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Phase 4 > Psych > Flashcards

Psych Flashcards

1
Q

ou are an FY2 working in a GP practice. See an 30 year old man with a year history of low mood, inability to concentrate in his job and lack of interest in socialising with others. He reports some recent episodes of self-harm and says he feels worthless and guilty most days. He is currently on 50mg OD PO sertraline.
What are the core symptoms of depression and some others?

A 
Low mood
Anergia
Anhedonia
Difficulty sleeping 
Not eating as well 
Loss of libido 
Loss of confidence 
Loss of concentration 
Suicidal ideation/self harm 
Feelings of guilt
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2
Q

How long do the symptoms have to be ongoing for to make a diagnosis of depression?

A

2 weeks minimum

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3
Q

Using the bio psychosocial model , what are the risk factors for depression?

A

Biological: genetics
Psychological: low self esteem, past history of child abuse or loss of parent, anxious personality
Social: recent tragic life incidents eg. loss of someone ,unemployment, homelessness. Lack of friends.
Chronic pain eg. fibromyalgia

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4
Q

What screening tool can be used in GP for depression?

A

PHQ-9

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5
Q

What are the treatment options used in depression?

A
  1. CBT, group therapy, IAPT in Sheff
    May also need medication if more severe:
  2. SSRI eg. sertraline, citalopram
  3. Mirtazipine (NAssA) or SNRI- venlafaxine
    3rd; MOA inhibitors e.g rasigiline or TCA- clomipramine , amitryptilline
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6
Q

What are some side effects of SSRIs?

A 
Initially- suicidal ideation increases
Sexual dysfunction 
Weight loss
Diarrhoea 
Insomnia
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7
Q

What are some side effects of TCAs?

A

Can’t spit, can’t shit, can’t see , can’t pee
Dry mouth, constipation, blurred vision, urinary retention
cardiac problems

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8
Q

What do you need to warn patients about who are on MAO inhibitors?

A

eating any tyramine rich foods eg. cheese, red wine, beer

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9
Q

What can be tried to treat severe depression not responding to any treatment?

A

ECT

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10
Q

What are side effects of ECT?

A

Memory loss- retrograde, aching muscles, headaches, confusion

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11
Q

What are some risk factors for suicide?

A

Risk factors:

  • Unemployed
  • No family or friends nearby
  • Multiple previous attempts of self harm/sucicide
  • Planning the next attempt i.e leaving a note or making sure no one finds them
  • Male
  • Alcohol or drug misuse
  • History of mental illness
  • History of chronic disease
  • Sorting out any final acts eg. selling belongings/ paying bills
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12
Q

Miss L is a 23 year old, single and shares a flat with her mother. She received SSRI treatment for depression 2 years ago following a termination of pregnancy. Her mother has brought her to see the GP as she is concerned that Miss L is “not herself”. Miss L appears excessively cheerful and talks loudly and quickly. She is wearing a lot of makeup in vivid colours. She tells you she is absolutely fine although sometimes she has trouble sleeping. She believes she is going to achieve stardom and become a world famous popstar next month. It is difficult to get a history from her as she changes the subject frequently, appears offended by some questions and laughs inappropriately at others. What is the likely diagnosis -specifically?

A

Bipolar disorder

Type 1 - mania and depression

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13
Q

What is the difference between hypomania and mania?

A

Mania will have psychotic symptoms eg. grandiose delusions, persecutory delusions

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14
Q

How will you manage an acute manic episode?

A

Antipsychotics eg. olanzapine

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15
Q

What is good to give to help treat the acute depressive episode?

A

Lamotrigine

Fluoxetine and olanzipine

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16
Q

You have diagnosed Miss L with bipolar disorder and treated her acute manic episode with olanzapine. You now need to manage her chronically. What are the options for treatment? Which one can you give 25 year old Miss L who doesn’t take any medication ?

A

Lithium
Sodium valproate
Antipsychotics eg. olanzapine

Lithium! - don’t need to be on contraception
Need to be on contraception to give sodium valproate

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17
Q

What are the side effects of lithium?

A

LITHIUM
Leucycottosis, inspidus, tremor, hydration- polyuria, polydipsia , GI disturbances, underactive thyroid- hypothyroid, metallic taste in mouth

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18
Q

Patient starts on lithium. Is having levels regularly monitored (weekly to begin with), 3 monthly once stable. Then presents to A+E with coarse tremor, blurred vision, jerking of her arms, diarrhoea and vomiting. What has happened and how do you manage?

