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FCM Matrix > Mental Health > Flashcards

Mental Health Flashcards

1
Q

What is the therapeutic range for Lithium?

A

0.4-1.0 mmol/L

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2
Q

Indication of lithium

A

Bipolar disorder

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3
Q

When do the lithium levels need to be checked when dose changed?

A

1 week

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4
Q

What is knight’s move

A

illogical leaps from one idea to another

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5
Q

What is flight of ideas?

A

Discernible links between ideas

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6
Q

What are the common features of PTSD?

A

1) Re-experiencing
2) Avoidance

3) Hyperarousal
4) emotional numbing

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7
Q

Management of PTSD

A
  • CBT or eye movement desensitisation and reprocessing

- Drug is not routine 1st line : Venlafaxine or SSRI (sertraline)

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8
Q

What ECG changes does Citalopram cause?

A

QT prolongation and Torsades de pointes

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9
Q

What are the examples of SSRI?

A

Citalopram
sertraline

Fluoxetine

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10
Q

Side effect of lorazepam

A

Anterograde amnesia

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11
Q

What should be monitored when initiating and titrating venlafaxine?

A

Blood pressure (HTN)

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12
Q

What is 2nd line option for depression?

A

SNRI - venlafaxine

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13
Q

What signs should be monitored when taking antidepressants?

A

Hyponatraemia

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14
Q

What is life-threatening side-effect of clozapine?

A

Agranulocystosis/Neutropenia

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15
Q

What is agranulocystosis?

A

Decreased WCC, primarily neutrophils

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16
Q

What is the 1st line medication for GAD?

A

SSRI - specifically Sertraline

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17
Q

What is the stepwise approach for managing GAD?

A

1) Patient education + monitor condition
2) Low-intensity psychological intervention
3) High-intensity psychological intervention. -drug treatment/CBT
4) highly specialist input

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18
Q

What is the management of severe OCD - (severe functional impairment)?

A
  • SSRI and CBT (including ERP)
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19
Q

What are the side effects of typical antipsychotics?

A
  • Acute dystonia (e.g. torticollis, oculgyric crisis)
  • Parkinsonism
  • Akathisia (severe restlessness)
  • Tardive dyskinesia
  • Neuroleptic malignant syndrome
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20
Q

What is torticollis?

A
  • Unilateral pain and deviation of the neck with pain on palpation and restricted range of motion
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21
Q

What is neuroleptic malignant syndrome?

A
  • Altered MSE
  • Generalised rigidity
  • Fever
  • Fluctuating blood pressure
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22
Q

What is tardive dyskinesia?

A
  • uncontrolled facial movements such as lip-smacking

- usually caused by long term use of antipsychotics

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23
Q

What are examples of typical antipsychotics?

A
  • Haleperidol

- Chlopromazine

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24
Q

What are examples of atypical antipsychotics?

A
  • Clozapine
  • Risperidone
  • Olanzapine
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25
Q

Why was atypical antipsychotics developed?

A

Due to problematic extrapyramidal side-effects

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26
Q

What is ESPEs?

A
  • Parkinsonism
  • Acute dystonia (sustained muscle contraction)
  • akathisia (severe restlessness)
  • tardive dyskinesia
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27
Q

Management of hypomania?

A

Routine referral to CMHT

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28
Q

Which intervention is most beneficial for schizophrenia?

A

CBT

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29
Q

MOA of venlafazine

A

Serotonin and noradrenaline reuptake inhibitor

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30
Q

What is cotard syndrome and what condition is it associated with?

A
  • Subtype of delusion where they believe they or part of them is dead
  • Associated with depression
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31
Q

What are the first rank symptoms of schizophrenia?

A

1) Auditory hallucinations
2) Thought disorder

3) Passivity phenomena
4) Delusional perceptions

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32
Q

For a diagnosis of PTSD, how long should symptoms be present for?

A

4 weeks

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33
Q

What is an effective treatment for borderline personality disorder?

A

Dialectical behaviour therapy

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34
Q

What is dialetical behaviour therapy?

