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My Final Year 4 Revision > Mental health > Flashcards

Mental health Flashcards

1
Q

[Insert a joke]

A

Mental health isn’t a joke

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2
Q

What is the structure of a mental health history?

A 
PC
HPC 
Past Psychiatric/ medical history 
Medications and allergies - illicit drugs, alcohol, OTC
FH - inc. personal history 
SH 
Forensic history 
Premorbid personality 
Informant history
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3
Q

What to include in a HPC?

A

Detail each symptom
Chronological account
Important +/-ve symptoms

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4
Q

What to ask in HPC if there are voices?

A

Detail of voice - content, number 2/3 person, commanding

Hallucinations in other modalities - visual, tactile, olfactory, gustatory

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5
Q

What to include in a past psychiatric history?

A 
Episodes or continuous 
Admissions 
Diagnosis and treatment 
Mental health act
Deliberate self harm 
Contact with services
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6
Q

What to ask about alcohol in medication history?

A 
CAGE only for screening 
calculate units, routine etc.
Dependency - physical or mental harm 
Priorities - bills, other activities 
Withdraw
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7
Q

What Illicit substances to ask about specifically?

A 
Cannabis 
Amphetamines 
Heroin 
Crack/ cocaine 
LSD/Ecstacy 
Mushrooms 
Novel psychoactive substances
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8
Q

What to ask in a family history?

A

Alive/ Dead
Quality of relationships
FH of psychiatric conditions

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9
Q

What to ask in personal history?

A 
Birth
Childhood milestones 
Abuse 
School 
Employment
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10
Q

What to ask in the forensic history?

A

Any contact with courts/police

Violence or thoughts of violence

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11
Q

What to ask about premorbid personality?

A

Describe themselves
Strengths and weaknesses
Hobbies and interests
Activity and socialisation

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12
Q

What are the sections of the mental state examinations?

A

A Speedy Mental Test Putting Crazies Inside

Appearance and behaviour 
Speech 
Mood and affect 
Thought 
Cognition 
Insight
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13
Q

What is waxy flexibility?

A

A form of catatonia in which tendency to remain in an abnormal posture - schizophrenia

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14
Q

What is negativitism?

A

A form of catatonia in which there is increased resistance to movement - schizophrenia

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15
Q

Side effects of antipsychotics?

A

Sedation
Difficulty initiating movement -PD
Extrapyramidal see effects - rhythmic movements
Tardative dyskinesia - lip smaking, tongue protrusion
Ataxia

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16
Q

What is pressure of speech?

A

Fast speech making little sense with little sense of conecton

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17
Q

What is Echolalia?

A

Reflection utterance of word said by others - schizophrenia

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18
Q

What is Palilalia?

A

Involuntary repetition of words, words are from themselves - schizophrenia

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19
Q

How is Mood different from Affect?

A

Mood is reported (subjective) by the patient. Affect expressed emotions by the patient.

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20
Q

How are the thoughts sections of the MMSE sub divided?

A

Form - how thoughts are constructed

Content - what e.g: delusion

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21
Q

What may be seen in thought form for a patient with schizophrenia?

A

Thought block
Derailment
Metonyms
Neologisms

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22
Q

What are metonyms and who get them?

A

Word approximation - word holder for book

Dementia, schizophrenia, mania

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23
Q

What may be seen in thought form for a patient with mania?

A

Flight of ideas - understand links
Word salad
Circumstantiality

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24
Q

What is a perversion of thought form?

A

Repition of thoughts or phrase, commonly cannot move away from that line of thought.

Seen in OCD, psychosis, Frontal lobe dementias

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25
Q

What is a delusion?

A

A fixed, false belief that lived outside of cultural, religious context

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26
Q

What is an over valued idea?

A

A thought which takes precedence over other ideas, can be challenged (and therefore isn’t fixed like a delusion)

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27
Q

What is a nihilistic delusion?

A

I do not exist - typically in depression

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28
Q

What is a Somatic delusion?

A

A delusion of symptoms - psychosis

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29
Q

What is a referential delusion?

A

Thinking things are referencing you - TV, Radio

Seen in schizophrenia

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30
Q

Delusion of perception?

