psych Flashcards
OCD severity scale
Y-BOCS scale
example of severe ocd
spends >3 hrs a day on obsessions/compulsions
seevre intereference /distress
very little control/resistance
body dysmorphic ssri
fluoxetine
ocd tx
mild functional impairment: CBT including ERP
mod: SSRI CBT ERP
SSRI CI = offer clomipramine
severe = refere 2ndry care in meantime offer the above
ptsd features
re-experiencung
aavoidance
hyperarousal
emotional numbing
ptsd vs acute stress disorder
ptsd>month
asd <month
ptsd tx
watch and wait if sx less than 4 weeks
trauma focucsed CBT
EMDR
dx not 1st line but if used = venlafaxine or ssri eg sert
less severe depression
PHQ-9 <16
more severe depression
PHQ-9 = 16+
2 depression screening qs
‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’
major depressive disorder criteria (DSM-5)
Low mood OR loss of interest (anhedonia)
and
2+ weeks
and 5 of following: SIG-E-CAPS
Sleep
interest
Guilt
Energy
Concentration
appetite
psychomotor
suicidal
switching from fluoxetine to another SSRI
taper then gap 4-7days (long half life) then titrate
switching SSRI to TCA
cross taper
EXCEPT fluoxetine = withdraw before starting TCA
switching from SSRI (not fluox) to venlafaxine
cross taper cautiously
start ven 37.5mg daily n increase v slowly
switch fluox to venla
withdraw then start 37.5mg daily and v slow increase
SSRI post MI
sertraline
SSRI in kids and teens
be careful when indicated = fluox
SSRI SE
GI Sx
inc risk of GI bleed (PPI if on nsaid)
counsell for inc anxiety and agitation after starting
fluox and paroxetine higher propesity for drug interactions
citalopram and escitalopram SE
max dose
long QT
40mg for adults
20mg: >65 or hepatic impairment
triptans and SSRI
serotonin syndrome
antidepressant w pt on warfarin/heparin
avoid ssri
use mirtazapine
MAOIs n ssri
serotonin syndrome
continue antidepressants how long
6mths post remission
paroxetine in pregnancy
increased risk of congen malformations esp in first tri
SSRI in pregnancy 1st n3rd tri
1st; small inc risk of congenital heart defects
3rd; persistatnt pul htn in newborn
lithium on renal
nephrotoxic polyurias, secondaru to nephrogenic diabetes insipidus
lithum ecg
t wave flattening/inversion
when should sample be taken when checking lithium level
12 hour post dose
lithiumwhen to check
when starting or changing dose. weekly until stabilised
then 3 mnthtly
thyroid and renal every 6mths
mania vs hypomania
mania = 7 days
psychotic sx
hypomania <week (3-4days)
no psychotic sx
section 135
police enter home
sectioned for 24 hrs (extended to 36 if not assesed in time)
section 136
police detain in public place
24 hrs (also extended to 36 if no asses)
section 5(4)
nurses ability to detain someone in hospital (ie stop them leaving) until dr assesses to see if need 5(2)
6 hrs
section 5(2)
doctors ability to detain in hospital for 72 hrs in order to receive assessment for detention under mental health act
section 2 MHA
up to 28 days
section 3 MHA
6 months
mania sx DIG FASTER
distractibilty
insominia
grandiosity
flight of ideas
agitation
sexual exploits
talkative
elevated mood
racing thoughts
bipolar tx
mood stabiliser =lithium (2nd valp)
mania: stop SSRI, antipsychotic ie olanzapine or haloperidol
comorbidities w bipolar
2-3 inc risk if diabetes CVD and copd
chronic insomnia
atleast 3 nights a week for more than 3 mnths
protective suicide factors
family support
having children at home
religious beliefs
factors with increased risk of completed suicde at later date post first attempt
efforts to avoid discovery
planning
leaving a written note
final acts ie sorting finances
violent method
charles bonet syndrome
hallucinations (visual/auditory) occuring in clear consciencness on background of visual impairment (age related mac degen (MC), glucouma, cataract)
risk factors for charles bonnet
advancing age
peripheral visual impairment
social isolation
senspry deprivation
early cog impairment
moai example
selegiline
cluster A odd or ecentric PD
paarnoid
schizoid
schizotypal
cluster B ‘dramatic, emotional, erratic’
antisocial
borderline
histrionic
narcissistic
cluster C ‘anxious nd fearful’
obsessive compulsive
avoidant
dependant
when do sx start in alcohol withdrawal
6-12hrs: tremor, sweating, tachycardia, anxiety
peak incidence of seizures alcohol withdrawal
36 hrs
peak incidence of delirium tremens
48-72hrs
course tremor
confusion
delusions
auditory and visual hallucinations, fever, tachy
negative sx of schizophrenia
incongruity/blunting of affect
anhedonia
alogia (poverty of speech)
avolition (poor motivation)
social withdrawal
suicide risk factors
male
hx of self harm
alcohol/drug misuse
hx of mental illness
hx of chronic disease
advancing age
unemployment or social isolation ie live alone
unmarried, divorced, widowed
somatisation disorder
multiple physical sx present for atleast 2 yrs
pt refuses to accept reassurance or negative test results
illness anxiety (hypochondriasis)
persisant belief that they have underlying DISEASE eg cancer
refuses to accept reassurance or test results
funcitional neuro disorder (conversion)
loss of motor or sensory function
pt not consciously feign sx or seek matieral gain
pt may be indifferent to disorder (la belle indifference)
dissociative disorder
seperate off certain memories from normal consciousness
involves psychiatric sx ie amnesia fugue stupor
factitious disorder
munchausens
intentional production of physical/pscyho sx
malingering
fraudulent simulation/exaccergation of sx for financial or other gain
clag associations
words and ideas only related bc sound similar eg
my mini mouse might make me mumble
cotard
believing they are dead
anorexia fx
most things low
ie low t3, LH,FSH, oest, prog, test, hypokalaemia
Gs and Cs raised:
growth hormone
glucose
salivary glands
cortisol
cholesterol
carotinamia
clozapine adverse affects
agranulocytosis n neutropenia
reduces seizure threshold
constipation
hypersalivation
myocarditis - take baseline ecg
dx causes of mania
anti depressants
cocaine amphetamines
corticosteroids
levodopa
procylidine
tests be lithium
TFT
FBC
U&E
ECG
+ves of HAD/PHQ
diagnostic
monitering of sx
research
-ves had/phq
significantly diff scores between different populations and cultures
only validated in hospitals not for general pop
other things to screen for w depression
mental - anxiety bipolar shizophrenia
medical - hypothyroid addisions perimenopause
mirtazapine class
noradrenergic and specific serotonergic antidepressant
inc release of neurotransmitters by blocking alpha 2 adrenoreceptors
