Psych Flashcards
What are some differentials for symptoms of low mood other than depression?
HYPOthyroidism
Sleep disorder
Low blood sugar
Which medications should be avoided when taking SSRIs, and why?
Aspirin
Warfarin
NSAIDs
SSRIs increase risk of GI Haemorrhage
What are some differentials for the symptom of anxiety and what questions may you ask regarding each one?
GAD - Nervous all the time, on edge, worrier?
OCD - Ritualistic? Thoughts they cannon get out of their head?
Panic - Sudden onset of panic, feeling of impending doom? Out of the blue? How long does it last
Phobia - Triggers? Place, person, thing?
Depression with anxiety - Any low mood? Could you be depressed?
HYPERthyroidism - changes in weight or appetite? Fluctuations in intensity of anxiety?
There are 6 types of delusions that should be questioned about in a psych history where there are symptoms of hallucinations and delusions emitted?
Name all 6 and a question or two that may cover it.
Persecutory - Do you feel like people are out to get you? Has anyone ever tried to harm you?
Reference - Do you feel like the TV, newspaper or signs outside leave messages just for you?
Perception - do you see things in the same way as others?
Grandeur - do you feel like you have special abilities or powers?
Passivity - Is anyone trying to control your actions or feelings?
Control - Is anyone trying to control you?
Nihilistic - do you feel like your organs are rotting? Do you feel like things around you are dying or rotting?
What are the first ranked symptoms of schizophrenia ICD-10?
Auditory hallucinations
Delusions of perception
Delusions of control
Thought echo
Thought withdrawal
Thought insertion
Thought broadcast
What are some common side effects of olanzapine?
Drowsiness
Weight gain
What are some other side effects of olanzapine?
Stiffness or uncontrollable movements
Raised blood sugar (DM) and cholesterol levels
Swollen leg and ankle
Dry mouth
What aspects will require monitoring by the GP for someone who is on olanzapine (or any other antipsychotic)?
Weight Blood sugar Cholesterol and Lipids LFT ECG
What are some defining features of mania?
Inflated self-esteem or grandiosity Decreased need for sleep Pressured speech Racing thoughts or flight of ideas Distractibility Increased activity Excess pleasurable or risky activity.
What is the diagnostic criteria for bipolar affective disorder?
- 3 or more symptoms of mania*
- 1 week duration
- Disturbance of normal functioning
* Inflated self-esteem or grandiosity Decreased need for sleep Pressured speech Racing thoughts or flight of ideas Distractibility Increased activity Excess pleasurable or risky activity.
Marked impairment not due to a substance or medical condition
What areas need covering in the risk assessment of someone with mania?
What questions may you ask when investigating these areas?
OVERSPENDING - Do you go on shopping binges? How are things financially?
POLICE - Have you gotten into trouble with the law recently? If so why?
SELF HARM / SUICIDE - Have you ever tried to harm yourself? Have you tried to use your special powers, and if so, how?
What 3 other diagnoses should you consider in a patient presenting with mania and what questions may you ask?
Bipolar - I know you feel fantastic now but have you ever felt depressed in the past?
Anxiety - Do you feel particularly worried or anxious about anything?
Psychosis - Have you seen or heard things you couldn’t quite explain?
What is the starting dose of lithium and what time of day is it usually taken?
200-400mg, titrated up to lowest dose that stops symptoms
Best taken at night, same time every day
What are some side effects of lithium?
What simple measure can be taken to reduce chance of side effects?
Nausea Fine tremor Metalic taste in mouth Polyuria and polydipsia Swollen ankles
Keep well hydrated especially when weather is hot or when ill with an infection (increased risk of dehydration)
What side effects should alert someone on lithium to seek urgent medical care?
BLURRED vision Loss of appetite D and V Muscle weakness Drowsiness Convulsions or slurred speech
What extra items will be provided on initiation of lithium therapy?
Information leaflet
Lithium ALERT CARD
- Details of treatment, dose, brand, GP address, NHS number, Contact of doctor under care
What questions are asked during a CAGE questionnaire?