A

External stimuli is contested to a delusion - schizophrenia

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31
Q

What is Othello delusion?

A

Partner is being unfaithful

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32
Q

What is Capgras delusion?

A

Someone is replaced by a identical clone

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33
Q

What is Couthards delusion?

A

Belief that they are dead, do not exist or do not have internal organs

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34
Q

What is Ekboms delusion?

A

Belief of infection with insect or parasites

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35
Q

What is Fregoli delusion?

A

Many people are infact the same person

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36
Q

What does Passivity in respect to thought content?

A

Subtype of delusion - thoughts (insertion, control), feeling and actions (impulses and actions)

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36
Q

What are the three core symptoms of depression according to ICD-10 criteria?

A

Low moodAnhedoniaAnergia/fatigue

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37
Q

What is a perception?

A

The process of turning an external stimuli into a meaningful psychological information

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37
Q

Other than the core symptoms what are some other features of depression?

A

Disturbed sleep with early morning wakeningPoor concentration Low self confidencePoor or increased appetiteSuicidal thoughts or actsPsychomotor retardationGuilt or self blame

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38
Q

What is an illusion?

A

Presence of a stimulus which leads to a misperception

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38
Q

Important questions to ask in depression to rule out other things?

A

Hypomanic or manic episodes- bipolar disorderNormal reaction to griefMedical disorders - chronic eg hypothyroidism, MS, alcohol and substance abuse

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39
Q

What might a fluctuation, polymorphic (in respect to modalities) indicate?

A

Delusion

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39
Q

Medication associated with depression

A

Corticosteroids Beta blockersStatinsOral contraceptives Isotretinoin

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40
Q

What Acronym can be used for insight?

A

RATE

Rationalisation
Attribute
Treatment
Engagement

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40
Q

Manic symptoms

A

Symptoms that affect social or occupational functioning or psychosis or hospitalisation distinguishes it from hypomanic Abnormally elevated, expansive or irritable mood Abnormal and persistent increased activity or energy Inflated self esteem, grandiosity, flight of thoughtsUnrestrained buying, spending or gambling spreesNo drugs or other causes

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41
Q

Side effects of sertraline

A

GI upset, dry mouth, decreased libido or sexual activity, reduced ability to orgasm, mild nausea, drowsinessUncommon- weight gain, tremor, palpitations, urinary incontinence, urinary retention

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42
Q

When to refer to psychiatric services ?

A
  • significant perceived risk of suicide, harm to others or severe self neglect - if there are psychotic symptoms- if there is a history or clinical suspicion of bipolar disorder- in all cases where child or adolescent is presenting with major depression
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43
Q

Assessing suicide risk

A

Thoughts of suicide or self harmWhat precipitated attemptWhy then, there and nowPlanned or impulsiveSuicide note leftIntoxicatedAny precautions against discoveryPrevious attempts at suicide or self harmHow do they feel nowDo a PHQ9Is there support at homeAny risks to anyoneAre there children at homeHow do they feel about the future

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44
Q

What increases risk of suicide ?

A

Age over 45MaleFamily history of depression, substance misuse or suicide UnemployedPhysical illnessPsychiatric illnessDivorced or widowed or singlePersonal substance misusePrevious attempts

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45
Q

Treatment of mild depression

A

Do not routinely medicate but consider use if there is moderate to severe recurrent depression or depression has persisted for more than 2-3 months Offer low intensity psychosocial intervention eg self guided CBT, computerised CBT, structured group physical activity programme

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46
Q

Treatment of moderate or severe depression

A

Provide a combo of antidepressant meds and high intensity psychological intervention such as CBT 1. SSRI- sertraline or citalopram2. SNRI- venlafaxine, mirtazapine3. Add an augmenting agent eg second gen antipsychotic such as quetiapine or lithium4. Tri cyclic - amitriptyline 5. MAOI

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47
Q

Important things to check in treatment resistant depression

A

Check diagnosisCheck alcohol or drug abuseFurther antidepressant trialsECTNeurosurgery

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48
Q

Electroconvulsive therapy

A

Most effective treatment for severe depression, life threatening depression, prolonged or severe mania, CatatoniaSE- memory loss, short term retrograde amnesia, confusion, headaches, clumsiness

