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Eggs 3a > PSYCH > Flashcards

PSYCH Flashcards

1
Q

What is in a MSE?

A
  1. Appearance and Behaviour
  2. Speech
  3. Mood and Affect
  4. Thoughts, Delusions, Perceptions and Hallucinations
  5. Cognition and Insight
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2
Q

What would you comment on in Appearance and Behaviour?

A
  1. Appropriately dressed?
  2. Socially appropriate
  3. Eye contact
  4. Psychomotor agitation or retardation
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3
Q

What would you comment on Speech?

A

Rate, rhythm, tone, volume

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4
Q

What would you comment on for Mood and Affect?

A

Mood- how they say they are feeling in their own words

Affect- How they come across overall. Is their mood congruent with the conversation? Blunted? Flat?

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5
Q

What would you comment on for Thoughts, Delusions, Perceptions and Hallucinations?

A

Content and form of thoughts
Thought disorder? Insertion? Withdrawal? Broadcasting?
Delusions? Persecutory or complimentary? Agency? Grandiose?
Perceptions? Illusions
Hallucinations? 2nd or 3rd person? Internal or external space? Visual,. Auditory or Tactile?

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6
Q

What would you comment on about Cognition and Insight?

A

Are they orientated to time and place?- AMT?

Are they insightful to their illness, do they accept that they are ill?

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7
Q

What is an illusion?

A

A misperception of a real external stimuli

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8
Q

What is a hallucination?

A

Perceptions occurring in the absence of an external physical stimulus. Can be auditory, visual or olfactory

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9
Q

What is a pseudo-hallucination?

A

Arise in the subjective inner space of the mind, not through of the external sensory organs

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10
Q

What is meant by ‘over-valued idea’?

A

A false or exaggerated belief sustained beyond logic or reason

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11
Q

What is a delusion?

A

A false, unshakeable idea which is out of keeping with the patients educational, cultural and social background; it is held with extraordinary conviction and certainty

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12
Q

Give some examples of different types of delusions

A
  1. Persecutory
  2. Grandiose
  3. Self-referential
  4. Nihilistic (Cotard’s syndrome)
  5. Misidentification
  6. Religious
  7. Hypochondrial
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13
Q

Give examples of types of thoughts patients may describe

A
  1. Thought insertion
  2. Thought withdrawal
  3. Thought broadcast
  4. Thought echo
  5. Thought block
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14
Q

Define circumstantiality

A

Irrelevant wandering in conversation

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15
Q

Define preservation

A

Repetition of a word, theme or action

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16
Q

Define confabulation

A

Giving a false account to fill a gap in memory.

Often seen in dementia patients

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17
Q

Define somatic passivity

A

The delusional belief that one is a passive recipient of bodily sensations from an external agency

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18
Q

Define catatonia

A

Excited or inhibited motor activity in the absence of a mood disorder or neurological disease

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19
Q

What is psychomotor retardation?

What conditions would it be present?

A

Slowing of thoughts and movements.

Seen in depression, Parksinson’s disease etc

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20
Q

Describe incongruity of affect

A

Emotional response s that seem grossly out of tune with the situation or subject being discussed

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21
Q

What is blunting of affect?

A

An absence of normal emotional responses

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22
Q

What is depersonalisation?

A

Feelings of detachment from own’s body; the patient fells like a spectator of his own activities

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23
Q

What is derealisation?

A

A sense of one’s surroundings lacking reality, surroundings may appear dull, grey, lifeless

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24
Q

Describe dissociation

A

When a person feels disconnected from his/herself and/or their surroundings

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25
Q

What is obsession

A

A recurrent persistent thought, image or impulse; it remains despite efforts to resist

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26
Q

What is compulsion

A

Repetitive, purposeful behaviour accompanied by a subjective sense that it must be carried out despite the recognition of its senselessness and resistance

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27
Q

What is akathisia

A

Motor restlessness, ranging from anxiety to the inability to lie/sit still

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28
Q

What is projection

A

What is emotionally unacceptable in the self is unconsciously rejected and projected to others eg mother projects her anxiety onto her children claiming they are anxious instead

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29
Q

Give 3 signs/symptoms of mania

A
  1. Pressured speech
  2. Lots of projects/things going on
  3. Delusions
  4. Increased energy/activity
  5. Overfamiliarity
  6. Impulsivity
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30
Q

What are affective disorders

A

Illnesses which affect the way you feel and think

Most common- depression and bipolar disorder

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31
Q

What are the 3 core symptoms of depression

A
  1. Low mood
  2. Anergia (Loss of energy)
  3. Anhedonia (Loss of enjoyment)
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32
Q

Other symptoms of depression

A
  1. Sleep disturbance
  2. Change in appetite
  3. Feelings of guilt and hopelessness
  4. Suicidal thoughts
  5. Lack of concentration and confidence
  6. Change in sex drive
  7. Agitation
  8. Diurnal variation of mood
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33
Q

What is needed for a diagnosis of Depression?

