Psych

Question 1

Acute stress disorder & PTSD mx

Answer 1

1.trauma-focused cognitive-behavioural therapy (CBT)

PTSD only
- eye movement desensitisation and reprocessing (EMDR)
- venlafaxine or a selective serotonin reuptake inhibitor (SSRI)

benzodiazepines- acute symptoms e.g. agitation, sleep disturbance

Question 2

PTSD px

Answer 2

Re-experience
Avoidance
Hyper arousal
emotional numbing

Question 3

Alcohol witdraw px

Answer 3

6-12: tremor, sweating, tachycardia
36: seizure peak
48-72: delirium tremens peak - coarse tremor, confusion, delusions, hallucinations

Question 4

Anerexia nervosa dx criteria

Answer 4

1. energy restriction
2. fear of gaining weigh
3. body dismorphia

Question 5

Anerexia nervosa mx

Answer 5

Adult
- eating-disorder-focused CBT, etc

Children
1. anorexia focused family therapy
2. CBT

Question 6

bipolar mx

Answer 6

litium
mania/hypomania - stop antidepressant & start antipsychotic .
depression: talking therapy, fluoxetine

co-morbidities: 2-3x risk of diabetes, cardiovascular disease and COPD

hypomania: routine referral to the community mental health team (CMHT)
Mania/ severe depression - urgent referral

Question 7

Bulimia nervosa tx

Answer 7

bulimia-nervosa-focused guided self-help for adults
individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
children: bulimia-nervosa-focused family therapy (FT-BN)

Question 8

Depression mx

Answer 8

less severe
- guided self help
- group CBT, etc
- SSRI

more severe
- individual CBT & antidepressant

Question 9

Depression dx

Answer 9

Screening:During the last month…
- feeling down, depressed or hopeless?
-having little interest or pleasure in doing things

dx criteria
- depressed mood
- anhedonia
- worthless
- biological: weight loss/ gain, sleep changes, fatigue, can’t concentrate
- Psychomotor agitation or retardation
- recurrent thoughts of death

Question 10

OCD mx

Answer 10

• CBT, exposure and response prevention (ERP)
• SSRI (2. clomipramine)
  -refer

Question 11

Schneider’s first rank symptoms

Answer 11

auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions

Question 12

Mental Health Act

Answer 12

section 2
- up to 28 days, not renewable
- Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR)
- recommendation of 2 doctors, one approved by sec12
- tx can be given

Sec 3
- up to 6 months, can be renewed
- AMHP along with 2 doctors who seen the patient within the past 24 hours
- tx can be given

section 4
- 72 hour assessment
- used as emergency, then changed to section 2
- a GP and an AMHP or NR

Section 5(2)
a patient who is a voluntary patient in hospital-legally detained by a doctor for 72 hours

Section 5(4)
- nurse to detain a patient who is voluntarily in hospital for 6 hours

Section 17a
- recall a patient to hospital for tx if not complying w community orders

135
- police to break into a property to remove a person to a Place of Safety

136
- found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
- can only be used for up to 24 hours