psych Flashcards
1
Q
Depression
A
- What do you know about depression?
- Sadness is a natural response to stress. Depression is an illness where there is persistent sadness due to an imbalance of chemicals in the brain. It affects 1 in 5 people.
- Common symptoms include those you’ve told me about today (recall symptoms). There is no one cause of depression though (recall relevant risk factors) are associated with it.
- We’d first suggest eating a healthy diet, exercising for at least 30 minutes daily and practising sleep hygiene to help with symptoms.
- Nearly 80% of people with depression benefit from treatment. We’d first suggest CBT- this is a type of therapy that looks at the way you think and behave. This would be 8-16 sessions, once a week.
- If this isn’t helpful, we can discuss medication, but this has side effects (diarrhoea/constipation, loss of appetite, dizziness, nausea and vomiting) and needs regular monitoring. It might also make symptoms worse for 2 weeks before it starts working.
- You can also find advice on the MIND website or the Depression Alliance.
- I’d like to catch up with you in 1 week to see if your symptoms have changed.
- Safety net: if your symptoms worsen or you believe yourself to be at risk of harming yourself or others, contact the GP immediately.
2
Q
Mania
A
- We believe you’re experiencing something called mania- this is when a chemical change in the brain leads to increased mood. Have you heard of this before?
- This might not sound bad as I know you’ve said you’re feeling great now, but it can be very damaging in the long run as it can lead you to make risky decision that can cause serious physical, emotional or financial harm.
- We would like to keep you in the hospital to give you some treatment that can normalise the chemicals in your brain and help you think clearer.
- After getting some immediate treatment, we can also discuss how we can help you get back to work and perhaps discuss any financial concerns you may have. We can also get support from Bipolar UK for you and your family.
- If they refuse: can you explain what I’ve just said to you? Can you tell me why you don’t want to go to hospital?
- If they continue to refuse: because of the symptoms you’ve been experiencing and what I believe is a lack of insight into your condition, 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.
- Safety net: if your symptoms worsen or you believe yourself to be at risk of harming yourself or others, contact the GP immediately.
3
Q
Psychosis and schizophrenia
A
- The symptoms you’ve been having (recall symptoms) are due to an imbalance of the chemicals in the brain. This is something we call psychosis- have you heard of this before?
- Normally, when you see something in life it will trigger a change in the chemicals in your brain to help you understand what is going on. If the chemicals are unbalanced, it can cause you to see and hear things that other people don’t see and hear.
- We would like to keep you in the hospital to give you some treatment that can normalise the chemicals in your brain and help you think clearer.
- We can also consider some therapy where a therapist will try to unpack these thoughts you’ve been having to assess with you how true they are likely to be.
- If they refuse: can you explain what I’ve just said to you? Can you tell me why you don’t want to go to hospital?
- If they continue to refuse: because of the symptoms you’ve been experiencing and what I believe is a lack to insight into your condition, 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.
- Safety net: if your symptoms worsen or you believe yourself to be at risk of harming yourself or others, contact the GP immediately.
4
Q
Postnatal depression
A
- The baby blues are normal and common. Postnatal depression is an illness where there is persistent sadness within 2 weeks of childbirth. It affects 1 in 10 women. Have you heard of this?
- The birth of a baby is a source of happiness but bring along many life changes as well as the physical trauma of childbirth and changes in your hormone levels. Common symptoms include those you’ve told me about today (recall symptoms).
- With the right treatment and support, PND can be treated. Support from your partner and family can be useful and we will involve the health visitors and midwives who will visit you daily until the baby is 28 days old. It’s also important that you make time for yourself daily to pursue your own interests and relax- perhaps leaving baby with a trusted relative or putting him to sleep.
- We’d like to refer you for CBT- this is a therapy where you are helped to recognise negative thoughts and reduce feelings of guild, anxiety or failure.
- It can also help to share your concerns with other new mothers going through the same thing – the organisation PANDAS provides support for anyone affected by postnatal depression, including your partner if you believe he/she might also benefit.
- We’d like to try a medication called an SSRI, but this has side effects and needs regular monitoring. They take 2-4 weeks to work and are effective in most patients. They are also safe while breastfeeding.
- I’d like to catch up with you in 1 week to see if your symptoms have changed. When we catch up, I’d like to talk about future pregnancies because postnatal depression can recur in 20-40% of cases.
- Safety net: if your symptoms worsen or you believe yourself to be at risk of harming yourself, your child or others, contact the GP immediately.
5
Q
puerperal psychosis
A
- We believe you’re experiencing something called puerperal psychosis- this is when a chemical change in the brain occurs after someone has given birth.
- This can be very damaging in the long run as it can lead you to make risky decisions that can cause serious physical or emotional to yourself or others.