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49
Q

Generalised anxiety disorder symptoms

A

Psychological- constant worries, pervasive feeling of apprehension or dread, poor concentration, frustration, instability to tolerate uncertainty Physical- trembling, sweating, nausea, SOB, difficulty swallowing, hot flashes, headaches, muscle ache or tension, twitching, irritability, insomnia, feeling in the edge, restlessnessBehavioural-putting things off due to feeling overwhelmed, avoidance, drug taking More than 6 months and not tied to specific situation or OCD

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50
Q

Things to exclude in GAD

A

PhobiaHyperthyroidism AnginaAsthmaExcessive caffeineAlcohol Drugs

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51
Q

Treatment for GAD

A

Simple lifestyle changes- increase exercise, improve work life balance, avoid excess caffeine and stimulant drugs, avoid excess alcohol Long term interventions such as CBT, SSRI self help Benzos not to be used for more than 2-4 weeks due to tolerance and dependence

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52
Q

Benzodiazepines

A

Symptoms of anxiety reduces in 30-90 minutes SE- sedation, reps depression, tolerance, dependence, impaired cognition

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53
Q

Discontinuation of antidepressants

A

Do slowly over a period of at least four weeks to prevent withdrawals and a recurrence of symptoms Stop at an appropriate time and not during times of stress

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54
Q

Antidepressant discontinuation syndrome

A

Common symptoms- dizziness, headache, nausea, lethargyRarer- ataxia, electric shock sensations, EPSE, hypomania or mania

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55
Q

Differentials of psychosis

A

SchizophreniaBipolarDeliriumDrug induced EncephalitisThyroid diseaseBrain tumourHugh dose steroidsTemporal lobe epilepsyDementiaBrain injuryMetabolic disordersLupus Drug withdrawal

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56
Q

Treatment of psychosis

A

Antipsychotic medication CBTSocial support

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57
Q

Questions to ask in psychosis

A

Describe experienceWhen did last feel normalHow have things changed since thenAsk about social life, family, friends, interestsAuditory hallucinations - describe the voice, what does it say, what does it sound like, Other strange or frightening experiencesTv or radio talking about or to youParanoiaSpecial powers?

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58
Q

Side effects of antipsychotics

A

Weight gain, diabetes. Metabolic syndrome, hyperlipidaemiaSedationMovement disordersProlonged QTRaised prolactin (mainly in clozapine)

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59
Q

Monitoring with antipsychotics

A

Weight Waist circumferencePulse BPFasting blood glucoseBlood lipid profileProlactin levelsAssess for movement disordersECG if necessary

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60
Q

What is section 2 of MHA?

A

Person can be detained under section two if suffering from mental health condition which warrants their detention in hospital with a view to the protection of themselves or othersUnder section two if not assessed in hospital before or have not been assessed for a whileLasts 28 days

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61
Q

Section 3 of MHA

A

Detained in hospital for treatmentCan follow a section two Up to 6 monthsForce treatment for first three months but needs reassessing after 3 months

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62
Q

Section 4 of MHA

A

72 hour emergency hold for treatment

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63
Q

Positive symptoms of schizophrenia

A

Delusions Hallucinations

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64
Q

Negative symptoms of schizophrenia

A

Blunted moodReduced speechPoor self careLoss of volition

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65
Q

Thoughts changes in schizophrenia

A

Disorders of speech Tangential Knights moveNeologisms

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66
Q

Causes or increased risk of schizophrenia

A

Birth asphyxia, childhood encephalitis, sexual abuse, cannabis, separation from parent, born in cityIncreased risk in Afro Caribbean and south Asian patientsPoor prognosis gradual onset, strong family history, low IQ, premorbid hisorur of social withdrawal and lack of obvious precipitation

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67
Q

Types of schizophrenia

A

Paranoid- commonest subtype, hallucinations and delusionsHebephrenic- age of onset 15-25, poor organisms, flu testin affect prominent with fleeting fragmented delusions and hallucinations Catatonic- characterised by stupor, posturing, waxy flexibility, negativity Simple and residual- negative symptoms predominant

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68
Q

Risk factors for delirium

A

CHIMPS PHONED ConstipationHypoxiaMetabolic disturbancePainSleepnlessnessPrescriptionsHypothermia or PyrexiaOrgan dysfunction eg hepatic or renal failureNutritionEnvironmental changesDrugs

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69
Q

What to ask in delirium history

A

History of dementia or depression Look for infection Medications- opiates or calcium supplementsVascular problems-previous MI, limb ischaemia (vascular dementia RF)Other presenting complaintsHistory of recurrent admissions

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70
Q

What is involved in a confusion screen?

