Psych Flashcards
Def Section 5 (4) + 5 (2)
Section 5 (4): inpatient kept for 6 hours for assessment
Section 5 (2): inpatient kept for 72 hours for MHA completion
Def Section 2, 3, 136
Section 2: detained for 28 days for assessment and treatment
Section 3: detained for six months for treatment
Section 136: police remove person for 72 hours for assessment
Def Section 17, 117, CTO
Section 17: patient allowed leave while under section 2/3
Section 117: patient entitled to after-care from local council after section 2/3
CTO: Community treatment order (patient allowed to live w/in community whilst being treated)
Def Depression + Sx
(Persistent low mood occurring on most days for > 2 weeks):
Low Mood,
Low Energy,
Low Enjoyment (Anhedonia)
Conditions to Excl for Depression
bereavement/adjustment disorder, dementia, mania/BPD, substance misuse, medical/organic cause
Somatic + Cog Sx of Depression
Somatic Sx:
Sleep/Weight changes,
Reduced libido,
Psychomotor Retardation/Agitation
Cog Sx: Guilt, Hopelessness, Suicidiality, Hypochondrical thoughts, Poor concentration/attention
Def Mania + Hypomania
Hypo:
Sx present > 4 days
Mania:
Sx present > 7 days w/ marked Impairment or Psychotic features
Def BPD 1 + 2
BPD 1:
1 episode of Mania/Mixed w/ 1 episode of Depression
BPD 2:
1 episode of Hypomania w/ 1 episode of Depression
BPD Mx
(Avoid Anti-D +/- => Mania),
Mood Stabilisers,
Anti-psychotics
Mood D Ddx - 6
(Normal fluctuations in mood) Adjustment D, Bereavement, PTSD Dementia (Cog decline) Personality D Anxiety D Substance Misuse
Mood D Mx:
Bio
Psycho
Social
Bio:
Meds (Anti-D, Mood stabilisers, Anti-psychotics, Anxiolytics),
ECT,
rTMS (Repetitive Trans-cranial Magnetic Stim),
tDCS (Trans-cranial DC Stim)
Psycho: Psych Ed (Illness, Relapse, Mx) Mindfulness, CBT, IPT (Interpersonal Therapy),
Social:
General coping strategies,
Targeted Interventions (Work, Family, Housing, Finance)
ECT Indications
Failed Medical Mx
Prolonged/Severe Mania
Stupor, Catatonia, Psychomotor Retardation
High-risk of Suicide
ECT Contraindications
Anaesthetic risk - 3
CVS risk - 8
Anaesthetic risk
(Resp Inf, Heart D, Electrolyte Imbalance)
CVS risk
(MI < 3mo, Cerebral/Aortic Aneurysm, Raised ICP, Uncontrolled HF, DVT, CVA < 1mo, Unstable #, Uncontrolled Phaeochromocytoma)
Psychosis Def + Sx
(Experience of reality different to everyone else) =>
Hallucinations (Perception of object w/out Ext Stimuli)
Delusions (Fixed, firmly-held beliefs despite evidence)
Formal Thought D
Disorder of Self (Thought broadcast/insertion, Passivity phenomena)
Lack of Insight
Schizophrenia Patho + (+) Sx
(Abnormal Act of Dopamine R => Early-onset, Gradual Mental Decline):
(+) Sx:
Hallucinations (3rd Person),
Delusions (Bizarre, Persecutory),
Disorganised Thoughts
Schizophrenia (-) Sx
Anhedonia (Lack of Enjoyment), Ambivalence (Flat Affect), Asociality (Lack of social interest), Avolition (Lack of motivation), Attention Def, Alogia (Lack of speech)
Schizophrenia Mx:
Bio
Psycho
Social
Bio
Anti-psychotics,
(Excl Organic causes: MRI/CT, Blood Cult, Endo Screen)
Psycho:
Supportive counselling,
Family Tx
Social:
Social Care/Carers,
Finance,
Housing
Anxiety Mx
Psycho-Ed, CBT
Anti-D (SSRi, SNRi)
Pregabalin
(Crises: Benzos)
PTSD Criteria
(Sx occurring > 4wks)
Re-experience (Flashbacks, Memories)
Avoidance (People, Situations)
Hyperarousal (Restlessness/Hypervigilance/OCD)
Self-harm Screening
