Psych Flashcards
What are the main two differentials for presentation with acute agitation, aggression and grandiose delusions?
Acute manic or psychotic episode–> organic episode or drug induced
What does NICE approve for the management of acute violence and aggression?
3 step approach - risk assessment, prevention of violence using de-escalation and interventions (including physical interventions, seclusion and rapid tranquilisation)
Whats does risk assessment in violence and aggression entail?
Evaluate current risk and predict future. Intregral part is assessing personal safety.
What risk factors with a patient in a psychotic episode are associated with high risk of continued violence and aggression?
Recent history of violence, current psychotic symptoms, past psychiatric symptoms, history of drug use, male gender and young adult age
What is the problem with physical restraint?
Should be used sparingly by trained staff as can comprimise patient’s breathing
When should seclusion be used with an aggressive and violent patient?
As a last resort
What is preferable to physical interventions in a violent and aggressive patient?
Rapid tranquilisation
How is rapid tranquilisation done?
Non-psychotic or CVS risk history then short acting benzodiazopine (diazepam long acting so avoid) orally or IM. Seek senior advice and record vital observations
Can a deaf person have auditory hallucinations?
Yes and they may also experience images of lips moving. The wernickes and Brocas areas are still intact as these are still language areas.
In patients who are deaf, what should not be interpreted as abnormal?
Very expressive faces and arm gestures
DD for deaf man hearing auditory hallucinations (lips moving despite no one being around). Male voice and says negative things like “bad man”, “devil” and “kill yourself”. Low mood for 9 months since relationship with GF broke down who he was hoping to marry (worried that won’t get married now)
Psychotic depression due to the severity of the depression. Exclude schizophrenia and organic causes. Carry out depression assessment in someone who Is BSL competent.
32 year old man. Metallic taste in mouth and auditory hallucinations for a few seconds and then has an out of body experience. After a few moments he comes around and is totally disorientated. During these episodes he is told that he behaves oddly with repetitive motions such as lip smacking. No collapsing or tonic clonic movements. Diagnosis?
Temporal lobe epilepsy with complex partial seizures
What are the auras in temporal lobe epilepsy referred to as? Describe them?
Simple partial seizures that occur in 75% of people with temporal lobe epilepsy. Conciousness is maintained-> different feelings, thoughts, emotions which may be familiar or totally unfamiliar (deja vu or jamais vu)
What can a simple partial seizure evolve into?
A complex/ generalised one when consciousness is impaired
What are classic behaviours in temporal lobe epilepsy?
Many people perform repetitive automatic movements called automatisms such as lip smacking and rubbing of the lips together.
