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Year 4 Additional Notes > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Monoamine Oxidase Inhibitors

A

Tryanylcypromine, phenelzine, moclobemide (reversible), and rasagiline

Used for atypical depression

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2
Q

SE’s of MAO-I’s

A

HTN with tyramine containing foods eg. Cheese, marmite, pickled herring etc.

Anticholinergic

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3
Q

Lithium Monitoring

A

Check lithium levels 12 hour post dose
After starting, check weekly until stable (resume weekly if dose changes- measure after 1 week)
When stable, every 3 months
Thyroid and renal function checked the every 6 months
Check for pregnancy

NB- give patient an info book, alert card, and record book, check levels during acute illness (dehydration can increase level)

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4
Q

Clozapine use

A

Treatment resistant schizophrenia/ schizophrenia not managed on 2 or more antipsychotic drugs for at least 6-8 weeks

NB- If clozapine doses are missed for more than 48 hours the dose will need to be restarted again slowly

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5
Q

Clozapine SE’s

A

Agranulocytosis and neutropenia
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation
Weight gain and increased apetite
EPSE’s eg, Parkinsonism

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6
Q

Clozapine monitoring

A

Initial weekly FBC UE LFT for 18 weeks, then 2 weekly for a year, then monthly

Baseline ECG

lipids weight etc.

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7
Q

Antipsychotics monitoring

A

FBC UE LFT- start and annually

Lipids & weight- start, 3 months and annually

BM & prolactin- start, 6 months and annually (patients can present with polyuria and polydipsia, as antipsychotics can dysregulate glucose)

BP- start and during dose titration

ECG- baseline

CV risk- annually

NB- check not pregnant first

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8
Q

SSRI Interactions

A

NSAIDs- give PPI
Warfarin/ heparin- consider mirtazapine
Triptan and MAO-I: risk of serotonin syndrome
Tramadol- Serotonin syndrome

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9
Q

Citalopram and QT Interval

A

Citalopram and escitalopram are associated with dose-dependent QT interval prolongation

Shouldn’t be combined with drugs that do the same

NB- citalopram can also cause torsades de pointes

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10
Q

Drugs that lengthen the QT Interval

A

Amiodarone
Chlorpromazine
Citalopram/escitalopram
Clarithromycin/erythromycin
Flecanide
Haloperidol
Lithium
Methadone
Ondansetron
Risperidone
Venlafaxine

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11
Q

Atypical vs typical antipsychotics

A

Atypical are used now due to reduced incidence if EP SE’s eg. Parkinsonism, dyskinesia etc.

They still have SE’s though that the old typical drugs had eg. Galactorrhoea, weight gain, anti cholinergic etc.

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12
Q

Typical antipsychotics

A

Haloperidol
Chlopromazine

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13
Q

Atypical antipsychotics

A

Clozapine
Olanzapine
Aripiprazole
Risperidone
Quetiapine

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14
Q

Depression Investigations

A

FBC, UE, LFT, TFT, B12 and folate, HbA1c, cap glucose

NB- pregnancy test/ BMI/ lipids/ ECG (citalopram, escitalopram, amitriptyline) etc.

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15
Q

Depression Management

A

Refer to talking therapy (CBT), time off work, lifestyle changes

Moderate-severe: SSRI (if doesn’t work, add another one)

Psychiatry referral: SNRI (after 2 SSRI’s)

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16
Q

When to refer a depressed patient to secondary service (psychiatry)

A

Treatment has failed (non-response to two treatments)

Significant risk of suicide (harm to others/ severe self-neglect)

Psychotic symptoms

Bipolar affective disorder suspected

Child or adolescent presenting with major depression

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17
Q

Depression relapse prevention

A

First episode (without risk factors (see when to refer..): 6-9 months after remission (consider 1 year if risks)

High risk patients (>5 episodes or >2 in last few years): 2 years, consider life-long

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18
Q

Assess a patient’s cognition

A

AMT10

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19
Q

AMT10

A

Year
Time
Place
Age
DOB
20-1
WW1
Monarch
2 People
Address (1 min and 5 min)

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20
Q

Assess a delirious patient

A

4AT

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21
Q

4AT

A

Alertness- 4 if abnormal

AMT4 (Age, DOB, location, year)- 2 if 2 or more mistakes

Attention (Dec-Jan)- <7 (1), untestable (2)

Acute change/ fluctuating- 4

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22
Q

AMT 10 Outcome

A

> 6 normal
4-6 moderate impairment
<3 severe impairment

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23
Q

4AT Outcome

A

> 4 high chance of delirium

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24
Q

Delusions of grandeur

A

Special powers or importance

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25
Q

Ideas of reference

A

Normal events are of special importance to the patient (eg. News reporter)

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26
Q

Nihilistic delusions

A

They believe they are dead, decomposed, no organs, not human etc.