A

Lithium toxicity
Bloods: FBC, U&E, LFTs, lithium level, TFTs
Stop lithium and supportive tx- rehydrate

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19
Q

Ms M is 32 years old with a known history of alcohol has been attending Alcoholics Anonymous. Members of these groups have asked her to seek help as she believes that a number of them are talking about her and calling her “paedo” (though they have reassured her that this is not the case). During the interview she seems nervous and distracted. Her speech is sometimes garbled, and she flits from one subject to a seemingly unrelated other one frequently. She says there is a conspiracy to frame her as a “paedo”. She tells you that staying clean and sober is extremely important to her, but that she feels she can no longer trust the other group members and is now reluctant to attend 12‐step meetings. What symptoms of schizophrenia is she showing?

A

Delusions
Thought disorder- Knight’s move thinking (flits from one subject)
Pressure of speech

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20
Q

What are the first rank symptoms of schizophrenia? What are some others?

A 
First rank:
3rd person auditory hallucinations
Delusional perceptions
Passivity phenomenon 
Thought disorder- thought broadcast, thought echo, thought insertion, thought withdrawal

Others: delusions, 2nd person auditory hallucinations, visual hallucinations, thought disorder eg. Knight’s move thinking- jumping from topic to topic, negative symptoms- apathy, blunted responses, catatonia

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21
Q

What is schizoaffective disorder and how is it treated?

A

Experience symptoms of mood disorder and schizophrenia at the same time and of the same intensity Tx: antipsychotic and mood stabiliser.

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22
Q

What is schizotypal?

A

It is a personality disorder with some schizophrenia symptoms

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23
Q

What is schizophreniform?

A

Fail to meet the criteria for schizophrenia but have some symptoms with deterioration in function.

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24
Q

Ms M is 32 years old with a known history of alcohol has been attending Alcoholics Anonymous. Members of these groups have asked her to seek help as she believes that a number of them are talking about her and calling her “paedo” (though they have reassured her that this is not the case). During the interview she seems nervous and distracted. Her speech is sometimes garbled, and she flits from one subject to a seemingly unrelated other one frequently. She says there is a conspiracy to frame her as a “paedo”. She tells you that staying clean and sober is extremely important to her, but that she feels she can no longer trust the other group members and is now reluctant to attend 12‐step meetings. She is diagnosed with schizophrenia.
What is her bio psychosocial plan for management?

A

Biological: atypical antipsychotic eg. olanzapine, risperidone
Psychological: CBT, alcoholic support groups - maybe a different one or involve the substance abuse team.
Social: address any job or housing issues, family issues?

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25
Q

What are some first generation (typical) antipsychotics? How do they work?

A

Haloperidol, Chlorpromazine, prochlorpromazine, sulpiride. They block D2 (dopamine) receptors

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26
Q

What are some side effects of 1st generation antipyschotics?

A

ESPEs
Tardive dyskinesia - lip smacking, chewing, grimacing
Akasthisia - pacing, inner restlessness
Parkinsonism
Acute dystonic reaction - muscular spasms, acute torticollis, ocular gyrate crisis

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27
Q

How do you treat acute dystonic reaction?

A

IV fluids, procyclidine (anticholinergics)

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28
Q

How do you treat tardive dyskinesia?

A

Very difficult - tetrabenazine

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29
Q

How do you treat akathisia?

A

Propranolol and switch to second gen antipschyotic

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30
Q

How do 2nd gen antipsychotics work and what are there side effects?

A

Block dopamine D2 receptors and serotonin receptors
Side effects:
weight gain, diabetes, hyperlipidaemia, hyperprolactinaemia- galactorrhea, amenorrhea, infertility, erectile dysfunction

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31
Q

What needs to be monitored when a patient is on antipsychotics?

A 
ECG- long QT 
Bloods: FBC, U&E, LFTs, prolactin, glucose, lipids , HBA1c
Side effects
Weight and waist circumference 
BP
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32
Q

What are the 3 clusters of personality disorders and an example from each?

