Knowledge revision - Psych Flashcards
What are the key options for depression and anxiety?
Medication
Lifestyle modifications
Counselling/CBT
What are the first-line medications for depression and anxiety?
SSRIs
Which SSRI is licensed in young people?
Fluoxetine
What is the major side effect of SSRIs for patients to be aware of?
Potential increase in suicidal ideation in first 4 weeks
Give differential diagnoses for psychosis.
Medication or drug-induced
Schizophrenia
Bipolar (mania)
Psychotic depression
Delirium
What are the first-rank symptoms of schizophrenia?
Auditory hallucinations
Delusions (usually persecutory)
Thought insertion, withdrawal, broadcasting
Made actions/feelings
Somatic hallucinations
Which medication class are typically used in the management of schizophrenia?
Anti-psychotics
Give examples of typical antipsychotics.
Haloperidol, chlorpromazine
Give examples of atypical antipsychotics.
Olanzapine, Quetiapine, Risperidone, clozapine
What is the major side effect to be aware of of typical antipsychotics?
Parkinsonism
What is the major side effect to be aware of for atypical antipsychotics?
Metabolic syndrome
What is the major risk with clozapine?
Agranulocytosis
Under which circumstances can clozapine be initiated?
psychosis/schizophrenia resistant to at least 2 antipsychotics from different classes
How is mania typically managed?
Anti-psychotics
How is bipolar depression typically managed?
Antipsychotics +/- antidepressants
How is bipolar managed long-term?
Mood stabilisers eg. lithium, lamotrigine etc
How long after a dose of lithium should levels be measured?
12 hours
Which symptoms may suggest lithium toxicity?
Confusion
Drowsiness
Visual problems
Excessive thirst/urination
What are the main headings for mental state examination?
Appearance
Behaviour
Speech
Mood
Affect
Thought
Perception
Cognition
Insight
Which areas should be considered under ‘thought’ in a MSE?
Form, content, possession
Moving quickly from one topic to another is called…
Flight of ideas
Give potential causes of memory loss.
o Dementia – Alzheimer’s, Parkinsons, vascular, LBD
o Delirium
o Head injury
o Encephalitis
o Thyroid/kidney/liver disease
o B12 deficiency
How would you investigate memory loss?
o Cognitive assessment eg. MMSE, MoCA
o Bloods inc Folate/B12, TFTs, LFTs etc
o CT head if ? bleed
o MRI brain may be useful if suspecting dementia
What is delirium?
Acute & fluctuating disturbance in consciousness, attention & cognition
Give causes of delirium
o Stroke, tumour, subdural haematoma
o Drugs
o Infection – CNS, UTI, sepsis
o Pain
o Electrolyte imbalance
o Change in environment, acute stress etc
What should you look for when examining someone with delirium?
Signs of infection & neuro exam
Which screening test is used for delirium?
4AT
What is included in 4AT?
Attentiveness
AMT4 – age, DOB, place, current year
Attention – months of the year backwards
Acute change or fluctuating?
How should delirium be managed?
o Treating any underlying cause
o Remove any aggravating drugs
o Environmental – orientating themselves – clock, date, room, people, hearing aids/glasses
Which drugs may aggravate delirium?
Opioids, anticholinergics, steroids, TCAs, zopiclone, BZDs
What can be given for agitation in deliriun?
0.5-1mg Haloperidol or lorazepam if very agitated/danger to self or others
What are the conditions for detention under the MH Act?
o Has a mental disorder
o Ability to make decisions is sig impaired due to mental disorder
o Detention in the patient’s best interests
o Sig risk to self or others if not detained
o Treatment is available & necessary
Which areas are important in assessing a person’s capacity?
ability to understand, weigh and retain information/decisions