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27
Q

Paranoid delusions

A

Exaggerated distrust of others and suspicious of motives

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28
Q

Delusions of Erotomania

A

Other individuals are in love with them

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29
Q

Persecutory delusions

A

Patient insists they are being cheated on, contoured against, or harassed

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30
Q

Somatic delusions

A

Experience bodily functions or sensations when none are present

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31
Q

Loose associations (Knights move/ derailment)

A

Incoherent thinking, expressed as illogical, sudden, frequent changes of topic

NB- Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas

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32
Q

Word salad

A

Incoherent thinking expressed as a sequence of words without a logical connection

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33
Q

Tangential speech

A

Nonlinear thought expressed as a gradual deviation from a focused idea or question

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34
Q

Neologisms

A

Creation of new words

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35
Q

Echolalia

A

Repetition of others words or sentences

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36
Q

Flight of ideas

A

Quick succession of thoughts usually demonstrated in a continuous flow of rapid speech and abrupt changes in topic (although discernible links between ideas)

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37
Q

Clang association

A

Using rhyming words rather than words of meaning

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38
Q

Circumstantial speech

A

Non linear thought expressed as a long winded manner of explanation, with many deviations from central topic, before finally expressing the central idea

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39
Q

Thought blocking

A

Objective observation of an abrupt ending in a thought process, expressed as sudden interruption in speech

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40
Q

Pressured speech

A

Accelerated thoughts expressed as rapid, loud, voluminous speech (often in absence of social stimulation)

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41
Q

Schizophrenia

A

A severe psychiatric disorder characterised by chronic or recurrent psychosis

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42
Q

Psychosis

A

Distorted perception of reality characterised by delusions, hallucinations, and or disorganised thoughts

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43
Q

Non organic causes of psychosis

A

Schizophrenia
Mania
Depression
Medication induced
Substance induced
Poisoning eg. Heavy metals/ insecticides etc.

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44
Q

Medications that can induce psychosis

A

Opiates
Levodopa
Antiepileptics
Corticosteroids

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45
Q

Substances that can induce psychosis

A

Alcohol
Cannabis
Cocaine
LSD
Glue
Amphetamines

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46
Q

Investigations for first psychotic episode

A

Bedside- ECG, urine drug screen, urine pregnancy test
Bloods- FBC UE LFT TFT CRP B12 Folate lipids blood glucose (HIV syphilis
serology potentially)
Imaging- MRI head (exclude dementia/ brain injury or disease)

NB- if person is a known schizophrenia/ bipolar, may want to do plasma drug level monitoring (are they compliant with medication eg. lithium levels in a BP patient)

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47
Q

Initial Management of Schizophrenia/ Psychosis

A

Urgent input from CRT
Section under MHA
Admit to acute psychiatry ward
Oral typical antipsychotic (not clozapine or olanzapine- big SE profile so reserved for more resistant disease) eg. Quetiapine, aripriprazole or risperidone
If necessary IM, or may need IM benzo

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48
Q

Ongoing management of schizophrenia/ psychosis

A

CMHT, EIT, CRT (crisis) give them access to these services when they need it (tell to make family and friends aware), organise care co-ordinator
Family therapy
Treat co-morbid conditions
Regular health check up’s (lipids, BP, prolactin, etc.)
Advice on lifestyle factors (help with above risk factors)

NB- address co-morbidities (AP therapy is high risk of CV disease)

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49
Q

Psychosis in mood disorders

A

Mood congruent ie. they fit with the mood
Depression- nihilistic, guilty of a major crime etc.
Bipolar (manic episode)- they have special powers

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50
Q

Schizoaffective disorder

A

affective disorder (manic and depressive episodes), with psychosis

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51
Q

Antipsychotic use in the elderly

A

increased risk of VTE and stroke

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52
Q

Causes of neuroleptic malignant syndrome

A

Antipsychotics
Sudden stopping of PD drugs (either due to lack of absorption (illness/ vomiting/ obstruction (constipation)) or not giving them at the correct time

