psych Flashcards
ADHD
Conner’s comprehensive behaviour rating scale - also monitor response with this
<10 years - 3 monthly weight; >10 years - 6months
height, BP every 6 months
ECG
10 week watchful waiting
methylphenidate if >10
<12 years and 6 months and 2 environments
antipsychotics
constipation most common symptom of clozapine; need to retitrate after 48 hours
can get hyperprolactianemia in all
NMS - creatine kinase is high, hyperthermia, hyporeflexia = stop, bromocriptine, transfer
Clopixol
dystonia: oculogyric crisis, tocolysis - give procyclidine
aripriprazole is partial antagonist
asymmetrical vs bilateral - clinical vs drug
IM olanzapine not to be given within 1 hr of IM lorazepam because of resp depression
myocarditis, hyperslivation, constipation, lower seizure threshold in clozapine, do not abruptly stop as rebound in 2 weeks
propanolol in akathisia
Delirium
acute confusional state with fluctuating consciousness
drugs - steroids, memantine, opiates, benzos, anti-cholinergies
retention
hypoxia, MI, PE
alcohol withdrawal
UTI
surgery
electrolyte imbalacmes -hypoNa
CAM - confusion assessment method -1,2 and 3/4
1 = acute mental status changes
2 = inattention
3 = disorganised thinking
4 = fluctuating consciousness
haloperidol
if on levodopa then lorazepam
Somatisation
recurrent, frequently changing symptoms present for at least 2 years
persistent somatoform disorder
autonomic - subjective (burning sensation) and objective symps (sweating. palps)
undifferentiated - <2 years
hypochondrial
continuity of care, rule out organic cause and co-morbidities, self help and reassurance, encourage normal actvities
Alcohol withdrawal
CIWA
benzodiazepines, inform DVLA
opthalmoplegia, confusion, ataxia
6-12 = autonomic dysfunction
36 hours = seizures
48-72 hours = delirium tremens
acamprosate for cravings
Autism
<= 3 years
>=2 of interaction,1 of behaviour and communication
make believe play
eye contact
specific routines
early bird and early bird plus
EHC plan
Applied behavioural analysis
home conditions - OT
Autism diagnostic observatory/ inventory schedule
otitis media, hearing and speech tests, WISC score
tuberous sclerosis, neurofibromatosis
SSRIs
in elderly with anticoagulants, use mirtazapine instead as inc riskof bleeding
serotonin syndrome: twitching muscles, dialted pupils, rhabdo, DIC, agitiation, creatinine kinase
wean over 4 weeks, can see effects in 4-6 weeks, full effect in 12 weeks
monthly for first 3 months then annual
discontinuation = hyponatraemia - new onset confusion, paraesthesia
paroxetine causes congenital heart defects in first trimester; persistent pulmonary HT of newborn in 3rd
discontinuation symptoms most seen in paroxetine
Other antidepressants
SNRIs do not give in HT, if on monitor BP
TCAs - urinary incontinence, gynaecomastia, weight gain
in TCAs and MOA in atypical depression i.e. hyperphagia
postural hypotension in moas
imipramine also used in enuresis
hypertensive crisis if thyramine
ECT
- Deliver small electrical currents to brain to change the chemical imbalances in brain which are causing negative emotions
- Induce a seizure - uncomfotable, minor risk of damage to teeth, transient short term memory loss, arrythmias
- Need 2 sessions a week max of 6-12
- Not to eat or drink 8 hours before session
Bloods, ECG (maybe), CXR (maybe) to check baseline and fitness
medication review of anticonvulsants, benzos (increase seizure threshold), lithium/ TCAs (decrease threshold)
under MCA can object, need to fill special consent form
if sectioned and had two sessions need SOAD
recent MI, raised ICP, epilepsy, risk of cerebral bleeding (haemorrhage stroke) are CI’s
Acute stress disorder
derealisation and depersonalisation
no risk taking behaviours
must last 3 days
if resolves in hours to days = transient disorder
adjustment disorder
brief depressive reaction <1 month
