Psych Flashcards
What is a delusion?
Fixed firmly held belief that is held despite evidence to the contrary and cannot be reasoned away. It is out of keeping with the person’s sociocultural norms.
What is a delusion of reference?
Thinking every day things (neutral events) have a special meaning or personal message behind them
What is a persecutory delusion?
Thinking that others are out to get them
What is a grandiose delusion?
Belied that they have special talents, are famous or particularly important
What is a depressive delusion?
Belief that they are guilty, worthless, end of the world is coming
What is delusional jealousy?
Preoccupation with thought that their spouse is being unfaithful without having logical proof
What is a delusion of control
Feeling under the control of a force or power
Describe thought withdrawal
Feeling that thoughts are being taken out of their head so mind left blank
What is thought broadcast
Thoughts transmitted, everyone can hear
What is thought echo?
Thoughts repeated like an echo!
What is thought insertion?
Someone else putting thoughts into the mind
What physical disorders can present like psychosis?
Dementia Thyrotoxicosis Cushing's Epilepsy of temporal lobe Drug misuse
What are the hallmark symptoms of psychosis?
Hallucinations
Delusions
Thought disorder
Lack of insight
What are the first rank symptoms of schizophrenia
Delusions of one type
Auditory hallucinations- echo, third person voices, running commentary
Thought disorder - insertion, withdrawal, broadcast
Passivity experiences
What are the negative symptoms of schizophrenia
Under activity Poverty of speech Low motivation Social withdrawal Emotional flattening Self neglect
What are the signs of schizophrenia on MSE
Appearance and behaviour: withdrawal, self neglect, stereotypical behaviours, responding to unseen stimuli
Speech: poverty of speech, loosening of associations
Emotion: flat affect
Thoughts: delusional beliefs, passivity, thought disorders
Perceptions: auditory hallucinations
Insight: lack!
According to ICD 10, which four symptoms do people need to experience one of for a diagnosis of schizophrenia?
Thought disorder
Delusions of control, passivity or influence
Hallucinatory voices - running commentary, third person,
Persistent delusions
What is the differential diagnosis for schizophrenia?
Delirium Drugs Mood disorder with psychotic symptoms Delusional disorder Schizoaffective Dementia
What is the treatment for schizophrenia
First line: atypical - risperidone, olanzapine
Then: typical - haloperidol
Then: clozapine
How quickly does schizophrenia improve following initiation of antipsychotic treatment?
After first few days excitement and irritability improve
After few weeks, hallucinations and delusions improve
What is schizoaffective disorder?
Schizophrenic and mood symptoms, both severe enough to reach ICD 10 criteria
How long do symptoms of schizophrenia need to be present for a diagnosis to be made?
One month
What is delusional disorder?
Delusion for at least 3 months
No presence of other symptoms
What are the core symptoms of depression
Anhedonia
Low mood
Lack of energy
For at least 2 weeks
What are some depressive cognitions?
I am worthless Guilt Hopelessness Constant worries about health Poor concentration Suicidal ideation
State the biological symptoms or depression
Early morning wakening Diurnal mood variation Lack of appetite Weight loss Loss if libido Psychomotor agitation or retardation
What is the ICD 10 classification for the severity of depression?
Mild - 2 core, 2 others
Moderate - 2/3 core, 3/4 others
Severe - 3 core, 4 others
What is the difference between grief reaction and depression?
In grief reaction: still have ability to feel pleasure, grief comes in waves, no thoughts of worthlessness of hopelessness, able to look forward to future
Management of mild to moderate depression
CBT
Then antidepressant if persists or if history of depression
Treatment of moderate to severe depression
Antidepressants
- SSRI
- different SSRI or SNRI
- mirtazapine or augment with lithium/quetiapine
AND
CBT/ IPT
ECT can be used if fast treatment needed, or situation is life threatening
Describe mania according to ICD 10
Mood which is predominantly elevated, expansive or irritable and definitely abnormal for the individual concerned.
Prominent and sustained for at least a week or severe enough to require admission to hospital
State some of the symptoms of mania
Increased activity Increased talkativeness Flight of ideas Loss of social inhibitions Less sleep Inflated self esteem Distract ability Reckless behaviour Sexual energy
Also psychotic symptoms
What is the difference between mania and hypo mania?
Hypo mania
only four days
Only some interference with personal functioning (mania there will be severe interference)
No psychotic symptoms in hypomania
What is the difference between bipolar I and bipolar II
I - manic episodes plus major depressive episodes
II - hypo mania plus depressive episodes
What could be differential diagnosis for bipolar?
