Mental health Flashcards
Safety plan - for suicide risk
- Identifying triggers/warning signs
- Creating a safe environment (get rid off lethal means)
- Identify reasons to live
- Internal coping strategies
- Family and friend support - being with them
- Professional contacts/access line
CHILDREN- Eating disorders
Indicators for Admission
- Temp< 35.5
- QTC: >450
- HR <50
- BP <80/50
- Hypokalaemia/neutropenia
- Postural drop >20mm
ADULTS- Eating disorders
Indicators for Admission
(note mental health admission cut offs less severe than medical admission)
- BMI <14
- SPB <90
- postural drop >10
- temp <35.5
- Na <130
- K <3
- Neutrophils <1.5
- Suicidal/ self harm/ high distress
Differentials (mental health diagnoses) for psychotic symptoms
- Schizophrenia
- Schizophreniform disorder
- First episode psychosis
- Drug induced psychosis
- Schizoaffective disorder
- Bipolar 1
Clozapine monitoring bloods & ECG
–Troponin
weekly first 6 we
eks then 3monthly
–FBC (agranulocytosis)
weekly for first 18 weeks then monthly
–Fasting BGL and lipids
3 months then 6 monthly
–ECG
Weekly to 4 weeks then at 3 months
– Annual Echo
- clozapine levels
Risk factors for suicide
- Access to means
- Previous attempts
- Family history of suicide
- Drug or etoH abuse
- Writing letter, giving away possessions
Psychological principles of first aid
- Promoting calm (acknowldge normalcy of symptoms)
- Promoting sense of safety (that was then, youre safe now)
- Promoting the sense of self efficacy (what has helped in the past when you’ve been overwhelmed to help overcome this)
- Promoting connectedness (is there someone you can spend some time with)
- Instill hope (Im confident you will get through this)
Acute stress disorder time frame
- 3 days to 1 month
Symptoms for stress disorder (main categories)
- Arousal symptoms
- Avoidance symptoms
- Dissociative symptoms
- Negative mood
- Intrusion symptoms
Trauma informed care based answer
- Safety (prioritise, are you safe at home)
- Foster capacity to soothe arousal
- Validate
- Colllaborate and empower
- Connect and stay involved
SSRI or SNRI for first line treatment of OCD?
SSRI
Difference between BPD and histrionic personality disorder
BPD has more
- Self destructive behaviour
- Angry disruptions
- Feelings of emptiness
Anti-depressant medications with higher chance of discontinuation symptoms:
Paroxtine
Venlafaxine
Desvenlafaxine
Duloxetine
Anti-depressant medication with least discontinuation symptoms
Fluoxetine
Depression in the elderly (what time of day are symptoms worse)
Morning
(diurnal too)
Features of Depression in the elderly:
a) onset
b) day to day pattern
c) Memory loss pattern
a) Often abrupt, often with life change
b) Diurnal but MORNINGS worse
c) Patchy memory “ISLANDS”
Two types of anorexia nervosa?
- Restrictive
- Binge eating/ purging subtype
a) Child and adolescent first line therapy for Bulimia
b) Adult first line therapy for Bulimia
A) Bulimia focused family therapy
B) CBT for bulimia nervosa
Performance anxiety first line therapy
CBT with exposure component
Performance anxiety pharmacological option
Propanolol
Time frame for “Chronic” insomnia
3 months
Drug free interval between swapping from SSRI to SNRI
2-4 days
Changing from Citalopram, escitalopram, paroxetine or sertraline to another short acting SSRI….
Drug free interval recommendation?
NIL
can start the next day
Lithium toxicity clinical presentation?
Gastrointestinal:
- Nausea, vomiting, diarrhoea
CNS
- Tremor, hyperreflexia, ataxia, dysarthria
CVD:
- QT prolongation, hypotnesion
Tests in lithium toxicity
Calcium
ECG
Lithium level
Renal function
TSH (affects TSH)
Testing with lithium - monitoring: what and how frequently
- Lithium levels 3-6 monthly
- Renal function 3-6 monthly
- TSH 6 monthly
Non-mental health (organic) causes for psychosis
- HIV
- CVA
- SOL
- Pituitary adenoma
- SLE
- CJD
- Vitamin B
- Wilsons
- Neurosyphilis
- Sleep deprivation
Acute mania acute treatment
Olanzapine
or Risperidone
3 options for Alcohol dependence….
Acamprosate
Naltrexone
Disulfiram
(contraindicated: CVD, HTN, cognitive impairment)
Self assessment tool for PTSD
PCL-5 (high risk if >38)
First line treatment for PTSD associated nightmares in young people
Prazosin
How to treat serotonergic toxidrome
ED and benzos
Antipsychotics in acute mania
(2x first line then a second line)
1st line:
- Olanzapine
- Risperidone
2nd line
- Aripiprazole
Mania / bipolar long term management features..
- Educate on how to reduce the chance of relapsed
- Advised against importance of medication compliance
- Educate on diagnosis of mania
- Drug cessation
- Educate on toxicity
- Referral to psychologist