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53
Q

Management of acute bipolar

A

Anyone in community with mania- urgent referral to CMHT and CRT
Psychosocial intervention (family therapy)
Medications- lithium is mood stabiliser of choice (also anticonvulsants like valproate or AP like quetiapine). Stop antidepressant during acute mania
Give AP if presenting with acute mania/hypomania
Can also give an antidepressant once mood stabiliser commenced (SSRI eg. citalopram)

NB- address co-morbidities (AP therapy is high risk of CV disease)

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54
Q

Antidepressants and BAD

A

Antidepressants should not be used before initiating therapy with mood stabilizers because antidepressants can precipitate a manic episode

eg. Stop someone’s mirtazapine/citalopram first

NB- antidepressants can cause a manic shift in undiagnosed BAD patients (follow up in depression is essential- make sure they don’t develop mania)

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55
Q

Features of a manic episode (DIGFAST)

A

Distractibility
Irresponsibility (sex, money)
Grandiosity (psychotic symptoms)
Flight of ideas
Activity increase
Sleep deficit
Talkativeness

NB- lasts for at least a 7 days

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56
Q

Difference between mania and psychosis

A

Patients psychotic due to schizophrenia may not be as restless and hyper agitated as manic patients
Illness course is different- patient will be less sick less often in mania (BAD) and will have depressive episodes. Schizophrenic/psychotic patients are constantly I’ll until treated
In mania there is no thought interference, 3rd person auditory hallucinations, running commentary etc.)

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57
Q

Investigations for anxiety

A

ECG, physical exam, observations
Bloods- FBC UE LFT bone profile TFT magnesium
Imaging- if phaechromocytoma suspected (CT abdomen)

58
Q

Management of GAD

A

Lifestyle management- sleep hygiene, substance misuse education, diet, exercise
Psychological support- low intensity CBT (high intensity if moderate to severe)
Medical- if moderate to severe, try SSRI (sertraline), then SNRI, then pregabalin

59
Q

Panic disorder

A

Recurrent spontaneous and unexpected panic attacks that often occur without a known trigger

NB- GAD= constant, doesn’t dissipate

60
Q

Social anxiety disorder

A

Pronounced anxiety lasting longer than 6 months of social situations that might involve scrutiny by others

Anticipatory anxiety and drinking
Avoiding social situations

61
Q

OCD Symptoms

A

Intrusive thoughts (ego dystonic)
Compulsions and rituals that cause relief
Time consuming and distressing

62
Q

Investigations for a dementia screen

A

ECG, ACE-III, BM, top to toe physical exam, urinalysis (no infection)
Bloods- FBC, UE, LFT, TFT, CRP, ESR, B12, folate, bone profile
Imaging- MRI brain

63
Q

Factors favouring delirium over dementia

A

Impaired consciousness
Fluctuating symptoms (worse at night/periods of normality)
Abnormal perceptions (hallucinations)
Agitation, fear
Delusions

64
Q

Factors suggesting depression over dementia

A

Short history, rapid onset
Biological symptoms eg. Weight loss, sleep disturbance
Patient worried about their memory
Reluctant to take tests, disappointed with results
Global memory loss (dementia- characteristically recent memory loss)

65
Q

Medications to be careful with in PDD or DLB

A

Neuroleptics eg. Antipsychotics

Can cause akinetic crises/NMS (also caused by withdrawal of levodopa meds). Don’t always have to treat the psychosis and if we do, quetiapine is best tolerated

66
Q

What types of dementia can medications be used for?

A

AD and LBD

NB- there is no direct treatment for vascular dementia

67
Q

Levodopa

A

Be careful in DLB as this can exacerbate neuropsychiatric and cognitive symptoms

68
Q

Management of acute stress disorder

A

CBT
Benzo’s (short term)

69
Q

Management of an eating disorder

A

Treat co morbidities/nutritional supplementation
Eating disorder focused CBT

70
Q

Management of panic disorder

A

CBT
SSRI (if not working, then imipramine)

71
Q

Charles Bonnet syndrome

A

Persistent complex hallucinations occurring in clear consciousness (no neuropsychiatric disturbance). May have visual impairment

72
Q

Cotard syndrome

A

Patient believes that they (or a part of their body) is dead. May not eat or drink for this reason

73
Q

De Clerembaults syndrome

A

AKA erotomania (a form of delusional disorder)
Delusional belief that a person is in love with the patient

NB- delusional disorder can be a disorder on its own

74
Q

Delusional parasitosis

A

Delusional belief that they are filled with worms/bugs/fungus etc.

