Other Psych Topics Flashcards
What is supportive therapy?
Explanation and reassurance
What is counselling?
Can be more problem focused, aims to resolve current life difficulties
What is DBT?
Form of CBT developed specifically for people with PDs
What is IPT?
Interpersonal therapy - addresses relationships
Depression and bulimia
What is psychodynamic psychotherapy?
Brings unconscious feelings to surface - problems rooted in childhood experinces
Relationship in therapy mirrors that of patient with people in real life = transference
What is CBT?
Talking therapy - structured, practical and understandable.
Involves problem solving and goal definition.
Based on the cognitive model.
Based in the here and now and is based on scientific evidence.
What is the cognitive model?
Not the situation that causes problems but the way we appraise it.
How we think about something affects mood, physiology and behaviour - all interlinked.
Early experiences –> core beliefs –> rules for living –> thoughts/beliefs –> behaviours –> emotions –> situations
What does CBT involve?
Problem definition Goal formulation Formulation Homework Feedback Collaboration Experiments Monitoring Summarising Being active Thought challenging
Name some unhelpful thinking styles?
Jumping to conclusions Catastrophisation All or nothing thinking Overgeneralisation Labelling Personalisation Magnification and Minimisation
How does CBT apply to patients?
Helps identify a problem they wantto work on
Define problem in terms of thoughts, feelings, behaviours and body responses
Practical goal setting
Formulation
Look at how they can make changes in their lives
What can changes in CBT involve?
Identifying problematic thought patterns
Identifying problematic behaviours and learning to behave differently
Behavioural experiments
Stop being critical of oneself
Learning that thoughts are just strings of words with no factual basis
Conditions for detention under MHA?
o Must be suffering from mental disorder
o Must be at risk to self/others or serious exploitation
o Must be unwilling to go to hospital voluntarily
o Alternatives must have been considered
o Recommendation by 2 doctors to the applicant (AMHP)
Conditions of MCA?
o Weigh up the information
o Retain
o Understand
o Communicate
Time and decision specific
All persons assumed to have capacity
Practicable steps must be taken to help them make a decision
Any action taken on behalf of person lacking capacity must be in patient’s best interests
What do you need to consider when making best interests decisions?
- Consider persons past/present/future wishes
- Beliefs and values
- Views of anyone named by person
- Anyone engaged in caring for the person
- Lasting power of attorney
- Deputy appointed by the court
- IMCA
Section 2 MHA?
Admission for assessment
AMHP + 2 registered doctors* (1 must be section 12 approved)
Maximum 28 days
Appeal within 14 days
Section 3 MHA?
Admission for treatment
AMHP + 2 registered doctors*
Maximum 6months
After 3months must obtain consent or recommendation of second doctor
Renewable – can detain people for life but must renew 6monthly
Appeal within first 6months on 2 occasions, then yearly then mandatory appeal every 3yr
Section 4 MHA?
Admission for assessment in cases of emergency
AMHP + 1 registered doctor
Can detain but not treat for up to 72hr
Section 5 MHA?
Detention of patients already in hospital
5(2): holding power so that MHA assessment can be carried out lasts 72hrs
5(4): registered mental health nurse for maximum 6hrs
Section 7 MHA?
Guardianship
Can require patient to
- live in a specified place
- attend specified places for training or medical assessment
- health worker can see them in their home
Doesn’t include treatment
Section 17 MHA?
Supervised community treatment order (CTO)
Aim to support patients detained on S3 and are likely to disengage from treatment on discharge
Ability to recall them to hospital if don’t meet agreed conditions
Section 135 MHA?
Warrant to search for and remove patients
Remove them to place of safety if concerns of neglect or issues of safety
Valid for 72hours
Section 136 MHA?
Mentally disordered persons found in public place
Police officers discretion
Valid for 72hours
Features of alcohol withdrawal?
- Compulsion to drink
- Primacy of drinking over other activities
- Stereotyped pattern of drinking (narrowing of repertoire)
- Increased tolerance to alcohol
- Repeated withdrawal symptoms
- Relief drinking to avoid withdrawal symptoms
- Reinstatement after abstinence
Biological consequences of alcohol dependence?
• Acute withdrawal symptoms
o Agitation, tremor, sweating, nausea, retching.
• Liver disease/pancreatitis
• Vitamin deficiency/Wernicke’s encephalopathy
Psychological consequences of alcohol dependence?
Anxiety
Depression
Memory problems (alcoholic dementia/Wernicke’s/Korsakoff’s)
Social consequences of alcohol dependence?
- Financial problems
- Housing
- Family/relationships
- Work
Forensic consequences of alcohol dependence?
- Drink driving
- Drunk-related offences
- Other substance misuse
Risk in alcohol dependence?
- Self-harm/suicide
- Risk to others
- Safeguarding – children!
Short term biological management of alcohol dependence?
- Oral thiamine + vitamin B
- Parenteral vitamins if concerned about Wernicke’s
- Detox with chlordiazepoxide 20-30mg QDS, reducing regime over 5-7 days – use lorazepam if significant liver disease.
