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PACES Mx > Psych > Flashcards

Psych Flashcards

1
Q

Moderate ADHD

A

CBT + Medical treatment:

Methylphenidate (Ritalin) - Monitor growth every 6 months, BP and pulse for pysch disorders

Atomoxetine

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2
Q

Alcohol dependence questions?

A 
Desire
Neglect
Withdrawal
Tolerance
Lost Control
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3
Q

Alcoholic Mx

A

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)

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4
Q

Behavioural Autism Mx

A

Parent training and education programmes.

Educational approaches - TEACCH

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5
Q

Moderate Autism Mx

A 
CBT + Medical treatment:
1st Risperidone (aggression, tantrums and self-injury) 
2nd Methylphenidate (attention difficulties and hyperactivity)
3rd Melatonin (sleep problems)
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6
Q

Anorexia questionnaire

Components?

A

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?

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7
Q

(Bipolar) Mania Questions (6)

A

Appetite
Concentration/Productivity

Sleep
Sex
Spending

Delusions?

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8
Q

Mania Mx

A

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

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9
Q

Delirium Ix

A

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

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10
Q

Delirium Prevention Options?

A

Prevention:

Maximise orientation
Decrease polypharmacy, decrease constipation and dehydration, avoid catheters
Promote wellbeing: encourage mobilisation, sleep + diet

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11
Q

Alzheimer’s Questions?

A

MOLD PPR

Memory
Orientation (lost?)
Language (talking/understanding)
Depression

Praxis (dressing/cooking)
Personality
Recognise

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12
Q

Alzheimer’s Ix

A

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)

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13
Q

Depression Ix

A
  1. Collateral History
  2. Physical Examination
  3. Blood – FBC (Anaemia), TSH (thyroid), U&E (dehydrated)
  4. Urine – Urine dip (DM), UDS (drugs)
  5. Rating Scale – PHQ (GP) HADS (hospital) CDI (child)
  6. Risk Assessment
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14
Q

GAD Mx

A

Education and active monitoring
Self help
CBT or SSRI/Venlafaxine

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15
Q

OCD Ix

A

Blood tests: FBC, TSH

Yale Brown OCS

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16
Q

OCD Mx

A

Mild: CBT
Moderate: CBT or SSRI
Severe: CBT + SSRI –> give TCA if resistant

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17
Q

Overdose Questions

A

Trigger
Planning
Precautions to stop being found
Method

Regret
Wish they were dead?

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18
Q

Ix of Overdose

A

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)

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19
Q

Overdose initial Mx

A

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

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20
Q

Overdose long term interventions

A

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 community􏰄to assure treatment
Support group – Samaritans and PAPYRUS (children and adolescent)

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21
Q

Baby blues/postnatal depression questions (5)

A 
Thoughts/feelings towards baby?
Bonding?
Planned?
Other Children?
Hurt?
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22
Q

Mx of Postnatal depression

A

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)

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23
Q

PTSD Questions?

A

HATER

Hyperarousal
Avoidance 
Trauma
Emotional Numbing
Re-experiencing
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24
Q

PTSD Ix

A

HADS

CAPS 5

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25
Q

PTSD Mx

A

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

26
Q

Psychosis Ix

A

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

27
Q

Mx of Psychosis

A

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

28
Q

AMTS questionnaire

A

My Arab Welt

Monarch
Year

Address (memorise one)
Recognise person
Age
Birthday

WW1 date
Enumeration
Location
Time

Remember that address I gave you

29
Q

Psychoeducation offered for depression? (4)

A

Sleep hygiene
Diet
Avoid smoking/alcohol
Exercise

30
Q

Antidepressants to avoid if there is a history of overdose

A

TCAs

Venlafaxine

31
Q

Mania Ix

A
  • Physical exam
  • FBC, TFT, HbA1c
  • Urine drug screen
  • Young Mania Rating Scale
32
Q

BPAD Mx

A

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

33
Q

Counselling: someone refuses admission

A

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.”

34
Q

Psychosis criteria

A

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
35
Q

Psychosis Mx

A

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

36
Q

Define autism

A

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

37
Q

Autism Ix (5)

A
  • Hearing test
  • Vision test
  • Speech and language assessment
  • Neuropsychological assessment including IQ
  • Childhood Autism Spectrum Test, Autism Spectrum Quotient
38
Q

Diagnostic tools for autism

A 
Childhood Autism Spectrum Test
Autism Spectrum Quotient
ADOS-2
ADI-R
DISCO
39
Q

Mx of autism

A
  1. Use play-based strategies with parents and teachers to increase attention and communication.
  2. Use psychosocial interventions as first line: applied behavioural analysis (a reward system for children <3y)
    Early Start Denver model, More Than Words programme
  3. Develop sleep plan for sleep hygiene.
  4. Use pharmacological interventions

National Autistic Society

40
Q

ADHD criteria?

Definition?

A

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

41
Q

ADHD Ix

A
  • Diagnostic questionnaires: Connor’s Rating Scales, Strengths & Difficulties.
  • Classroom observation and educational psychology assessment.
42
Q

Mx of ADHD >5y/o?

A

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

43
Q

Anorexia Criteria?

A

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

44
Q

Anorexia Ix?

Bulimia Nervosa Ix?

A
  • BMI
  • Squat test
  • FBC, U&E, LFT, phosphate, albumin, CK, glucose, TFT, ESR
  • ECG
  • DEXA
45
Q

Anorexia Mx

A 
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

46
Q

Bulimia Nervosa Mx

A

Pyschoeducate
Advice regarding vomiting and laxatives
BN focused self-help/therapy (family if young)

Refer to eating disorder service
BEAT

CBT

47
Q

Delirium Ix (8)

A
  • 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
48
Q

Key Ix for GAD

A

Beck Anxiety Inventory
HADS
GAD7

49
Q

GAD and Panic Disorder Mx

A

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

50
Q

PTSD Criteria

A

ICD-10

51
Q

Alzheimer’s assessments

A

MMSE
MoCA
ACE

52
Q

Alzheimer’s Mx

A

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.

53
Q

Counselling for Alzheimer’s?

A
  • 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.
54
Q

Tests of cognition?

A

6CIT

MIS
10-CS

55
Q

Frontotemporal Dementia Mx

A
  1. Do not offer acetylcholinesterase inhibitors or memantine.
  2. Offer supportive care with benzodiazepines used short-term for acute restlessness/irritability.
56
Q

Frontotemporal Dementia Ix (6)

A
  • 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
57
Q

Parkinsons Ix

A

UK PD Society Diagnostic Criteria

58
Q

Parkinson’s Mx

A

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

59
Q

Mx of antisocial personality disorder?

A

Measure severity using PCL-R
Use HCR-20 to develop a risk management strategy

Behavioural interventions
CBT

60
Q

Antidepressant used in PTSD?

A

Paroxetine

PACES Mx (4 decks)

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