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
Differential for a patient with psychotic symptoms of duration
Shizophrenia-like psychotic disorder (acute/transient psychotic disorder)
Differential for a patient with psychotic symptoms present for longer than 3 months with delusions only?
Delusional disorder
Differential for a patient with typical schizophrenic symptoms in the absence of prominent mood symptoms?
Schizophrenia
Differential for a patient with typical psychotic symptoms in the presence of prominent mood symptoms?
Schizoaffective disorder
Differential for a patient with psychotic symptoms (usually mood-congruent) in the presence of prominent mood symptoms?
Depression or Mania with psychotic features
What investigations would you like to perform for ?dementia after taking a history?
MSE with AMTS
General exam:
- Thyroid r/o hypothyroidism
- Neuro r/o SOL, stroke
- Cardio screen for risk factors, e.g. hypertension or AF
- r/o self-neglect or falls injuries as a consequence of dementia
Bloods (looking for reversible causes):
- B12/Folate r/o deficiency/malabsorption
- TFTs, calcium, glucose, U+Es r/o hypothyroidism, hypercalcaemia, Cushing’s or Addison’s
CT/MRI:
- r/o SOL, subdural haematoma or normal pressure hydrocephalus
name the dementia
Generalised cerebral atrophy
Widened sulci
Dilated ventricles
Thinning of the width of the medial temporal lobe
Alzheimer’s disease
name the dementia
Single/multiple areas of infarction
Cerebral atrophy
Dilated ventricles
Vascular dementia
name the dementia
Greater relative atrophy of the frontal and temporal lobes with knife-blade atrophy
Frontotemporal dementia
Knife-blade atrophy = atrophied gyri
name the dementia
Dilated ventricles with atrophy of caudate nuclei (loss of shouldering)
Huntington’s disease
name the dementia
bilaterally evident high signal in the pulvinar (post-thalamic) region
new variant CJD
this appearance is also known as the hockey stick sign
List all questions of the AMTS
- What is your age?
- What is the time?
- Remember this address for me (e.g. 42 West Street)
- What year is it?
- When is your date of birth?
- Where are we?
- Name who these two people are.
- When was WW1/2?
- Who is the current PM?
- Count down from 20–>1
Recall the address from Q3.
Many physical symptoms from different parts of the body. Unable to find a particular cause.
Somatisation disorder
Fearing that minor symptoms may be due to a particular serious disease. Reassurance is not helpful.
Hypochondriasis
Neurological symptoms that have developed quickly in response to a stressful situation.
Conversion disorder
Great concern over an aspect of their physical appearance which is not necessarily apparent to other people.
Body dysmorphic disorder
Persistent pain that cannot be attributed to a physical disorder.
Pain disorder
What is the difference between factitious disorder and malingering?
Factitious disorder = focus on internal/primary gain of assuming the sick role (i.e. to become a patient)
Malingering = focus on external/secondary gain of being ill (i.e. avoiding military service/legal duties/getting benefits)
What are the pharmacological steps in treating mania/hypomania?
- stop anti-depressants
- Start one of the following antipsychotics:
- Haloperidol
- Olanzapine
- Quetiapine
- Risperidone - If not tolerated/poor response at max dose then swap for a different one
- Try Lithium (or if not appropriate then valproate)
