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
Creutzfeld Jakob
- Gets bad unusually FAST
AIDS related dementia
HIV-associated dementia occurs when the HIV virus spreads to the brain. Symptoms of HIV-associated dementia include loss of memory, difficulty thinking, concentrating, and or speaking clearly, lack of interest in activities and gradual loss of motor skills.
Learning disability
LEvels
most common?
Syx of autism?
69-50 - mild LD
50-35 - Moderate LD
35-30 - Severe LD
< 20 = Profound developmental level 12 months
3 common
- TRisomy 21
- Fragile X
- Foetal aclohol
autism syx= difficulties with
Social interaction
Verbal and non-verbal communication
Restricted and repetitive behaviours
Post-traumatic stress disorder
Specific treatment?
- Follows severe stressful experience
- -> Onset within 6 months
- -> Syx last one month
Persistant intrusive thinking/flash backs, avoidance of reminders, numbing, detatchment, increased arousal
TX: EYE MOVEMENT DESENSITISATION and reprocessing therapy
Phobic anxiety disorders
Agorophobia: Fear of crowds/ public places
TX: CBT
Social phobia: Most common. Fear of social situations
TX: CBT, self help, SSRI
Specific phobia: fear of specific people/ object/ situation
TX: GRADED EXPOSURE
Personality disorders
- Paranoid, schizoid and Schizotypal
Antisocial, EUPD (borderline or impulsive), Histronic, Narcissitic
Avoidant, dependant, obsessive compulsive
Dx- Treating delerium in hosptail
Haloperidol 1 week
Normal pressure hydrocephalus (NPH)
Brain disorder in which excess cerebrospinal fluid (CSF) accumulates in the brain’s ventricles, causing thinking and reasoning problems, difficulty walking, and loss of bladder control.