Short term psychological management of alcohol dependence?
- Simple counselling and advice
2. Motivational interviewing (esp if in contemplation phase)
Short term social management of alcohol dependence?
• Support to access services – housing, citizens advice bureau etc.
Long-term biological management of alcohol dependence?
- Disulferam 200mg OD – aversive agent, blocks alcohol dehydrogenase enzyme – will vomit if ingest alcohol – 6 months to 1 year.
- Anti-craving agents
o Acamprosate 666mg TDS – enhances GABA neurotansmission
o Naltrexone 50mg OD – opitate antagonist
Long-term psychological management of alcohol dependence?
• Relapse prevention strategies
o CBT
o Social network and behavioural therapy remove from social drinking, have a contact to call when cravings are severe.
Long-term social management of alcohol dependence?
- Alcoholics anonymous
* Rehabilitation
What is a dissociative/conversiond disorder?
Traumatic event results in a disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment
What is a dissociative amnesia?
Loss of memory commonly for a traumatic or stressful event
What is a dissociative fugue?
Memory loss or confusion about personal identity or assumption of another identity
May last several months
When it ends the memory of the fugue is lost
What is a dissociative stupor?
Motionless and mute, no response to stimulation
What is a dissociative motor disorder?
Commonly involve paralysis of muscle groups
Atasia abasia: inability to stand or walk
What is dissociative anaesthesia/sensory loss?
Commonly glove and stocking distribution
What are dissociative convulsions?
Psuedoseizures with no organic basis
What is Ganser’s syndrome?
Approximate answers (2+2=5), absurd statements, confusion, hallucintions, psychogenic Sx
Shows that they know what the question means but are answering incorrectly
What is a somatoform disorder?
Physical symptoms which cannot be accounted for by a physical disorder or other psychiatric disorder and are thought to result from psychological factors
What is a somatisation disorder?
Long history of multiple and severe physical symptoms that cannot be accounted for by a physical or psychiatric disorder
F > M
Briquet’s syndrome, St louis hysteria
What is hypochondria disorder?
Fear or belief of having a serious physical disorder despite medical reassurance to the contrary
Includes body dysmorphic disorder
RF: male, medical students
What is persistent somatoform pain disorder?
Chronic pain that cannot be accounted for by a physical disorder or other psychiatric disorder
What is factitious disorder
Sx which are manufactured or exaggerated for the purpose of assuming the sick role
Munchausen Syndrome
What is malingering?
Sx which are manufactured or exaggerated for a purpose other than assuming the sick role e.g. to evade to police, get compensation
Features of lithium toxicity?
Severe N+V Severe diarrhoea Reduced appetite Fine tremor Ataxia Dysarthria Blurred vision Drowsy Confused Seizures Collapse
What can lithium toxicity be precipitated by?
Drugs: ACEi, NSAIDS, diuretics
Renal failure
UTI
Dehydration
Investigations in lithium toxicity?
Lithium levels >1.5
Check renal function
U+E, eGFR and creatinine
Management of lithium toxicity?
STOP LITHIUM
Fluid replacement to promote diuresis
Consider dialysis
Treat the cause
Features of serotonin syndrome?
Hyperthermia Autonomic dysfunction Rigidity Myoclonus Encephalopathy Diaphoresis
What is serotonin syndrome precipitated by?
Serotonergic agents
Combination of agents which stimulate serotonin receptors e.g. SSRIs
Investigations in serotonin syndrome?
No specific Ix
Check renal function
Management of serotonin syndrome?
STOP THE SEROTONERGIC AGENT IV fluids Close monitoring Cooling blankets for hyperthermia Anticonvulsants for seizures Clonazepam for myoclonus Nifedipine for HTN
Most recover in 24 hours
Features of neuroleptic malignant syndrome?
Fever
Altered mental state
Muscle rigidity (lead pipe)
Autonomic dysfunction
What can precipitate neuroleptic malignant syndrome?
Dopaminergic agents
Rapid antipsychotic inititation or dose increase
Withdrawal of antiparkinson meds
Investigations in neuroleptic malignant syndrome
Creatine phosphokinase elevated in the 1000’s
ECG: tachycardia
ABG: metabolic acidosis
Management of neruoleptic malignant syndrome?
STOP ANTIPSYCHOTIC
Benzodiazepines for agitation Supportive measures: O2, fluids… Cooling blankets for hyperthermia IV sodium bicarbonate to prevent renal failure Dantrolene/lorazepam for rigidity Close monitoring Bromocriptine prophylaxis
Potential consequences of neuroleptic malignant syndrome?
Respiratory failure CV collapse Renal failure Seizures Arrhythmias DIC 20-30% mortality rate if untreated
What is behavioural activation?
Behavioural activation is about not waiting till you feel better to start doing stuff or will never do anything and stay in viscious cycle
Treatment involves getting people to act according to a plan rather than how they feel and involves DOING things
What is interpersonal therapy?
Focuses on interpersonal difficulties, roles and grief
Brief, pragmatic and highly structured
What is psychodynamic therapy?
