Psych Flashcards
Risk assesment components
SAD PERSONS
Sex (male)
Age (older)
Depression
Previous attempts
Ethanol
Rational thinking loss
Social support lacking
Organised plan
No spouse
Sickness (chronic illness)
Symptoms of mania
DIG FAST
Distractibility/irritability
Irresponsive or eratic behaviour
Grandiose delusions or delusions of persecution
Flight of ideas
Activity increased, inc libido + weight loss
Sleep decreased
Talkativeness / pressured speech
Clang associations
Ideas related only by rhyme or being similar sounding e.g “my mini mouse might make me mumble”
Echolalia
Patients repetition of words and phrases used by an interviewer
When words are inappropriately substituted e.g “I baked the cake in the dustbin, then I put butter in the dog”
Semantic paraphrasia
Word salad
Thought disorder characterised by nonsensical speech with random collection of words forming sentences why have some grammatical coherence and meaning but no significance e.g “Colourless green ideas sleep furiously’
Tardive dyskinesia
A SE of antipsychotics after being on the drug for a long time.
Choreoathetoid movements, abnormal + involuntary movements e.g lip smacking.
Hypochondriasis
Illness anxiety disorder - the persistent belief in the presence of an underlying serious disease
Malingering
Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gains e.g getting pain relief.
Somatisation disorder
Persistent belief of multiple physical symptoms lasting at east 2 years despite being given reassurance + negative test results.
Different to hypochondriasis (as this is a belief in a serious disease e.g brain tumour - whereas somatisation is a group of Sx)
Conversion disorder
Functional neurological symptoms e.g numbness, paralysis & seizures with no associated clear cause + can often be traced back to a psychological trigger
Cirumstantiality
The inability to answer a question without giving excessive unnecessary detail
Flight of ideas
A feature of mania - thought disorder where there a leaps fromone topic to another but with discernible links between them
Knight’s move
A severe loosening of associations - where there are unexpected and illogical leaps from one idea to another.
= feature or schizophrenia
Tangeatiality
Wandering from a topic without returning to it
SSRI discontinuation symptoms
Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms e.g diarrhoea, vomitting, cramping
Paresthesia
*Paroxetine has higher incidence of discontinuation symptoms. When stopping SSRIs the dose should be gradually reduced over 4 weeks (not neccessary with fluoxetine)
SSRI drug interactions
NSAIDs - make sure to co-prescribe PPI
Warfarin / Heparin
Aspirin
Triptans - inc risk of serotonin syndrome
MAOIs - inc risk of serotonin syndrome
1st line treatment of PTSD
Trauma - focused CBT or EDMR (Eye movement desensitisation & reprocessing therapy)
Zopiclone moa + SEs
GABA agonist
SE = agitation, constipation, hypotonia, dizziness, dry mouth, bitter taste in mouth & Inc risk of falls in the elderly
Cotards syndrome
A nilhilistic delusion in which a pt believes they or part of them is dead or does not exist
- Associated with severe depression
Extra-pyramidal side effects
Common SE of antipsychotics (mainly typical)
* Parkinsonism
* Acute dystonia - sustained muscle contraction - Torticolis + occulogyric crisis are the main ones
* Akathisia - restlessness
* Tardive dyskinesia - late onset SE usually occuring after months/years of treatment where choreoathetoid movements occur - commonly pouting of the mouth
Neuroleptic malignant syndrome
Rare / life threatening SE often with new antipsychotic or a dose increase.
* Muscle stiffness + rigidity
* Autonomic disturbance e.g Fever, tachycardia, labile BP
* Altered conciousness
Bloods show raised creatinine and WCC
Schneider’s 1st rank symptoms of schizophrenia
Primary delusions
Thought disorder (withdrawal, insertion, broadcasting)
Somatic passivity - *belief that your thoughts or feelings are being controlled by someone else *
Delusional perception
Auditory 3rd person hallucinations
Features of refeeding syndrome
- Hypophosphatemia
- Hypokalemia
- Hypomagnesemia - can lead to torsades de pointes
- Abnormal fluid balance
First line management of depression in children and adolescents
Fluoxetine SSRI
First line management of depression in children and adolescents
Fluoxetine SSRI
Management of tardive dyskinesia
Tetrabenazine
Section 2 MHA
Assesment order
Detainment for up to 28 days for assesment.
Medication can be administered if observation of treatment response is needed for diagnosis.
Must be approved by 2 independent doctors (one of whom is a section 12 approved doctor) and 1 AMHP
Section 3 MHA
Treatment order
Detainment for up to 6 months for treatment
Must be approved by 2 independent doctors (1 of whom is approved until section 12) and 1 AMHP. Diagnosis and Tx plan needed before section.
Can be renewed indefinitely if needed.
Section 4 MHA
Emergency section
Detainment for 72 hours for emergency medical treatment.
Section 5 (2)
Doctors holding power.
If voluntarily admitted to hospital, but change mind and wish to leave early, any doctor can hold them on the ward for up to 72hrs if of best interest
Section 5 (4)
Nurses holding power. Allows 1st or 2nd level mental health nurse to hold on ward for up to 6 hours (if in best interests) for a 5(2) assesment
Section 136
Allows a police officer to remove a person (whom they consider to be mentally disorganised) from a public place to a place of safety for further assesment for up to 72hours.
Community treatment orders
Any patient with community treatment order can be returned to hospital against their free will if they fail to comply with a treatment regime in the community.
(i.e power to monitor Tx compliance, not a power to give Tx against will).
Section 17
Gives a responsible clinician the power to grant patients leave for specified periods of time
Section 117
Health authorities and local authorities have a legal duty to provide free after care indefinetlye for anyone who has previously been detaned under section 3, 37, 47 or 48
Section 35, 36, 37
Similar to section 2 & 3 but requires approval from the crown court and is applied to those acused of a crime.
