MENTAL HEALTH Flashcards
Lewy body dementia treatments
Donepezil is a cholinesterase inhibitor which is the first-line treatment for cognitive impairment and behavioural symptoms in DLB.
Carbidopa/Levodopa are dopaminergic agents used to treat motor symptoms which present in Lewy body dementia
Clonazepam is used to treat REM sleep behaviour disturbances and should be given in low doses 30 minutes before bedtime.
Sertraline is an SSRI which are the preferred drugs to treat depression with Lewy body dementia because they have limited side-effects and favourable pharmacokinetics
Hypertrophic obstructive cardiomyopathy - is associated with
Wolff-Parkinson White
kidny stones gold standard investigation
The gold standard investigation is a spiral non-contrast CT scan.
Adult-onset Still’s disease features
Features arthralgia elevated serum ferritin rash: salmon-pink, maculopapular pyrexia typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash lymphadenopathy rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
Adult-onset Still’s disease management
Management
NSAIDs
should be used first-line to manage fever, joint pain and serositis
they should be trialled for at least a week before steroids are added.
steroids
may control symptoms but won’t improve prognosis
if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
Short-term side-effects of ECT
Short-term side-effects headache nausea short term memory impairment memory loss of events prior to ECT cardiac arrhythmia
Erotmania
specific form of delusional disorder that is characterised here by the patient’s belief that a famous actor is in love with her, alongside no other symptoms suggesting psychosis or mood disturbance.
Other subtypes of delusion include grandiose and persecutory.
Antipsychotics in the elderly
ncreased risk of stroke and VTE
Anorexia features
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
r borderline personality disorder
Efforts to avoid real or imagined abandonment
Unstable interpersonal relationships which alternate between idealization and devaluation
Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
Recurrent suicidal behaviour
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts
personality disorder management
Management
PDs are often thought to be ‘untreatable’ by definition
however, a number of approaches have been shown to help patients, including:
psychological therapies: dialectical behaviour therapy
Schizotypal
Ideas of reference (differ from delusions in that some insight is retained) Odd beliefs and magical thinking Unusual perceptual disturbances Paranoid ideation and suspiciousness Odd, eccentric behaviour Lack of close friends other than family members Inappropriate affect Odd speech without being incoherent
Schizoid
Indifference to praise and criticism Preference for solitary activities Lack of interest in sexual interactions Lack of desire for companionship Emotional coldness Few interests Few friends or confidants other than family
Histrionic
Inappropriate sexual seductiveness
Need to be the centre of attention
Rapidly shifting and shallow expression of emotions
Suggestibility
Physical appearance used for attention seeking purposes
Impressionistic speech lacking detail
Self dramatization
Relationships considered to be more intimate than they are
NICE published guidelines on the management of schizophrenia in 2009.
Key points:
oral atypical antipsychotics are first-line
cognitive behavioural therapy should be offered to all patients
close attention should be paid to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients (linked to antipsychotic medication and high smoking rates)
Rapid tranquillisation
- intramuscular lorazepam on its own or intramuscular haloperidol combined with intramuscular promethazine for rapid tranquillisation in adults.
- If there is insufficient information to guide the choice of medication for rapid tranquillisation, or the service user has not taken antipsychotic medication before, use intramuscular lorazepam.
haemophilia A cause
clotting factor VIII deficiency
haemophilia B cause
which is caused by a factor IX deficiency
Typical symptoms of haemophilia may include
Severe epistaxis
Bleeding gums
Haematuria: gross or microscopic (i.e. detected on dipstick).
Intra-articular or intramuscular bleeds: commonly affected joints include the knees, ankles and elbows.
Excessive bruising/ecchymoses, contusions or spontaneous haemorrhage during childhood play.
Prolonged bleeding after a surgical or dental procedure, or post-venepuncture.
Findings associated with haemophilia include:
Normal platelet count on FBC
Normal prothrombin time (PT), bleeding time (BT), fibrinogen levels and von Willebrand factor levels.
Prolonged activated partial thromboplastin time (APTT): although this can be normal in mild disease.
Reduced factor VIII or factor IX activity level: for haemophilia A or B respectively.
haemophilia vs VWD
Haemophilia A/B/C only APPT increased
VWD Bleeding time increase APPT normal or increased
ADHD management
DHD is managed with behavioural techniques and stimulant medicines such as methylphenidate. These medicines increase function of the frontal lobe to increase executive function to increase attention and reduce impulsivity.
ADHD may impair a child’s ability to perform well at school, and they might benefit from extra support. However, ADH does not generally affect intellectual ability.
e Mental Capacity Act - 5 key principles
A person is assumed to have capacity unless proven otherwise
Steps must be taken to help a person have capacity
An unwise decision does not mean a person lacks capacity
Any decisions made under the MCA must be in the person’s best interests
Any decisions made should be the least restrictive to a person’s rights and freedoms
Munchausen’s syndrome:
patients intentionally fake signs and symptoms (e.g. adding blood to urine and complaining of pain) in order to gain attention and play “the patient role”.
ECT in depression
For severe depressive episodes that are life-threatening or require a rapid response, NICE guidelines recommend Electroconvulsive Therapy (ECT).
It is not known exactly how ECT works but there is evidence to suggest that the induced seizure has more of a treatment effect than ‘placebo’ ECT or ‘sham’ ECT. Short-term side effects of ECT can include headache, muscle aches or pains, nausea, temporary memory loss, confusion. Long-term side effects of ECT can include persistent memory loss. Due to the induced seizure, there is a risk of damage to the teeth or mouth, and due to the general anaesthetic, there is a small risk of death.
CO2 poisoning treatment
Treatment is largely supportive, with 100% oxygen and early intensive care involvement. Hyperbaric oxygen can be considered in more serious cases.
Obstructive sleep apnoea
A diagnosis of OSA is made using sleep studies.
Treatment of OSA includes lifestyle changes such as weight loss and smoking cessation; night time CPAP and consideration of surgical interventions.
nausea, vomiting, colicky pain and increased secretions can be treated with a number of agents;
Hyoscine butylbromide
Octreotide
Ondansetron
Atropine
a fib management
According to the NICE guidelines;
Rate control should be offered first line, except for patients with new onset AF, reversible causes or heart failure. Rate can be controlled using a beta blocker or calcium channel blocker
Digoxin should be considered in patients with heart failure
Amiodarone should not be given for long term rate control
Rhythm control can be pharmacological or by electrical rhythm control
DC cardioversion should be done in patients with unstable atrial fibrillation
Patients with new onset AF should be started on anti-coagulation as they are high risk for stroke