75
Q

When is ECT used

A

Severe depression refractory to medication (Catatonia) or with severe psychotic symptoms

NB- Antidepressant medication should be reduced but not stopped when a patient is about to commence ECT treatment

76
Q

Side effects of ECT

A

Headache
Nausea
Cardiac arrhythmia
Short term memory loss (some people report these memory problems long term but they are usually transient)

77
Q

Othello syndrome

A

Pathological jealousy that a partner is cheating on someone without proof

78
Q

SAD

A

Treat normal as you would with depression
No sleeping tablets
Light therapy not routinely recommended

79
Q

Section 17a (CTO)

A

Used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as medication compliance

80
Q

Capgras delusion

A

Family have been replaced by an identical imposter

81
Q

Formication

A

Parasthesia- feels like insects are crawling on the skin

82
Q

Managing BAD in primary care- Symptoms of mania/ severe depression

A

Urgent referral to CMHT
Routine referral- hypomania or non severe depression

The CMHT can then decide if they need to section them

NB- this is for BAD, wouldn’t refer everyone with severe depression to CMHT

83
Q

Antisocial PD

A

Failure to conform to social norms with respect to lawful behaviour
More common in men
Deception and lying
Impulsiveness
Aggressiveness (fights)
Disregard for safety
Irresponsibility
Lack of remorse

84
Q

Avoidant PD

A

Avoidance of activities which involve interpersonal contact
Preoccupied with ideas that they are being criticised or rejected in social scenarios
Restraint in intimate relationships
Reluctance to take risks due to fear of embarrassment
Inferior view of self
Self isolation but craving for social contact

85
Q

Borderline (Emotionally unstable) personality disorder

A

Efforts to avoid abandonment
Unstable interpersonal relationships which alternate between idealisation and devaluation
Unstable self image
Impulsivity in damaging areas eg. Sex and substances
Recurrent suicidal behaviour
Affective instability
Difficulty controlling temper
Chronic feelings of emptiness

86
Q

Dependent personality disorder

A

Difficulty making everyday decisions without help from others
Need others to assume responsibility for major areas of their life
Difficulty in expression disagreement for fear of losing support
Lack of initiative
Unrealistic care of being left to care for themselves
Urgent search for relationships
Extensive efforts to obtain support from others

87
Q

Histrionic personality disorder

A

Inappropriate sexual seductiveness
Centre of attention
Rapidly shifting and shallow expression of emotions
Suggestibility
Physical appearance used to seek attention
Self dramatisation
Relationships considered more intimate than they are

88
Q

Narcissistic personality disorder

A

Grandiose sense of self importance
Preoccupation with fantasies of unlimited success, power, or beauty
Sense of entitlement
Taking advantage of others
Lack of empathy
Excessive need for admiration
Chronic envy
Arrogant and haughty attitude

89
Q

Obsessive compulsive personality disorder

A

Occupied with details, rules, lists, order, organisation
Perfectionism that hampers tasks
Dedicated to work and efficiency to the elimination of spare time activities
Rigid about etiquette of morals, ethics, etc.
Can’t throw away insignificant things
Inability to delegate work
Stingy spending habits

90
Q

Paranoid personality disorder

A

Hypersensitivity
Unforgiving attitude when insulted
Questions loyalty of friends
Reluctance to confide in others
Preoccupation with conspiracy beliefs and hidden meaning
Perceives attacks on character

91
Q

Schizoid personality disorder

A

Indifference to praise or criticism
Preference for solitary activities
Lack of interest in sexual relationships
Lack of desire for companionship
Emotional coldness
Few interests
Few friends or confidants other than family

NB- negative symptoms of schizophrenia

92
Q

Schizotypal personality disorder

A

Ideas of reference (but some insight retained) eg. TV talks to them
Odd beliefs and magical thinking
Unusual perceptive disturbances
Paranoid ideation and suspiciousness
Odd eccentric behaviour
Lack of close friends other than family
In appropriate affect
Odd speech without being coherent

NB- positive symptoms of schizophrenia

93
Q

Management of personality disorders

A

Dialectical behavioural therapy

NB- can’t diagnose until out of teens

94
Q

Pseudodementia

A

Another psychiatric disorder presenting as dementia eg. Depression, anxiety

95
Q

MRI Head Alzheimer’s

A

Can be normal, or may show cortical atrophy

NB- early changes in Alzheimer’s: temporal lobe deficits

96
Q

EPSE’s

A

Parkinsonism
Acute dystonia (sustained muscle contraction eg. Torticollis (twisted neck), oculogyric crisis (eye deviation)- procyclidine
Akathisia/(severe restlessness)
Tardive dyskinesia (abnormal involuntary movements eg. Chewing, jaw pouting)

