Psych Flashcards
Moderate ADHD
CBT + Medical treatment:
Methylphenidate (Ritalin) - Monitor growth every 6 months, BP and pulse for pysch disorders
Atomoxetine
Alcohol dependence questions?
Desire Neglect Withdrawal Tolerance Lost Control
Alcoholic Mx
Admit if risk of DT or seizures – involve MDT
Descending regime of Chlordiazepoxide + Pabrinex (thiamine B1)
Consider Motivational Interviewing – if they think they don’t have problems
Long Term
Alcoholics Anonymous (12 step programme) Psychological therapies – CBT
Medication – Disulfiram (prevents relapse), Acamprosate (stops craving)
Behavioural Autism Mx
Parent training and education programmes.
Educational approaches - TEACCH
Moderate Autism Mx
CBT + Medical treatment: 1st Risperidone (aggression, tantrums and self-injury) 2nd Methylphenidate (attention difficulties and hyperactivity) 3rd Melatonin (sleep problems)
Anorexia questionnaire
Components?
SCOFF
Do you make yourself sick because you feel uncomfortably full?
Do you worry you’ve lost control over how much you eat
Have you lost more than one stone in the last 3 months?
Do you believe you’re too fat when others say you’re too thin?
Does food dominate your life?
(Bipolar) Mania Questions (6)
Appetite
Concentration/Productivity
Sleep
Sex
Spending
Delusions?
Mania Mx
Admit and record suicidal ideation
Stop antidepressant
Consider atypical antipsychotic (olanzapine), if not sleeping BDZ (Lorazepam)
If resistant then give Lithium monitor LFT and Renal Function
Also consider CBT, MDT and psychoeducation Support groups - MIND and Bipolar UK
Delirium Ix
Collateral history + MSE + MMSE
Physical examination – neuro and infection, trauma
Blood - FBC (anemia) white cells, neutrophils, CRP, ESR (infection) U&E (dehydration) blood glucose (DM) TSH (thyroid) LFT (uremia) Ca (Hypercalcemia), Folate and B12, VDRL (syphilis)
Urine Dip + MSU
Delirium Prevention Options?
Prevention:
Maximise orientation
Decrease polypharmacy, decrease constipation and dehydration, avoid catheters
Promote wellbeing: encourage mobilisation, sleep + diet
Alzheimer’s Questions?
MOLD PPR
Memory
Orientation (lost?)
Language (talking/understanding)
Depression
Praxis (dressing/cooking)
Personality
Recognise
Alzheimer’s Ix
Assessing cognition AMTS, then MMSE, then Addenbrooke’s Cognitive Examination (ACE-R)
Delirium screen
Neuroimaging – CT/MRI (not MRI if pacemaker), SPECT (shows how your organs works - LBD 100% specific)
Depression Ix
- Collateral History
- Physical Examination
- Blood – FBC (Anaemia), TSH (thyroid), U&E (dehydrated)
- Urine – Urine dip (DM), UDS (drugs)
- Rating Scale – PHQ (GP) HADS (hospital) CDI (child)
- Risk Assessment
GAD Mx
Education and active monitoring
Self help
CBT or SSRI/Venlafaxine
OCD Ix
Blood tests: FBC, TSH
Yale Brown OCS
OCD Mx
Mild: CBT
Moderate: CBT or SSRI
Severe: CBT + SSRI –> give TCA if resistant
Overdose Questions
Trigger
Planning
Precautions to stop being found
Method
Regret
Wish they were dead?
Ix of Overdose
Rating Scale – Columbia Suicide Severity Rating Scale
Physical examination – pupils, resp, abdo, neuro, cardio
IV access – bloods paracatamol levels (4 hrs post), LFT, INR, FBC, glucose, ABG, ECG (potentially), CT (neuro signs)
Overdose initial Mx
ABCDE + IV Access + glucose + NAC infusion (paracetamol) Involve specialist in psych assessment
Medium/Mild risk: home management
High risk: admit to psychiatric ward
Treat underlying condition
Overdose long term interventions
Follow up within a week – via community mental health team (outpatients) OR GP+CBT
Crisis resolution team - support at home
Assertive outreach Team (OAT) – intensive treatment and support in the communityto assure treatment
Support group – Samaritans and PAPYRUS (children and adolescent)
Baby blues/postnatal depression questions (5)
Thoughts/feelings towards baby? Bonding? Planned? Other Children? Hurt?
