 Severe motor and communication impairment, lack of continence, and need for constant care.

Answer 69

History of current mental disorder, FH of bipolar, schizoaffective

Answer 70

Normal sense of euphoria in the first 48 hours after giving birth

Answer 71

Day 3-10 post-partum 48 hours of emotional lability, tearfulness, mild anxiety, irritability

Answer 72

2-4 weeks postpartum most common, then after 3 months Depressive sx; parental ability may be affected, reduced affection for baby, intrusive thoughts Mild-moderate - CBT, mother-baby groups, counselling, visits Severe - SSRIs; paroxetine, sertraline Admission if suicidal/infanticidal

Answer 73

Behavioural disturbances: insomnia, restlessness, perplexity Hallucinations, delusions, fear Mother-baby units atypical antipsychotics for 12 months after remission

Answer 74

Acute confusion, rapid onset, fluctuating intensity: Disturbances of consciousness, worsening confusion, fluctuating levels of new sx, evidence of underlying cause Hypoactive - apathy, withdrawal, lethargy Hyperactive - increased motor activity, agitation, hallucinations Mixed - ^^^

Answer 75

AMT then CAM if abnormal: Assess acute changes, inattention, disorganised thinking, altered consciousness.

Answer 76

GCS, infection screen, bloods, hydration and nutrition status, bladder scan, bowels checked, neurology, cognition, CXR, urine MC+S

Answer 77

symptoms: 6-12 hours seizures: 36 hours delirium tremens: 72 hours

Answer 78

After a change in dose, lithium levels should be taken a week later and weekly until the levels are stable

Answer 79

White blood cell monitoring weekly for 18 weeks, then fortnightly for up to one year, and then monthly. Blood lipids and weight should be measured at baseline, every 3 months for the first year, then yearly. Fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months.

Answer 80

After a change in dose, lithium levels should be taken a week later and weekly until the levels are stable Then, 3 monthly plasma levels, TFTs every 6 months,