PACES psych Flashcards
depression counselling
- persistently low mood that impacts on day to day functioning
- very common, every year 1/4 suffer from MH problem
- address social needs
- explain role of psych therapy (CBT = talking therapy based on principle that thoughts, mood and behaviour are intertwined)
- role of medication (takes a number of weeks to work, can make feel worse first, F/U in 1 week, warn about side effects)
- advise about crisis resolution and home treatment team
- support: mind.co.uk, Samaritans
BPAD counselling
- consider admission and section if risky
- explain is a condition where people experience extremes of emotion for variable lengths of time
- important to control
- both extremes can lead to making certain decisions and taking risks that you would otherwise regret
- medications available that help balance the chemicals in the brain
- advice about crisis resolution team and samaritans
alcohol misuse counselling
- establish risks (driving, suicide, dependents)
- assess social issues (SAFEGUARDING)
- establish goals (elimination or moderation)
- symptoms of withdrawal worse in 48 hours, should pass after 3-7 days
- advise against stopping drinking abruptly
- referral to drugs and alcohol service
- assisted withdrawal uses benzodiazapines, psych treatment, relapse prevention and social support
opiate withdrawal counselling
- explain worth getting tests done for blood-borne diseases, offer vaccinations
- features of withdrawal (restlessness, anxiety, sweating, diarrhoea, abdo cramps, N/V, palpitations)
- begin within 24 hours, peaks after 2-3 days, should be better by 1 week
- detox involved giving a subsititue that should lessen symptoms of withdrawal
- symptomatic treatment given to reduce nausea, diarrhoea
- psych therapies to prevent relapse and address underlying MH issues
- role of a key worker to support patient through detox
- support: narcotic anonymous, SMART recovery
Benzo misuse counselling
- explain harmful effects of benzos (in long term can cause worsening of psych symptoms and cognitive impairment)
- can be reduced very gradually
- role of CBT to address underlying MH and provide help on sleep hygiene
- advice against driving if feeling drowsey
main psych in Dementia
group cognitive stimulation
group reminiscence therapy
drugs to avoid in forms of dementia
no Ach inhibitors in frontotemproral
no anti-psychotic in LBD
panic disorder management ladder
- recognition and diagnosis
- treatment in primary care (self help)
- review, consideration of alternative treatments (CBT + SSRI)
- review and referral to specialist mental health services
- care in specialist mental health services
PTSD counselling
- condition that occurs after trauma
- characterised by flashbacks, hyperarousal, avoidance
- impact on patients life
- trauma focused CBT for 8-12 sessions: explores how trauma has affected belief systems and outlook
- medications e.g. sertraline and mirtazapine
- consider group therpay
- follow up
SSCM, MANTRA
specialist supportive clinical management
Maudsley Anorexia Nervosa treatment for adults
anorexia counselling
- explain characterised by morbid fear of fatness, reduced calorie intake and a low BMI
- risks of anorexia = osteoporosis, infertility and cardiac problems (arrythmias)
- psychological therapy options (CBT-ED, SSCM, MANTRA, family therapy)
- involves exploring through processes driving these behaviours
- set an eating plan and feasible weight gain targets
- medical therapy if depressed e.g. fluoxetine
- support: BEAT
management of bulimia nervosa
- referral for specialist care
- BN-focused guided self help
- if ineffective after 4 weeks = ED-focused CBT
- trial of high dose fluoxetine
postnatal depression counselling
- consider admission to mother and baby unit if severe
- involve HTT and health visitor
- likely due to hormonal changes
- occurs in 1/10 women
- address any concerns and provide support at home if needed
- explain psych treatment (CBT)
- medical treatment = sertraline which is safe in breastfeeding
- prognosis = most recover in moneth
- postnatal community mental health team will be involved
puerperal psychosis counselling
- ADMIT
- explain that may be linked to hormonal changes causing chemical imbalances in brain
- treatment is anti-psychotics
- admission to mother and baby unit is needed to keep both safe
- recovery usually takes 6-12 weeks
- 30% risk of recurrence
EUPD counselling
- explain is characterized by increased sensitivity to emotions
- likely to be linked to stressful life circumstances and experiences
- personality disorders are often underdiagnosed (10% have personality disorder)