A

Cluster A: odd/eccentric ‘Mad’- schizotypal, paranoid PD
Cluster B: dramatic/emotional ‘Bad’ - emotionally unstable , antisocial, histrionic, PD
Cluster C: anxious/avoidant ‘Sad’ - dependent, obsessive compulsive PD

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33
Q

A 23 year old man has a history of being very suspicious of everyone around him. He has often accused his friends for trying to kill him or trying to hurt him even though they try and reassure him that they aren’t. He doesn’t have any close family or friends as he doesn’t trust anyone. What type of PD is this?

A

Paranoid PD - tends to be males, very suspicious and mistrusting about everyone’s actions

34
Q

A 23 year old man has a history of being very distant with his friends. His girlfriend (now ex girlfriend) said that he never showed any emotion or care to her and was always very cold and distant. He says he prefers to spend time by himself with his own thoughts. What type of PD is this?

A

Schizoid - tends to be males, very emotionally distant and cold. Limited capacity for expressing emotion, prefers to be alone.

35
Q

A 25 year old man has a history of violent behaviour. He has a criminal record for violent offences against people. He doesn’t care what people think about him and is very easily frustrated by small things which make him violent. On asking whether he regrets his violent offences, he says he does not and doesn’t care how they feel. What type of PD is this?

A

Antisocial PD- history of criminal behaviour, lack of guilt about behaviour, no concern for others, aggressive and can be violent.

36
Q

A 25 year old female has a history of having random outbursts in her mood, she is known for having frequent mood swings which are unpredictable. She has very intense relationships which then rapidly become unstable. She has scars on her arms showing she has a previous history of self harm and continues to. You ask her to tell you about her and she says she doesn’t even really know who she is. What type of PD is this?

A

Emotionally unstable - borderline / impulsive if more impulsive acts in question

  • Intense and unstable relationships
  • Unclear self image
  • Self harm/suicide
  • Mood swings
37
Q

A 25 year old female has a history of being quite overdramatic. She will exaggerate stories about things that have happened to her in order to get attention. She often takes any sort of criticism or instruction poorly and her feelings get hurt very easily. What type of PD is this?

A

Histrionic: overdramatic, exaggerates, self centred- wants attention, easily hurt feelings

38
Q

A 25 year old man has a history of obsessive behaviours. He compulsively worries and doubts everything he has done and spends an hour in the morning checking all the switches are off numerous times. He is quite rigid in this routine and gets anxious if he cannot do this. What type of PD is this?

A

Anankastic- obsessive compulsive

39
Q

A 25 year old female has a history of very low self confidence. She wants to be liked by everyone and doesn’t respond well to criticism or any sort of rejection. She is very insecure and feels she is not a good as everyone else. What type of PD is this?

A

Avoidant/anxious

40
Q

A 25 year old female has a history of repeated relationships that don’t end well. She has never had a period of time where she has had a partner and would struggle to be alone. She feels very incompetent without someone there and says she cannot function unless there is someone she can rely on. She is scared everyone in her life will leave her and she wouldn’t know what to do. What type of PD is this?

A

Dependent

41
Q

How do you treat personality disorder?

A

DBT- dialectical behaviour therapy- uses individual and group therapy with CBT and mindfulness
CBT can be used
Social interventions
Only medication to treat a co-morbid issue eg. antidepressants if depressed

42
Q

Ms C is a 25 year old woman who is referred to your clinic by her GP. She has been on anti‐depressants for over one year with little effect.
Before you see her you have a look at her notes. You discover that she was neglected as a child and often left alone for long periods of time by both her parents who had problems with substance misuse. She was eventually placed into foster care. Whilst in foster care she was sexually abused by one of her carers and at this point began drinking alcohol regularly.
She tells you that her mood is “all over the place” and has recently experienced relationship breakdown, has no friends, and can’t cope anymore. She feels unsafe in her current accommodation. She says that she constantly wants to kill herself and regularly cuts herself with a Stanley knife.
What are the causes of her presentation based on the biopsychosocial model based on 3 Ps?