A

Targeted therapy that is based CBT, but has been adapted to help people who experience emotions very intensely.

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35
Q

What is the key difference between mania and hypomania?

A

Psychotic symptoms

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36
Q

What are the symptoms associated with depression?

A

DSM-5
5/9 symptoms required for diagnosis (everyday for at least 2 week):

Core symptoms:

  1. Low mood
  2. Anhedonia

Associated symptoms:

  1. Disturbed sleep
  2. Decreased or increased appetite
  3. Fatigue /loss of energy
  4. Agitation or slowing of movements
  5. Poor concentration
  6. Feelings of worthlessness
  7. Suicidal thoughts
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37
Q

What tools can be used to assess the degree of depression?

A

HAD scale

PHQ-9

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38
Q

What investigations should be carried out for depression?

A
  • Bloods to eliminate other causes
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39
Q

What is the management of subthreshold /mild depression?

A
  • CBT
  • Group - based CBT

Do not routinely offer antidepressants unless:

  • past hx of moderate or severe depression
  • persistent symptoms > 2 years
  • failed with other interventions
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40
Q

What is the management of moderate to severe depression?

A
  • Antidepressant (normally SSRI : citalopram, fluoxetine or sertraline)
  • Psychological intervention
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41
Q

What is seasonal affective disorder?

A

Depression which occurs predominately around the winter months.

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42
Q

Management of SAD?

A
  • Treated the same way as depression
  • Mild depression: psychological therapies
    Follow-up in 2 weeks to check no deterioration
  • SSRI - after therapy if needed
  • In SAD, you should not give the patient sleeping tablets as this can make the symptoms worse.
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43
Q

What is dsythmic disorder?

A
  1. Chronic depressive state (2 years or more)
  2. Persistent low mood not meeting depression diagnostic criteria
  3. Not the consequence of a partly resolved major depression
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44
Q

Management of dsythmic disorder?

A
  1. Antidepressants (first line): –> Citalopram
  2. Psychotherapy
    - -> Or group-based CBT
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45
Q

Define bipolar disorder

A

Chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of depression.

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46
Q

What are the types of bipolar disorder?

A
  1. type I disorder:
    mania and depression (most common)
  2. type II disorder:
    hypomania and depression
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47
Q

Difference between mania & hypomania

A
  1. Hypomania:
    • Mild elevation of mood and increased energy / activity
    • 4 days of manic symptoms
    • Does NOT disrupt life
2. Mania:
• Mood change (7 days of persistently high, expansive, or irritable mood) AND 3 manic symptoms:
--> Increased activity level
--> Talkativeness
--> Racing thoughts
--> Distractibility
--> Reduced need for sleep
--> Inflated self esteem
--> Faulty judgement
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48
Q

What is the management of bipolar disorder?

A
  1. Admission for acutely manic patient
  2. Pharmacotherapy
    - -> Mood stabilizers – 1st line: lithium, Valproate
    - -> Sedatives
  3. Mania:
    - -> Antipsychotics- mainly atypicals (eg. risperidone), olanzapine, haloperidol
  4. Depression
    - -> talking therapies
    - -> fluoxetine is the antidepressant of choice
  5. ECT
  6. Psychosocial
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49
Q

Referral criteria for bipolar disorder?

A
  1. if symptoms suggest hypomania = routine referral to the community mental health team (CMHT)
  2. if there are features of mania or severe depression then an urgent referral to the CMHT should be made
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50
Q

Define obesity

A

BMI 25-29.9 kg/m2

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51
Q

Management of obesity

A
  1. Assess underlying cause
  2. Conservative:
    - Exercise
    - Diet
  3. Drug treatment
    - orlistat (with hypocaloric diet)
    - only considered after diet + physical activity
  4. Bariatric surgery
52
Q

What is the criteria for anorexia?

A

A. Restriction of energy intake relative to requirements, leading to a significantly low weight in the context of age, sex, developmental trajectory, and physical health

B. Intense fear of gaining weight or persistent behaviour that interferes with weight gain

C. Disturbance in body image.

53
Q

What are the physical clinical features for anorexia?

