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Psych Flashcards

1
Q

What tests do you do when investigating depression

A 
- any malnutrition?
Exclude medical causes =
- FBC: anaemia, MCV will be raised if alcoholic
- U+E: Calcium
- Gluc: diabetes 
- TFT: hypo or er thyroid
- Inflam markers
Before administering AntiDs =
- Na levels
- LFTs and GFR for baseline
- TFTs for lithium
Other tests =
- Cushings, intracranial pathology
Mg, HIV or syphilis serology, or drug screening
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2
Q

Average length of manic episode?

Number of manic episodes in 25 years on average?

A

6 months

10

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3
Q

Cyclothymia

A

Mood instability but not enough to meet threshold

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4
Q

Dysthymia

A

Chronic low mood but not enough for depression

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5
Q

Double depression

A

depression in dysthymia

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6
Q

What must you check when prescribing lithium

A
  • is she on contraception (+folic acid)
  • UandE, TFT, FBC, Calcium
  • GFR + renal func (renally excreted)
  • ECG, weight, BP, pulse
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7
Q

Treatment in bipolar mania

A
  • AntiP, Lithium/valproate, benzos, STOP ANTID
  • Psychoed
  • Low stimulus environment and admission?
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8
Q

Bipolar depressive treatment

A
  • Antidepressants, mood stabiliser, Atypical antiP
  • CBT if mild, psychoed
  • Social inclusion, carer support, inpatient if risk, education, training employment support
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9
Q

Bipolar remission treatment

A
  • Avoid AntiD, mood stabiliser
  • CBT, fam intervention, psychoed
  • Education, training, employment, carer, social inclusion, CPN, House benefit support
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10
Q

How long do you have to stay on AntiD before deciding its failed
How long do AntiDs take to work

A

4 weeks

2-3 weeks

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11
Q

What do you monitor when someone is on lithium and how often?

A

Blood levels - 0.4-1.2 3M
U+E 6M
TFT 6M

as nephrotoxic and thyrotoxic

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12
Q

Which Neuroleptic has a risk of steven johnson syndrome

A

Lamotrigine

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13
Q

What would you use Lamotrigine for

A

Bipolar depression, bipolar prophylaxis, treatment resistant depression

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14
Q

When would you use carbamezapine

A

acute mania, prophylaxis of bipolar, bipolar depression (ALL 3 BIPOLAR)

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15
Q

Someone has come in to A+E and self harmed - what would you do?

A
  • Initially assess physical and mental health + treat any injuries
  • Safeguarding concerns? Social circumstance?
  • Risk assess
  • Refer to specialist in 2y mental health of psychosocial assessment
    IF already involved with 2y mental health:
  • risk management plan
  • psychological interventions specifically for self-harm
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16
Q

Differential diagnosis for a Manic episode?

A

Manic episode or bipolar affective disorder
Acute and transient psychotic disorder
Stimulant intoxication
Physical disorders - hyperthyroidism, space occupying lesion, metabolic disorders
Medication - steroids.

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17
Q

What can precipitate a manic episode

A

lack of sleep, life events or stressors, not taking meds, substance misuse, childbirth, natural disease fluctuation

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18
Q

Section 2?

A

< 28D. 2docs and 1 AMPH
when no diagnosis
if diagnosis at 28 days can have 3. cant b2b 2

19
Q

Section 3

A

Treatment order 6M = 2 docs and 1 AMPH

can renew

20
Q

Section 4

A

Emergency for <72h

21
Q

Section 5 (2)

A

<72h - holding order. ONLY NEED 1 DOCTOR
for mental health assessment
has to be Inpatient (not A+E)

22
Q

When someone is sectioned under a 5 (2) and the MHA timing runs out –> what are your options

A
  • cant b2b

- assess for section 2 or 3

23
Q

Diff between 5 (2) and 5 (4)

A

4 is only for 6 hours and you only need a mental health nurse

24
Q

What is a community treatment order?

A

Live in the community but treated under MHA
Only for psych stuff
can recall to ward if think not taking meds

25
Subjective and objective?
``` Subjective = their opinion Objective = your opinion ```
26
Perserbaration?
repeating words
27
Examples of when: - subjective opinion not supported by objective - objective opinion not shared subjectively
- Not actually that depressed - Poor insight, may have psychotic element (nihilistic and hypochondriacal). also may not feel worthy of treatment. or learning disability
28
What is somatic passivity?
The body is controlled by an external force
29
Auditory hallucinations - 2nd person definition - 3rd person definition
``` 2 = taling TO patient 3 = talking about patient to each other ```
30
What is Lilliputian? | When does it occur?
Visual hallucinations of animals or little men - common n delirium tremens
31
Difference between pseudohallucination and hallucination?
pseudo = INSIDE head and not like real voices (schizo outside and real voices) - pseudo can also become more vivid as you concentrate whereas schizo constant and unchangeable. Common in EUPD
32
What are overvalued ideas?
ideas that are understandable and reasonable but dominate a patients life
33
Name 4 indications for ECT
treatment resistant depression, life threatening depression, treatment resistant mania, catatonia
34
name some ECT contraindications
cochlear implant, raised ICP, recent MI 3m ago, aortic aneurysm, uncontrolled arrthymias, HF decompensated, intracranial aneurysm
35
Difference between delusional disorder and schizohrenia?
delusional disorder you have no 1st rank symptoms just delusion. must have or over 3 months
36
name the first rank symptoms for schiz and how many do you need for diagnosis
only need ONE: - thought echo, insertion, broadcasting - delusions of control or delusional perception - hallucinatory voices (commentary or 3rd person)
37
Name the 4 second rank symptoms of schiz and how many do you need for diagnosis
1st rank OR need TWO of: - persistent hallucinatons of any modality (+ delusion or persistent overvalued idea) - Neologisms or breaks in through = incoherent speech - Negative symptoms - Catatonic behaviour
38
What id deficit syndrome
just neg symptoms of schizo for over 12 months
39
Good or bad prognostic factors? a- long prodrome b- female c- prominent -ve symptoms
a- bad b- good c - bad
40
Name some baseline tests prior to antipsychotics
ECG, weight/ height, BP, FBC, U+E, LFT, prolactin, gluc, fasting lipids, TFT, lipid profile drug screen?
41
What happens with neuroepileptic malignant syndrome
sweating, muscles go rigid, confusion, increased HR and RR, up or down BP, tremor, RAISED CK, low PH - metabolic acidosis, SNS liable,
42
side effects of anti Ps and which are worst for them
weight gain sedation metabolic disturb Best --> worst Aripip, risperid, quitiapi, orlanzo, cloz
43
how long do you continue antiPs after an episode of psychosis?
1-2 year

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