A

Early warning scoreBP and pulse (check for sepsis, dehydration, hypotension)ObsCT head- bleeds, strokes, SOLBloods- FBC (anaemia, WCC, MCV), U&Es (electrolyte imbalance high calcium, dehydration), LFT (alcohol intake, liver failure), TFTs, calcium, b12, glucose, CXR, blood cultures upfield query sepsis, urine dip for UTI

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71
Q

Differentials for memory problems

A

Alzheimer’sVascular dementiaDementia with Lewy BodiesTraumatic brain injuryFrontotemporal dementiaSemantic dementiaCreutzfeldt Jakob diseaseNormal pressure hydrocephalus Wernicke KorsakoffPseudo dementia secondary to depressionConfusion secondary to infection

72
Q

Tests and tools to assess confusion and cognition

A

Addenbrookes cognitive assessmentMontreal cognitive assessment- MoCAMini mental state examHospital anxiety and depression scale

73
Q

Vascular dementia

A

Usually caused by an acute, such as stroke or TIACan also develop over time from small blockages or slowing of bloodRisk factors- diabetes, hypertension, high cholesterol, CHD, peripheral artery disease Step like decline in memory or cognition Lower the vascular risk- aspirin and statins

74
Q

Alzheimer’s

A

Most common form of dementiaUsually Begins in 60sRisk factors- age, geneticsGradual downward slope decline, starting from memory, thought and language,

75
Q

Clinical presentation of Alzheimer’s

A

Involvement in cortical function eg aphasia, agnosia, apraxiaDecrease of motivation and drive Slow rate of progression CT and MRI show cerebral atrophy Hallucinations, delusions, anxiety, marked agitation, aggression, agitation, wandering, hoarding, sexual inhibition

76
Q

Genetics with dementia

A

Early onset is autosomal dominant so 50% chance of getting it. 50% of those with Down’s syndrome who live to 60 will get AD Late onset genetics- apolipoprotein E (E4 increases risk, E3 normal risk, E2 reduced risk)

77
Q

Pharmacological management of Alzheimer’s and Lewy Body

A

Cholinesterase inhibitors - donepezilRivastigmineMemantine- NMDA receptor blockers Meds slow down progress of the disease Delays worsening of dementia for 6-12 months

78
Q

Non pharmacological treatment for dementia

A

CBTreminiscence therapyAromatherapy Sensory stimulationMusic therapy

79
Q

Criteria for dementia

A

Decline in memory, decline in emotional control or motivation ApathyCoarsening of social behaviourMust not have deliriumMust be present for at least 6 monthsShould be irreversible

80
Q

Lewy body dementia

A

Memory impairmentSleep disturbances- nightmares, aggressive movements, disturbed sleep cycleAutonomic dysregulationVariable cognition Urinary incontinence Visual spatial difficulties, language impairment, dyspraxiaMemory, motor and psychosis Deposits of alpha synucleinMemory difficulties and problems develop at least one year before motor Give rivastigmine and maybe memantine

81
Q

Parkinson’s dementia

A

One third with PD develop dementia Memory and psychotic symptoms develop one year after motor difficulties Also alpha synuclein deposits

82
Q

Front- temporal dementia

A

Frontal lobe- behaviour, problem solving, executive function (planning)Temporal lobe- language, recognising objects and peopleLost inhibitions, lose empathy, apathy, change in eating habits

83
Q

Borderline personality disorder

A

Impulsive aggression, affective lability, self injury and identity diffusionUnstable self image, fears of abandonment, transient psychotic symptoms, Maladaptive patterns of thought and behaviour Treatment- co morbidities such as anxiety and depression, CBT, DBT,