NB- torticollis is also known as cervical dystonia

97
Q

SSRI Interactions

A

NSAID (give PPI if together)
Warfarin and heparin (give mirtazapine instead)
Triptans
MAO-I

98
Q

Review period after starting an SSRI

A

2 weeks
Under 25 or high risk, 1 week

99
Q

Length of SSRI treatment

A

6 months after symptoms abate

100
Q

Stopping an SSRI

A

Over a 4 week period (not fluoextine)

101
Q

Discontinuation symptoms

A

Mood changes eg. anxiety
Restlessness
Difficulty sleeping
Unsteadiness and dizziness
Sweating
GI symptoms
Parasthesia eg. electric shock sensations

NB- treatment= give old dose of SSRI

102
Q

TCA Side effects

A

Anti cholinergic eg.

Drowsiness
Dry mouth
Blurred vision
Constipation
Urinary retention

QTc lengthening

103
Q

Lithium SE’s (different to toxicity)

A

N v diarrhoea
Fine tremor
Polyuria, nephrogenic DI
Hypothyroidism
Weight gain
T wave flattening, inversion
Intracranial hypertension
Leukocytosis
Hyperparathyroidism and hypercalcaemia

NB- benign leukocytosis

104
Q

Mirtazapine

A

Good if 2 SSRI’s can’t be taken (warfarin),p or not tolerated
SE- weight gain and sedation

Class- Noradrenergic and specific serotonergic antidepressants

105
Q

Antidepressants and addiction

A

Antidepressants are not addictive but when stopped suddenly they can cause discontinuation syndrome

106
Q

Antipsychotics known for increasing prolactin

A

Typical- zuclopenthixol, haloperidol
Atypical- amisulpride, risperidone

107
Q

Antipsychotics not typically associated with increasing prolactin

A

-pine

Olanzapine
Clozapine
Quetiapine

NB- aripiprazole has one of the better side effect profiles

108
Q

Combining antidepressants

A

Not typically done, but may see venlafaxine + mirtazapine (increased risk of serotonin syndrome and antidepressant SE’s)

109
Q

Factors likely to be in a VD history

A

TIA/stroke
Can almost pinpoint when things started to change (rather than AD- insidious onset)
Emotional lability

110
Q

Support for people with dementia at home

A

Occupational therapists- safe around the home/blister packs
Carers- personal care
Physiotherapists- stairs
Fire brigade- gas (stove)
Social services- LPA

111
Q

Pharmacological management of BPSD’s (Behavioural and Psychological Symptoms of Dementia)

A

Carbamazepine
AD
AP
Severe cases- benzodiazepines

112
Q

Pseudohallucinations

A

They are part of the normal grieving process

113
Q

Extrapyramidal side effects

A

Symptoms associated with the extrapyramidal system of the cerebral cortex (involuntary movement). They include;

Dystonia (continuous and sustained contraction eg. oculogyric crisis, torcillosis)
Akathisia (inner restlessness and inability to sit still)
Parkinsonism
Tardive dyskinesia- irregular jerky movements, typically of face and neck (lip smacking)

114
Q

Alternative to methadone

A

Buprenorphine is a mixed opioid agonist/antagonist. It is typically given as a sublingual tablet

115
Q

Causes of altered clozapine levels

A

Smoking cessation can cause a significant rise in clozapine levels, and so it should be discussed with a psychiatrist before stopping smoking. Starting smoking, or smoking more, can reduce clozapine levels. Stopping drinking can also reduce levels, as alcohol binges can increase the level. Omitting doses will cause a reduction in clozapine levels, and stress and weight gain won’t have significant effects on the level.

