Psych Flashcards
How do you test someone’s delusions? What must you avoid?
- DO NOT GIVE SOMEONE A REASON TO MISTRUST YOU
- how did you come to know this?
- can you explain why you feel this way to me?
- what if someone was to say it was for (logical reasoning)
- seems to be a good understanding, but I’m a little confused, can you tell me a little bit more?
What is a framework for treating psych conditions? Can you apply it to mood disorders?
- Biopsychosocial model, in the short term, medium term and long term.
- Depression treatment:
- ST - bio - med titration/diagnosis, psycho - Risk assessment/psychoeducation, social - admitted under MHA?
- MT - bio - med titration, psycho - community services/case worker, social - employment, accomodation, finances
- LT - bio - monitor CVD RFs, fetility impact of hyperprolactinemia, psycho - continued therapy, social - empower about MHA, and encourage to participate in community.
What are the 5 side effects of SSRI Initiation?
5xSAD
- SiADH
- Suicide
- Sex
- serotonin syndrome
- Anticholinergic (anti-SLUD)
- Diarrhoea
What is NMS?
Neuroleptic malignant syndrome: antipsychotic drug
FEVER:
- fever
- encephalopathy
- vital sign instability
- elevated CPK/WBC
- rigidity
What is antidepressant discontinuation syndrome? What signs and symptoms do you get?
- FINISH:
- flu-like
- insomnia
- nausea
- imbalance
- sensory disturbance (l’hermitte’s sign)
- hyperarousal
What is serotonin syndrome?
HARMED:
- hyperthermia
- autonomic instability
- rigidity
- myoclonus
- encephalopathy
- diaphoresis
How do you counsel someone about a treatment or drug?
- explore why? (what is the treatment for, do they understand?)
- drug counselling:
- what are you taking?
- why?
- how to take it?
- how to stop?
- don’t with with what?
- side effects?
- how long will it take to work?
- opportunity for questions
What is CAGE acronym?
- cut down (get symptoms?)
- annoyed when people tell you to cut down?
- guilt?
- eye-opener
What is an acronym you can use for MSE?
- ASPETIC
- apperance/behaviour
- speech
- emotions/affect
- perception (hallucinations)
- thought
- insight/judgement (risk assessment)
- cognition
What different psychological therapies are there?
- CBT - anxiety
- ERP (exposure response prevention therapy) - OCD
- family based therapy - eating disorders
- ACT - acceptance and commitment therapy
- group therapy
- mindfullness
- social skills training - schizophrenia
What are the 4Ps of Formulation for a risk assessment? What are some risks of suicide?
- Predisposing (development, occupation)
- Precipitating
- Perpetuating
- Protective (family, relevant negatives, family history)
SAD PERSONS for risk:
- S= sex = male
- A - age <19 >45
- D - depression
- P - previous attempts
- E - excess alcohol/substances
- R - rational thinking lost
- S - no spouse
- O - organised plan
- N - no social supports
- S - sickness
What is an acronym for depression?
SIG E CAPS + mood
- Sleep
- Lost interest
- Guilt (hopelessness/worthlessness)
- Energy low
- Concentration low/indecision
- Appetite change
- Psychomotor retardation/agitation
- Suicidal ideation
rule out manic/hypomanic, rule out grief (preserved self esteem, + memories), substance use and other conditions.
What is the diagnostic criteria for Bipolar affective disorder?
- GST PAID
- grandiosity
- reduced sleep need
- increased talking (pressured speech)
- painful consequences
- activity increased (goal directed +/- psychomotor)
- ideas - flight of
- distractibility
need a moof stabiliser
What is an acronym for GAD? What should you consider?
- excessive anxiety/worry for >6months
- >3 of
- BE SKIM:
- blank mind
- reduced energy
- sleep disturbance
- keyed up/on edge/restless
- muscle tension
- BE SKIM:
- think of substance use - caffience/nicotine/EtOH and triggers
- initial increase in symptoms when starting SSRIs (higher dose)
What is PTSD?
- adults + children >6 years
- C- TRAUMA
- cognition change (negative)
- trauma - real, threatened, violence, injury
- re-exposure
- avoidance
- unable to function
- 1 month at least
- arousal/reactivity.
- C- TRAUMA
What are the features of schizophrenia?
- >2 for >1mths:
- delusions
- hallucinations
- disorganised speech
- disorganised behaviour
- negative symptoms (4As - blunted affect, anhedonia, avolition, apathy, impoverished though)
What is the criteria for anorexia? how is it classified and treated?
DSM5 criteria:
- restricted intake with significant weight loss
- intense fear of gaining weight
- body dysmorphia/failure to recognise decreased weight
classified:
- mild <17
- mod 15-17
- severe 15-16
- extreme <15
Admission?
- medical - HR <40, BP <90, serum changes temp <36
- behavioural - suicidal
- restore healthy weight - target, nutritional rehb + refeeding syndrome (Mg, Phos, K, thiamine). Insulin spike drived metabolites into cells (arrhythmias, rhabdo, serizures 3-4 days after).
- psychotherapy - family based therapy, CBTE
What is bullimia nervosa?
- recurrent binge-purge cycles
- compensatory behaviours = purge
- bonge - no control over eating
- >1week in the last 3 months
- more common in BPD, childhood obesity, childhood assault
What are the signs of alcohol withdrawal? How do you control it?
- 6-8hours after heavy drinking
- tremors/shakes/agitation/anorexia/cramps/diarrhoea
- seziures
- hallucinations
- delirium tremens
- wernickes = ataxia, CN6 palsy (nystagmus), confusion
- Korsakoff’s = retrograde amnesia, confabulation, not acute delirium
Treatment:
- diazepam - first (prevent seizure)
- thiamine - before glucose
- haloperidol + diazepam fordelirium (consider benztropine for EPSE)
- long term - try disulfiram, acamprosate and natrexone (suboxone - combo with buprenorphine).
What is the acronym for BPD?
- IDESPAIRR
- identity disturbance
- dissociation
- emptiness
- suicidal behaviour
- paranoid ideation
- abandoment (fear of)
- impulsivity (>2 self-damaging areas)
- relationships (unstable/splitting)
- rage