- dialectical beahvioral therapy helps (helps you understand your thought processes and teaches you not to view things as black and white, teaches skills to cope with difficult emotions)
- use of therapeutic communities (meet other people with similar issues and support each other in recovering)
- crisis management: numbers for crisis team, community mental health nurse, out-of-hours social worker, Samaritans
- support: mind.co.uk
depression history
ask all core symptoms
biological symptoms
cognitive symptoms
forensic history
depression investigation important details
PHQ9
physical exam
blood (FBC, TFT, Ca)
depression management
- CBT + SSRI
4-6 weeks to work, 2 week follow up, SEs (nausea, appetite change, anxiety) - advice: sleep hygiene, exercise, self-help, IAPT
somatisation DDx
- delusional disorder
- adjustment disorder
important thing to check in psych history
insight
Lewy body dementia management
- patient adaptions with OT (reality orientation, environmental modifications)
- social support
- optimise physical health
- pysch therapies e.g. reminiscence
- Parksinons symptoms can treat with Parkinsons drugs but make hallcuinations worse
- Ach inhibitors
DLB on CT
mild atrophy
if child psych history
some aspects of paeds history
counsellin in anorexia
- condition characterised by restriction of energy intake
- leads to low body weight, intense fear of gaining weight and disturbance in way individual perceives body
- can lead to physical health problems so we would like to treat her to help her achieve healthy weight
- anorexia focused family therapy = show how you can support your daughter
schizophrenia counsel
- voices you have been hearing and feeling are due to imbalance in chemicals in your brain
- when these chemicals are unbalanced, can cause you to see and hear things that other people don’t
- we can give you medications to help balance these chemicals and make symptoms go away
what to check in psychosis?
are taking steroids
main important management in delirium
admit as it fluctauates
important question to assess insight
“are the thoughts your own”
counsel in OCD
it is a condition where you have recurrent intrusive thoughts to do something and it can really affect your life
this can be managed by CBT (explain CBT)
what to do when start SSRI?
1 week F/U
important lifestyle question in anxiety?
caffeine intake
what is agoraphobia?
fear of being unable to easily escape to safe place
counsel about trauma-focused CBT
trauma can shatter previous belief systems
these beliefs can be examined and tested
doesn’t require patient to vividly recall trauma
helps patient understand link between current feelings and trauma
counsel about PTSD
condition that occurs when someone has gone through major traumatic event
characterised by episodes where you may feel anxious and on high alert
can affect your behaviour and cause you to avoid things that trigger these memories
important question to ask in child with fever/unwell
are they tugging at their ear
investigations in febrile seizure
FBC, ESR, CRP for sign of infection
U&E for electrolyte imbalance
GLUCOSE exclude hypoglycaemia
management of seizure
ABCDE approach give oxygen, gain IV access check blood glucose give buccal midazolam IV lorazepam phenytoin infection
assess what in a manic patient
capacity
Pysch and social management of BPAD
Psychological (CBT – identify relapse indicators, relapse prevention strategies), Social (family support, aiding return to work, deal with financial issues resulting from overspending)
mania counselling
o We believe you’re experiencing something called mania – this is when a chemical change in your brain can lead to a very increased mood
o This may not sound like a bad thing and I know you’ve told us that you feel great right now, but it can actually be very damaging in the long run
o It can lead you to make risky decisions that you wouldn’t otherwise make and this can cause you serious harm (financial, physical, emotional)
o We would like to keep you in the hospital to give you some treatment that can normalise the chemicals in your brain and help you think clearer
o When you’re feeling back to normal, we can also discuss how we can help you get back to regular work and perhaps discuss any financial issues that you may have
if patient presented in depressive phase of BPAD
Antidepressant (e.g. SSRI) with an atypical antipsychotic (e.g. aripiprazole, quetiapine) to prevent triggering mania
1st line = quietapine/olanzapine/fluoxetine + olanzapine/lamotrigine
what drug does clozapine interact with?
lithium
PHQ 9 score meanings
0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.
medically unexplained symptoms
conversion disorder
chronic fatigue
fibromyalgia
