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IPE Flashcards

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1
Q

What are the different ward obs

A

1a - in arms reach
1b - eye sight
2- intermittent obs (15minutes)
3- general obs

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2
Q

What are the principles of mental capacity act?

A

Assume all have capacity
Try to make all practical steps to allow patients to show they have capacity
People can make unwise descisions
If lack capacity decision must be made in their best interest
Decision made must be the least restrictive of a person’s rights and freedom of action

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3
Q

What questionnaires can be used to diagnose PD?

A

PDQ4 and SCID II

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4
Q

What are the features of someone with a paranoid personality disorder?

A

Suscipious of others around them
Bear grudges
Can’t trust those around them
Read threats and danger in normal situations

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5
Q

What are the features of someone with a schizoid PD?

A

Prefers not to interact
Emotionally cold and distant
Rarely have meaningful relationships- not interested in getting to know others

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6
Q

What are the features of someone with a schizotypical personality disorder?

A 
Specialist powers
Eccentric behaviour
Tends to go off on tangents 
Obsessions without resistance
Desire to have relationships
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7
Q

What are the features of a antisocial PD?

A

impulse and reckless behaviour without thinking of consequences
Needs infront of others
no guilt on mistreating others
Struggle to keep down a job
May be charming and manipulative at first site

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8
Q

What are the features of a borderline PD?

A 
Lack a sense of self and unsure about purpose
May have psychotic episodes
may act impulsively and regret later 
unstable moods- stable instability
Suicide attempts common
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9
Q

What are the features of a histrionic PD?

A 
likes to be the center of attention
excessive emotion
easily influenced by others 
Egocentric- cares little about others
Provokative dress
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10
Q

What are the features of a narcissistic PD?

A

Believes they are more special than others
Fragile self esteem and need praise from others
put their needs ahead of others
look down on people below and despise those above them

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11
Q

What are the features of avoidant PD?

A

Shy and socially inhibited
sensitive to rejection
desire close relationships- lack ability to form them
unable to work as dont like to be around others

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12
Q

What are the features of dependent PD?

A

difficulty making decisions without guidance
lack of confidence stops them doing things
urgently need relationships
unrealistic and constant fear that they will be abandoned

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13
Q

What are the features of an anakastic PD?

A

Need to keep everything under control
set unrealistically high expectations of self
Very rigid rules
Prefer to work on their own- egosyntonic - happy the way they are

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14
Q

How does atypical depression present?

A

Variable mood
increased appetite and increased sleeping
extreme fatigue
heaviness in limbs and pronounced anxiety

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15
Q

What are some secondary causes of depression and low mood?

A

Physical - anaemia, malignancy, parkinson, MS, hypothyroidism
Psychiatiric - dementia, alcohol and schizophrenia
Drugs - digoxin, B blocker, anti-epleptics and corticosteriods

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16
Q

What are the diagnostic questionnaires for depression?

A

PHQ9 and HADS

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17
Q

What are the differentials for bipolar?

A 
Normal fluctation in mood
Adjustment disorder
PTSD
dementia
underlying physical disease
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18
Q

How is acute mania managed?

A

Antipsychotics and if 2 is not sufficient to control add lithium or sodium valproate
Benzos short term may be needed

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19
Q

How often must the symptoms of OCD be present to make diagnosis?

A

most days for 2 weeks

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20
Q

What is an acute stress reaction?

A

Stressor and onset of symptoms have a clear temporal sequence - resolves in days

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21
Q

What are the organic causes of psychosis?

A 
Drug induced
Complex partial epilepsy
Delirium
Dementia 
SLE
B12 deficiency
SOL
Ca levels
22
Q

What are the first rank symptoms of schziophrenia?

A

3 rd person hallucinations
Thought blocking, withdrawal and insertion
Somatic hallucinations
Passive phenomenon - feeling that external forces are controlling their actions or feeling body sensations
Delusional perceptions

23
Q

What investigations should be done in a patient presenting with schizophrenia like symptoms?

A 
FBC - anaemia or infection
urine - ilict drugs or infection
TFT
Glucose and HbA1c- effects of antipsychotics
Serum Ca
B12 and folate
Cholesterol - metabolic effects of antipsychotics 
ECG
Consider EEG and  CT
24
Q

Outline the treatment of schizophrenia

A

Risk assessment
Oral antipsychotics and CBT
patients should be monitored for at least 1 year with treatment plan and clear crisis plan

25
Q

What gives a poor prognosis of schizophrenia?

A 
Strong FH
gradual onset
decreased IQ
premorbid history of social withdrawal
no obvious precipitant
26
Q

What is hebephrenic schizophrenia?