Mx of Postnatal depression
Reassurance & Support – Pre And Post Natal Depression Advice & Support (PANDAS)
Mild-Moderate: Facilitated Self-help Strategies, with support practitioner (Home CBT)
Moderate-Severe: CBT (all)
SSRI - Paroxetine (if declined psych therapy/failure) Mother Baby Unit (if severe or children are at home –
ensuring safe environment)
PTSD Questions?
HATER
Hyperarousal Avoidance Trauma Emotional Numbing Re-experiencing
PTSD Ix
HADS
CAPS 5
PTSD Mx
Reassurance and support – MIND
<4 weeks: Watchful waiting
>4 weeks: 1st - trauma focused CBT or Eye Movement Desensitisation and Reprocessing (EMDR)
2nd - SSRI (Paroxetine)/ NASSA (Mirtazapine)
>12 weeks: TCA (Imipramine/Amytriptalline)
Cannot Sleep - Lorazepam
Psychosis Ix
Collateral History
Physical Examination
Blood – FBC (clozapine weekly), U&E, lipids and LFT (before antipsych), VDRL (syphilis), CT (if organic suspected)
Urine – UDS (drugs)
Rating Scale – Brief Psychiatric Rating Scale
Assess status – ADL assessment and housing and financy
Mx of Psychosis
Acute
Early Intervention Service (EIS) – to minimise the duration of untreated psychosis to 3 months (provide psychoeducation and reduce relapse)
Antipsychotics (olanzapine) - use Depot (Risperidone/ Flupentixol) if compliance issues
Long term
CBT Family Therapy
Support groups:
SANE
MIND
AMTS questionnaire
My Arab Welt
Monarch
Year
Address (memorise one)
Recognise person
Age
Birthday
WW1 date
Enumeration
Location
Time
Remember that address I gave you
Psychoeducation offered for depression? (4)
Sleep hygiene
Diet
Avoid smoking/alcohol
Exercise
Antidepressants to avoid if there is a history of overdose
TCAs
Venlafaxine
Mania Ix
- Physical exam
- FBC, TFT, HbA1c
- Urine drug screen
- Young Mania Rating Scale
BPAD Mx
Refer all suspected BPAD (including hypomania) to CMHT to confirm
For mania:
PO Antipsychotic (olanzapine)
Trial 2nd
If still inffective add lithium or sodium valproate
+ fluoxetine for depression
Long term = Lithium
Counselling: someone refuses admission
Can you explain what I’ve just said to you?
Can you tell me why you don’t want to go to hospital?
“I think you are a potential danger to yourself or others. I’m going to have one of my senior colleagues come and talk to you about what we call ‘formal admission’ under the Mental Health Act. This is in your best interests and to help get you treatment.”
Psychosis criteria
DSM 5 (same name as mania)
Two or more of the following present for a significant portion of time over 1 month, with at least one being of the first 3 symptoms:
• Delusions
• Hallucinations
• Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms
Psychosis Mx
Same day assessment
CBT
Antipsychotic - titrate dose up to optimum dosage over 4-6 weeks
Create care plan with recovery goals
Monitor for at least 12 months
Inform DVLA
MIND
Define autism
A group of disorders defined by abnormal development that manifests before age 3 and characteristic of impaired functioning in 3 areas of psychopathology.
Reciprocal social interaction, communication and restricted, stereotyped, repetitive behaviour
Autism Ix (5)
- Hearing test
- Vision test
- Speech and language assessment
- Neuropsychological assessment including IQ
- Childhood Autism Spectrum Test, Autism Spectrum Quotient
Diagnostic tools for autism
Childhood Autism Spectrum Test Autism Spectrum Quotient ADOS-2 ADI-R DISCO
Mx of autism
- Use play-based strategies with parents and teachers to increase attention and communication.
- Use psychosocial interventions as first line: applied behavioural analysis (a reward system for children <3y)
Early Start Denver model, More Than Words programme - Develop sleep plan for sleep hygiene.
- Use pharmacological interventions
National Autistic Society
ADHD criteria?
Definition?
