PSYCH Flashcards
** Suicide assessment and management
+ Parasuicide
Assessment:
- Past psych history
- Depressive syx
- medication
- alcohol and drug use
- mental state
- previous self harm
- age, gender, social situation
- relationships
- access to lethal methods
+ assess current intent and plans
+ assess needs- mental/ physical
Management: Modify risk factors, make crisis plan, self management strategies, medication, CBT, counselling
- Dementia
- Alzheimers
- multinfarct vascular
- lewy body
- alcohol induced
Alzheimers: gradual onset, memory loss, increased ventricle size. TX = DONPENEZIL.
Vascular: stepwise deterioration, TX = ASPIRIN + manage HTN
Lewy body: fluctuating cognition and alerntess + visual hallucinations
TX = Donpenezil + levodopa
Alcohol induced: korsakoff syndrome memory loss
Tx = pabrinex
** Risk assessment of confuded older adults
-
Adjustment disorders
acute + chronic
When someone cant cope with stress/ major life event
- Onset within weeks and lasts under 6 months
Syx: depression, axiety, autonomic arousal
TX: practical support, CBT,
Bereavement
Abnormal bereavement is >2 years, delayed onsent, greater intensity
TX: CBT and review relationships
Anxiety/ panic attacks
Assessment and initial mangement
-
Bipolar affecttive disorders
manic and hypomanic
1 and 2
> 2 episodes of depression + mani or hypomania
bipolar 1 = major depressive episodes and mani
bpolar 2 = major depressive episodes and hypomania
Mean age onset = 21 years
Management:
manic episode: Bzs, antipsychotic and modd stabilisers = lithium
Depressive epsiode: antidepressant and mood stabiliser eg lithium
Maintaintance = LITHIUM 1ST LINE
Depressive disorders
2 week history of at lease one of 1. persistent low mood 2. fatigue 3. anhedonia \+ disturbed sleep, poor concentration, low self confidence, suicidal thoughts, appetite disturbance
Management: CBT if mild, Moderate –> Antidepressant SSRI
Bulimia Nervosa
BMI
Signs
Management
BMI > 18.5
Morbid fear of fatness, distorted body image, craving for food, binging and purging.
15-30 yrs
Diagnosis = loss of control when binging + self loathing
Signs
- Low K, renal damage, signs of vomiting = russels sign, mallory weis tear, metabolic alkalosis
Management: guided self help
CBT + IPT
Fluoxetne 60mg
Anorexia Nervosa
BMI
Risk asses?
Management
hospitilise when?
complications
-BMI <18.5
Morbid fear of fatness, deliberate weight loss
Onset 13-20
Risk assess: BMI, ECG, bradycardia, QTc prolongation, bloods, FBC, U+Es, glucose
Management: Hospitalisation BMI >13.5, risk of suicide
Management
- Refeeding 0.5kg a week for inpatients- 3000 kcal a day
- Family therapy
- MANTRA = CBT + motivation enhancement therapy
- MARSIPAN guidance
- fluoxetiene sometimes used
Complications
- Low K, low Na, ECG abnormalities, peptic ulceration, mitral valve prolapse
Mental health act
- To detain someone - must be suffering metnal disorder and at risk of harming self/other Section 2 = assessment for 28 days section 3 = treatment up to 6 months 117 = aftercare 5'2 doctors holding power 72 hours 5'4 nurses holding power 6 hours
Obsessional compulsive disorder
how many hours spent a day thinking about it?
Management
> 1 hour a day spent on obsessions + compulsions
Most days for 2 weeks and interfere with ADL.
Obsessions: unwellcome and intrusive thoughts
Compulsions: Reptitive purposeful physical or mental behaviours
Management:
CBT
SSRI
Schizophrenia and paranoid disorders including drug-induced psychosis
- Schizophrenia ABCD Auditory hallucinations Broadcasting Control Delusions
Symptoms need to be present for 1 month and in presence of no drugs
Drug induced = hallucinations etc but caused by drugs
Somatisation
Presentation?
TX?
- Results in significant disrupition of daily life + 1 somatic symptom
- spend excessive time devoted to concerns
Presentation: 4 pain symptoms
- 2 GI, one sexual / reproductive, one psuedoneuro
TX: prevent medical tests, encourage exercise, CBT and mindfulness
Picks disease
Fronto-temporal dementia
CF: earlier onset, social disinhibition TX = SSRI