A
  • BMI <85% predicted (<17.5 adults). Often rapid loss
  • Amenorrhea 3/12 or longer
  • Delayed puberty
  • Fatigue, fainting, dizziness
  • Intolerance to cold
  • GI: constipation, abdo pain
  • Appearance: wearing baggy clothes
54
Q

What are the psychological clinical features of anorexia?

A
  • fear/ dread gaining weight
  • Distorted body image
  • Social withdrawal
  • Denial of problem/ resistance to treatment
55
Q

What is the management of anorexia?

A
  1. Weight restoration
    - -> Dietician – gradual increase of meal plan + multivitamin and mineral supplements
    - -> Monitor bloods – refeeding syndrome.
    - -> Pancytopenic – resolved gradually with weight restoration
  2. Individual psychology
  3. OT, psychology, medical groups
  4. Medical: restarted olanzapine and fluoxetine.
  5. Psychotherapeutic
    - -> CBT - ED
  6. Manage physical risks – escalate early
    - -> Blood tests: FBC, U&E, bone profile, LFT, TFT, iron studies, folate, B12. consider ABG
    - -> Replace electrolytes as needed – risk of ↓K+ in particular
    - -> BM - ↓ glucose
    - -> IV fluids if dehydrated
    - -> ECG – long QT, bradycardia
  7. Other medical treatment - Consider SSRI if low mood
56
Q

What is the mechanism behind alcohol withdrawal?

A
  1. chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) + inhibits NMDA-type glutamate receptors
  2. alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)
57
Q

What are the features of alcohol withdrawal?

A

Symptoms start at 6-12 hours:

  • tremor
  • sweating
  • tachycardia
  • anxiety
58
Q

As a result of alcohol withdrawal, when is it most likely for seizures and delirium to occur?

A
  1. peak incidence of seizures at 36 hours
  2. peak incidence of delirium tremens is at 48-72 hours:
    - coarse tremor
    - confusion
    - delusions
    - auditory and visual hallucinations
    - fever
    - tachycardia
59
Q

Management of alcohol withdrawal

A
  • Pt with complex withdrawals should be admitted until stabilised

1st line = long-acting benzodiazepines
e.g. chlordiazepoxide or diazepam.

60
Q

What the first medical management for alcohol withdrawal for hepatic failure?

A

Lorazepam

61
Q

What is staggered overdose?

A

if all the medication is not taken within 1 hour

62
Q

What medication should be give if patient presents within 1 hours of paracetamol overdose?

A

activated charcoal

63
Q

What the management of paracetamol overdose?

A

Acetylcysteine if:

  • staggered overdose or doubt of ingestion time
  • the plasma conc is on or above single line of 100mg/l at 4 hours and 15 mg/L at 15 hours
64
Q

How is acetylcysteine given?

A

IV over 1 hour

65
Q

What is the criteria for liver transplantation due to paracetamol liver failure?

A

Aterial pH < 7.3 + 24 hours after ingestion

or all of the following:

  1. prothrombin time > 100 seconds
  2. creatinine > 300 µmol/l
  3. grade III or IV encephalopathy
66
Q

Example of natural opiates

A

morphine

67
Q

Example of synthetic opioid

A
  • buprenorphine

- Methadone

68
Q

Features of opioid misuse

A
  • rhinorrhoea
  • needle track marks
  • pinpoint pupils
  • drowsiness
  • watering eyes
  • yawning
69
Q

What is the emergency management of opioid overdose?

A

IV or IM naloxone:
- has a rapid onset and relatively short duration of action

Long-term for dependence:
1st line = buprenophine

70
Q

What is Bulimia Nervosa?

A
  • Type of eating disorder characterised by:
    1. episodes of binge eating followed by
    2. intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.
71
Q

What is the diagnostic criteria for Bulimia Nervosa?

