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PACES 2 > Psych > Flashcards

Psych Flashcards

1
Q

Questions to ask a suicidal patient who has not attempted suicide

A
  • Do you still get pleasure out of life?
  • Are you able to face each day?
  • Do you feel life is a burden?
  • Do you wish it will all end?
  • Have you ever thought about ending your own life?
  • What is stopping you from trying to commit suicide?
  • Have you thought about how you would do it?
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2
Q

Questions to ask a patient who has attempted suicide

A
  • Was it premeditated?
  • Did you make any attempts to stop people from finding you?
  • Did you tell anyone about it?
  • Did you write a suicide note/ change your will Violent act?
  • Did you think it would be final/ reversible?
  • Do you have any regrets?
  • Did you try and get help after the attempt? Previous attempts?
  • Alcohol/ drugs involved?
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3
Q

Questions for a depressed patient

A
  • Low mood?
    • Duration?
  • Anhedonia
    • Loss of interest in hobbies?
  • Anergia
    • Diurnal variation (worse in mornings?)
  • Poor concentration/ memory
  • Poor sleep?
  • Appetite/ weight Guilt/ worthlessness
  • Suicidal ideation?
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4
Q

Questions for the manic patient?

A
  • Excessive spending?
  • Decreased sleep?
  • Ambitions?
  • Grandiose ideas
  • Disinhibition
  • Sexual energy/ libido
  • Flight of ideas
  • Pressure of speech
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5
Q

Questions for the delusional patient

A
  • Has anything been worrying you lately?
  • What’s been on your mind?
  • Has anything odd been happening to you lately that others are finding it difficult to believe?
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6
Q

Questions for a patient with hallucinations

A
  • Has anything unusual happened to you recently?
  • Did you hear voices which no one else can hear?
  • Did you ever see things that are strange or that other people cannot see?
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7
Q

First rank symptoms of schizophrenia

A
  • Thought possession (insertion, withdrawal. broadcasting)
  • Passivity phenomena (somatic, thoughts, emotions, acts)
  • Auditory hallucinations (usually 3 rd person, thought echo or commentary)
  • Delusional perception
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8
Q

What is a delusion?

A

A false belief which is kept despite proof to the contrary and out of keeping with the patient’s social, cultural and educational backgrounds

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9
Q

Questions to ask the anxious patient?

A
  • Feelings of worry/ apprehension?
  • Irritability
  • Restlessness
  • Depersonalisation
  • Insomnia
  • Psychogenic symptoms
  • Memory problems
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10
Q

Questions to ask about panic attacks?

A
  • Fear/ feeling of threat, panic or doom which is out of proportion to the perceived danger
  • Avoidance of anything that may trigger the panic attack
  • What triggers it?
  • How severe is the panic attack?
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11
Q

Questions about phobias

A
  • How often?
  • Trigger avoidance
  • Safe at home?
  • Do they need anyone to be at home with them?
  • Affect on a day to day relationships
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12
Q

OCD questions

A
  • An intrusive thought
  • Recognition it’s their own Irrational feeling?
  • The resistance of these thoughts?
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13
Q

PTSD Questions

A
  • Flashbacks
  • Panic attacks
  • Emotional numbing
  • Avoidance
  • Nightmares
  • Over arousal
  • Depression
  • Substance misuse
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14
Q

Features of dependence

A
  • Stereotypes pattern
  • Primacy
  • Tolerance
  • Withdrawal
  • Relief drinking (to stop withdrawal symptoms)
  • Compulsion to drink
  • Relapse after abstinence
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15
Q

Questions to ask an alcoholic patient

A
  • What is drunk?
  • How much?
  • How often?
  • Where?
  • When?
  • Triggering?
  • Binges?
  • When did this start?
  • Abstinent?
  • Have you sought help before?
  • FH?
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16
Q

SCOFF Questionnaire

A
  • Sick: do you make yourself feel sick?
  • Control: do you worry you have lost control over what you eat?
  • One stone: loss in the last three months?
  • Fat: do you think you are too fat when others think you are too thin?
  • Food: Do you think food dominates your life?
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17
Q

Eating disorder questions

A
  • How would you feel if you gained weight?
  • How do you see yourself when you look in the mirror?
  • Amenorrhea?
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18
Q

Biological eating disorder symptoms

A
  • Lanugo hair
  • Breast atrophy
  • Skin looks rough
  • Low BP
  • Extremities cold
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19
Q

What is CBT?

A
  • Based on Beck’s model of depression
  • Negative thinking can depress mood which generates negative thoughts
  • Resulting in a downward spiral
  • The therapist helps the patient to notice negative automatic thoughts (NATs)
20
Q

Symptoms of depression?

