Joe Vincent Passmedicine Psych Flashcards
You are on a GP placement and a 40-year-old women presents with a history of being consistently tired. You are concerned that they might be depressed.
What tool wold you use to assess their depression?
What tool wold you use for suicide risk?
PHQ-9
SADPERSONs
A 54-year-old man presents with a variety of physical symptoms that have been present for the past 9 years. Numerous investigations and review by a variety of specialties have indicated no organic basis for his symptoms. This is an example of? Difference between this and hypochondrial disorder?
Somatisation disorder
he patient is concerned about persistent, unexplained symptoms rather than an underlying diagnosis such as cancer (hypochondrial disorder). Munchausen’s syndrome describes the intentional production of symptoms, for example self poisoning
A 29-year-old fireman presents following a recent traumatic incident where a child died in a house fire. He describes recurrent nightmares and flashbacks which have been present for the past 3 months. A diagnosis of post-traumatic stress disorder is suspected. What is the most appropriate first-line treatment?
When would watchful waiting be the appropriate choice?
Drug treatments are not first line, but when they are used which drugs would you use?
CBT or eye movement desensitisation reprocessing therapy
Mild sx lasting less than 4 weeks
Paroxetine or mirtzapaine
Key facts about conversion disorder?
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
Key facts about Dissociative disorder ?
D issociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder
What drug can be used to manage troublesome sleep paralysis?
Clonazepam
Way to remember hypnogogic and hypnopompic?
Gogol - of to the land of gog (wake - sleep)
Pomp (sleep to wake)
Alcohol withdrawal features? Peak seizure / delirium Tremens time? Management 1st line? Others?
6-12 hours - tremor, sweating, tachycardia, anxiety
Peak seizure incidence at 36 hours
Peak delirium Tremens at 48-72 hours
-coarse tremor, delusions, hallucinations, fever, tachycardia
first-line: benzodiazepines e.g. chlordiazepoxide. Typically given as part of a reducing dose protocol
carbamazepine also effective in treatment of alcohol withdrawal
Panic disorder 1st line? If no response in 12 weeks / CI what else can be offered?
SSRI
TCA - Imipramine / clomipramine
Stepwise approach from mx of GAD? First line drug? What consideration with this drug?
step 1: education about GAD + active monitoring
step 2: low intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
step 3: high intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment. See drug treatment below for more information
step 4: highly specialist input e.g. Multi agency teams
Sertraline
-warn patient risk of suicidal thoughts and weekly follow up for 1st month
Egs of psychotic sx which would indicate mania over hypomania?
Delusions of grandeur
Auditory hallucinations
Most potent side effects of mirtazepine?
Increased appetite -> weight gain
Drowsiness (so much it is used off formulary as a sleep aid)
Best SSRI post MI?
Sertraline
Best antidepressant when indicated in children / adolescents ?
Fluoxetine
SSRI and NSAID - what do you need to do?
Prescribe a PPI
