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MRCPsych - CASC > General Adult > Flashcards

General Adult Flashcards

1
Q

Genetic risk of schizophrenia

A 
Population risk - 1%
Grandchildren - 5%
Half-sibling - 6%
Full sibling - 9%
Child - 13%
Fraternal twin - 17%
Child (dual mating) - 46%
Identical twin - 48%
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2
Q

Risk of pueperal psychosis

A

Baseline risk - 1-2/1000
BPAD - 50%
Subsequent pregnancies 50-80%

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3
Q

OCD (history)

A
  • HPC (onset and duration)
  • Elicit core Sx (origin, nature, obsessions, compulsions)
  • Impact on functioning
  • Risk assessment (self, others, children)
  • Comorbidity (mood, enjoyment, sleep, appetite, hallucinations, delusions, passivity)
  • Substance use
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4
Q

Psychosis (MSE)

A
  • Core delusional belief (evidence, challenge)
  • Other delusions (persecution, grandiose, reference)
  • Hallucinations (auditory and other modalities)
  • Thought interference
  • Passivity experiences
  • Impact on mood
  • Substances
  • Risk
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5
Q

Questions about auditory hallucinations

A
  • Do you hear sounds or voices that others cannot?
  • How many voices?
  • Are they as clear as me speaking to you now?
  • What do they say?
  • Do they speak to you or about you or both?
  • Do they give you instructions or commands?
  • Do they comment on your actions?
  • How do you feel about them?
  • Could there be any alternative explanation?
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6
Q

Questions about non-auditory hallucinations

A
  • Has there been anything wrong with your sense of smell recently?
  • Have you noticed that food or drink tastes differently to normal? Strange taste in your mouth at other times?
  • Have you had any strange feelings in your body?
  • Have you been able to see things that others cannot? What kinds of things do you see?
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7
Q

Questions about thought interference

A
  • Do you feel that somebody is interfering with your thoughts? Who?
  • Do you ever feel that you have thoughts in your head that are not your own? Where do you think these come from?
  • Do you ever feel that other people can know what you are thinking?
  • Do you ever feel as though thoughts are being removed from your head?
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8
Q

Mania (history)

A
  • HPC (onset, duration)
  • Core mania symptoms (elation, irritability, energy, sleep, appetite, racing thoughts)
  • Grandiose delusions
  • Hallucinations (all modalities)
  • Thought interference and passivity
  • Risk (Police, spending, substances, promiscuity, self, others)
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9
Q

Delirium Tremens (history)

A
  • HPC (onset, duration)
  • Visual hallucinations (content, clarity, alternative explanation)
  • Hallucinations in other modalities
  • Orientation (time, place, person)
  • Alcohol history (quantity, duration, last drink, withdrawal, prev abstinence)
  • Risk (self, others)
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10
Q

Panic disorder (history)

A
  • HPC (onset, duration, first episode, frequency, triggers)
  • Physical symptoms
  • Psychological symptoms
  • DDx (generalised anxiety, social anxiety, phobia, OCD, PTSD, depression)
  • Impact on life and coping strategies
  • PPHx, FHx, brief PHx, PMHx, medications
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11
Q

Pass review (MSE)

A
  • Reason for admission and change since then
  • Auditory hallucinations
  • Delusional beliefs
  • Thought interference and passivity experiences
  • Mood (sleep, appetite, enjoyment)
  • Insight (understanding, medication)
  • Risk (plans at home, self, others, plan to return)
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12
Q

Psychotic depression (history)

A
  • HPC (onset, duration)
  • Nihilistic delusions (challenge these)
  • “How were things for you before you died”
  • Mood (sleep, appetite, enjoyment, energy, future)
  • Other psychotic symptoms
  • Risk
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13
Q

Adult ADHD (history)

A
  • Core features (hyperactivity, inattention, impulsiveness)
  • Impact on functioning (work, leisure, relationships, Police)
  • Childhood history (childhood symptoms, academic attainment, previous treatments, comorbid disorders)
  • Mood and substances
  • Risk (violence, impulsivity, driving)
  • Address other concerns
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14
Q

Panic disorder (explanation)

A
  • Clarify diagnosis and explain symptoms
  • Explain aetiology (stressors, FHx, personality)
  • Pharmalogical treatment
  • Psychological treatment (CBT)
  • Other concerns and leaflets
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15
Q

Hyperprolactinaemia (explanation)

A
  • Explain result and cause
  • Elicit symptoms (abnormal periods, breast changes, sexual dysfunction, fractures)
  • Screen for pituitory tumor (headaches, blurred vision, weakness, numbness)
  • Explain long-term side-effects (osteoporosis, risk of breast cancer)
  • Options for management (change antipsychotic, add aripiprazole)
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16
Q