A
  • Core symptoms:
    • Low mood
    • Anhedonia
    • Anergia
  • Cognitive symptoms:
    • worthless
    • feelings of guilt
    • pessimistic view of the future
    • poor concentration
  • Biological:
    • insomnia
    • early morning waking
    • fatigue, hyperphagia, weight gain
    • reduced libido
21
Q

Ix for Depression

A
    1. Collateral history
    1. Physical examination
    1. Blood tests (include others as suggested by history and examination):
      * TFT (to rule out hypothyroidism)
      * FBC (anaemia causes fatigue)
      * G or HbA1c (diabetes causes fatigue)
    1. Rating scales can measure severity or monitor treat- ment response,
      * e.g. Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS)
    1. CT or MRI head are never routine but may help to rule out suspected cerebral pathology
22
Q

Psychological Therapy for depression

A
  • IAPT talking therapies
    • if mild then computer based or self-help
  • Cognitive Behavioural Therapy: focusing on the now
  • Psychodynamic psychotherapy: talking to a therapist, allows you to put into words how you feel with the prompts of the therapist
  • Interpersonal Therapy: focuses on unresolved loss, psychosocial transitions, relationship conflicts
23
Q

Common side effects of SSRIs

A
  • Insomnia
  • Tremor
  • dizziness
  • Headache
  • Sweating
  • Sexual dysfunction
24
Q

Presentation of MSE

A
  • A - Appearance/Behaviour
  • S - Speech
  • E - Emotion (Mood and Affect)
  • P - Perception (Auditory/Visual Hallucinations)
  • T - Thought Content (Suicidal/Homicidal Ideation) and Process
  • I - Insight and Judgement
  • C - Cognition
25
Q

Biological management of depression

A
  • 1st line: SSRI
  • 2nd line:
    • SNRI (venlafaxine)
    • NASSAS (mirtazapine)
    • NARI (reboxetines)
    • MAOI (Phenelzine)
    • RIMA (Moclebemide)
26
Q

Physical causes of depression

A
  • Cushing’s syndrome
  • Hypothyroidism
  • Addison’s disease
  • Dementia
  • Head injury
  • Stroke
  • PD
  • MS
27
Q

Management of suicide

A
  • Admit if at high risk of suicide
  • Same as per depression
  • Could also consider discharging with HTT
  • Suicide hotlines given
  • Establish a plan for what the patient will do if they feel this way again
28
Q

Management of puerperal psychosis

A
  • If severe admit to mother and baby unit
  • Treat psychosis with atypical antipsychotic (olanzapine and quetiapine are safe in breastfeeding)
  • Treat depression with SSRIs (paroxetine and sertraline are safe in breastfeeding)
  • Severe cases may need ECT
29
Q

RF for puerperal psychosis

A
  • Personal or family history of puerperal psychosis
  • BPAD
  • Puerperal infection
  • Obstetric complications
30
Q

Features of lithium toxicity

A
  • GI disturbance (diarrhoea and vomiting)
  • Sluggishness
  • Giddiness
  • Ataxia
  • Gross tremor Fits
  • Renal failure
31
Q

What are the teratogenic effects of mood stabilisers in pregnancy?

A
  • Lithium – Ebstein’s anomaly
  • Valproate and Carbamazepine – spina bifida
32
Q

Management of psychosis

A
  • Can be managed at home with HTT support • If <30 can refer to EIS
  • If at risk then admit under section
  • Biological
    • Acute: Consider IM lorazepam
    • Chronic:
      • 1st line atypical antipsychotic (olanzapine, risperidone (can be depot), quetiapine, clozapine, aripiprazole) o
      • 2nd line typical antipsychotic (e.g. chlorpromazine, haloperidol- these are better as depot injections
  • Psychological
    • CBT: reality testing, as these patients tend to jump to conclusions
    • Family therapy: especially preventing relapse in high expressed emotional families •
    • Concordance therapy: collaborative approach where the patient decides the pros and cons of their treatment
  • Social
    • Social skills training to improve interpersonal skills
    • Education
    • Rehabilitation accommodation
    • Social services
    • Creative writing
33
Q

Management of acute mania in patients with BPAD

A
  • Stop anti-depressants, steroids and dopamine agonists
  • Check lithium levels
  • IM atypical anti-psychotic à olanzapine/quetiapine/risperidone
  • BDZ for agitation
  • For patients already on medication try combining medication (i.e. antipsychotic + mood stabiliser + benzo)
  • Stabilise using mood stabiliser
  • ECT may be considered if medication is ineffective
34
Q