- We would like to keep you in the hospital to give you some treatment that can normalise the chemicals in your brain and help you think clearer. The hospital has a mother and baby unit so you can bring your child with you.
- If they refuse: can you explain what I’ve just said to you? Can you tell me why you don’t want to go to hospital?
- If they continue to refuse: because of the symptoms you’ve been experiencing and what I believe is a lack to insight into your condition, 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.
- Safety net: if your symptoms worsen or you believe yourself to be at risk of harming yourself, your child or others, contact the GP immediately.
6
Q
Autism
A
- Autism is a group of disorders affect brain development, leading to maldevelopment of normal communication (recall relevant symptoms). Have you heard of this?
- It occurs in 1 in 2000 children usually before the age of 3. There is no known cause but there are various theories of genetic and environmental factors.
- Your child will be under the care of a child psychiatry specialist and he can be treated behaviourally. We want to reduce unhelpful behaviours and promote the use of good communication skills.
- We will involve special education to help with language and communication skills and speech and language therapists too. Occupational therapists can help you and the family adapt to any challenges. The National Autistic Society provides support for autistic people and their families and is particularly useful in advising on schools.
- Medication is rarely used but sometimes may help control outbursts of excitement or aggression.
- There is no cure for autism. Special education and support aim to maximise the potential of the child as they grow older. It’s great that you’ve come in now as its thought that the earlier specialist input is started, the better the outcome.
- You will receive regular clinic appointments with the specialist and your GP will also be informed.
7
Q
ADHD
A
- ADHD is a behavioural disorder. Have you heard of this?
- It occurs in 2 in 100 children in the UK and normally by age 7. Symptoms must last 6 months.
- A mixture of genetic and environmental factors are suspected to contribute to ADHD but a direct cause is unknown.
- Your child will be under the care of a child psychiatry specialist and he can be treated behaviourally. We want to reduce unhelpful behaviours and promote the use of good behaviour.
- We will involve special education and liaise with the school to discuss support he can receive there.
- We also recommend a parent training programme for family education and support. There is also good evidence to show that family therapy or CBT may be useful. This is where you talk to a therapist as a family about the underlying thoughts your child may be having and how to break the cycle between those thoughts and behaviours.
- We’d like to start him on a medication called methylphenidate (if over 6) which increases dopamine in the brain to improve concentration and reduce hyperactivity. The drug is given 3x a day first and lasts for 3-4 hours each time. We will increase the dose slowly and then he might take a longer acting version of the drug once a day. We will monitor for side effects such as headache, insomnia, loss of appetite and poor growth. We recommend ‘drug holidays’ to reduce these.
- We will review him every 6 months to check height, weight and blood pressure.
- The medication may not be necessary as he grows older, but we will check this in clinic.
- If methylphenidate doesn’t work, we can consider other medication.
- The prognosis is variable, but symptoms are controlled with medication in 1/3 of children. It is best started early and consistently to improve the prognosis.
8
Q
Alcohol misuse
A
- Alcohol in excessive amounts is toxic to the body and can affect the brain, nerves, liver, stomach and heart (recall relevant symptoms).
- It’s very good that you’ve come in to speak to us today and shows that you are willing to take agency to overcome excessive drinking and reduce the likelihood of these complications in future.
- I will examine you and do some routing blood tests to rule out any medical problems and admit you to hospital.
- Alcohol detoxification requires several steps which we will support you through: the first step is medical treatment to ease the withdrawal symptoms which start from about 6 hours after stopping drinking and last several days. We commonly use chlordiazepoxide which is from the benzodiazepine family of drugs used for sedation. We give chlordiazepoxide in a daily reducing dose to avoid undue sedation.
- We particularly want to avoid seizures that can happen during detox so medical staff will monitor you for this and give medication to terminate the fit if it does happen.
- We will also give you vitamin injections or tablets as deficiency is common in people who have been drinking excessively. These vitamins help prevent memory impairment.
- Once detoxified, we will give some medications for 6 months to help maintain abstinence. We use disulfiram to sensitise you to alcohol and acamprosate to reduce cravings.
- We also recommend group therapy or social network therapy like Alcoholics Anonymous to ensure you’re supported to remain abstinent.
9
Q
Anorexia nervosa
A
• Anorexia nervosa is a condition characterised by restriction of energy intake leading to low body weight, an intense fear of gaining weight and a disturbance in the way an individual perceives their body shape/weight. Have you heard of this before?
• This can lead to several physical health problems which is why we’d like to treat your daughter and help her achieve a healthy weight. The symptoms you describe may be a sign of this.
• This will involve attending 8 sessions of anorexia-focused family therapy – this involves showing you how you can support your daughter in developing a healthier attitude towards food and body image.
• Amenorrhoea is likely to be due to the very low weight and this will likely resolve once she has regained weight.