84
Q

Mental state exam

A

Appearance- overall impression, physical conditions suitability of dress, cleanlinessBehaviour- appropriateness of behaviour, distractibility, eye contact, rapportSpeech- rate, rhythm, volume, tone, coherence, relevance, quantity and fluency, abnormal associations, flight of ideasMoodPerception- delusional perception, illusion, hallucinationThought- form- linear, tangential, circumferential, derailmentContent- suicidal or violent thoughts, delusions, overvalued ideasCognition- alert, attention concentration, orientation to time and place, short term memory Insight- recognition of illness and need for treatment

90
Q

What are the Core symptoms of depressive disorder?

A
  • Persistent low mode - Loss of pleasure/ interest- Fratigue/ low energy
91
Q

What other (not core) symptoms of depression are there?

A
  • Insomnia - early morning waking - Loss concentration - Change in appetite - Suicidal ideation - Psychomotor retardation- Guilt
92
Q

What investigations might be done for a low mood?

A

Bedside - BP, Pulse, ECG, BMI Bloods - Baseline, TFT, HbA1c, Vit B12, Folate Special - PHQ-9

93
Q

What is the PHQ-9?

A

A questionaire used to measure the severity of depression

94
Q

What treatment are there for depression?

A

Conservative - lifestyle, watch and waitMedical - SSRI, CBT

95
Q

What are the common side effects of SSRI?

A

DrowsinessDry mouth GI upset Nausea Decreased labido, anorgasmia

96
Q

What RF increase risk of suicide?

A

Divorced, widowedUnemployed Illness - psych or physical Substance >45yo Previous attempt Male

97
Q

How should a SSRI be stopped?

A

Tapering dose over a minimum of 4wAvoid during stressor events

98
Q

What are the symptoms of SSRI withdraw?

A

Mood changesRestlessness NauseaLethargyHeadaches Dizziness

99
Q

What differentials are there for low mood/ depression?

A

Depressive disorderBipolar Grief reaction Schizophrenia/ Psychosis Organic cause

100
Q

What organic causes are there for depression?

A

hypothyroidism CushingsAnaemia Drugs…

101
Q

What drugs can contribute for depression?

A

Steroids Interferon-beta - MS treatment PPIAnti-hypertensiveDRUGS AND ALCHOL

102
Q

What SSRI is used post MI?

A

Sertraline - least affect on QT interval and electrolytes

103
Q

What additional side effects are there fore SNRI over SSRI?

A

Increased drowsiness Increase BPIncrease dry mouth

104
Q

What SSRUs used for young people and DM?

A

fluoxetine

105
Q

What electrolyte abnormality can SSRIs cause?

A

Hyponatraemia via SIADH

106
Q

In elderly what causes are there in particular for low mood?

A

The 3Ds Dementia Depression Drugs

107
Q

Why does SSRI increase bleeding risk?

A

serotonin receptors on platelets, can lead to thrombocytopenia

108
Q

How long does an SSRI take to become effective?

A

2-4 weeks

109
Q

What is the bigger SE with mtrazapine?

A

Weight gain

110
Q

What SSRI is used in patient with an eating disorder?

A

Fluoxetine as less weight gain

111
Q

What are the indications for ECT?

A

Treatment resistance Pregnancy (benefit:risk) Quick response needed

112
Q

What are the contraindications for ECT?

A

Any contraindications for general anaesthesia

113
Q

What is the main side effect of ECT?

A

retrograde amnesia

114
Q

What structure for a risk assessment should be used?

A

1 - Now/ current episode2 - How they feel now 3 - Past attempts/self harm

115
Q

How long should SSRI be continued if there is low risk of depression relapse?

A

6-9 months

116
Q

How long should SSRI be continued if there is high risk of depression relapse?

A

2 years

117
Q

What is serotonin syndrome?

A

Serotonin excess leading to autonomic dysfunction, abdominal pain, myoclonic seizures, cardiovascular shock

118
Q

What are the symptoms of anticholinergics?