Schizophrenia - in mania the content of delusions and hallucinations changes quickly
Dementia
Endocrine - hyperthyroid!
Drug misuse
Describe treatment of bipolar disorder episode
Admission is likely to be needed
Pharmacological
Mania: antipsychotic (olanzapine, quetiapine, risperidone, haloperidol), if two fail then lithium, if fails then sodium valproate
Depression: antipsychotic (quetiapine), then olanzapine + fluoxetine, then lithium, then SSRI
Why are SSRI used with caution in those with bipolar depression?
Switching to Mania
Describe how bipolar relapses are prevented
Continuation therapy: lithium first line, then add valproate.
Lamotrogine or carbamezepine also
Education of early signs of relapse
What are the early signs of relapse in bipolar?
Reduced need for sleep Over spending Increased activity Racing thoughts Elated mood Irritability Unrealistic plans
What are the psychological a symptoms of anxiety?
Racing thoughts Increased alertness Feeling of dread Restlessness Inability to focus
What are the physical symptoms of anxiety
Palpitations
Sweating
Breathlessness
Shaking
What is GAD
Worries about worries
Maintained by belied that worries are helpful
What is social anxiety disorder
Fear of negative evaluation by others
Avoidance of feared situations
Unhelpful evaluation following social encounters
What is adjustment disorder?
Subjective distress and emotional disturbance, interfering with social functioning and performance, arising in period of adaption to significant life change.
What is a grief reaction?
Develops within three months of stressor
Does not persist for more than 6 months after stressor is no longer present
What is agoraphobia
Fear of leaving home, going to public places, travelling alone on public transport
What is an obsession in OCD?
Recurrent unpleasant thoughts or images
Ego dystonic
Coming from person’s mind, recognised as being excessive or unreasonable
What is a compulsion in OCD
Action or ritual related to the obsession
Person tries to resist, but feels driven to perform them
It is not pleasurable to carry out
What is the management for anxiety disorders?
CBT
SSRI
Anxiolytics in short term
What are the core symptoms of PTSD
Re-experiencing
Avoidance or rumination
Hyper-arousal
How is PTSD treated
Trauma focused CBT
EMDR
Drug treatment as adjunct or if not able to do CBT
Paroxtine, mirtazapine
What is a personality disorder?
Deeply ingrained and enduring behaviour patterns
Present since adolescence
Stable over time
Manifests In different environments
Significant deviation from average
Associated with distress and problems with social performance
Recognised by friends and acquaintances
What are the features of dissocial personality disorder?
Incapacity to maintain enduring relationships Disregard for consequences of actions Disregard for social norms, rules and obligations Incapacity to experience guilt Disregard for others feelings Criminal behaviour Comorbid depression and anxiety Drug and alcohol use
When can dissocial personality disorder be diagnosed?
What can be diagnosed before this?
After age 18
Conduct disorders - antisocial, aggressive or defiant behaviour. Persistent and repetitive
How would someone with EUPD present?
Relationship difficulties recurrent self harm Threats of suicide Depression Impulsivity Social difficulties
What are the features of EUPD?
Unstable and intense interpersonal relationships
Poorly controlled impulses
Fear of abandonment and rejection
Strong tendency towards suicide and self harm
What is the treatment for personality disorders?
Psychotherapy - long term
Drug treatment for comorbidies
Crisis plan
What is somatisation disorder
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
What is hypochondrial disorder
persistent belief in the presence of an underlying serious DISEASE
patient refuses to accept reassurance or negative test results
What is a conversion disorder
symptoms present despite lack of organic cause
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
What is factitious disorder
Munchausen’s syndrome
the intentional production of physical or psychological symptoms
What is malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
What are some predisposing factors in depression
genetic factors (higher risk if first degree relative), childhood abuse, parental loss
What are some precipitating factors in depression
life event
substance abuse
severe physical illness
what are some perpetuating factors in depression
social withdrawal stress finances work lack of confiding relationship
State some differentials for depression
grief reaction
dementia
substance misuse - anabolic steroids, alcohol, cannabis
hypothyroidism
bipolar disorder
drug side effects - benzodiazepines, POCP
schizophenia (if depression with psychosis)
What investigations should be carried out in depression
TFTs
What questions about secondary symptoms in depression are important to ask?
how is your sleep? appetite? concentration? Mood throughout the day memory? thoughts about the future/self? relationships?