Management of Dementia

A

Social

  • Referral to memory clinic
  • Environmental control: always carry ID with address, dossett boxes for medication, change gas to electricity, reality orientation
  • Social Support: personal care, meal preparation, day centres, day hospitals
  • Support for carers:
    • Carer support (Alzheimer’s Association, National institute on Aging)
    • Written instructions

Psychological Therapies:

  • Reminiscence therapy
  • Validation therapy
  • Multisensory Therapy
  • Cognitive Stimulation Therapy
  • Regular follow up with an old age psychiatrist

Biological therapies: not to be used long-term

  • Acetylcholinesterase inhibitors e.g. donepezil, galantamine and rivastigmine
  • NMDA agonist – memantine
  • SSRIs in those with depression
35
Q

List some key differences between DLB, AD and VD

A
  • VD has a stepwise decline, DLB and AD has more of a gradual decline
  • AD has an insidious onset, VD is sudden and DLB varies
  • DLB causes parkinsonism, hallucinations and syncope but short-term memory is less affected than in VD and AD
36
Q

Eating Disorder Management

A
  • 1stline: Anorexia-focused family therapy with dietician involvement
  • 2ndline: ED-CBT
  • Other options: specialist supportive clinical management (SSCM), Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
  • If co-morbid depression à fluoxetine
  • Possible long-term follow up for complications e.g. osteoporosis
37
Q

When would you consider the admission of a patient with anorexia?

A
  • BMI < 13 or extremely rapid weight loss >1 kg/week
  • Serious physical complications → Hypotension, Bradycardia, Electrolytes, Hypothermia
  • High suicide risk
  • NOTE: MHA may be used to enforce compulsory feeding
38
Q

What are some physical complications of anorexia nervosa?

A
  • Bradycardia and hypotension (risk of sudden death)
  • GI upset (constipation, abdominal pain, ulcers)
  • Amenorrhoea and infertility
  • Osteoporosis
  • Peripheral neuropathy
39
Q

Alcohol rating scales

A
  • AUDIT to identify use disorder
  • SADQ to determine severity of dependence
  • APQ to assess then nature of problems arising from alcohol

CIWA Ar alcohol to determine severity of withdrawal

40
Q

Management of addiction

A

Bio – Assisted Withdrawal

  • Community-based - Drug and Alcohol Service
  • Fixed-dose drug regimen (chlordiazepoxide or diazepam)
    • Titrate based on severity of alcohol dependence
    • Gradually reduce the dose over 7-10 days (give 2 days of medication at a time)
  • After successful withdrawal, consider acamprosate or naltrexone (for 6 months) with individualised psychological intervention
  • Thiamine supplementation
  • Expectations: withdrawal symptoms are worst within the first 48 hours, and takes about 3-7 days after the last drink to completely disappear

Psychological

  • CBT, behavioural or social network and environment-based
  • Focus on alcohol-related cognitions
    • Weekly 1-hour sessions for 12 weeks
  • Refer to self-help resources and support groups (Alcoholics Anonymous, SMART Recovery)

Social

  • Direct to the relevant services regarding legal and financial support (e.g. benefits)
    • Direct to services that can help find a new job (e.g. job centres)
    • Driving – DVLA will need to be informed about you receiving treatment (can’t drive during treatment)
  • Follow-Up
    • Arrange an appointment for any time after you finish withdrawal
    • Safety Net: if symptoms become very severe, go to A&E
41
Q

SSRI discontinuation syndrome

A
  • Symptoms can include diarrhoea, nausea and vomiting.
  • Flu-like symptoms such as headaches and sweating may also be seen, and in some cases, patients can present with symptoms of vertigo
42
Q

Physiological changes in anorexia

A
  • hypokalaemia
  • low FSH, LH, oestrogens and testosterone
  • raised cortisol and growth hormone
  • impaired glucose tolerance
  • hypercholesterolaemia
  • hypercarotinaemia
  • low T3

Most things low

  • G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
43
Q

Interpret the MMSE

A
  • 24-30- no cognitive impairment
  • 18-23- mild cognitive impairment
  • 0-17- Severe cognitive impairment
44
Q

Drugs to help with alcohol dependence

A
  • Disulfiram: makes you throw up after having alcohol (
  • Acamprosate: tablet taken three times a day which reduces craving
45
Q

How does serotonin syndrome present?

A

Serotonin syndrome presents with the triad of:

  • altered mental status (e.g. agitation, confusion, coma)
  • autonomic dysfunction (e.g. hyperthermia, hypertension, tachycardia)
  • neuromuscular abnormalities (e.g. tremor, clonus, hyperreflexia).

PACES 2 (5 decks)

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