A

Dry mouth, blurred vision, urinary retention, confusion

119
Q

What are the symptoms of anti-adrenergics?

A

postural hypotension, sexual dysfunction, tachycardia

120
Q

What are the symptoms of anti-histamines?

A

Sedation, weight gain

121
Q

When are MAOI used?

A

severe depressionWatch out for hypertensive crisis

122
Q

What classes of mood stabilisers are there?

A

Lithium Anticonvulsanst - NaValproate, Carbamazapine, lamatrogine Antipsychotics - Olanzapine, resperidone, Quetiapine

123
Q

What is the advantage of lithium?

A
  • Prophylaxis of mania and depression - Decreases suicide risk
124
Q

What risk are there for lithium in pregnancy?

A
  • Teratogenic in 1st trimester- Ebsteins anomaly
125
Q

What monitoring is required for lithium?

A

Trough levels UE - creatinineTSH

126
Q

What SE are there of lithium?

A

GI distress - nause, D&V Tremor ADH antagonism - polydipsia, polyuria (DI)

127
Q

What advice should be given to patient with Li treatment?

A

Teratrogenic Drink plenty of water

128
Q

What is Autistic spectrum disorder (ASD)?

A

A developmental triad of - impaired social interactions - Impaired communication - rigidity in thinking

129
Q

What is the Triad for attention deficit disorder (ADHD)?

A
  • Inattention- Impulsivity - Hyperactivity
130
Q

What criteria for ADHD diagnosis?

A

Symptoms with significant functional impairment for at least 6m under the age of 7y years.

131
Q

Treatment of ADHD?

A
  • lifestyle, information- behavioural stratergies- Methyl phenidate
132
Q

What should be considered when the diagnosis is not ASD or ADHD?

A

Behavioural issuesAdditionally usually seen in one environment (unlike ASD ADHD)

133
Q

7yo struggling in large groups, fidgets, aggressive at school, Picky with food and difficult getting to sleep at home. Keeps running away when going shopping with mum. MLD?

A

ADHD

134
Q

4yo with delayed speech seen by SLT. Does not make friends and plays with same cars. flaps hands, picky with food at home. MLD?

A

ASD

135
Q

Fussy with food, disobedient to mother, fights sister. Doesn’t stay on naught step. Normal at day care. MLD?

A

Behavioural issues, isolated to one environment (the home).

136
Q

What assessment tool is used for ADHD?

A

CONNERS questionnaire

137
Q

What assessment tool can be used for ASD?

A

ADIADOS-2DISCO

138
Q

what does the Sally Anne test assess?

A

Theory of the mind - assessment of deficits in empathy and understanding other. Indicates ASD

139
Q

What pharmacological treatment is there fore aggressive behaviour in children?

A

Respiridone

140
Q

What are positive symptoms of psychosis?

A

Hallucinations Delusions Thought disorders

141
Q

What are the negative symptoms of Psychosis?

A

The A’s: Apathy Affect - flat Anhedonia Avolition Alogia - poverty of speech

142
Q

What is the pathophysiology of psychosis?

A

Dopamine deficit in mesocortiyal pathway leading to negative symptoms. dopamine excess in the mesolimbic pathway leading to positive symptoms.

143
Q

What are the extrapyramidal SE of antipsychotics?

A

Dystonia Akanthisia Psuedoparkinsons Tardative dyskinesia

144
Q

What is Akathisia?

A

Restlessness, compulsion to move

145
Q

What examples of tardative dyskinesia?

A

Lip smoking Tongue protrusion Chorea pelvic thrusting

146
Q

What is are the symptoms of hyperprolactinaemia?

A

gynecomatia, galactorrhea, decreased labido, interference with labido

147
Q

What is the pathophysiology of a raised prolactin?

A

Dopamin antagonism in the tuberoinfundibular pathway stops the inhibition of prolactin

148
Q

Psych patient has a fever, with altered mental state and autonomic dysfunction. MLD?

A

Neuroleptic malignant syndrome

149
Q

What complications are there from neuroleptic malignant syndrome (NMS)?

A

Rhabdomyolysis Hyperkalaemia Renal failure Seizures

150
Q

What blood test can be done to confirm NMS

A

CK - should be raised

151
Q

How is NMS treated?