For patients with mild/moderate depression, when can the use of antidepressants be considered?
a past history of moderate or severe depression
initial presentation of subthreshold depressive symptoms that have been present for a long period (at least 2 years)
subthreshold depressive symptoms or mild depression that persist(s) after other interventions
if a patient has a chronic physical health problem and mild depression complicates the care of the physical health problem
Which antidepressant is most suitable in thetreament of children and young people?
fluoxetine
What are the side effects of SSRIs
GI: bleeds, nausea, dyspepsia, bloating, flatulence, diarrhoea and constipation Sweating Tremor Rashes Extrapyramidal Sexual dysfunction Sleepiness Hyponatraemia
What are the advantages of SSRI’s compared to TCAs
less toxic in overdose
less sedative
less cardiotoxic
How long do SSRI’s take to have their full effect
6-8wks
How long should someone take an SSRI for depression
at least 6 months
Define alcohol intoxication
chracterised by slurred speech, impaired coordination and judgement and labile affect
Describe the characteristics of acute alcohol withdrawal
• Insomnia and fatigue. • Tremor. • Mild anxiety/feeling nervous. • Mild restlessness/agitation. • Nausea and vomiting. • Headache. • Excessive sweating. • Palpitations. • Craving for alcohol. seizures hallucinations
What are the signs of alcohol dependence?
Compulsion to drink
Aware of harms but persist
Neglect other activities
Tolerance to alcohol
Stopping causes withdrawal Stereotyped patterm on drinking Time preoccupied wiht alchohol Out of control of use Persistent futile wish to cut down
What are tools used to screen for alcohol dependence?
FAST
AUDIT
CAGE
State the components of the CAGE questionnaire
o Have you ever felt the need to Cut down?
o Have people Annoyed you by criticising your drinking?
o Do you ever feel Guilty about your drinking?
o Ever had an Eye-opener to steady your nerves in the morning?
What signs on examination can be seen in alcohol dependency
palmar erythema gynecomastia ascites jaundice spider naevi
How is classical conditioning modelled in alcohol dependancy?
feeling good after having a drink
(association between drinking and pleasure)(
How is operant conditioning modelled in in alcohol dependencu
avoiding withdrawal symptoms
What are some predisposing factors for alcohol dependency
genetics family history occupation impulsive traits culutre
What are some precipitating factors for alcohol dependency
divorce or relationship problems
psychiatric illness
peer pressure
economic situation
What are some perpetuating factors of alcohol dependency
no motivation to change
social reinforcement
avoiding withdrawal symptoms
association with pleasure activates dopaminergic reward pathway
What is Wernicke’s encephalopathy due to?
thiamine deficiency damaging mamilliary bodies
What are the signs of Wernicke’s encephalopthy?
ataxia
nystagmus
opthalmoplegia
acute confusion
What are the neuropsychiatric complications of alcohol dependency
wernicke's peripheral neuropahty ED cerebellar degeneration dementia
What are the social complications of alcohol dependency
unemployment family breakdown prostitution debt domestic violence road accidents suicide
What are the features of foetal alcohol syndrome
decreased muscle tone poor cooridnation developmental delay heart defects facial abnormalities
What is delirium tremens?
most severe form of alcohol withdrawal manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse.
begins 24-72 hours after alcohol consumption has been reduced or stopped
What are the features of delirium tremens
- Hallucinations (auditory, visual, or olfactory).
- Confusion.
- Delusions.
- Severe agitation.
- Seizures
What is the management of Wernicke’s encephalopathy?
IV thiamine
How is acute alcohol detoxification managed?
admission to hospital - risk of delerium tremens/seizures
sedation for symptoms of withdrawal - benzodiazepines
Vitamin B complex is given as IV Pabrinex® to inpatients for a couple of days and then patients are given oral thiamine and multivitamins to prevent Wernicke’s encephalopathy
What is the treatment for delerium tremens
ITU admission
control blood glucose
benzodiazepines
prevent Wernicke’s with thiamine
What are some treatment for alcohol dependence
motivational interviewing
self help groups
psychological therapies
meds - disulfiram or acamprosate
What is the mechanism of action of disulfiram
inhibition of acetaldehyde dehydrogenase.
so alcohol intake causes severe reaction due to Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms.
therefore promotes abstinence
What is the mechanism of action of acamprosate
activates GABA system and reduces NMDA receptor excitation to reduce cravings for alcohol and risk of relapse.
