Psych Flashcards
Questions to think of in depression
Low mood?
Interest in things?
Energy levels?
Poor concentration?
Sleep?
Slow thoughts?
Appetite?
Anything that could have caused it?
Initial work up of depression
PHQ-9 to categorise
Bloods- FBC, U&Es, Calcium, TFTs
Questions to think of in anxiety
What worry about?
Related to any specific places or situations?
Feel heart racing?
Sleep?
Stiff in your muscles?
How manage these thoughts?
OCD questions to ask
Do you ever get uncomfortable thoughts you cant get rid of?
Where do these thoughts come from?
Do you believe them?
Do you have any rituals used to ease the anxiety?
If yes how many times? And often?
Questions to ask if manic?
Do you feel like on top of the world?
Is this normal for you?
Do you feel like can do things could not do?
Do you feel like can do things others cant?
Do you feel special?
Been sleeping much?
Have you made any purchases recently?
Explain CBT to a patient
Talking therapy where will speak to a specialist who is expert in dealing with people like yourself
Helps you by changing the way you think and behave. Wont help problems but it can helo you deal with them in a positive way
Management of a patient who is in middle of grief/adjustment disorder
Investigations
- PHQ9 to assess if depression present
Bio
- none
Psycho
- discuss CBT as an option but more if other methods do not work
Social
- grief counselling
- support helplines (SAMARITANS and CALM for men)
Counselling for adjustment disorder
Based off what have told me today I think suffering from what we call an adjustment disorder which is an extreme reaction to a life event which has caused a lot of distress to you and presents with a lot of the symptoms you have discussed today. Of course some of these feelings are normal in response to something like that which you cared about but its good youve come to seek medical help as we can help you work through how feeling
In terms of how we do this with situations like this its very much up to you on what you think suits you best so I can go through some options
Have you thought about what you would like to get out of today?
- go away today and read up some more about it and then come back in a few weeks and we can assess again
- grief counselling
- support helplines
- CBT
Investigations for depression
PHQ9
?GAD7
Bloods
- FBC anaemia
- TFTs
Counselling for depression
Based off what have told me today and looking at the questionnaire it looks like you are suffering from depression at the moment.
Do you know much about that?
Depression is when you have a persistently low mood which can impact your day to day functioning whether than be eg your lack of concentration, your lack of energy
Does that sound like what been experiencing?
Yes so its a good thing you came in today and as there are lots of options of things we can do to help you
Options include talking therapies and medications
Questions for depression
Subjective mood?
Enjoying things?
Feeling tired?
Concentration?
Sleep?
Appetite?
Sex interest?- are you sexually active at the moment? interest in sexual relationships?
Risk assess
Questions for dementia?
Memory short term and long term?
Confusion?
How affected daily function?
Doing crossword?
Behaving differently?
Incidences with tap or oven?
Drive?
Physical symptoms?
Investigations for dementia
In all
- AMTS
- MMSE or MOCA
- refer to dementia clinic where will get CT
If vascular dementia picture look at BP and metabolic syndrome bloods with urine dip
Questions for eating disorder
What does a typical day of eating look like for you? Add on about exercise, pills etc
Do you ever make yourself sick after eating?
Do you think you can’t control these feelings?
How much weight have you lost recently?
Do you think food dominates your life?
Have you ever thought that you were fat when someone has said you were thin?
Ask about periods and interest in sex
Screen for OCD, depression and anxiety
Investigations for eating disorders
Examination of abdomen, mouth and hands
Weigh and height for BMI
Squat test
Obs
ECG
Bloods
-FBC
- U&Es
- LFTS
- TFTS
If indicated
- PHQ9
- Yale and brown questionnaire
Counselling for eating disorders
Based off what youve told me today we think that you are siffering from what is called anorexia nervosa
Do you know what this is?