C - Have you ever felt you should CUT DOWN on your drinking?
A - Does other peoples criticism ANNOY you?
G - Do you every feel GUILTY about drinking?
E - Do you need alcohol first thing in the morning as an EYE-OPENER?
What is the ICD-10 criteria for dependence?
3 out of the 6 below over a 12 month period
- COMPULSION, CONSEQUENCES and no CONTROL
- PRIMACY - Is drinking your main priority in life
- PREVIOUS TREATMENT - Detox? Relapses?
- TOLERANCE built
- WITHDRAWAL
- LOSS OF INTEREST in activities
What questions should you ask in Past Alcohol History?
When did you START drinking?
What was your LONGEST PERIOD OF ABSTINENCE?
Does anyone else in the FAMILY have alcoholism?
Have you ever tried a DETOX?
Have you ever tried THERAPY such as AA?
What questions should you ask when investigating SOCIAL COMPLICATIONS of alcohol abuse?
RELATIONSHIPS: Friends, family, partner
WORK and FINANCE: Job, income, expenditure
LIVING: Home, flat, who with
LAW: Police, driving, violence, self harm
What questions should you ask when investigating MEDICAL COMPLICATIONS of alcohol abuse?
Physical - Weight loss, appetite, memory
Depression / Anxiety
Psychosis
Self harm and suicide
In an alcohol history, how would you inquire about MAINTAINING factors and MOTIVATION TO CHANGE?
Maintaining
- Access to alcohol
- Motivation to drink? Social isolation, avoiding withdrawal, coping mechanism
Motivation to change
- Has the Pt expressed a desire to change?
What investigations would you carry out in an intoxicated alcoholic?
Talk about
- Physical exam
- Bloods
- Further investigations for pathologies
Physical exam: Assess malnurishment, signs of liver disease and heart disease (AF and alcoholic cardiomyopathy)
Bloods: Alcohol level, FBC (marcocytic), Vitamin (THIAMINE), Glucose, U&Es, CRP, LFTs, y-GT, Clotting, Lipids,
Further investigations: Abdominal USS & CT/MRI for liver disease, Echo for CVD
What medication may be given in acute alcohol withdrawal to negate the effects of agitation and tremor in delirium tremens?
Chlordiazepoxide (aka Librium)
A type of long-acting benzodiazepine
What is the clinical triad of Wernicke’s Encephalopathy?
Mental status changes
Ophthalmoplegia
Gait dysfunction
What medication may be given to help control cravings when abstaining from alcohol?
Acamprosate
What medication is used as an adjunct in the treatment of alcohol dependence by causing an accumulation of acetaldehyde in the body?
Disulfiram
Causes extremely unpleasant systemic reaction to even small amounts of alcohol
What are the SCOFF (screening tool) questions for eating disorders?
Sick: Do you make yourself sick because you are uncomfortable full?
Control: Do you worry you have lost control over how much you eat?
One stone: Have you lost more than 6kg (~1 stone) in the past 3 months?
Feel fat: Do you believe you are fat despite others thinking you are thin?
Food dominates: Would you say food dominates your life?
What are the WAIF questions for assessing eating disorder?
Weight: Do you mind me asking how much you weight and how tall you are (calculate BMI)
Amenorrhea: Have you been having regular periods?
Induced vomiting: Have you made yourself throw up after eating? Do you exercise, and if so, how much?
Fear of fatness: How would you feel if you gained weight?
What are the features of anorexia nervosa?
- Underweight (BMI < 17.5)
- Distorted body image
- Food dominates
- Utilisation of methods for weight loss
- Fear of gaining weight
- Amenorrhoea / Oligomenorrhoea as hormones are affected by diet
What are the features of bulimia nervosa and how may you manage it?
Unlike anorexia, a normal or over weight
- Binge eating
- Purging
- Irregular eating patterns
- Amenorrhoea / Oligomenorrhoea
- Erosion of teeth, sore throat, reflux
Manage with psychotherapy (CBT or IPT). SSRIs can help with urge to binge and purge.
