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?
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?
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?
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
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?
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?
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
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
9
Q
Questions to ask the anxious patient?
A
- Feelings of worry/ apprehension?
- Irritability
- Restlessness
- Depersonalisation
- Insomnia
- Psychogenic symptoms
- Memory problems
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?
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
12
Q
OCD questions
A
- An intrusive thought
- Recognition it’s their own Irrational feeling?
- The resistance of these thoughts?
13
Q
PTSD Questions
A
- Flashbacks
- Panic attacks
- Emotional numbing
- Avoidance
- Nightmares
- Over arousal
- Depression
- Substance misuse
14
Q
Features of dependence
A
- Stereotypes pattern
- Primacy
- Tolerance
- Withdrawal
- Relief drinking (to stop withdrawal symptoms)
- Compulsion to drink
- Relapse after abstinence
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?
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?
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?
18
Q
Biological eating disorder symptoms
A
- Lanugo hair
- Breast atrophy
- Skin looks rough
- Low BP
- Extremities cold
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
- Collateral history
- Physical examination
- 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)
- Blood tests (include others as suggested by history and examination):
- Rating scales can measure severity or monitor treat- ment response,
* e.g. Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS)
- Rating scales can measure severity or monitor treat- ment response,
- 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
Biological management of depression
* 1st line: SSRI
* 2nd line:
* SNRI (venlafaxine)
* NASSAS (mirtazapine)
* NARI (reboxetines)
* MAOI (Phenelzine)
* RIMA (Moclebemide)
26
Physical causes of depression
* Cushing’s syndrome
* Hypothyroidism
* Addison’s disease
* Dementia
* Head injury
* Stroke
* PD
* MS
27
Management of suicide
* 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
Management of puerperal psychosis
* 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
RF for puerperal psychosis
* Personal or family history of puerperal psychosis
* BPAD
* Puerperal infection
* Obstetric complications
30
Features of lithium toxicity
* GI disturbance (diarrhoea and vomiting)
* Sluggishness
* Giddiness
* Ataxia
* Gross tremor Fits
* Renal failure
31
What are the teratogenic effects of mood stabilisers in pregnancy?
* Lithium – Ebstein’s anomaly
* Valproate and Carbamazepine – spina bifida
32
Management of psychosis
* 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
Management of acute mania in patients with BPAD
* 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
Management of Dementia
***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
List some key differences between DLB, AD and VD
* 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
Eating Disorder Management
* **1****st****line**: Anorexia-focused family therapy with dietician involvement
* **2****nd****line**: 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
When would you consider the admission of a patient with anorexia?
* 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
**What are some physical complications of anorexia nervosa?**
* Bradycardia and hypotension (risk of sudden death)
* GI upset (constipation, abdominal pain, ulcers)
* Amenorrhoea and infertility
* Osteoporosis
* Peripheral neuropathy
39
Alcohol rating scales
* 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
Management of addiction
**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
SSRI discontinuation syndrome
* 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
Physiological changes in anorexia
* 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
Interpret the MMSE
* 24-30- no cognitive impairment
* 18-23- mild cognitive impairment
* 0-17- Severe cognitive impairment
44
Drugs to help with alcohol dependence
* Disulfiram: makes you throw up after having alcohol (
* Acamprosate: tablet taken three times a day which reduces craving
45
How does serotonin syndrome present?
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).