SADPERSONS
Edinburgh Scale
Def Parity of Esteem
Valuing MH as much as Physical Health to close inequalities in mortality, morbidity and Delivery of care
Organic Psychoses Types
Type 1 (Hallucinations): Epilepsy, Migraines
Type 2 (Delirium): Drugs, Hypoxia, Metabolic changes, Head Injury/Lesions, CVA
Type 3 (Dementia): Dementia, PD, Huntington’s Chorea
Type 4 (Delusions): Head Injury, Stroke
Difference btw Somatization D, Conversion D, Hypochondriasis
Somatization D:
Multiple physical complaints w/ no med explanation
(Onset < 30yo, Sx last years, Excl all other DDx)
Conversion D:
Single physical complaint (Loss of Funct) w/ Psych explanation
Hypochondriasis: Illness Anxiety (Fear of having D w/ no evidence)
SSRi Examples + SE
(Sertraline, Citalopram, Fluoxetine, Paroxetine)
Restlessness/Agitation N+V, GI disturbance Headaches Weight changes Sexual dysfunction
SNRi Examples + SE
(Duloxetine, Venlafaxine)
Sedation
N+V
Sexual dysfunction
Mirtazapine MOA + SE
(Nor-A/Histamine/Serotonin Antag)
Sedation
Weight gain
TCA Indication + SE
(Neuropathic Pain)
Musc (Dry mouth, Urin retention, Hot dry flushed skin)
Hist (Sedation, N+V)
MAOi Examples + SE
(Rasagiline, Selegiline)
Significant D-D Interactions Tyramine React (Cheese/Meat/Wine => Migraines + HT)
Discontinuation Synd Examples, Patho + Sx (SPINTH)
Interruption/reduction/discontinuation of Anti-D meds (Paroxetine, Venlafaxine) following continuous use > 1 month
Sweating Paraesthesia Insomnia N+V Tremors Headaches
Discontinuation Synd Mx
Switch to Fluoxetine + Titrate slowly
Serotonin Synd Patho + Sx
(Excess Fluoxetine/Serotonin)
Sweating Myoclonus Tremors TachyC Hyperthermia Hyperreflexia Headaches Hypomania
Serotonin Synd Mx
Reduce Fluoxetine,
Fluids and monitoring
Typical Antipsychotics Examples + SE
(Haloperidol, Chlorpromazine)
Musc (Dry mouth, Urin retention, Hot dry flushed skin)
Hist (Sedation, N+V)
Sexual dysfunction
EPSE (PD: Bradykinesia, Rigidity, Tremors)
Atypical Antipsychotics Examples + SE
(Clozapine, Olanzapine, Risperidone)
Sero (Restlessness/Agitation, N+V, Headaches, Weight changes, Sexual dysfunction)
Weight gain, Dyslipidaemia, DM
Clozapine MOA + Indication
(Dopamine/Serotonin Antag)
Indication:
2 Failed Anti-psychotics (Each for 6-8wks, > 1 Atypical) in Schizophrenia
Clozapine SE
Hypersalivation
Urin Incontinence
GI Hypermobility (=> Constipation/Obstruction)
Agranulocytosis (Req weekly FBC for 18wks)
Myocarditis (Baseline ECG)
Neuroleptic Malignant Synd Patho + Sx
(Excess Anti-psychotics – High potency Dopamine Antag)
Sweating, Fever, Muscle rigidity, Rhabdomyolysis (+/- => Renal Fail), Seizures
Neuroleptic Malignant Synd Mx
Stop Anti-psychotic,
Fluids,
Anti-Inflamm
EPSE Patho + Sx
(Excess ACh compared to Dopamine w/in Nigostriatal pathway => Dystonic React)
PD: Bradykinesia, Rigidity, Tremors
Hot dry flushed skin
Dilated pupils
Delirium
EPSE Mx
Anti-cholinergics (Procyclidine, Benzatropine)
Mood Stabiliser (Li) MOA + SE + Contras
(Increase Serotonin synthesis, Decrease Nor-A release) =>
Dry mouth/Metallic taste, Polydipsia/Polyuria, Weight gain, Fine Tremor (LT: HypoTh, Renal Fail – Req annual TFTs + U+Es)
Contras:
NSAIDs, ACEi (Loop D safest)
Mood Stabiliser (AED) Examples + SE
(Na+Valproate, Carbamazepine, Lamotrigine, Pregabalin)
Sedation,
Weight gain,
Thrombocytopenia (Check FBC)
Mood Stabiliser (Quetiapine) SE
