PSYCH Flashcards
MSE
- Appearance and behavior
- Speech
- Mood
- Thought
- Perception
- Cognition
- Insight
- Risk
Abbreviated Mental Test Score
- Age
- Time (to nearest hour)
INSERT: Address for recall - Year
- Location
- Identify 2 people
- Date of birth
- Dates of WW1
- Name of monarch
- Count backwards 20-1 10. Address recall
Depression
• Explain the diagnosis of depression (persistently low mood that impacts on day-to-day
functioning)
• Explain that it is very common (each year 1 in 4 people suffer a mental health problem)
• Address social needs
• Explain the role of psychological therapy (CBT – talking therapy based on the principle that
thoughts, mood and behaviour are intertwined)
• Explain the role of medication (takes a number of weeks to work, follow-up in 1 or 2 weeks,
warn about side-effects)
• Advise about the crisis resolution and home treatment team
• Support: mind.co.uk, Samaritans
Mania and Bipolar Affective Disorders
• Consider admission and section if at risk
• Explain the diagnosis (condition where patients tend to experience the extremes of emotion
for variable lengths of time)
• Explain the importance of controlling it (both extremes can lead to making certain decisions
and taking risks that you would otherwise regret)
• Explain that there are medications available (helps balance the chemicals in the brain)
• Advise about crisis resolution team and Samaritans
Alcohol Misuse
• Establish risks (driving, suicide, dependents)
• Assess social issues and advise accordingly (SAFEGUARDING)
• Establish goals (elimination or moderation)
• Explain that symptoms of withdrawal (worst in the first 48 hours and should pass after 3-7
days)
• Advise against stopping drinking abruptly
• Explain referral to drugs and alcohol service and the process of assisted withdrawal
(benzodiazepines, psychological treatment and relapse prevention
Opiate Misuse
• Explain that it would be worth getting tests done for blood-borne diseases and offer vaccinations
• Explain the features of withdrawal (restlessness, anxiety, sweating, yawning, diarrhoea, abdominal cramps, nausea and vomiting, palpitations)
Manage expectations and explain timescale (begin within 24 hours, peaks after 2-3 days and should be significantly better by 1 week)
• Explain detoxification regime (giving a substitute that should lessen the symptoms of withdrawal)
• Explain that symptomatic treatments will be given to reduce nausea, diarrhoea and autonomic symptoms
• Explain the role of psychological therapies in preventing relapse
• Explain the role of the key worker
• Support: Narcotic Anonymous, SMART Recovery
Benzodiazepine Misuse
• Explain the harmful effects of benzodiazepines (long-term worsening of psychiatric
symptoms)
• Explain that benzodiazepines can be reduced very gradually, considering the symptoms the
patient is experiencing
• Explain the role of CBT
• Advise against driving if feeling drowsy
Generalised Anxiety Disorder (GAD)
• Propranolol: helps deal with anxiety that has a lot of physical symptoms (e.g. shakiness,
sweating, flushing) such as social anxiety
• Never give a benzodiazepine to anyone with anxiety because of high risk of dependence (it
may be given for specific phobia in the short term (e.g. dental phobia))
Obsessive Compulsive Disorder
This is exactly the same as in PTSD, but you will also give trauma-focused CBT or EMDR therapy
Post-Traumatic Stress Disorder (PTSD)
• Explain the diagnosis (a condition that occurs after trauma and is characterised by flashbacks, hyperarousal and avoidance)
• Be wary of the impact it is having on the patient’s life
• Offer trauma-focused CBT (explain that this can be done by computer or face-to-face and consists of 8-12 sessions)
o Involves exploring how the trauma has affected belief systems and outlook
• Consider pharmacological management (e.g. sertraline, mirtazapine)
• Consider group therapy
• Offer follow-up
Anorexia
• Explain the diagnosis (characterised by a morbid fear of fatness, reduced calorie intake
and endocrine problems, based on numbers (BMI) not opinions)
- SCOFF
• Explain the risks of anorexia (osteoporosis, infertility, cardiac problems (e.g. arrhythmia))
• Explain the psychological therapy (CBT-ED, SSCM, MANTRA, Family Therapy (children))
o Involves exploring the thought processes that drive these behaviours
o Set an eating plan and feasible weight gain targets
• Explain medical therapy if depressed (e.g. fluoxetine)
• Support: Beat (Eating Disorder Charity)
Postnatal Depression
• Consider admission to mother and baby unit if severe
• Involve the home treatment team and health visitor
• Explain that diagnosis (likely to be due to hormonal changes)
o Occurs in 1 in 10 women
• Address any concerns (e.g. being a bad mother) and provide support at home if needed
• Explain psychological treatment (CBT)
• Explain medical treatment (sertraline is safe to use when breastfeeding)
• Explain prognosis (most will recover within a month)
• Explain that the postnatal community mental health team will be involved
Puerperal Psychosis
• Admit
• Explain the diagnosis (may be linked to hormonal changes, causing chemical imbalances
in the brain)
• Explain the treatment (antipsychotics)
• Explain that admission to mother and baby unit is necessary to keep the mother and baby
safe
• Recovery usually takes 6-12 weeks
• 30% risk of recurrence
Emotionally Unstable Personality Disorder
• Explain the diagnosis (explain that it is characterised by an increased sensitivity to
emotions and is likely to be linked to stressful life circumstances and experiences)
• Explain that personality disorders are often undiagnosed (~10% may have a personality
disorder, ~2% have EUPD)
• Explain dialectical behavioural therapy (helps you understand your thought processes and
teaches you to not view things as black and white, teaches skills to cope with difficult
emotions)
• Explain the use of therapeutic communities (meet other people with similar issues and
support each other in recovering)
• Crisis management: provide numbers for crisis resolution team, community mental health
nurse, out-of-hours social worker, Samaritans
• Support: mind.co.uk
CAGE (alcohol)
- Have you ever felt you should “cut” down on your substance use?
- Have people “annoyed” you by criticizing your substance use?
- Have you felt bad or “guilty” about your substance use?
- Have you ever used a substance first thing in the morning to steady your nerves or start the day (an “eye” opener)?