In anorexia people have an intense fear of putting on weight and disturbance in the way in which they see their body. as a result of this they restrict how much they eat which reduces their body weight. What is concerning to us is that this can have serious phyiscal side effects such as the irregular periods, electrolyte disturbances and on the heart. What we want to do is be able to support you in returning to a normal pattern of eating which will help restore body weight
What happens in anorexia focussed family therapy
Attending will involve showing your family how to support her in returning to a normal pattern of behaviour
What happens in MANTRA
Over 20 sessions with a psycologist
MANTRA aims to address the cognitive, emotional, relational and biological factors which tend to maintain AN by working out what keeps people stuck in their anorexia, and gradually helping them to find alternative and more adaptive ways of coping.
What happens in SSCM (specialist supportive clinical management)
Allocated a therapist whith whom create goals for treatment of your anorexia. Then over a period of sessions you will work together to build on your own skills to help achieve your goals. This is different as psychologist works more as a facilitator and is far more flexible to what you want to do as opposed to following a set rigid plan
Physical complications of AN
Bradycardia and hypotension
GI upset
Amenorrhoea and infertility
Osteoporosis
Peripheral neuropathy
Counselling for a psychosis
Based off what youve said today and after speaking to my seniors we think that the voices/beliefs that you have been having are because your mind can sometimes play tricks on us. This is as a result of some chemicals in the brain. Normally when you hear/see something it triggers a change in the chemicals in the brain to let you know its there however when these become unbalanced, it can cause you to hear or see things which are not there
What we can do is give you a drug to help balance out these chemicals
Investigations for psychosis
Examination
- FBC
- U&Es
- LFTs
- glucose
Lipids and Hba1c is starting an antipsychotic
Management of schizophrenia
Bio- atypical antipsychotic
Psycho- CBT to help deal with these hallucinations, coping mechanisms
Social- OT to assess living conditions, money
Difference in time taken to work between SSRIs in depression and GAD
Depression- 2-4 weeks
GAD- 6-8 weeks
How to counsel a patient with mania?
We believe that you’re experiencing something called mania- this is when a chemical change in the brain can lead to a very increased mood. I know this sounds like a good thing as you probably feel great right now however we are concerned as it can be very damaging in the long run
When our mood is elevated we are more likely to carry out very risky behaviour that we wouldnt normally do if we were being ourselves whether this be spending all of your money or putting yourself in physical danger
Managment of mania
Biological- antiphsycotic, mood stabiliser
Psycho- CBT
Social- help sort out work, finances etc
Purpose of CBT in mania
Help identify relapse indicators and how to manage these
How to manage a delirium patient
Keep on ward as even though may be lucid now it does fluctuate
Identify source
- stool culture
- urine dip
- CXR
Treat source
What drugs can cause psychosis (recreational and medicinal)
Steroids
Ethambutol
Cannabis
Cocaine
Counselling on delirium
Based off what have told me and the investigations that we have done, we think that you are experiencing delirium. This is a change in mental state from a physical cause which can affect your mood, your thinking and then also cause your mind to play tricks on you.It has most likely been caused by …… therefore what we are going to do is keep you on the ward and try and find the source … then when we do we can treat this. In the meantime we think it would be best if kept on the ward
Safety net about feeling a change in behaviour
Questions for OCD
Where do these thoughts come from? Are they your own?
What do you do when you get these thoughts?
Have you ever acted on them?
Does acting on them help?
How often do you do?
Does this affect your day to day function?
Job, socials, relationships?
Management plan for someone who has just attempted to commit suicide
Assess using PHQ9 and GAD7
Bio
- sertraline
- add anti-psychotic if affective psychotic symptoms
Psycho
- CBT longer term
Social
- consider admitting if high risk of committing suicide again
- if not manage under crisis team
Counselling for GAD
Based off what you have said to me today and speaking to my seniors it seems like you have been suffering from a generalised anxiety disorder
Do you know much about this?
So essentially what it does is it caues you to feel anxious about a wide range of things like in your case theres the worrying about x and y. Obviously it is completely normal to be feeling anxious about certain things in your life which everyone does however when the worrying begins to take up so much of your life and affects your functioning we tend to think about diagnosing a generalised anxiety disorder. So it is very good you came in today as there a wide range of things we can do to help you feel more relaxed
