Psych Flashcards
Indication for haloperidol in agitation
Cautions
First line for ETOH intoxication
Small risk of long QT - do not use IV in pts at risk
Extrapyramidal side effects - do not give in Parkinson’s, Lewy Body
Indication for second generation antipsychotics in agitation
Cautions
Use in agitation due to psychiatric illness and delirium in elderly
1. oral risperidone
2. IM ziprasione or olanzapine
Lower risk of EPSE
Quetiapine - high rates of orthostatic hypotension
Aripiprazole - less effective
Indication for benzos in agitation
Cautions
Use in recreational drug intoxication (except ETOH)
ETOH withdrawal
Risk of respiratory depression
Can make delirium worse
Anxiolytics for levels of risk for QTc prolongation
No long QT, no risk
- clozapine
No long QT, risk factors present
1. olanzapine, aripiprazole
2. risperidone, quietiapine, haloperidol
Long QT <500ms
- Aripiprazole, olanzapine, risperidone, quetiapine
Long QT >500ms
- Aripiprazole, valproate, trazodone, benzos
Risk factors for suicide
Male
Age 15-24
Maori
Has a plan
Recent suicide attempt
Family/friend suicide
Lack of supports
Psychiatric illness
Less: single, sexual minority, general medical illness, chronic pain, TBI, unskilled occupation, childhood trauma, rural, family hx, relationship loss
Vulnerability factors: low self-esteem, poor social skills, family conflict, bullying, frequent moving, homelessness, parent with mental illness/ETOH/drug, low SES, school suspension, abuse/neglect
Protective factors for suicide
Family support
Cultural identity
Spiritual belief that discourages suicide
Belonging to community
Makes valued contributions
Supportive friends
Developing skills, volunteering, contributing
Most common method of suicide
Asphyxiation (hanging, suffocating, ligature)
Comorbidity triangle in youth for suicide
Depression, substance abuse, victim of abuse
PH-2 screening for depression
PH-9 questions and scoring
Over last 2 weeks:
Feeling little interest or pleasure in doing things
Feeling down, depressed, hopeless
0- not at all
1 - several days
2 - more than half days
3 - nearly every day
Score 3+ proceed to PH-9 questionnaire - above plus:
- Sleep
- Energy
- Appetite change
- Feeling bad about yourself
- Trouble concentrating
- Moving/speaking slow or restless
- Thoughts of death, self-harm
1-4 minimal
5-9 mild
10-14 moderate
15-19 mod-severe
20+ severe
Medications for depression
Start in moderate - severe depression
SSRIs first line
Citalopram - lowest interactions
Sertraline - lowest exposure in breastfeeding
Fluoxetine - evidence for <18
Paroxtine - lowest long QT risk
Delirium vs acute psychosis symptoms
Delirium
- Inattention, easily distracted, disoriented, fluctuating course
Psychosis
- normal attention, alert, intact memory, disorganised thinking
3 manifestations of psychosis
Delusions - false unshakeable belief, out of keeping with education/culture/social background
Hallucinations - auditory most common
Thought disorder - lack of coherent, logically connected thoughts
Medications for psychosis
Cause unknown
- Haloperidol 0.5-5mg + lorazepam 0.25-2mg
- Benztropine/diphenydramine to prevent EPSE/dystonia
OR risperidone/olanzapine/ziprasidone
Likely psychotic illness
- pt’s regular antipsychotic
- Olanzapine 5-10mg
- or risperidone 0.5-2mg + lorazepam 0.5-2mg
- or haloperidol + lorazepam, olanzapine, ziprasidone
Suspect acute mania
- Above antipyschotics PLUS
- valproate 600mg daily divided
Risk factors for anxiety
Females
Young adults
Family history
Comorbid psych condition
Drug and ETOH
Chronic medical condition
Hx trauma, abuse, family violence
Maori, Pacific, Asian
Low SES
Loss of employment, relationship, stress
Ongoing conflict - sexual, spiritual, cultural
GAD-7 anxiety screening
Over last 2 weeks:
- Feeling nervous/anxious/on edge
- Unable to stop/control worrying
- Worrying about different things
- Trouble relaxing
- Hard to sit still
- Easily annoyed, irritable
- Afraid something awful will happen
0 = not at all
1 = several days
2 = more than half days
3 = nearly every day
5 mild
10 moderate
15 severe