A

P’s- predisposing
P’s- precipitating
P- perpetuating

Predisposing: bio: genetics, psych: neglected as child, social: unsafe environment
Precipitating: bio: alcohol use, psych: sexual abuse by carers, social: unsafe foster home
Perpetuating: bio: alcohol intake, psych: self harm, social: lack of friends and support system, no where safe to live

43
Q

Ms C is a 25 year old woman who is referred to your clinic by her GP. She has been on anti‐depressants for over one year with little effect.
Before you see her you have a look at her notes. You discover that she was neglected as a child and often left alone for long periods of time by both her parents who had problems with substance misuse. She was eventually placed into foster care. Whilst in foster care she was sexually abused by one of her carers and at this point began drinking alcohol regularly.
She tells you that her mood is “all over the place” and has recently experienced relationship breakdown, has no friends, and can’t cope anymore. She feels unsafe in her current accommodation. She says that she constantly wants to kill herself and regularly cuts herself with a Stanley knife.
What is the biopsychosocial model for management?

A

Biological: antidepressants
Psychological: DBT, alcohol therapy, CBT- past trauma
Social: find her supportive housing, support group for social support, look for job

44
Q

20 year old female, reports palpitations and feeling of impending doom. She has been struggling to concentrate at work. Her sleep quality has been poor for the last few months. She reports these symptoms occurring everyday for the majority of the day. She has previously been on propranolol for anxiety. Given the likely diagnosis, what treatment can be offered?

A

Psychological: progressive relaxation training, CBT with relaxation
Medication: 1. SSRI- sertraline
2. SNRI/TCA
Can give benzo’s for acute anxiety attacks and beta blockers for symptoms

45
Q

A patient presents to clinic as she has had a few episodes where she has had intense feelings of fear, feeling her heart beating, chest pain and struggling to breathe. Often she gets quite dizzy as well. In these episodes she feels like she is going to die and doesn’t have control to stop herself falling over or anything. The episodes last 10 minutes and then stop and she feels worn out but physically fine afterwards. What is the likely diagnosis? and how are you going to treat?

A

Panic disorder - <20 min episodes of intense fear with autonomic symptoms.
Tx:
CBT
Meds: 1. SSRI . 2nd line : TCA

46
Q

Mrs B is a 34 year old married mother of two. She is currently on maternity leave after
having her second child who is now 7 months old. When her baby was a few weeks old, he caught Norovirus and was very ill with diarrhoea and vomiting. Mrs B has always been “house proud” but has become more fixated on cleaning and washing since this incident. She spends “hours” sterilising all the baby’s bottles and feeding implements. She herself washes her hands 40‐ 50 times daily (they are raw and chapped). Her mood, sleeping and energy are all fine.
What is the difference between obsessions and compulsions?

A

Obsessions: repeated purposeless words/ thoughts
Compulsions: repeated senseless acts to help to deal with the obsessions

47
Q

Mrs B is a 34 year old married mother of two. She is currently on maternity leave after
having her second child who is now 7 months old. When her baby was a few weeks old, he caught Norovirus and was very ill with diarrhoea and vomiting. Mrs B has always been “house proud” but has become more fixated on cleaning and washing since this incident. She spends “hours” sterilising all the baby’s bottles and feeding implements. She herself washes her hands 40‐ 50 times daily (they are raw and chapped). Her mood, sleeping and energy are all fine.
Given the likely diagnosis , how are you going to treat her?

A

CBT/exposure therapy

Meds: clomipramine (TCA) or SSRI- fluoxetine if higher impairment

48
Q

A 50 year lady comes into clinic by her husband. He says that she won’t leave the house anymore at all and it was a big effort to get her here. On questioning her, she says she is very scared of going outside her house now and doesn’t feel safe in open spaces. When she gets there, she feels panicky, her heart starts racing and she feels nauseous. This is happening nearly every time they go out eg. in a park or in a queue or on public transport. She is fine at home, her mood is stable and she has no psychotic symptoms. What is the likely diagnosis and how can you treat?

A

Agoraphobia.

Tx: exposure therapy

49
Q

Mr A is a 28 year old ex‐soldier who returned from Iraq 18 months ago. Since then, he has been living at home and unable to work. He does not want to leave the house because he gets into conflicts with strangers which have led to physical fights. When interviewed, he is jumpy and overreacts to the slamming of a car door outside. He does not watch television because any news story about war or conflict brings back “bad memories”.
His wife is struggling to cope with him and their three young children. She reports that he is drinking heavily, although he denies this. He has no contact with the rest of his family or friends.
What are the symptoms of PTSD?