A

A. Recurrent episodes of binge eating, character sited by BOTH:
• Eating objectively large amount of food (larger than most would in a similar time period, and circumstances) in a discrete period of time (e.g. 2 hours)
• Loss of control overeating during episode

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain – e.g. vomiting, using laxatives/ diuretics/enemas/ other meds

C. Binge Eating and inappropriately compensatory behaviors both occur, on average at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight

E. Disturbance does not occur exclusively during episodes of anorexia nervosa.

72
Q

What are some clinical features you may see with Bulimia Nervosa?

A
  • Weight fluctuation
  • Low mood
  • Low self esteem
  • Body image concerns
  • Dental erosion
  • Parotid hypertrophy
  • Arrhythmias
73
Q

What is the management of Bulimia Nervosa?

A 
- Referral to specialist for all cases
• Psychotherapeutic: CBT-ED
• Diet: meal planning
• Medical: 
	- manage physical risks
	- consider SSRI or SNRI - fluoxetine (not long-term, high-dose treatment)
74
Q

What is acute stress disorder?

A
  • Acute stress reaction that occurs first 4 week after a person has exposed to a traumatic event
75
Q

What are the features in acute stress disorder?

A
  1. intrusive thoughts e.g. flashbacks, nightmares
  2. dissociation e.g. ‘being in a daze’, time slowing
  3. negative mood
  4. avoidance
  5. arousal e.g. hypervigilance, sleep disturbance
76
Q

What is the management of acute stress disorder?

A
  1. 1st line = trauma-focused CBT
  2. benzodiazepine
    - -> used in acute symptoms
  3. Beta-blockers
    - -> relieves physical symptoms caused by stress hormone
77
Q

What is bereavement?

A

A period of mourning or loss

78
Q

What are the stages of grief?

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
79
Q

What is the management of bereavement ?

A

1st line = counselling

Medication:
1st line = SSRIs

80
Q

What are some types of elder/child abuse?

A
  1. Neglect
  2. Sexual
  3. Physical
81
Q

What are some features of abuse?

A
  1. story inconsistent with injuries
  2. repeated attendances at A&E departments
  3. late presentation
  4. child with a frightened, withdrawn appearance - ‘frozen watchfulness’
82
Q

What are some physical symptoms of abuse?

A
  1. bruising
  2. fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
  3. torn frenulum: e.g. from forcing a bottle into a child’s mouth
  4. burns or scalds
  5. failure to thrive
  6. sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas
83
Q

What is the management of abuse?

A

Social services

- referral for sexual assault referral centre

84
Q

What is domestic violence?

A

Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence, or abuse between people aged 16 years or over who are, or have been, intimate partners or are family members regardless of gender or sexuality

85
Q

What are the types of domestic violence?

A
  • Psychological
  • Physical
  • Sexual
  • Emotional
  • financial
86
Q

What is the management for domestic violence?

A
  1. inform senior

2. referral to social services

87
Q

How do you manage deliberate self-harm?

A
  1. Examine physical injuries
  2. Asses protective factors (may reduce the person’s risk)
  3. Refer to A & E
  4. Follow-up – offer information for support
  5. Refer to CAMHS
  6. Manage other mental health problems
88
Q

What does ADHD stand for?

A

Attention Deficit Hyperactivity Disorder

89
Q

What is the definition of ADHD?

A

DSM 5: Condition incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent.

90
Q

What are the diagnostic features for ADHD?

A

For children up to the age of 16 years, 6 of these features have to be present; in those > 17 y/o the threshold is 5 features:

Inattention:

  1. Does not follow through on instructions
  2. Reluctant to engage in mentally-intense tasks
  3. Easily distracted
  4. Finds it difficult to sustain tasks
  5. Finds it difficult to organise tasks or activities
  6. Often forgetful in daily activities
  7. Often loses things necessary for tasks or activities
  8. Often does not seem to listen when spoken to directly

Hyperactivity/Impulsivity:

  1. Unable to play quietly
  2. Talks excessively
  3. Does not wait their turn easily
  4. Will spontaneously leave their seat when expected to sit
  5. Is often ‘on the go’
  6. Often interruptive or intrusive to others
  7. Will answer prematurely, before a question has been finished
  8. Will run and climb in situations where it is not appropriate
91
Q

How is ADHD diagnosed?