A
  • Cessation of medication - ICU - Active cooling - Medications
152
Q

What medications are used for NMS?

A

Bromocriptine Dantrolene Amantadine

153
Q

What do typical antipsychotics target?

A

Antagonism of D2

154
Q

What do atypical antipsychotics target?

A

Antagonism of dopamine and serotonin (but in an atypical way)

155
Q

Why is the cardiovascular risk greater in atypical antipsychotics?

A

high cholesterolhigh triglycerides hyperglycaemia

156
Q

What monitoring is required for Clozapine?

A

FBC - agranulocytosis - weekly then biweekly for 6m LFTCardiovascular risk

157
Q

What DD for psychosis?

A

Schizophrenia DementiaDrugsSevere depression Mania - bipolar

158
Q

What treatment is used for first episode Psychosis?

A

AntipsychoticCBT or gamily intervention

159
Q

What are the common SE of antipsychotic medications?

A

Raised prolactinSedation DM

160
Q

What is section 135 used for?

A

For Police to gain asses to property

161
Q

What is section 136 used for?

A

Removal of a patient from a public place

162
Q

What is section 2 used for?

A

Admission and assessment for uptimes o 28 days. Can start treatment

163
Q

What is section 3 used for?

A

Admission and Treatment for 3m before 2nd opinion.

164
Q

What is a section 4 used for?

A

Assessment for treatment. 72 hours. Recommendation by doctor

165
Q

What is section 5 (2) for?

A

RN for emergency holding for 6hours

166
Q

What is section 5(4) for?

A

Doctor for emergency holding for 72 hours.

167
Q

Which have more EPSE, typical or atypical antipsychotics?

A

typical antipsychotics have more EPSE SE.

168
Q

What type of antipsychotic is clozapine?

A

typical

169
Q

What is included in a risk assessment?

A

HealthSelf Others

170
Q

What is Lofepramine?

A

An SNRI with a lower overdose profile

171
Q

What is included in the health assessment?

A

Nutrition Dehydrations Medical conditions and medication taking

172
Q

What is Donepezil, rivastigmine and galantamine?

A

Acetylcholinesterase inhibitors

173
Q

What is memantine?

A

A glutamate receptor antagonist

174
Q

When is rivastigmine used for memory?

A

Parkinson’s diseaseLewy body dementia

175
Q

When Memantine used?

A

Severe a Alzheimers disease or AChE intolerance/ contraindication

176
Q

What is the cholinergic hypothesis?

A

Deteriorating cognition is associated with decrease in cholinergic neurones and therefore ACh

177
Q

What is the MOA of memantine?

A

Decreasing glutamate decreases excitotoxicity

178
Q

Where is donepezil metabolised?

A

At the liver - therefore affected by liver enzymes inducers etc.

179
Q

Where is mamentine metabolised?

A

it is excreted from kidney, therefore do UE

180
Q

Side effects of cholinergic activity?

A

Nausea, vomiting, diarrhoea Insomnia Dizziness Urinary incontinence

181
Q

What may make the SE of AChE inhibitors worse?

A

Beta blockers

182
Q

What may make the side effects of mamentine worse?

A

Glutamate receptor antagonists like ketamine. Can lead to a pharmacological psychosis

183
Q

What investigation should be done before starting AChE inhibitor?

A

ECG - QTc interval, LBBBUE - mamentine

184
Q

When should AChE inhibitors be prescribed with caution?

A

Gastric ulcer seizures

185
Q

hat are the side effects Clozapine side effect?

A

Sedation Hyper-salivationConstipation

186
Q

Why is an ECG used for antipsychotics?

A

QTc prolongation Myocarditis

187
Q

How long does psychosis have to last until diagnosable as schizophrenia?

A

1 month

188
Q

Why is sodium valproate used in psychiatry with an antipsychotic?

A

Used for low mood Treatment of a lower seizure threshold due to antipsychotics

189
Q

What is he time course of pupura psychosis?

A

Within 2 weeks of birth. Insidious onset with behavioural and confusion learning upto psychosis.Thought to be part of underlying bipolar/effective disorder.

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