A

Hypervigilance
Flashbacks / nightmares of trauma - autonomic sx with this - hyperventilation, palpitations
Insomnia
Detachment from other people
Poor concentration
Depression
may have substance abuse and suicidal thoughts

50
Q

You have diagnose your patient with PTSD. What should you immediately NOT do?

A

Debrief- don’t go into the event straight away= makes symptoms worse

51
Q

What is the biopsychosocial model for management of PTSD?

A

Biological: 2nd line to therapy/in combo with: SSRI, mirtazipine
Psychological: trauma focused CBT or EMDR- eye movement desenitisation and reprocessing
Social: support groups- particularly if ex military - groups for them in particular

52
Q

How do you treat alcohol withdrawal acutely?

A

Chlordizepoxide
Pabrinex supplements - vitamin b1
Same staff member, well lit room

53
Q

You see the alcohol withdrawal pt a week later. Is now out of hospital. Wants help with abstinence long term. How will you manage?

A

Alcohol support groups
Medications: acamprosate- anti-craving, disulfiram- hangover like effects, naltrexone- anti-craving, makes features less pleasurable.

54
Q

Miss D is a 20 year old student who has been admitted to Medical Assessment Unit (MAU) after a collapse in her Hall of Residence. She is 5’4” and weighs 5 stone. She has a body mass index of 12. On examination, she is emaciated, and she has a pulse of 50 bpm, BP 86/60, respiratory rate 8/ per minute. She has angular stomatitis and proximal muscular weakness with some small fine hair growth on her ams. Given the diagnosis, what abnormalities might you find on blood tests?

A 
Anorexia nervosa 
Most thing's low eg. potassium, testosterone, oestrogen. FSH and LH
G's and C's raised 
- Growth hormone
- Glucose 
- Salivary gland enlargement 
-Carotenes
-Cortisol 
- Cholesterol
55
Q

What are the signs and symptoms of anorexia nervosa?

A 
Fatigue 
Loss of concentration 
Intense FEAR of putting on weight 
Low BMI 
Amenorrhea
Failure of secondary sexual characteristics 
Cold intolerance
Dry skin and hair 
Proximal muscle weakness 
Lanuga hair - fine hair growth
56
Q

How do you manage a patient with anorexia?

A

May need admitting to hospital
Refeeding - slowly
CBT- eating disorder focused
Family therapy if under 18

57
Q

What is this? Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen’s

A

Malingering

58
Q

What is this? The intentional production of physical or psychological symptoms due to the psychological goal of receiving attention/care/comfort
Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen’s

A

Munchausen’s

59
Q

What is this? Loss of motor or sensory function, may be brought on by stressful life event.
Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen’s

A

Conversion disorder

60
Q

What is this? Multiple physical SYMPTOMS present for at least 2 years. Patient refuses to accept reassurance or negative test results
Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen’s

A

Somatisation disorder

61
Q

What is this? Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer. Patient again refuses to accept reassurance or negative test results
Options: somatisation disorder, hypochondries disorder, malingering, conversion disorder, fictious/munchausen’s

A

Hypochondrial disorder

62
Q

Go through a MMSE

A

Appearance: well kempt, well dressed
Behaviour: fidgety? anxious? making eye contact? responding to any hallucinations? self harm?
Speech: rate, rhythm and volume- loud/quiet. Pressure of speech or mutism? Thought disorder- jump from topic to topic
Mood: subjective- their mood. objective- your assessment and affect
Thought- delusions or obsessions and what the form is
Perceptions- hallucinations and modality or illusions
Cognition- orientated to time and place?
Insight- insight into illness, do they want help?

63
Q

You are an FY2 working on A+E. Pt has attempted overdose. Pt states when leave are going to jump off nearby bridge. Pt is leaving now and liaison psych who you have bleeped have not answered. There are no other staff present. What section of mental health act will you use?

A

Section 4- emergency order

In A&E so can’t use 5(2)

64
Q

Once sectioned with mental health act- patient is displaying symptoms of pneumonia. Can you treat?

A

No - you can only treat the mental disorder until MHA. You can only force treatment for physical under the mental capacity act

65
Q

You are an FY2 working on a general medicine ward. Patient is being treated for overdose. She now is demanding to leave and saying she will go take another overdose. What section of the MHA will you use?