Based on Freud
Focus on past conflicts contributing to current difficulties – insight orientated
Neutral therapist, focus on patient – therapist relationship
- Transference: bring past feelings to present interaction
- Counter transference: feelings in therapist given by patient
Allow to work through problems in a safe relationship
What is motivational enhancement therapy used for?
o Addictions
o Compliance
o Changing behaviour
What is dialectical behaviour therapy (DBT)?
Borderline PD
Managing feelings and self-harm
What is eye movement desensitisation used for?
PTSD
What is family therapy used for?
Seeing and treating people in context
Children, eating disorders, psychosis
Improve communication within family
What is group therapy used for?
Support/adjustment following diagnosis
Self help e.g. AA, weight watchers
CBT based groups: anxiety, depression, assertiveness
Counselling on ECT?
Risks associated with GA
Adverse effects = memory impairment
Risks of not receiving ECT
Informed consent and right to withdraw consent at any time
Cocaine
Class? Effects? Negative effects?
A
On top of the world, wide-awake, confidence, reduces hunger, short-acting.
Tachycardia, raised temperature, MI, HF, hypertension, seizure, depression, anxiety, panic attack, paranoia.
Heroin
Class? Effects? Negative effects?
A
Warm feeling, mild euphoria, relaxed, drowsiness, analgesia, constricted pupils.
Constipation, addiction/dependency, respiratory depression, hallucination
Withdrawal effects of heroin?
Sweating, malaise, anxiety, depression, akathisia, excessive yawning/sneezing, tears, rhinorrhoea, insomnia, cold sweats, chills, aching, nausea, vomiting, diarrhoea, involuntary limb spasms, cramps.
MDMA
Class? Effects? Negative effects?
A
Energised, happy, alertness, increased affection, chatty, dilated pupils.
Anxiousness, panic attacks, confused episodes, paranoia, psychosis, tachycardia, hyperpyrexia, electrolyte disturbances, de- and over-hydration.
Psilocybin mushrooms
Class? Effects? Negative effects?
A
Disorientation, lethargy, giddiness, relaxed, euphoria, perceptual and sensory changes, hallucinations.
Poisoning, death, nausea, disorientation, diarrhoea, stomach pains, depression, anxiety, paranoia, panic attacks, ‘bad trips’, flashbacks.
Ketamine
Class? Effects? Negative effects?
B
NMDA antagonist. Relaxation, altered bodily sensations, floating feelings, dissociation, altered perceptions, hallucinations
Anaesthetic (injectable GA) – ulcerative cystitis, bladder pain, memory problems, dependency, panic attacks, confusion, agitation
Cannabis
Class? Effects? Negative effects?
B
Chilled out, relaxed and happy, giggles, very talkative, hungry
Cravings & psychological dependency, anxiety, paranoia, poor concentration, poor memory, psychosis, precipitate schizophrenia.
Amphetamine
Class? Effects? Negative effects?
B
Wide awake, excited, talkative, reduced hunger/appetite, more energy.
Dependency, insomnia, poor concentration, anxiety, depression, irritability, aggression and paranoia, psychosis, cardiac problems.
Mephedrone
Class? Effects? Negative effects?
B
Feel alert, confident, talkative, euphoric, increased affection, reduced appetite.
Nausea, anxiety, headache, agitation, hallucinations, seizures, reduced peripheral circulation, epistaxis, addiction, paranoia, self-harm
Benzodiazepines
Class? Effects? Negative effects?
C
Relaxed, calm, less anxious, sedated
Respiratory depression, falls, hangover, memory loss, sedation, death with injection
GHB/GBL
Class? Effects? Negative effects?
C
Euphoria, reduced inhibitions and drowsiness.
Nausea, dizziness, drowsiness, agitation, visual disturbances, respiratory depression, unconsciousness, coma, death (esp if mixed with alcohol)
Amyl nitrate
Class? Effects? Negative effects?
N/A
Rush/high
Hypotension, unconsciousness, nausea, headache, confusion, arrhythmia and death.
What are acute dystonias? Treatment?
Often painful spastic contraction of certain muscles or muscle groups most commonly affecting the neck, eyes and trunk. For example, tongue protrusion, grimacing, torticollis.
May respond to anticholinergics (procyclidine).
What is akasthisia? Treatment?
Distressed feeling of inner restlessness manifested by fidgety leg movements, shuffling of feet, pacing etc.
May respond to anticholinergics, propranolol, cyprohepatadine (antihistamine), benzodiazepines or clonidine.
What is parkinsonism? Treatment
Parkinsonian triad of tremor, muscle rigidity and bradykinesia.
May respond to anticholinergics.
What is tardive dyskinesia? Treatment?
Involuntary, repetitive, purposeless movements of the tongue, lips, face, trunk, and extremities that may be generalised or affect only certain muscle groups, typically orofacial muscle groups. TD occurs after several months or years of antipsychotic treatment and is often irreversible.
No consistently beneficial treatment and may be exacerbated by anticholinergics.