Clozapine (explanation)

A
  • Clarify rationale and response rate (60%)
  • Explain side-effects
  • Explain monitoring (bloods - initially weekly, obs, ECG)
  • Missed doses (as soon as remembers, unless 4hours until next dose, retitrate if >48hrs)
  • Smoking and alcohol
  • Other concerns and leaflet
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17
Q

Lithium augmentation (explanation)

A
  • Clarify rationale
  • Explain side-effects
  • Baseline investigations (ECG, TFTs, U&Es, calcium)
  • Explain titration and monitoring
  • Signs of toxicity and risk of pregnancy
18
Q

ECT (explanation)

A
  • Clarify rationale
  • Explain procedure (baseline tests, anaesthetic)
  • Explain side-effects (headache, muscle pains, amnesia, confusion)
  • Questions and leaflet
19
Q

Schizophrenia (explanation)

A
  • Clarify diagnosis and common symptoms (voices, delusional beliefs, passivity exp, low mood, apathy and lack of interest)
  • Cause (genetic and environmental components)
  • Pharmacological treatment (type, side effects, 6m)
  • Alternative treatment (CBT, CPN)
  • Questions and leaflets
20
Q

Schizophrenia (Hx from CPN)

A
  • History of last admission (HPC, medications, MSE on discharge)
  • PPHx (previous admissions, MHA, past meds, risk)
  • Current MSE (mood, sleep, appetite, activities, psychosis)
  • Risk assessment (self, others, substances)
  • Current concerns (med compliance, support needs)
21
Q

Bipolar disorder (explanation)

A
  • Clarify diagnosis and common symptoms
  • Causes (genetic and environmental)
  • Explain medications (mood stabiliser, side-effects)
  • Alternative treatments (CPN support, CBT)
  • Concerns and leaflets
22
Q

Lithium in pregnancy (explanation)

A
  • Clarify concerns and understanding
  • Risks of lithium (heart defects - 0.1%, stillbirth, changes in Li level)
  • Option to stop meds gradually (risk of relapse)
  • Option to switch to antipsychotic
  • Option to continue (increased monitoring - pt and baby)
  • Breastfeeding
  • Concerns and leaflets
23
Q

Treatment-resistant Depression (treatment)

A
  • Explore reasons for poor response (PMHx, substances, compliance, other stressors)
  • Medication options (previous medications, reasons for stopping, increase dose, augmentation)
  • Combine meds and therapy
  • ECT
  • Questions and leaflets
24
Q

OCD (explain medications)

A
  • Clarify diagnosis and understanding of meds
  • SSRIs: mechanism, effectiveness (50-80%), side-effects, onset of action, duration (12m)
  • Address other concerns (addictive, withdrawal, missed doses)
  • Questions and leaflets
25
Q

PTSD (history)

A
  • Clarify HPC (onset, duration, trigger, others involved, survivor guilt, initial response)
  • Intrusive thoughts (flashbacks, nightmares)
  • Hyper-arousal (easily startled, irritability)
  • Avoidance
  • Emotional numbing (derealization, depersonalization , response to news, talking to others)
  • Comorbidity (mood, sleep, appetite, concentration, memory, enjoyment, psychosis substance use)
26
Q

Parasuicide assessment

A
  • HPC (act, intent, planning, trigger)
  • Circumstances (location, avoiding discovery, alcohol, final acts)
  • Events following (presentation to A&E, regret, ongoing intent)
  • Risk and protective factors (previous attempts, PPHx, PMHx, FHx, future planning)
  • Underlying mental illness (mood, sleep, appetite, enjoyment, concentration, hallucinations, delusions, substances)
27
Q

Grief reaction (history)

A
  • HPC (timing and circumstances of bereavement, relationship with deceased, funeral)
  • Comorbid depression (enjoyment, sleep, appetite, concentration, motivation)
  • Stages of grief (anger/blame, bargaining)
  • Atypical grief Sx (Avoiding dealing with possessions, hallucinations, guilt, suicidal thoughts)
28
Q

Body dysmorphic disorder (history)

A
  • HPC and explain psych input (onset, others’ comments, trigger, other body parts)
  • Challenging beliefs (inc. plans if refused surgery)
  • Impact on functioning (work, relationships, avoidance, use of mirrors, camoflage)
  • Risk (suicide, self-harm, self-surgery)
  • Mood, enjoyment, sleep, appetite, concentration, psychosis, FHx, PPHx
29
Q

Insomnia (history)

