Psych Flashcards
5 Criteria for assessment order
- Appears to have a mental illness
- Imminent risk to self/others
- Treatment available at gazeted facility
- Incapable of making informed consent or unwilling to give consent
- Least restrictive method
DSM V for GAD
A. Excessive anxiety / worry, occurring most days for 6 months
B. Difficult to control the worry.
C. Associated with three or more of the following symptoms (Only one item is required in children).
1.Restlessness / feeling keyed up or on edge.
2.Being easily fatigued.
3.Difficulty concentrating or mind going blank.
4.Irritability.
5.Muscle tension.
6.Sleep disturbance
D. Significant functional impairment (work/social/self-care)
E. Not attributable to a substance or medical condition (e.g., hyperthyroidism).
F. Exclude other mental disorder
DSM V criteria for Schizophrenia
A) 2 or more for a sig. portion of 1 month of; Delusions, Hallucinations, Disorganised Speech, catatonia, negative symptoms
B) Impaired functioning (occupation/social/self-care)
C) Continuous signs of disturbance for 6 months
D) Not part of another illness
E) Not due to substance or medical condition
F) If autism or ID, only Dx if prominent delusions/hallucinations for 1 month
DSM V for anorexia nervosa. What are the subtypes?
A) Persistent restriction of energy intake leading to significantly low body weight
B) Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain
C) Disturbance in perception of body image or persistent lack of recognition of the seriousness of the current low body weight.
Subtypes:
Restricting type
Binge-eating/purging type
DSM V for bulimia nervosa
A) Recurrent episodes of binge eating. (characterised by eating abnormally large amounts of food AND a perceived lack of control during episode
B) Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
C) Sx occur at least once a week for three months.
D) Self-evaluation is unduly influenced by body shape and weight.
E) The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
DSM V for Major depression
Depressed mood AND/OR anhedonia for majority of the past 2 week period with 3 more of the following: -weight changes -Sleep disturbance -psychomotor agitation/retardation -Low energy -worthlessness/guilt -Concentration impairment -Suicidality (Excludes Sx due to general medical condition or delusions/hallucinations)
DSM V for Mania
Abnormally and persistently elevated, expansive, or irritable mood > 1 week with 3 or more of the following:
- Pressured speech/more speech than usual
- Inflated self-esteem
- Decreased need for sleep
- Distractibility
- Flight of ideas OR racing thoughts (subjective)
Medical criteria for admission in eating disorder patients
- BMI less than 14
- HR less than 40
- BP less than 90/60 and/or postural drop
- hypothermia less than 36 degrees
- hypoglycaemia
- Electrolyte imbalances
- proximal myopathy
Physical signs of anorexia nervosa
- Lanugo hair
- cachexia
- oedema (low alb, CCF)
- cyanosis
- anaemia
- systolic flow murmurs
- infection (e.g. pneumonia)
- proximal myopathy
- peripheral neuropathy (B12 def.)
- osteoporotic fractures)
- self harm
Vomiting signs = Russell’s sign, parotidomegaly, poor dentition, dehydration)
Describe pathophysiology of refeeding syndrome
- Usually occurs 10 days after refeeding, follow at least 20 consecutive days of fasting
- Insulin levels decrease when fasted, body reserves of K, Mg, PO4, B12 decrease
- refeeding with CHOs cause insulin spike and drop in serum levels of electrolytes
- Causes cardiac arrhythmias, confusion, coma, convulsions, cardiac failure
Management of refeeding syndrome
- Prevention using thiamine, vit. B complex and multivitamins/minerals is recommended
- Milk is preferred; naturally high in phosphate and easily tolerated
- Oral route preferred, parenteral if severe
- Energy intake should be 50-75% of normal for first 3-5 days
- GIT upset is common (colic, reflux, nausea, early satiety
- MONITOR BIOCHEM CLOSELY
Outline contraindications to ECT
- Raised ICP
- Cerebral Malignancy
- Recent stroke
- Thyroid storm
Side effects of ECT
- Retrograde/anterograde amnesia
- Decreased cognitive ability (confusion)
- Lethargy
- headaches
- muscle ache
- nausea
6 criteria for safe discharge
- Medically Stable
- psychologically stable
- discharge destination
- follow up organised
- trial of home completed
- low/no risk to self or others
Dual Dx interactions
- Common cause/trigger
- self-medication
- disorder fostering disorder
- bidirectional
