Psych Flashcards
Management of PTSD
BIO
- SSRI - Sertaline or SNRI
- Atypicall antipsychotics
PSYCHO
- Trauma-based CBT (will need to touch on trauma briefly)
- EMDR
SOCIAL
support groups, help with work/sick leave
Diagnosis of PTSD
> 1 month after event, within 6m
- rexperiencing
- avoidance of trigger
- hyperarousal
Other
Sleeping difficultly, emotional numbing, anxiety symptoms, depressive symptoms
Definition of alcoholism/dependence
3+ in the last month of:
- tolerance
- craving
- withdrawal symptoms
- out of control use
contiune despite harm - neglecting other aspects of life addiction
- returning to the saame place
- same substance/drink
Outline the process of community based alcohol withdrawal
Used when pt drinks 15+ units/day or scores 20+ on AUDIT
ACUTE:
Oral chlordiazapoxide +/- IV pabrinex on a reducing dose
2-4 meetings per week for 3w
CHRONIC:
1. acamprostate/naltrexone
2. Difulsuram
Individualised intervention plan
How would you manage a learning disability?
MDT
Psychiatrist, OT, SALT, specialaist nurse, educational support, social worker involvement
BIO:
Treat co-morbid medical/psych problems
Melatonin for sleep
Antipsychotics if challenging behaviour (rispiridone)
PSYCHO:
CBT, family therapy, psychodynamic therapy, art therapy if talking is difficult
SOCIAL:
Education
Finanial support/benefits/carer
SCOPE disability charity
Outline the process of inpatient alcohol withdrawal
Used when pt drinks 30+ units/day or 30+ on SADQ score, PMHx of epilepsy, DT,
ACUTE:
Oral lorazepam +/- pabrinex rapid reducing dose
CHRONIC:
1. acamprostate/naltrexone
2. Difulsuram
Individualised intervention plan
How would you investigate/diagnose autism?
ADI-R = autism diagnostic inventory ADOS = autism diagnostic observatory schedule
WISC-V cognitive assessment
SALT and hearing assessment
Management of Autism
- psychosocial play-based therapy with play specialist
Challenging behviours:
- psychosocial assessment - also investigate for co-existing mental health or physical disorders
- Pharm: APs, melatonin, methylphenidate, SSRI
Diagnostic Criteria for schizophrenia
1m+ of:
1+ schneiders 1st rank sx
OR
2+ paranoia/hebephrenic (disorganised mood and speech)/catatonic/negative sx (simple - these are also the subtypes) AND present most of the time AND not caused by substance/organic source
Describe the progression of schizophrenia
- prodrome/at risk mental state - negative sx dominant
- acute pphase - positive sx dominant
- chronic phase - negative dominant
What are the risk factors for schizophrenia
1st degree relative, 50% concordance in MC twins substance abuse ethnic miniority low premorbid IQ adverse life experiences
How would you manage schizophrenia?
URGENT:
crisis resolution team and home treatment time
NON-URGENT but still an EMERGENCY: Early intervention in psychosis team (psychosis is dangerous, esp if untreated for >3m)
Rapid Tranquilisation = Oral –> IM Lorazepam, Haliperidol/lorazepam
BIO
1. 6w atypical AP - aripip/quietapine (weaker, fewer SE), olanzapine/rispiridone (stronger, weight gain, SE)
augment with BDZ or mood stabaliser is ?schzoaffective
2. 2w Typical AP
3. clozapine
PSYCHO
- CBT - 16 sessions, testing reality
- Family therapy
SOCIAL
Risk aassessment
housing, benefits, work, education
Define Schizoaffective disorder
affective + psychotic sx equally prpesent
Manic:
Mania + schiz
Depressive:
depression + schiz
1 episode of psychosis lasting >2w without mood disorder
AND
1 episode psychosis with obvious mood overlap
Risk factors for Panic Disorder?
Aged 20-30m Female White Positive family history Major life stressors/ history of recent trauma Comorbid disorders Asthma/ respiratory variability Cigarette smoking/caffeine use
What are some organic causes of Panic disorder?
Hyperthyroidism → TFTs Too much caffeine → history Alcohol → LFTs/gGT/MCV Drugs → UDS Arrhythmia → ECG/ 24 hour ECG Hypoglycemia → glucose (while anxious) Pheochromocytoma → 24 hour urine VMA