What is korsakoff’s psychosis?
chronic memory disorder (amnesic disorder with confabulation) caused by severe deficiency of thiamine
What are the features of opioid dependency
rhinorrhoea needle track marks pinpoint pupils drowsiness watering eyes yawning
Define delirium
acute onset of impaired consciousness and attention
+ perceptual or cognitive disturbance
+evidence it may be related to a physical cause
State how dementia and delirium can be differentiated
dementia:
slow deterioration
slowly progressive course, alert consciousness, impoverished thought content, hallucinations not common
delirium:
acute onset, fluctuating course, clouded consciousness, vivid and complex thought content, , visual hallucinations very common
What investigations should be done in suspected delirium
Urinalysis, ECG
FBC, U+E, glucose, TFTs, LFTs, calcium, folate, B12
CXR
What can cause delirium?
renal or hepatic failure thiamine, B12 or folate deficiency trauma UTI pneumonia sepsis surgery alcohol thyroid probs glucose - high or low
How should delirium be managed?
environmental - clear signage, clocks and calenders, staff explanations, appropriate lighting, sleep hygiene
if distressed or a risk to self or others, short term haloperidol is given
What is dementia
acquired, progressive, usually irreversible global deterioration of higher cortical function in clear consciousness
What features need to be present for a diagnosis of dementia
multiple cognitive deficits - memory, orientation, language, reasoning, judgement
impairment in activities of daily living
clear consciousness
What are the importnant questions to ask when taking a dementia history?
onset short and long term memory orientation to time place and person sleep cooking/cleaning adaptions mood/personality change medical and drug history
Describe the pathophysiology of Alzheimer’s
amyloid cascade hypothesis states that AD is caused by an imbalance of (too much) brain Aβ production and (too little) Aβ clearance leading to amyloid plaques and neurofibrillatory tangles
What are the macroscopic
cerebral features of Alzheimer’s
cortical atrophy
increased sulcal widening
enlarged ventricles
Describe the pathophysiology of Vascular dementia
mulitple infarcts lead to loss of cortical parenchyma
Describe the pathophysiology of Dementia with Lewy bodies
Lewy bodies (abnormal deposits of protein inside nerve cells). and neurites in basal ganglia and cortex
What are the classic features of vascular dementia
step wise progression
focal neurologcial sx
What are the classic features of dementia with lewy bodies
parkinsonian features
fluctuation of cognition and alertness
What are the classic features of fronto-temporal dementia
early personality changes
intellectual sparing
What tests should eb done to exclude physical causes of memory loss in suspected dementia?
FBC, U&E, LFTs, calcium, glucose, TFTs, vitamin B12 and folate levels.
neuroimaging (e.g. Subdural haematoma, normal pressure hydrocephalus)
What are important differentials tp consider in dementia
hypothyroidism delirium normal pressure hydrocephalus subdural haematoma psychosis depression thiamine deficiency B12 deficiency hearing or visual problems
How can Alzheimer’s be managed?
mild/moderate:
AChE inhibitors - donepezil, galantamine or rivastigmine
o Side effects include nausea, dizziness, headache, diarrhoea
moderate/severe: memantine - NMDA receptor antagonist
What factors increased he risk of depression in the elderly
dementia physcial illness soical isolayion bereavement being a carer loss of independence
How can depression be distinguished from dementia in the elderly?
