General understanding Flashcards
what is the difference between loosening of associations and flight of ideas?
loosening of associations/knights move thinking;
- illogical, ideas not connected
- eg; “what meds are you on?” - “afghanistan robbery”
flight of ideas;
- answer picks up on something you said, so relates to
question but due to speed of thinking say a lot
- “the pill is red, apple is red, apple is fruit…”
- ideas connected
- bring it back to the point eventually
if a patient is demonstrating delusions but you can’t quite name which kind of delusion, what do you say?
delusions of broad themes
when taking hx from patients, if you think they are presenting with a delusion, how do you establish this?
you must challenge the delusions gently! and provide alternative explanations!
this is vital to establish whether they still firmly believe it despite evidence to the contrary
what is the significance of expressed emotion in the family/carers of people with schizophrenia?
expressed emotion (excessive hostility, criticism or over-involvement)
can increase risk of relapse.
education is important to reduce expressed emotion in family/carers
which ALT AST ratio suggests alcoholic liver disease?
ratio greater than 2
which transpeptidases implicated in alcohol abuse mainly?
GGT, ALP
also;
alt, ast
what is The threshold for the CAGE suggesting potential problems?
a score of 2 out of 4
what are some symptoms of acute intoxication with alcohol use?
slurred speech, dizziness, clumsiness,
unsteadiness, blackouts, collapse and somnolence
what could be the possible cause of abdominal pain in an heavy alcohol user?
Peptic ulceration and pancreatitis can lead to
abdominal pain.
in a patient presenting with paracetamol overdose, what are some key questions to ask and why?
- What is the time of the ingestion?
- What are the blood tests showing?
within 1 hour -> treat with activated charcoal
after 1 hour -> n-acetyl cysteine (can measure paracetamol levels in bloods after 4 hours and they show v high paracetamol levels)
what are the NICE guideelines for de-escalation in cases of violent patients?
NICE guidance suggests three steps;
1• Risk assessment 2• De-escalation 3• Intervention - Physical intervention or ‘restraint’ - Seclusion - Rapid tranquilisation
difference between delirium and psychosis?
Delirium; there is a fluctuation in consciousness
this is not present in psychosis
Delirium: visual hallucinations more common. EEG abnormal. Involuntary movement often present.
(Usually auditory hallucinations, in psychosis - EEG normal
how would you diffrentiate between a delusional belief and a religious/political belief?
delusional beliefs;
- often self-centred ; about themselves
- not a shared belief generally
what are mood congruent symptoms?
Major depressive disorder with mood-congruent psychotic features means that the content of the hallucinations and delusions is consistent with typical depressive themes. These may include feelings of personal inadequacy, guilt, or worthlessness
how can you tell the difference between a person with repeated serious suicidal intent vs one with emotionally unstable personality disorder?
Suicidality:
will have plans and intent to end life
EUPD:
self harm and suicide threats following negative/stressful events eg relationship trouble. afterward no plans necessarily to end life.
a patient with long hx of schizophrenia has repeated tremor in his hands and blood tests reveal high prolactin.
what drug is he likely to be on?
signs of EPSE - tremor; Parkinsonism
so you know they must be on a typical antipsychotic due to epse - typicals can raise prolactin too
BUT:
Respiridone is the one ATYPICAL that is usually associated with very high prolactin AND causes a movement disorder like the typical antipsychotics.
what is an informal patient in psychiatry?
A person is admitted informally when they want to receive treatment in hospital and agree to their admission.
what is a formal patient in psychiatry?
A person becomes a formal patient when they are admitted to hospital under a section of the Mental Health Act. This compels them to remain in hospital (even if they don’t want to)
how to manage repeat suicide attempts in an emotionally unstable personality disorder patient currently on the Inpatient wards?
treat depression aggressively - eg maximum dose of antidepressant if their on it - sertraline
discharge under the care of the crisis resolution/HTT.
resolve housing and employment issues in the community
how would you calculate pack years of smoking for 5 cigarettes a day?
1 pack (20 cigs) for 1 year is 1 pack year
1 pack for 10 years is 10 pack years.
thus 5 cigarettes a day for 10 years is 1/4 of a normal pack intake for 10 years hence its 2.5 pack years.
when liason psych see a patient in A&E or wards etc, what are their 2 options next?
- refer for inpatient psych care
2. discharge under care of GP with or without meds.
what kind of patients do liason psych see on wards?
dementia, alzheimers, delirium
when a patient is being sectioned, what is golden rule for treatment?
treat in the least restrictive way
somebody undergoing prolonged grief reaction requires which kind of treatment?
bereavement councilling in form of person centred counselling
what is ‘transference’ in transference based therapy?
Transference is the theoretical process by which the patient transfers feelings or attitudes experienced in an earlier significant relationship onto the therapist
the presence of clonus can help distinguish which conditions?
Clonus - serotonin syndrome
lead pipe rigidity - NMS