What questions should you explore in the HPC of someone with an eating disorder?
Tell me about your eating
Typical day?
Do you binge? How do you feel afterwards? Do you do anything to counteract? What do you do? Do you make yourself sick afterwards or use laxatives?
Onset - How long has this been going on for?
Triggers? - Anything bring it on?
Home environment? - How are things at home?
What are the 5 core diagnostic factors of PTSD?
Exposure and response to trauma
Intrusion symptoms: Re-experiencing aspects of event in a vivid and distressing way resulting in gross impairment in functioning.
Avoidance of symptoms: Effortful avoidance of reminders, triggers, discussion of or thinking about the event
Negative alterations in cognition and mood: Anhedonia, negative distorted beliefs, ideas of blame, inability to recall key aspects of the traumatic event
Alterations in arousal and reactivity: Hypervigilance, startled responses, irritability, angry outburst, self destructive or reckless behaviour, concentration and sleeping problems
What symptoms should you question about in a depression / low mood history?
SIG E CAPS
Sleep
Interest lost
Guilt and worthlessness
Energy low
Concentration
Appetite and weight loss
Psychomotor retardation / agitation
Suicidal thoughts
What other diagnosis should you rule out in a patient presenting with low mood?
Hypothyroidism
Bipolar
Psychosis
Anxiety
What may you say ‘To Finish’ a consultation with a depressed patient?
Insight and support - From what you have said it seems like you have depression. Would you agree with me? Why not? There is treatment available. Does this interest you?
Follow-up - I would like to see you again. Can we arrange a time to meet, perhaps next week? We can discuss how to go on forward from here.
There is less chance of a suicide risk if the patient has something to look forward to so offer a follow up appointment the next week.
What may low moods coupled with hallucinations and delusions indicate a likely diagnosis?
Schizoaffective disorder
What is the general management of low mood and depression?
Regular management
Sleep hygiene
CBT
SSRIs
If high risk to self or others, admit to ward under MHA
What are the symptoms of an acute stress reaction?
Sudden onset of anxiety, low mood, emotional ability developing quickly over minutes or hours post-stressful event (attack, trauma, terrorism).
Settles fairly quickly but can last for several days or weeks.
What may be a likely differential for anxiety coupled with hallucinations, rapid onset of confusion, seizure, fever?
Alcohol withdrawal
Nonspecific anxiety symptoms with delirium tremens, hallucinations, fever and seizures occurring in severe cases.
What questions should you ask when investigating symptoms of auditory hallucinations?
What about other hallucinations?
Open question - Can you tell me about these voices? How many are there?
True / False - Are they inside or outside of your head? Can you stop them?
Second / Third person - Do they speak to you or about you?
Commands - Do they ever tell you to do anything? What do they tell you to do?
Running commentary - Do you hear them like a running commentary?
Visual hallucinations - Can you see things that others cant? What do you see? How have things progressed since they started?
Olfactory / Gustatory - Can you smell or taste things you cant explain? When did this start? How have things progressed?
How may you question insight in a patient presenting with hallucinations or delusions?
If I were to say as a doctor I thought you had a psychiatric problem, how would you feel?
Would you take treatment for this if a psychiatrist felt it appropriate?
What are the positive and negative symptoms of schizophrenia?
Positive
- Hallucinations of any modality
- Catatonia (involuntary movements)
- Neologism (new words created out of thin air)
- Tangential speech
Negative
- Anhedonia (loss of pleasure)
- Blunted
- Poverty of speech
- Marked apathy (lack of interest and enthusiasm)
What are the features of depression with psychosis?
Core features of depression present
- Anhedonia
- Low mood
- Fatigue
Plus, DELUSIONS of
- Persecution
- Paranoia
- Guilt
- Nihilism
Patient may believe that they are being punished for a wrongdoing that they had no influence over. May include hallucinations that are heavily critical of them.