• I’d like to catch up in 4 weeks’ time to see how therapy is going. In the meantime, the organisation BEAT has a great website and runs virtual get-togethers for people with bulimia to share their experiences and get support.
OR
• We’d like to admit your daughter because her weight is severely affecting her health. In hospital she’ll be seen by the eating disorder service and be placed on a feeding plan- being in hospital allows us to monitor her closely as the body can react negatively to food after being restricted for a while.
• She will still receive family therapy if she is hospitalised, but the priority is reducing the risk of immediate complications.
• Safety net: if your symptoms worsen, contact the GP immediately.
10
Q
Bulimia nervosa
A
- Bulimia nervosa is a condition characterised by alternating periods of binging and purging due to a disturbance in the way an individual perceives their body shape/weight. The symptoms you describe are a sign of this.
- This can lead to several physical health problems which is why we’d like to treat your daughter and help her achieve healthy eating habits.
- This will involve attending 8 sessions of bulimia-focused family therapy – this involves showing you how you can support your daughter in developing a healthier attitude towards food and body image.
- Her symptoms are likely to resolve once she has regained weight.
- I’d like to catch up in 4 weeks’ time to see how therapy is going. In the meantime, the organisation BEAT has a great website and runs virtual get-togethers for people with bulimia to share their experiences and get support.
- Safety net: if your symptoms worsen, contact the GP immediately.
11
Q
GAD
A
- GAD is a condition in which you have general worry and anxiety. The worry can affect your ability to complete tasks in day-to-day life.
- This can be managed with CBT- it’s a type of therapy where a therapist discusses the thought processes behind the anxiety and recommends coping strategies to reduce it. It will take (at least) 12 sessions, one every week.
- We can also consider medications such as SSRIs which reduce anxiety, although these have side effects, so they are something to talk about if CBT isn’t very helpful. On the medication you would also need regular monitoring.
- I’d like to catch up with you in 2 weeks to discuss how your symptoms are and whether CBT has been helpful.
- Safety net: if your symptoms worsen, please contact the GP immediately.
12
Q
OCD
A
- OCD is a condition in which you have recurrent intrusive thoughts to do something. These thoughts can be disturbing. You also feel compelled to perform the action because not doing so causes anxiety to build up.
- This can be managed with CBT- it’s a type of therapy where a therapist discusses the thought processes behind OCD to help break the cycle between having intrusive thoughts and needing to act on them. This will hopefully reduce the anxiety that comes with the thoughts also. It will take (at least) 10 sessions, one every week.
- We can also consider medications such as SSRIs which reduce anxiety, although these have side effects, so they are something to talk about if CBT isn’t very helpful. On the medication you would also need regular monitoring.
- I’d like to catch up with you in 2 weeks to discuss how your symptoms are and whether CBT has been helpful.
13
Q
PTSD
A
- PTSD is a condition that occurs after someone has experienced a traumatic event. You might feel like you’re reliving the trauma and might feel on high alert and anxious. It might also affect your behaviour and make you avoid things that can trigger the emotions.
- We first recommend something called CBT- it’s a type of therapy where a therapist examines and tests your beliefs about the world. It doesn’t require you to vividly recall the trauma but can help you understand the link between your current feelings and the trauma. It will take 12 weekly sessions.
- We can also consider something called EMDR where you recall the experience while doing some actions to help you process the event, though that’s something to talk about later.
- I’d like to catch-up in 4 weeks to see how you’re getting on with CBT and whether there has been any difference in your symptoms.
14
Q
Alzheimers
A
- Alzheimer’s disease is a degenerative disease of the brain. Have you heard of this?
- It is a type of ‘dementia’, causing progressive decline in brain function due to loss of nerve cells and collection of protein. It is irreversible and leads to many symptoms which vary (recall relevant symptoms). It usually occurs in the elderly.
- The cause is unknown. Some genes have been linked and it is thought to occur due to some factors related to ageing.
- The process is irreversible so there is no cure to stop it. We can use drug and non-drug treatments to slow the process.
- The main drug is an anticholinesterase inhibitor. These increase acetylcholine in the brain which is a chemical thought to be lower in patients with AD due to nerve damage. These are for patients with mild-moderate AD and aren’t guaranteed to be effective.
- We recommend validation and cognitive stimulation therapy to help the person come to terms with the diagnosis and to improve cognition.
- 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.
- We will review him regularly at the GP and he will be seen in a memory clinic for older adults to start medication and have regular check-ups. You can discuss other medications in memory clinic if the first medication isn’t effective.
- The course of AD varies but medication may help its symptoms. AD does not itself directly cause death but can predispose the patient to fatal complications such as infection.
- We can arrange care assessment for yourself and recommend Alzheimer’s UK for ongoing support.