A

Clinical diagnosis

92
Q

What is the management of ADHD?

A
  1. 10-week watch and wait approach
    - -> If symptoms don’t resolve referral to secondary care.
  2. Drug therapy should be last resort:
    - -> Only available for > 5 years
    - -> 1st line: methylphenidate (6-week trial basis)
    - ——–> Potentially cardiotoxic – perform ECG for baseline
93
Q

What is schizophrenia?

A

Fundamental and characteristic distortion of thinking and perception and affects that are blunted or inappropriate.

94
Q

What are the types of symptoms in schizophrenia?

A
  1. Auditory hallucinations
  2. Thought disorder:
    - thought insertion
    - thought withdrawal
    - thought broadcasting
  3. Passivity phenomena:
    - bodily sensations being controlled by external influence
    - actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
  4. Delusional perceptions
    - A two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.
95
Q

How is schizophrenia diagnosed?

A

Clinical diagnosis

96
Q

What is the management of schizophrenia?

A

1st line = Atypical antipsychotics e.g. Respirdone

Acute setting = haliperidol (aggressive)

CBT should be offered to all pts.

97
Q

What is delusional disorder?

A

False beliefs which are sustained despite contrary evidence

98
Q

What are the types of delusional disorder?

A
  • Grandiose
  • persecutory
  • mixed
  • erotomanic
  • jealousy
  • somatic
  • not classified
99
Q

What are some symptoms of delusional disorder?

A
  1. Jealousy/paranoia
  2. Aggression
  3. Abnormal behaviours
  4. Feeling of persecution
  5. Disordered thinking
100
Q

What investigations should be carried out in delusional disorder?

A
  1. Bloods
    o To rule out organic causes like anaemia, electrolyte abnormalities
  2. X-ray Imaging
    o CT or MRI brain
  3. Special Tests
    o Urine toxicology
101
Q

What is the management of delusional disorder?

A
  1. Refer to a psychiatrist
    - -> Speed of referral depends on risk of harm to self or others
  2. Psychotherapy
102
Q

What is shizoaffective disorder?

A

Symptoms of schizophrenia and a mood disorder (depressed or manic) are equally prominent

103
Q

What is the management of shizoaffective disorder?

A
  1. Admit to hospital if symptoms of acute psychosis 2. When stable, treatment options depend on prevailing symptoms
    • e.g antidepressants if depressive symptoms
    • or antipsychotics if schizophrenia
104
Q

What questionnaire is used for diagnosis of PTSD?

A

Trauma Screening Questionnaire

105
Q

What is the 2nd line medication for GAD?

A

SNRI : Duloxetine

106
Q

What advice should be given when starting medication for GAD?

A
  • Warn patients of the increased risk of suicidal thinking & self-harm
107
Q

What is the follow-up after starting medication in GAD?

A

Weekly follow-up for the 1st month

108
Q

What is the diagnostic requirement for GAD?

A

DSM-5: core symptoms of excessive widespread worry for more days than not for at least 6 months

109
Q

What are some symptoms in GAD?

A
  • Restlessness
  • Easily fatigued
  • Poor concentration
  • Irritably
  • Muscle tension
  • Sleep disturbance
110
Q

What are some types of phobia?

A
  • Agoraphobia
  • Social phobia
  • Simple phobia
111
Q

What is the management of some phobias?

A
  1. Agoraphobia
    o Psychological therapy - Systematic desensitization
    o Medication can be useful – SSRI’s usually (sertraline or escitalopram)
  2. Social phobia
    o CBT
    o Medication can be useful – SSRI’s usually
  3. Simple phobia
    o Psychological therapy - Systematic desensitization
112
Q

What are the symptoms of panic disorder?

A 
A panic attack is defined as a discrete episode of intense subjective fear, where at least four of the characteristic symptoms:
•	Palpitation
•	Sweating
•	Trembling or shaking
•	Dry mouth
•	SOB
•	Chest pain or discomfort
•	Dizziness
113
Q

What is the stepwise management for panic disorder?