Depression:
Poor concentration
Slowness and self-neglect
Depressed mood preceded memory problems
Poor performance in memory testing improves when interest is aroused
In depression, patients are unwilling to cooperate in interview, in dementia they are usually willing to reply to questions, but make mistakes
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
Name some SSRIs
sertraline
citalopram
fluoxetine
paroxetine
What are the side effects of SSRIs
GI bleeds
hyponatraemia
sexual dysfuynction
increased agitation and suicidal ideation in first 2 weejs
Whcih SSRI is safe in unstable angina or prev MI
sertraline
What are the symptoms of stopping SSRIs abruptly
Gastro-intestinal disturbances, headache, anxiety, dizziness, paraesthesia, electric shock sensation in the head, neck, and spine, tinnitus, sleep disturbances, fatigue, influenza-like symptoms, sweating
How should SSRIs be stopped
tapered over at least a few weeks
What is serotonin syndrome
syndrome caused due to increased serotonin -increased dose, change of SSRI
What are the signs and symptoms of serotonin syndrome
neuromuscular hyperactivity - clonus, tremor, hyperreflexia, rigidity
autonomic dysfunction - BP changed, increased HR, hyperthermia, diarrhoea
altered mental state - confusion, agitation, mania
Name some SNRI
venlafaxine
duloxetine
What are the side effects of SNRIs
hypertension
prolonged QTc
sweating
What is the mechanism of action of mirtazapine
presynaptic alpha2-adrenoceptor antagonist, increasing concentrations of NA and serotonin transmission
What are the side effects of mirtazapine
dry mouth
weight gain
drowsiness
Name some TCAs
amitrityline
imipramine
clomipramine
What is the mechanism of action of TCAs
inhibit breakdown of NA and serotonin
Which TCAs are more and less sedative
more - amitrityline, chlomipramine
less - lofepramine, imipramine
What are the side effects of TCAs
fatally toxic in overdose
increased mortality from cardiac disease
anticholinergic
Name some MAOI
phebelzine
What are the significant side effects of MAOIs
hepatotoxicity
hypertensive crisis if interaction with tyramine ricj foods - red wine, cheese
What is the mechanism of action of MAOIs
inhibition fo breakdwon of serotonin by monoamine oxidase
Name some typical antipsychotics
chlorpromazine
haloperidol
What are the extrapyramidal (antidopaminergic) side effects of antipsyhcotics
parkinsonism
acute dystonia
akathisia
tardive dyskinesia
Describe parkinsonism
pill rolling tremor
shuffling gait
difficulty turning
rigidity
Describe acute dystonia
spasm of facial muscles
grimacing
Describe akathisia
restlessness
pacing
feet in constant motion
Describe tardive dyskinesia
tongue protrusion
abdnormal jerking of limbs
lip smacking
What is the management if tardive dyskinesia occurs
stop the drug - prevent worsening
Which extrapyramidal side effects are reversible and which might not be
acute dyskinesia, akathisia and parkinsonism reversible
tardive dyskinesia might not be
What are the signs and symptoms of hyperprolactinaemia
sexual dysfunction decreased bone density menstrual disturbances, breast enlargement, galactorrhoea.
Name some atypical antipsychotics
olanzapine
quetiapine
clozapine
risperidone
Which antipsychotic is proven to be more efficacious than others?
clozapine
When can clozapine be prescribed
when treatment with 2 other antipsychotics has been tried and not been able to control symptoms
What are the important side effects of clozapine
agranulocytosis
seizures
What should be monitored in clozapine specifically
FBC
every week for 18weeks
every fortnight for 1 year
then every month
What are the side effects of antipsychotics
high prolactin weight gain hyperglycaemia cardiovascular - raised HR, arrhythmias, prolonged QTc hypotension sexual dysfunction neuroleptic malignant syndrome
Which antipsyhchotic has the lowest incidence of sexual dysfunction
quetiapine
What are the signs and symptoms of neuroleptic malignant syndrome
hyperthermia,
fluctuating level of consciousness,
muscle rigidity,
autonomic dysfunction - pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence
associated with recent increased in dose of antipsychotic
What monitoring needs to be done in antipsychotic treatment?
pre: BP, ECG, weight. FBC, U+E, LFT, fasting glucose, blood lipids
at 3m: lipids and weight
at 6m: fasting glucose
every year: FBC, U+E, LFT, blood lipids, fasting glucose, weight
When is a depot antipsychotic used?
issues with non-adherance
What do levels 1a, 1b, 2 and 3 mean on a psychiatric ward
1a = staff within an arms length at all times 1b = staff within eye contact at all times 2 = pt checked on every 15 mins 3 = general observations
What is the Frontal Assessment Battery
bedside test used to test for frontal lobe dementia
Define formal thought disorder
= an impaired capacity to sustain coherent discourse, and occurs in the patient’s written or spoken language.
indicates a disturbance of the organisation and expression of thought.
In what conditions can hallucinations occur
schizophrenia depression with psychosis delerium drug induced psychosis Cushing's epilepsy SOL dementia with Lewy bodies
What is the therepeutic range for lithium in bipolar disorder
0.4-1mmol/L
How is lithium excreted?
by the kidneys
What are the common side effetcs of lithium
nausea and vomiting polydipsia, polyuria fine tremor hypothyroidism weight gain metallic taste in mouth
What should women of child bearing age be advised when taking lithium
use effective cnootraception - teratogenic in first trimester
What tests should be done before initiating lithium therapy?