A

5(2)- patients already admitted.

72 hours.

66
Q

What is a section 2 and 3?

A

Section 2- assessment- 28 days
Section 3- treatment - 6months
need 2 doctors and 1 approved mental health professional for both

67
Q

What sections can police use?

A

135- home

136- public place

68
Q

Pt on ward is acting aggressively, refusing medication, asking to leave. They are under a DOLS. Thrown hot coffee at nurse. What are you going to try first?

A

De-escalation techniques- speaking softly, explaining what’s happening, asking them their concerns

69
Q

Pt on ward is acting aggressively, refusing medication, asking to leave. They are under a DOLS. Thrown hot coffee at nurse. You have tried de-escalation techniques. What can you do now?

A

Oral lorazepam
or oral haloperidol + promethazine
If oral doesn’t work: IM

70
Q

What are the key side effects to watch out for when you give lorazepam or haloperidol?

A

Acute dystonic reaction

Respiratory depression- lorazepam

71
Q

What antidote should you have to hand when giving lorazepam for the respiratory depression?

A

Flumenazil

72
Q

What can you give for a paracetamol OD?

A

Activated charcoal within the hour

NAC - plot on graph and give. If staggered OD: give anyway.

73
Q

Sam is a 26-year-old female who is brought in to the Emergency Department unconscious after having been found slumped on the floor in town. She has pinpoint pupils, GCS 8, hypothermic, muscle spasms and evidence of track marks on her arms. What is your initial management? What is your long term management?

A

Naloxone IV

Detox: methadone or buprenorphine

74
Q

A 25 year old presents with A&E with new onset confusion and agitation. She also looks very sweaty. You do a neuro exam due to the presence of her tremor which shows hyperreflexia. She says she takes sertraline regularly for months now but 2 days ago they started a new anti-depressant. What is the likely diagnosis?

A

Serotonin syndrome

75
Q

What is the triad of symptoms in serotonin syndrome?

A

Autonomic sx: sweating, tachycardia
Neuromuscular: hyperreflexia, tremor
Mental state: confusion, aviation

76
Q

How do you manage a patient with serotonin syndrome?

A 
ABCDE
Remove offending drug
Supportive treatment eg. IV fluids
BENZO- midazolam/diazepam 
cyprohepatidine can help - serotonin receptor antagonists
77
Q

A 26 year old with a background of schizophrenia presents with A&E with a new onset high fever. Her muscles are very rigid when you examine her. She is also sweating. Obs show a high fever and tachycardia. She is confused but she manages to tell you they started her on a new drug for her schizophrenia yesterday. What is the likely diagnosis and how will you manage her?

A 
Neuroleptic malignant syndrome 
ABCDE 
Stop drug. 
IV fluids, cooling blankets
IV benzo - lorazepam 
Dopaminergic drugs- bromocriptine, amantadine
78
Q

50 year old man reports feeling increasingly anxious, sweating and experiencing episodes where he sees insects that aren’t there. He is acutely confused but m manages to tell you he has decided to stop drinking 12 hours ago. Was drinking 5 pints of beer a night for many years. What is the diagnosis and how are you going to manage him?

A 
Delirium tremens - psychotic symptoms
ABCDE 
Chlordiazepoxide - PO/ IV if vomiting 
Pabrinex- IV 
If having seizures: diazepam
79
Q

50 year old man with a history of severe chronic alcohol abuse presents to A&E with new onset confusion, blurred vision and unstable gait. He walks with a very wide stance and on testing eyes- there is some nystagmus present. What is the likely diagnosis and management?

A

Wernicke’s encephalopathy - triad of confusion, ophthalmoplegia- nystagmus, ptosis and ataxia

Mx:
Thaimine /pabrinex
Check glucose and give this before

80
Q

You have diagnosed your patient with chronic alcohol abuse with Wernicke’s encephalopathy. What other condition is he at risk of developing? what would be the symptoms?

A

Korsakoff’s - chronic

Confabulation due retrograde amnesia- invent memory, antegrade amnesia- can’t make new memories, apathy, ataxia

81
Q

You have a patient who is addicted to his lorazepam but is now willing to slowly withdraw from them with your help. How will you help?

A

Change to diazepam first- helps and withdraw by 2mg a week

Phase 4 (15 decks)

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