A

Appears at the time of puberty
Disorganised behaviour and speech
Less likely to hallucinate or have delusions
Emotional response is often silly and inappropriate - acting silly or childish, inappropriate laughter or facial responses

27
Q

What is the management of NMS?

A 
Stop medication
treat hyperthermia aggressively - cooling packs 
airway and breathing support
Benzos
IV fluid and dialysis 
Dantrolene 
Bromocriptiene - dopamine agonist
28
Q

What are the complications of AN?

A

GI - gastroparesis, colonic dysfunction, volvulus and abormal LFTs
CV- bradycardia, arrhthymias, hypotension and reduced cardiac mass
Electrolyes - all low
Nutritional deficiencies - decreased B1, zinc, B12, folate and iron
Endocrine - low sex hormones leading to osteoporosis

29
Q

How often must binge episodes be for a diagnosis of BN?

A

2 a week for 3 months of 1 a week for 6 months

30
Q

What is the treatment for BN?

A

CBT and interpersonal psychotherapy
Self help guides
Treat consequences and underlying MH conditions

31
Q

What are echolalia, palilalia and logoclonia?

A

Echolalia - repeition of a word or phrase
Palilalia - repeat one word used by others
Logoclonia - repeat first syallable of a word

32
Q

Define dementia

A

6 month decline in memory,cognition, personality, behaviour and executivve functioning with preserved awareness of enviroment.

33
Q

ICD 10 for dementia

A

evidence of decline in memory and decline in other cognitive abilities
Preserved awareness of enviroment
decline in emotional control or motivation or change in social behaviour
must have been present for 6/12

34
Q

What may also be present in patients with vascular dementia as well as memory changes?

A

UMNL signs

35
Q

What is the pathophysiology behind lewy body dementia?

A

Lewy bodies in the neurones - especially in the hippocampus, cerebrum and substantia nigra

36
Q

What is important about the diagnosis of dementia in terms of ADLs?

A

DVLA must be informed

37
Q

What should be done in a patient with suspected dementia?

A 
Blood tests - anaemia and infection,
Hypoglycaemia
Hypercalcaemia
Hypothyroidism
Urine dip - UTI
CXR 
Sphyllis - reversible dementia
Imaging of the brain
ECG - any ischaemic events and ACE-I cant be prescribed in bradycardia
EEG - fronto temporal of CJD suspected
38
Q

What type of hallucinations are common in deliruim?

A

visual

39
Q

What the IQs for mild, moderate and severe LDs?

A

Mild 50-69
Moderate 50-35
Severe <34

40
Q

What is the definition of a LD?

A

Triad of low intellectual performance, onset at birth and wide range of functional impairment
Diagnosed by 18y/o
IQ <70

41
Q

What is the ICD 10 for ASD?

A

Presence of abnormal development before the age of 3
Qualitative abnormalities in social interaction
Qualitative abnormalities in communication
Restrictive, repetitive and stereotyped pattern of behaviours, interest and activities
Clinical picture not attributable to other varieties of pervasive developmental disorders

42
Q

What is the ICD 10 for ADHD

A

Demonstrate abnormalities of attention, activity and impulsivitiy at home
Demonstrate abnormalities of attention, activity and impulsivitiy at school
Directly observed abnormalities of attention or activity
Doesnt meet the diagnosis of pervasive developmental disorder, Mania, depressive or anxiety disorder
Onset before 7
Duration of at least 6 months
IQ >50

43
Q

What are the features of a conduct disorder?

A

Exhibit interaction and behaviour outside their age
Often violate the rights of others around them
Often ignore and disobey rules- vindictive and spiteful

44
Q

What is the go to treatment for mental health disorders?

A

CBT and screen for other mental health disorders

45
Q

What are the signs and symptoms of opiate withdrawal?

A 
Lacrimation 
Yawning 
tremor
dilated pupils
cold clammy skin
abdo cramps
increased BP and HR
46
Q

What can be given to help alcoholic detox>

A

Acamprosate- blocks GABA and reduced NMDA excitation- decrease craving
Naltrexone - competative antagonist at opioid receptor-decreases the pleasure from drinking
Disulfaram- acetaldehyde dehydrogenase inhibitor so hangover while drinking

47
Q

What technique is useful in treating addiction to substances?

A

Motivational interviewing

48
Q

What are the EPSEs of antipsychotics?

A

Acute dystonia- eg oculogyric crisis
Parkinsonism
Tardive dyskinesia -late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw
Akathisia- severe restlessness
Due to blocking of dopamine in the basal ganglia at the nigrostrial pathway

49
Q

What type of auditory hallucinations are the most dangerous?

A

Second person - may be telling patient to do things

In risk assessment - assess what they would do if they couldnt do what the patient was asking them to

50
Q

What is the SSRI of choice in children and adolescence?

A

Fluoxetine

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