A
  • HPC (onset, duration, falling asleep, staying asleep)
  • PMHx (snoring, medications)
  • Sleep hygiene (shift work, bedtime routine, screen use, caffeine, daytime exercise, lighting)
  • Mental state (mood, appetite, enjoyment, concentration, stressors, psychosis, suicidality)
  • Personal and FHx (PPHx, FHx, substances, personality)
  • Management (sleep hygiene, relaxation, short course of meds)
  • Questions and concerns
30
Q

Capacity for medical procedure

A
  • Clarify medical diagnosis
  • MSE (PPHx, medications, mood, enjoyment, sleep, appetite, delusions, hallucinations, thought interference)
  • Understanding (cause, investigations, purpose)
  • Retain information (advantages and risks or procedure)
  • Weigh information (decision and reasoning)
  • Plan (discuss with medical team)
31
Q

Capacity for social care

A
  • MSE (PPHx, medications, mood, enjoyment, sleep, appetite, psychosis)
  • Understanding (diagnosis)
  • Retention (reasons for social care, risks of refusing)
  • Weigh information (decision and reasoning)
  • Summary and plan
32
Q

Neuroleptic malignant syndrome (explanation)

A
  • Explain rationale for treatment
  • Explain NMS and Sx (1/100, high temperature, unstable HR/BP, rigidity)
  • Management (transfer to acute, exclude other illness, stop antipsychotic)
  • Longer term management (record allergy, alternative antipsychotic)
  • Questions and concerns
33
Q

Borderline PD (history)

A
  • HPC (event, trigger, previous DSH, intent)
  • Relationships (arguments, coping with endings, previous relationships)
  • Identity disturbance (chronic emptiness, self-image, future planning)
  • Impulsivity
  • Affective instability
  • Pseudohallucinations
34
Q

Eating disorder (history)

A
  • Core AN Sx (avoidance, exercise, obsession with food, calorie-counting, body image, current and ideal weight)
  • Core bulimia Sx (binging, vomiting, laxatives)
  • Complications (periods, dizziness, weakness, hospital admission)
  • Aetiology (family relationships, FHx, reaction to illness, personality, childhood events)
  • Co-morbidities (mood, enjoyment, sleep, concentration, psychosis, risk)
35
Q

Anorexia (d/w student)

A
  • Clarify diagnosis and understanding
  • Explain symptoms (deliberate weight loss, weight <15% expected, distorted body image, physical complications)
  • Aetiology (FHx, childhood illness, personality traits, family dynamics, cultural norms)
  • Treatment (obs, bloods, admission if compromised, dietician, CBT/FBT)
  • Good prognostic factors (onset <15y/o, higher weight at Dx, early Rx <3m, recovery <2y, supportive family, motivation to change)
36
Q

Anorexia (explanation to relative)

A
  • Clarify understanding and concerns
  • Admission criteria (weight loss <1kg/wk, HR/BP abnormalities, hypothermia, electolyte imbalance, worsening co-morbid disorder, failure OP Rx)
  • Treatment options (weight restoration 0.5-1kg/wk, vitamin supplements, dietician, psychotherapy)
  • Questions
37
Q

Re-feeding syndrome (explanation to nurse)

A
  • Clarify concerns and history
  • Explain diagnosis (electrolyte imbalance - K/phos/Mg)
  • Signs and Sx (oedema, constipation, vomiting, diarrhoea, lethargy, arrhythmias, seizures)
  • Management (admission, correction of electrolytes, dietician)
38
Q

Postnatal depression or psychosis (history)

A
  • HPC
  • Risk factors (PPHx, FHx, pregnancy/delivery, relationship with partner, feeding, bonding, support)
  • Depressive Sx (variation in mood, enjoyment, energy, sleep, appetite, guilt)
  • Psychotic Sx (hallucinations, delusions, thought interference, passivity)
  • Risk (self, baby - inc neglect)
39
Q

Postnatal psychosis (explanation to relative)

A
  • Clarify diagnosis and Sx
  • Management (admission to MBU, medication, ECT)
  • Potential complications (risk, affect bond)
  • Questions and concerns
40
Q

Depot (explanation)

A
  • Clarify diagnosis and understanding
  • Explain rationale for depot (non-compliance, risk of relapse, injection - med released over weeks)
  • Administration (test dose, CPN, injection into deltoid/buttock)
  • Potential risks (EPSEs, pain, sedation)
  • Questions and leaflet
41
Q

MHA (explanation to relative)

A
  • Clarify diagnosis and understanding
  • Explain use of MHA (mental disorder, SIDMA, risk, admission is necessary, no alternative)
  • Explain type of section, duration, appeal, advocacy, named person etc

MRCPsych - CASC (10 decks)

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