Sero (Restlessness/Agitation, N+V, Headaches, Weight changes, Sexual dysfunction)
Weight gain, Dyslipidaemia, DM
M2M Dementia Mx + SE
Acetylcholinesterase Inhib:
(Donepazil, Galantamine, Rivastigmine)
N+V, Diarrhoea, Anorexia
Insomnia
M cramps
BradyC (ECG + HR)
M2S Dementia Mx + SE
Glutamate/NMDA Antag: (Memantine => Reduces challenging behaviour)
Headaches,
N+V,
Insomnia,
Drowsiness
ADHD Mx + SE + Monitoring
(CNS Stim): Methylphenidate, Dextroamphetamine
+/- Dependence, (Monitor Weight, Height, HR)
(Nor-A Reuptake Inhib): Atomoxetine
ADHD Criteria
Poor Attention/Concentration, Inattention
Physical Overactivity, Impulsivity
Occurs in > 1 environment, Sx > 6yrs
ASD Criteria
Social Diff,
Comm Diff,
Rigid Thinking/Behaviour
Occurs in > 1 environment, Sx > 3yrs
LD Criteria
Sub-average IQ Funct (< 85)
2 areas of Adaptive Funct Skills limited/impaired concurrently
Disability occurred before 18yo
LD Mx
Acute Liaison Nurse (Adjust Reasonable Adjustments),
Primary Care Liaison Nurse
Health Action Plan
(Annual health check, Immunisations, Screening/Monitoring, Healthy Lifestyle)
Def Diagnostic Overshadowing
Believing current Sx is due to LD rather than another cause (Must seek alt DDx)
AN Features
(BMI < 17.5): Body-shape disturbance +/- Amenorrhoea, Osteoporosis
Intense fear of gaining weight/Refusal to maintain ideal body weight
AN Types
Restrictive:
Food avoidance, Eating rules, Calorie limits
Binge w/ purging:
Laxatives, Self-induced vomiting, Meds (Diuretics, Amphetamines)
BN Features
(Normal BMI): Self-perception of fatness
Binging (Recurrent Overeating) and Cravings (Persistent strong desire to eat) +/- Purging
BN Types
Purging (Compensatory behaviour):
Vomiting, Laxatives
Non-purging:
Fasting, Excess Exercise
Binge-eating Features
(Loss of control):
Associated w/ guilt (Secretive, Isolating)
Large amount, Calorie-laden, Forbidden foods
Refeeding Synd Patho
Rebuild of body => Reduced minerals/vitamins/electrolytes
=> Def of Phosphate, Potassium, Magnesium, Folate/B12
+/- => Organ failure
Refeeding Synd Mx
Specialist Mx (Refer if BMI < 13)
Daily monitoring (U+Es)
PO/IV Supplements
Eating D (AN/BN) Mx + Referral Criteria
CBT, Guided Self-help, Family Tx
AN: Restore to healthy weight
BN: Regular Eating w/ Binge Analysis
Referrals:
Pt wants to change but cannot progress,
No adequate local Tx,
Pt in immediate danger
Opiate Abuse Sx + Mx
Miotic (Constricted) Pupil,
Reduced consciousness,
Reduced RR
Mx:
Naloxone,
Mech Vent
Opiate w/drawal Sx + Mx
Dil Pupil (w/ Lacrimation/Rhinorrhoea),
Persistent yawning,
TachyC,
Restlessness
Mx:
Methadone,
Buprenorphine (Agon-Antag),
Detox (Come off) + Rehab (6 months Tx)
Anti-D Choices
1st line: SSRi, SNRi
Major Weight loss/Insomnia: Mirtazepine
Neuropathic pain: TCA (Amitriptyline)
Anti-D Switching
SSRi/SNRi should be continued for 4wks
If no benefit at typical dose: Switch
If partial benefit: Titrate up
(If used in Anxiety + no benefit: Titrate up)
(If significant SE’s: Switch +/- Continue for few wks)
Anti-psychotic Monitoring - 7
Baseline:
FBC, Lipids, LFTs, HbA1c, Weight, ECG, BP/HR
Anxiolytics MOA
Pregabalin/Benzodiazepines
Increase in GABA (=> Reduced excitability of N)
Def Oppositional D + Conduct D
Oppositional D:
Uncooperative/Unwilling to comply (frequent tantrums)
Wilful, Defiant +/- Aggressive
Conduct D:
Lying, Stealing, Truanting, Violence
Socialised (Less serious, phasic)
Unsocialised (+/- => Crime, ASBOs)