116
Q

Pellagra

A

Dermatitis, diarrhoea, dementia/delusions, leading to death (vitamin B3 deficiency)

117
Q

Conversion disorder

A

Typically involves loss of motor or sensory function. May be caused by stress

118
Q

Features of PTSD

A

Symptoms often present later after the event, and have to be present for a month

re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
avoidance: avoiding people, situations or circumstances resembling or associated with the event
hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
emotional numbing - lack of ability to experience feelings, feeling detached from other people
depression
drug or alcohol misuse
anger
unexplained physical symptoms

119
Q

Management of PTSD

A

Conservative- watchful waiting may be used for mild symptoms lasting less than 4 weeks, or trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases/after 4 weeks

Medical- if CBT hasn’t worked- venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used

120
Q

Risk factors for PTSD

A

Exposure to trauma or combat, refugee/asylum seeker status, first responder occupation, combat specific (duration of exposure, low morale, poor social support, lower rank, unmarried, low educational attainment, childhood adversity), previous psychiatric disorders.

121
Q

Management of a patient who has attempted suicide

A

If they say they would do it again -admit to a psychiatric hospital for assessment (section 5(2) as a junior doctor- hold for 72 hours, if they are unwilling)

If not- refer to CMHT, take a bio/psycho/social approach eg. talking therapy, address any social concerns, may require medication eg. for concomitant depression

122
Q

Pharmacological management of Alzheimer’s

A

First line- acetylcholinesterase inhibitor (donepezil, galantamine, rivastigmine)

Second line- memantine (NMDA receptor antagonist)

NB- don’t use donepezil if bradycardia, and it can cause insomnia

123
Q

Schniders first rank symptoms

A

3rd person/ running commentary/ heading thoughts out loud auditory hallucinations

Thought with drawl/insertion

Thought broadcasting

Somatic hallucinations

Delusional perceptions

124
Q

Causes of serotonin syndrome

A

monoamine oxidase inhibitors
SSRIs- St John’s Wort, often taken over the counter for depression, can interact with SSRIs to cause serotonin syndrome
ecstasy
amphetamines
tramadol

125
Q

Features of serotonin syndrome

A

neuromuscular excitation
-hyperreflexia
-myoclonus
-rigidity

autonomic nervous system excitation
-hyperthermia
-sweating

altered mental state
-confusion

126
Q

Treatment of serotonin syndrome

A

supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

127
Q

Features of neuroleptic malignant syndrome

A

pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
raised creatine kinase
Acute kidney injury (secondary to rhabdomyolysis) leukocytosis

128
Q

Management of neuroleptic malignant syndrome

A

stop antipsychotic
patients should be transferred to a medical ward if they are on a psychiatric ward and often they are nursed in intensive care units
IV fluids to prevent renal failure
dantrolene may be useful in selected cases
bromocriptine, dopamine agonist, may also be used

129
Q

SS vs NMS

A

SS- faster onset, hyperreflexia, myoclonus (muscle jerks, rather than rigidity), dilated pupils

NMS- slower onset, hyporeflexia, lead pipe rigidity, normal pupils

130
Q

SSRI SE’s

A

-gastrointestinal symptoms are the most common side-effect
-reduced libido and sexual performance
-there is an increased risk of gastrointestinal bleeding in patients taking SSRIs. A proton pump inhibitor should be prescribed if a patient is also taking a NSAID
hyponatraemia (duodenal ulcers)
-patients should be counselled to be vigilant for increased anxiety and agitation after starting a SSRI
-fluoxetine and paroxetine have a higher propensity for drug interactions

NB- may initially worsen symptoms (why people are reviewed soon after)

131
Q

SSRI and pregnancy

A

Use during the first trimester gives a small increased risk of congenital heart defects
Use during the third trimester can result in persistent pulmonary hypertension of the newborn

132
Q

OCD Management

A

Mild- cognitive behavioural therapy (CBT) including exposure and response prevention (ERP)
Severe- admit to a secondary service and treat whilst waiting referral, SSRI and CBT (including ERP)

133
Q

Somatisation Disorder

A

multiple physical SYMPTOMS (S for S) present for at least 2 years
patient refuses to accept reassurance or negative test results

134
Q

Illness anxiety disorder (hypochondriasis)

A

persistent belief in the presence of an underlying serious DISEASE, e.g. cancer (C in cancer and hypochondriasis)
patient again refuses to accept reassurance or negative test results

135
Q

Conversion Disorder

A

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

136
Q

Conversion Disorder

A

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

137
Q

Dissociative disorder

A

dissociation 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

138
Q

Factitious Disorder

A

also known as Munchausen’s syndrome
the intentional production of physical or psychological symptoms

139
Q

Malingering

A

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain (ie. they want something out of it)

140
Q

Brief psychotic disorder

A

This describes an episode of psychosis lasting less than a month with a subsequent return to baseline functioning.

Year 4 Additional Notes (17 decks)

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