A

step 1: recognition and diagnosis

step 2: treatment in primary care

step 3: review and consideration of alternative treatments

step 4: review and referral to specialist mental health services

step 5: care in specialist mental health services

114
Q

What is the treatment of panic disorder in primary care?

A

Either CBT or drug

1st line = SSRI
–> if non-responsive for 12 weeks = imipramine or clomipramine

115
Q

What are personality disorders?

A

Series of maladaptive personality traits that interfere with normal function in life.

116
Q

What are the clusters of personality disorder?

A

Cluster 1: Odd or eccentric

  • Paranoid
  • Schizoid
  • Schizotypal

Cluster 2: Dramatic, emotional or erratic

  • Antisocial
  • Borderline (Emotionally Unstable)
  • Histrionic
  • Narcissistic

Cluster 3: Anxious & Fearful

  • Obsessive-Compulsive
  • Avoidant
  • Dependent
117
Q

What are characteristics of paranoid?

A
  1. Hypersensitivity and an unforgiving attitude when insulted
  2. Unwarranted tendency to questions the loyalty of friends
  3. Reluctance to confide in others
  4. Preoccupation with conspirational beliefs and hidden meaning
  5. Unwarranted tendency to perceive attacks on their character
118
Q

Shizoid features

A
  1. Indifference to praise and criticism
  2. Preference for solitary activities
  3. Lack of interest in sexual interactions
  4. Lack of desire for companionship
  5. Emotional coldness
  6. Few interests
  7. Few friends or confidants other than family
119
Q

Shizotypal features

A
  1. Ideas of reference (differ from delusions in that some insight is retained)
  2. Odd beliefs and magical thinking
  3. Unusual perceptual disturbances
  4. Paranoid ideation and suspiciousness
  5. Odd, eccentric behaviour
  6. Lack of close friends other than family members
  7. Inappropriate affect
  8. Odd speech without being incoherent
120
Q

Anti-social features

A
  1. Deception
  2. Impulsiveness
  3. Irritability
  4. Reckless
  5. Consistent irresponsibly
  6. Lack of remorse
121
Q

Bordeline (Emotionally unstable) features

A
  1. Efforts to avoid real or imagined abandonment
  2. Unstable interpersonal relationships
  3. Unstable self image
  4. Impulsivity in potentially self damaging area
  5. Recurrent suicidal behaviour
  6. Affective instability
  7. Chronic feelings of emptiness
  8. Difficulty controlling temper
  9. Quasi psychotic thoughts
122
Q

Histrionic features

A
  1. Inappropriate sexual seductiveness
  2. Need to be the centre of attention
  3. Rapidly shifting and shallow expression of emotions
  4. Suggestibility
  5. Physical appearance used for attention seeking purposes
  6. Impressionistic speech lacking detail
  7. Self dramatization
  8. Relationships considered to be more intimate than they are
123
Q

Narcissitc Features

A
  1. Grandiose sense of self importance
  2. Preoccupation with fantasies of unlimited success, power, or beauty
  3. Sense of entitlement
  4. Taking advantage of others to achieve own needs
  5. Lack of empathy
  6. Excessive need for admiration
  7. Chronic envy
  8. Arrogant and haughty attitude
124
Q

Obsessive- compulsive features

A
  1. Is occupied with details
  2. perfectionism
  3. Is extremely dedicated to work
  4. Is meticulous, scrupulous, and rigid about etiquettes
  5. Is not capable of disposing worn out or insignificant things
  6. Is unwilling to pass on tasks or work with others
  7. Takes on a stingy spending style
125
Q

Avoidant features

A
  1. Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection.
  2. Unwillingness to be involved unless certain of being liked
  3. Views self as inept and inferior to others
  4. Social isolation accompanied by a craving for social contact
126
Q

What is somatisation disorder?

A
  1. multiple physical SYMPTOMS present for at least 2 years

2. patient refuses to accept reassurance or negative test results

FCM Matrix (17 decks)

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