Psych Flashcards
What are the causes of delirium?? (It’s a mnemonic!!!!)
"DELIRIUM" Degenrative Epilepsy (post-ictal state) Liver failure Intracranial (SAH/abscess/trauma) Rheumatoid chorea Infections (pneumonia/sepsis) Ureamia Metabolic (electrolyte disturbance)
Management approach for somebody with delirium (it’s a menmonic!!!)
“DELirium”
Diagnose and treat underlying cause
Environment and Medications - ensure calm, consistent nursing staff. Presence of a family member/friend can be reassuring. Increase visual acuity (spectacles)/ensure they can hear (to avoid misinterpretation of stimuli). Clocks/calendars.
Legal issues: capacity/consent and ?legislation.
Mnemonic for psych history.
“SOCk SOAP”
- when did symptoms START
- what was the ONSET - sudden/gradual
- what are the symptoms’ CHARACTERISTICS - constant/intermittent/worsening
- SOCIAL impact
- OCCUPATIONAL impact
- ASSOCIATED symptoms: “DOPAS” Depression/Mania, OCD, Psychosis, Anxiety, Substances
- PERSONAL history: “SO FAR” Social issues, Occupational record, Forensic history, Alcohol/substance, Relationships.
What is a person’s lifetime risk of developing schizophrenia if no relatives of theirs have schizophrenia?
1%
What is a person’s lifetime risk of developing schizophrenia if one parent has schizophrenia?
10%
What is a person’s lifetime risk of developing schizophrenia if both of their parents have schizophrenia?
50%
What is a person’s lifetime risk of developing schizophrenia if their monozygotic twin has schizophrenia?
50%
What is a person’s lifetime risk of developing schizophrenia if their sibling has schizophrenia?
10%
What is a person’s lifetime risk of developing schizophrenia if their dizygotic twin has schizophrenia?
10%
How can treatment-resistant schizophrenia be defined?
A lack of satisfactory clinical improvement despite the sequential use of at least two antipsychotics for 6-8 weeks, one of which should be a second generation antipsychotic.
Acute dystonia is a potential side-effect of antipsychotics. What pharmacological agent might you use to treat this side-effect?
Use an anticholinergic, e.g. parenteral procyclidine.
What side-effect should you be aware of specifically when using chlorpromazine?
photosensitivity
What side-effect should you be aware of specifically when using haloperidol?
QTc prolongation (take a baseline ECG)
What side-effects should you be aware of specifically when using Clozapine?
Agranulocytosis
Hypersalivation
Which first generation antipsychotics can be given as IM depots?
Haloperidol
Flupentixol
Zuclopenthixol
Which second generation antipsychotics can be given as IM depots?
Risperidone
Side effects of antipsychotics? (It’s a mnemonic!)
“HE Met C”
Hormonal - increased serum prolactin
Extrapyramidal - akathisia, dyskinesias, dystonia
Metabolic - Weight gain, diabetes
Cardio - QT prolongation
What’s the general ‘biological’ approach to schizophrenia management?
Antipsychotics
Physical health check before starting antipsychotics (BMI, BP, cardio exam, diet, physical activity, glucose, assess for movement disorders)
Consider benzodiazepines if there are behaviour disturbances, insomnia, aggression, agitation
What’s the general ‘psychological’ approahc to schizophrenia management?
Support, advice, reassure the patient/carers
CBT - shown to improve insight and help patient spot early signs
Family therapy - shown to reduce relapse/readmission rates
What’s the general ‘social’ approach to schizophrenia management?
Optimise integration into community.
Assess for a Care Programme Approach (CPA)
Involve: Social services, local authorities, local/national support groups.
Involve: Community psychiatric nurses (CPNs), consultants, OTs, psychologists, social workers.
Financial benefits
Accomodation
Support for carers
Occupation
Daytime activities
Treatment for benzodiazepine overdose?
IV Flumazenil
What pharmacological agent would you like to use to tranquilise an agitated/aggressive patient?
Benzodiazepine - lorazepam oral or i.m.
What parameters would you like to explore in a psychotic patient? (it’s a mnemonic!)
“BeNT PerP”
Beliefs - delusions vs overvalued ideas
Negative symptoms - apathy, blunting of affect, social isolation, cognitive deficit
Thought disorders - circumstantiality, flight of ideas, knight’s move, block, echolalia, perseveration
Perceptions - auditory, visual, olfactory, gustatory, somatic
Psychomotor function - catatonia
Differential for a patient with psychotic symptoms secondary to a medical condition or psychoactive substance usage?
Organic psychotic disorder
or
Substance-induced psychotic disorder