ICD 10
A hyperkinetic disorder characterised by 6 months of inattention, hyperactivity and impulsivity which is persistent and manifests in multiple environments in a child younger than 7 years
ADHD Ix
- Diagnostic questionnaires: Connor’s Rating Scales, Strengths & Difficulties.
- Classroom observation and educational psychology assessment.
Mx of ADHD >5y/o?
ADHD-focused group parent-training programmes
Offer medication if ADHD symptoms are causing persistent significant impairment in at least one domain after environmental changes were implemented
Methylphenidate TDS 6 weeks (titrate up dose)
- Lisdexamfetamine 6 weeks
- Atomoxetine
Monitor height, HR, BP every 6 months.
Monitor weight every 3 months <10y/o or every 6 months if older
CBT
Anorexia Criteria?
ICD 10
- Actual body weight is 15% less than expected.
- Weight loss is caused by the avoidance of high-calorie foods
- Body image is distorted.
- Secondary amenorrhoea or loss of libido
Use of 1 of: self-induced vomiting, excessive exercise, appetite suppressors or diuretics
Anorexia Ix?
Bulimia Nervosa Ix?
- BMI
- Squat test
- FBC, U&E, LFT, phosphate, albumin, CK, glucose, TFT, ESR
- ECG
- DEXA
Anorexia Mx
Psychoeducate Treat comorbid psychiatric illness Set realistic weight gain targets MANTRA (family therapy if young)
Refer to eating disorder service
BEAT (for eating disorders)
BMI < 13.5 - admit
Bulimia Nervosa Mx
Pyschoeducate
Advice regarding vomiting and laxatives
BN focused self-help/therapy (family if young)
Refer to eating disorder service
BEAT
CBT
Delirium Ix (8)
- Confusion Assessment Method, Observational Scale of Level of Arousal
- FBC, U&E, LFT, TFT, CRO, Ca, B12, folate, glucose
- Urine dip and MCS
- ECG
- CXR
- Urine drug screen
- ABG
Key Ix for GAD
Beck Anxiety Inventory
HADS
GAD7
GAD and Panic Disorder Mx
Follow a stepped care model:
Self help
CBT (weekly, for 3 months)
SSRI (review in 2, 4, 6, 12 weeks)
If ineffective at 12 weeks offer alternative SSRI in GAD or imipramine in panic disorder
Refer to Mental health services
PTSD Criteria
ICD-10
Alzheimer’s assessments
MMSE
MoCA
ACE
Alzheimer’s Mx
Refer to community Old Age service
Offer CT or MRI to rule out reversible causes
Group CST (cognitive stimulation therapy) Offer acetylcholinesterase inhibitor (donepezil) Add memantime if severe or acetylcholinesterase inhibtors are contraindicated
Can offer antipsychotics if at risk of harm or psychotic Sx
Recommend adaptations such as carrying ID, using dossett boxes, changing the gas stove to electric and using assistive technology.
Counselling for Alzheimer’s?
- Management involves a multidisciplinary approach. Occupational therapists will visit to help adapt the home - they may change the gas stove to electric, install some assistive technology or arrange dossett boxes for medication. You should not drive and must inform the DVLA of your diagnosis.
- The process is irreversible so there is no cure to stop it. We can use drug and non-drug treatments to slow the process.
Tests of cognition?
6CIT
MIS
10-CS
Frontotemporal Dementia Mx
- Do not offer acetylcholinesterase inhibitors or memantine.
- Offer supportive care with benzodiazepines used short-term for acute restlessness/irritability.
Frontotemporal Dementia Ix (6)
- Collateral history
- FBC, U&E, LFT, TFT, CRP, glucose
- Urine dip and MCS
- Cognitive testing (10-CS, 6CIT, MIS, TYM)
- MMSE/MoCA/ACE
- FDG-PET or perfusion SPECT if diagnosis uncertain and FTD suspected
Parkinsons Ix
UK PD Society Diagnostic Criteria
Parkinson’s Mx
Levodopa for motor symptoms
(add ropinerol or MAO-B inhibtor if develop dyskinesia with levodopa)
Offer AChE inhibitor if severe, consider memantine
Clonazepam for sleep problems
Mx of antisocial personality disorder?
Measure severity using PCL-R
Use HCR-20 to develop a risk management strategy
Behavioural interventions
CBT
Antidepressant used in PTSD?
Paroxetine