prolongded <2 years
mixed anxiety and depression
onset within weeks (3 months) and lasts <6 months
ptsd like symps
but not affecting sleep, appetite, no suicidal ideation
prolonged grief
normal: shock, anger, guilt, sad, acceptance
prolonged: greater intesnity, problematicrelationship/ sudden death, pseudohallucinations, symptoms focussed around person lost
Personality disorders
type A: paranoid (loyalty of friends), schizoid (lack of desire for companions), schizotypal
type B: histrionic (centre of attention, seductive), narcissistic, EUPD, antisocial
type C: dependent (excessive reassurance from others), avoidant (criticism, rejection), obsessive compulsive
dialectical behaviour therapy
psychodynamic in cluster A: relationship between therapist and themselves
mentalisation based: cluster B, accept other people thoughts
need second interview
social help, substance misuse
CBT: antisocial, help with impulsiveness
no improvement in A, slow in B, good in C
Dementia
memory assessment clinic referral
normal pressure hydrocephalus: 3 W’s
RUDAS, MOCA <26, <
<7 AMTS, <18 MMSE
LFTs for Korsakoff
Structural group cognitive stimulation sessions
do ECG before giving anticholinesterase inhibitors
labile emotion in vascular and daily aspirin, focal neuro signs
DAT scan - lewy body
memory affected much later in frontotemporal = can give antidepressants
CI for anticholinesterase inhibitors = anticholinergics, beta blockers, NSAIDs
<10 = severe impariment in alzherimers
give memantine first line if severe
depression
2,2
2,3
3,4
2 weeks watchful - sleep hygiene, MIND UK
see every 2 weeks for first 6 weeks to increase dose from 50-200, review every 2 weeks for 3 months
seasonal, depressive stupor, anxiety induced, agitated, atypical
early morning wakening
CAMHS no improvement in 2-3 months
PHQ 3 x 9 = 20-27 severe, >5 = depression, >10 = moderate
HAD = 21 for each (7 each), 11+ = anxiety/ depression
if severe say if psychosis or not, may need sectioning
children depression inventory
bipolar
complete recovery
4 days is hypomania
lithium only
coexisting - fluoxetine and olanzapine
long term 4 weeks after acute episode
CBT helps ensure drug compliance, help sleep .etc.
cant diagnose in PC - urgent referral to CMHT
GAD
motor, autonomic, constant apprehension
GAD-7: 7 questions, 5,10, 15 - mild, moderate, severe
8 week trial of SSRI
6 weeks self help
16-20 hours of CBT
schizophrenia
catatonic
>= 2antipsychotics then clozapine - if longer 48hrs then retritrate
1 monthly clopixol
6 weeks trial of drugs
urgent = crisis team or home treatment team
non urgent - early intervention in psychosis
· Weight and waist circumference (weekly for 6 weeks, at 12 weeks, annual thereafter)
Pulse and BP (at 12 weeks, annual thereafter)
gradual, low IQ, social withdrawal
cannabis smoking
HIV/ syphilis screen
Delusional perception
anorexia
routine referall for both mild and mdoerate
marsipan = management of really sick patients with anorexia nervosa
proximal myopathy = admit
raised cholesterol, growth hormone, large salivary glands
amenorrhoea
low potassium phosphate and magnesium
<17 8 weeks watchful + routine referral, 15-17, <15
admi if <13, suicide risk, serious physical complications
deliberate weight loss, fear of gaining weight, BMi <17.5 = need to have all 3 otherwise atypical
PTSD
EMDR - eye movement desnsitiation and reprocessing 3 months after non-combat
if mild - watchful waiting for 4 weeks and treat co-morbids e..g depresison
trauma screening questionnaire - 10 questions (>=6 = PTSD)
OCD
chlomipramine is 3rd line
12 weeks to see effect of SSRI need to continue for 12 months after remission
if severe impairment - referal
antenatal care
listeriosis, salmonella
vit D
avoid flying >37 weeks
>32 weeks if multiple pregnancy
bulimia
binging, purging, fear of weight gain
mild = <2x purging a week - beat and monitor 12 weeks
