Management

Question 1

Different steps of Management

Answer 1

Safety
Clarifying Dx
Biological
Psychological
Spiritual/Cultural

Question 2

Safety things to identify

Answer 2

Risk to self (suicide, self harm, financial, driving, sexual disinhibiton)
Risk to others (violence)

So MHA or not?
IP or OP treatment?

Question 3

Clarifying DX

Answer 3

Collateral history
Note review if seen by services before

W/ Biological, Investigations!
Admission physical (top to toe), Bloods (FBC, LFT’s, TFT’s, U+E’s, STI Screen)
ECG
Urine Toxicology

Question 4

Biological

Answer 4

Admission physical (top to toe), Bloods (FBC, LFT’s, TFT’s, U+E’s, STI Screen)
ECG
Urine Toxicology

Drugs: SSRI’s, SNRI’s, others, AP’s, Benzo’s etc

Question 5

Psychological

Answer 5

CBT, DBT, psychoeducation, AA, CADs

Question 6

CBT
used for?
What is it based on?
How is it cinducted?

Answer 6

Cognitive behavioural therapy
depression, phobia, GAD, OCD
Idea that thoughts, feelings/ emotions and behaviours with environment are connected (feelings thoughts behvaiour)
min 4-6 sessions (up to 18), patient and therapist interacting, asking about

Question 7

DBT

Answer 7

Dialectical behavioural therapy good for borderline
Aim of great therapeutic alliance but not dependance
4 parts
Individual therapy
Group Skills (mindfulness, discussing with others)
Phone consults- when at home when on the spot
Consultation teams-

Question 8

MHA

Answer 8

Section 8a (family member, nurse who recognises issue)
8b any docotr, must be assessed by DAO in 5 days
9 DAO assessment
10 psychiatrist assessment

Question 9

Depression therapy

Answer 9

CBT, IPT( do not know what this does)

Question 10

Schizophrenia

Answer 10

CT for persistent delusions, hallucinations + compliance use. Family therapy?

Question 11

Bipolar

Answer 11

None?

Question 12

GAD

Answer 12

CBT ( simialr efficacy to medication)

Question 13

Panic disorder

Answer 13

CBT (use medication also, superior to one alone)

Question 14

Agoraphobia/speciifc phobia

Answer 14

BT and CBT

Question 15

PTSD

Answer 15

tf-CBT and EMDR (eye movement desensitisation and reprocessing, visualise truamtic event + volunatry eye movements

Question 16

OCD

Answer 16

BT and CBT

Question 17

Bulimia nervosa/anorexia

Answer 17

CBT, family therapy + education around diet etc

Question 18

Specific Inv for mild/mod depression

Answer 18

Something to quantify - Edinburgh Depression Scale, PHQ-9

Fam hx of bipolar- be aware if starting SSRI

Question 19

SSRI’s what to warn

Answer 19

May see rebound anxiety/depression
must use for several weeks before notice effect
safe
GI upset/nausea, sexual dysfunction, (suicidal ideation)

Question 20

SSRI first line and dose

Answer 20

Sertraline 50mg od

Question 21

AP first line and dose

Answer 21

Olanzapine 10mg nocte

Quetiapine 200mg od

Question 22

Mood stabiliser first ling and dose

Answer 22

lithium 400mg nocte (depends on RF, TF, LFT)

Question 23

Benzo?

Answer 23

lol cbf, up to 8/10mg of lorazepam