ECG, BMI, weight
FBC, U+E, TFT, eGFR
What monitoring needs to take place whilst on lithium
test lithium levels every week until stable therapeutic range has been reached for at least 4 weeks
then test lithium levels every 3m
test TFT, U+E, eGFR and BMI every 6m
When should lithium levels be taken
12 hours after dose
What should be gievn to patients started on lithium
patient information leaflet
alert card
lithium record book
How is lithium affected by sodium levels
low sodium increases lithium levels
due to competitive reabsorption of sodium and lithium in the kidneys
How should lithium therapy be stopoed
not suddenly - can lead to relapse
gradually - over 3m
What level of lithium can cause toxicity
1.5mmol/L
but if symptomatic, can be caused by lowet
Which drugs can cause low sodium and therefore increase risk of lithium toxicity
NSAIDs
ACEi
diuretics
What are the symptoms and signs of lithium toxicity
anorexia ,V + D coarse tremor drowsiness and restlessness dissxiness ataxia
What are the symptoms and signs of severe lithium toxicity
convulsion, hyperreflexia collapse low potassium dehydration circulatory failure
What is the management fo lithium toxicity
mild-moderate toxicity: volume resuscitation with normal saline
haemodialysis if severe toxicity
What is the mechanism of action of benzodiazepines
enhance the effect of the inhibitory neurotransmitter GABA by increasing the frequency of chloride channels.
What problems are associated with long term use of benzodiazepines
dependance
tolerance
How long can a benzodiazepine be prescribed for
max of 2-4weeks
How should the dose of benzodiazepine be withdrawn
in steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight
what are the features of benzodiazepine withdrawal syndrome
insomnia irritability anxiety tremor loss of appetite tinnitus perspiration perceptual disturbances seizures
What are the drugs used to treat parkinsonism
levo-DOPA
antimuscarinics to decrease rigidity and tremor (decreases excitation of peripheral nerves)
How should neuroleptic malignant syndrome be managed?
stop antipsychotic
benzodiazepiens for agitation
cooling devices
dialysis if severe AKI from muscle breakdown
What are the dangers of rapid tranquilisation
respiratory depression, loss of consciousness, sedation
Describe a section 5(2)
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours in order to complete a MHA assessment
What are the criteria for the implementation of the MHA
presence of a mental disorder
that is of a nature or severity that poases a significatn risk to their safety or others safety
there is no alternative to hospital admission
What is a mental disoder according to the MHA
any disorder or disability of the mind
Describe a section 5(4)
allows a nurse to detain a patient who is voluntarily in hospital for 6 hours in order to complete a MHA assessment
Describe a section 2
admission for assessment and treatment for up to 28 days, not renewable
an Approved Mental Health Professional (AMHP) makes the application on the recommendation of 2 doctors
one of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
Describe a section 3
admission for treatment for up to 6 months, can be renewed
AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours
What is section 17a
Some patients who are detained under Section 3 are well enough to leave hospital and carry on receiving their treatment in the community.
The patient’s Responsible Clinician and an AMHP may decide that a CTO is appropriate rather than complete discharge from the section.
A patient on a CTO must keep to particular conditions and can be recalled to hospital if there are concerns about their compliance with the conditions or their deteriorating mental health.
A CTO lasts for up to six months and might be renewed for a further six months then yearly.
in teh case of relapse, The patient’s Responsible Clinician can call the patient to hospital and has up to 72 hours to decide what to do. The CTO can be revoked and the patient readmitted
What is section 136
police power to remove someone to a place of safety for further assessment
What are the four stages to consider when making a capacity assessment
1 = does the patient have a disorder of brain functioning? if yes = doe snot have capacity
understand
retain
weight up
communicate decision
What are the differences between psychodynamic psychotherapy and CBT
psychotherapy - focusses or therapeutic relatioinship. results in understanding od unconscious conflicts adn brings resolution to these
CBT - addresses the role of dysfunctional thoughts and beliefs and what behaviours are produced and maintained. exposes and challenged thoughts
What is transference in psychotherapy
the re-enactment of past relationships and emotions with the therapist
What is paraphrenia
late onset schizophrenia with no negative symptoms
What is harm minimisation
strategy aiming to lessen the social and physical consequences of using drugs
reduce incidence of blood borne viruses, give control help prevent overdose and help to detox
Which illicit drugs may produce a schizophrenia like state
amphetamines
cocaine
cannabis
LSD