moderate = > 2x a week same as above and monitor for 8 weeks
severe = daily purging and urgent referral
conduct disorder
<10 =oppositional defiant disorder
unsocialised
socialised
>6 months
parent training
problem solving in groups
multisytemic therapy - family, school, criminal justice
missed school - edu support
anger management
refer to CAMHS
schizoaffective
2 epsiodes
1 lasting 2 weeks of psychosis only
1 overlap
fluoxetine and olanzapine
benzos
alcohol pic
can get delirium trmens on withdrawal, anxiety most common, can get anterograde amnesia
resp depression with overdose
reduce 1/8th daily dose every 2 weeks until half original
reduction also halves every 2 weeks
if cant tolerate switch to diazepam/ dififcult to titrate/ short acting like lorazepam
driving risk
max prescription should be 2-4 weeks
lithium
0.4-1mmol/L
>1.5mmol = toxicity
12 hours post dose
check every 3 months
6 moths renal and TFTs
hypothyroidism, hypercalcameia -hyperPTH, tremors, nephrogenic DI, leukocytosis
ACEi, alcohol, diuretics increase toxicity - give fluids
i f change dose weekly monitor until stable
Ebsterin’s anomaly
opiates
harm reduction - sharing needles, vaccinations
low dose if not wanting to stop, high dose if do
give naloxone
loperamide
tolerance reduced
4 weeks vs 12 weeks
ECG, CBT, urine drug screen, signs of withdrawal
LFTs, U&E’s
malnitrition
2 days in urine
cocaine
harm reduction
nasal septum necrosis
anxiety
bruxism and dancing, hyperthermiia and death = ecstasy
risky behaviour, inc confidence
cannabis
panic attacks, euphoria
abstinence
irregular smoking is okay
PO is slower onset lasts longer
smoking shorter onet and lasts couple hours, peaks 30 mins
cannabis
panic attacks, euphoria
abstinence
irregular smoking is okay
PO is slower onset lasts longer
smoking shorter onet and lasts couple hours, peaks 30 mins
John is a 78 year old male who was admitted 2 days ago with a productive cough and consolidation on his chest x-ray. On admission he was confused, and his next of kin report he is off his baseline. Over the next few days his confusion appears to fluctuate and he has at times become anxious reportedly seeing snakes on the ward. Nurses call you as John has become increasingly agitated and has removed his IV required for his antibiotics. He is shouting and wandering trying to get off the ward. The nurse informs you they have tried verbal de-escalation techniques.
You review John’s notes and find he is allergic to nitrofurantoin. His regular medication includes aspirin, ramipril, levo-dopa and metformin. He is being treated with IV co-amoxiclav and clarithromycin.
0.5mg PO lorazepam
A 17-year-old female with BMI of 17 believes she is obese. She is always on a low calorie diet and walks excessively. She reports a regular menstrual cycle.
What is the most likely diagnosis?
atypical anorexia
tca side effects
imipramine, amitryptalline
Urinary retention
Drowsiness
Blurred vision
Constipation
Dry mouth
pruritis side effect of what drug
opiate
scoring system for social phobia
SPIN
cigarette
CO <=10 = abstinence
set quit date and commit
brief advice and harm reduction
nicotine patches - early mornig smoking
varenicline - <18, renal
buproprion - BPAD, <18, eating disorder, seizures, cirrhosis
both not in pregnancy or breastfeeding
nicotine started on quit data
others 7-14 days before
buproprion max 7-9 weeks
2 weeks follow up if NRT 3-4 if meds
measure 4 weeks after quitting CO
switching antidepressants
SSRI–>SSRI taper over 4 weeks
fluoxetine –> SSRi 2 weeks taper then 4-7 days washout
fluoxetine –> SNRI withdraw and strat
SSRI –> SNRI/ TCA cross taper
flooding
exposure to worst fear to overcome phobia
how long do dols last
7 days
paroxetine or citalopram
citalopram as paroxetine used in majr depression
hypersalivation tx in clozapine
hyoscine
therapy for self harm in child
CBT