A

2 core symptoms, everyday for at least 2 weeks- ICD10
MILD- 2 CORE + 2 MORE
MODERATE- 2 CORE + 3 MORE
SEVERE 3 CORE + 5 MORE

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34
Q

Signs of depression

A
  1. Weight loss
  2. Alteration of motor activity
  3. Emotional reactions may change
  4. Avoid eye contact
  5. Speech slow and quiet
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35
Q

Investigations for Depression

A
  • TFTs to rule out hypothyroidism
  • Urine drug screen for ongoing substance misuse
  • Medications review
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36
Q

Non-medical treatment of Depression

A
  • Self help groups
  • Guided self help
  • Computerised CBT
  • Individualised CBT
  • Psychotherapy
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37
Q

Medical Treatment of Depression

A
  • Antidepressants ( cont for 6 months after symptoms stop). Normally fluoxetine for <18s and sertraline for >18s
  • For resistant depression- lithium, atypical antipsychotic, another antidepressant
  • ECT in very severe depression
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38
Q

Symptoms of Bipolar Disorder

A
  1. Increased energy
  2. Pressured speech
  3. Recklessness
  4. Impaired judgement
  5. Inflated self-esteem
  6. Elevated mood
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39
Q

What is Bipolar I?

A

Mania and depression

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40
Q

What is Bipolar II?

A

Mild Hypomania and more episodes of Depression

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41
Q

What are the S&S of Hypomania?

A

> 4 days

  • elevated mood
  • increased energy, talking
  • poor conc
  • mild reckless behaviour
  • sociability
  • ^ libido, confidence
  • decreased need for sleep
  • change in appetite
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42
Q

What are the S&S for Mania?

A 
>1 week
Affecting daily functioning 
- extreme uncontrollable elation
- overactivity 
- pressure of speech
- impaired judgement
- extreme risk taking
- social disinhibition
- inflated self esteem 
- psychotic symptoms
- insight often absent (they enjoy being manic usually)
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43
Q

Typical onset of Bipolar Disorder

A

Early 20s

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44
Q

What is needed for a diagnosis of Bipolar Disorder?

A

One episode of (hypo)mania

History of 2 mood disorders

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45
Q

Causes of Bipolar Disorder and Risk Factors

A
  • Post-partum female
  • Substance misuse
  • Chronic illness
  • Past trauma/mental health problems
  • Sleep deprivation
    Genetic
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46
Q

MSE of someone with Bipolar Disorder

A
  • May be flamboyantly dressed
  • Difficult to interrupt
  • Pressure speech
  • Overactivity
  • Usually Elated or angry or low
  • Grandiose delusions
  • Verbal associations
  • Persecutory delusions
  • Auditory hallucinations
  • Cognition impaired, insight absent in mania
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47
Q

Treatment of Bipolar Disorder

A 
Antipsychotics (haliperidol, olanzapine, quetiapine, risperdone)
Mood Stabilisers (Lithium, Sodium Valproate, Lamatogine, Carbamezapine)
BDZs short term 
Psychoeducation, promoting social functioning
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48
Q

Antidepressants in Bipolar Disorder

A
  • (fluoxetine) for depressive episodes- must be prescribed with mood stabiliser
  • discontinue if manic
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49
Q

When is the onset of schizophrenia most typical?

A

2nd or 3rd decade

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50
Q

What is the cause of schizophrenia?

A

Dopamine excess

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51
Q

What are the first rank symptoms of schizophrenia?

A
  1. Delusional perceptions
  2. 3rd person hallucinations
  3. Thought disorder (alienation)
  4. Passivity Phenomena
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52
Q

What are 2nd rank symptoms of schizophrenia?

A
  1. Delusion
  2. 2nd person auditory hallucinations
  3. Thought disorder
  4. Negative symptoms
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53
Q

What are positive symptoms of schizophrenia?

A
  • Delusions
  • Hallucinations
  • Formal Thought Disorder
  • Passivity phenomena
  • Lack of insight
  • Mood disturbance
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54
Q

What are Negative symptoms of schizophrenia?

A
  • Poverty of speech
  • Flat affect
  • Poor motivation
  • Social withdrawal
  • Lack of concerns for social conventions
  • Blunting affect
  • Self neglect
  • Lack of insight
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55
Q

What are some cognitive symptoms of schizophrenia?

A
  • Poor attention and memory
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56
Q

Investigations for schizophrenia

A
  • Urine to rule out UTI delirium
  • Urine drug screen
  • CT to rule out organic neuro cause
  • HIV if applicable
  • Syphilis if applicable
  • Check lipids, and ECG before starting antipsychotics
  • Bloods: FBC, TFTs, U+Es, LFTs, CRP, fasting glucose
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57
Q

Diagnosis of schizophrenia

A

Need 2 1st rank symptoms for > 1month,
2 2nd rank for >1month.
At least 2 must be delusions/hallucinations or disorganised speech.
Must negatively impact life

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58
Q

Treatment for schizophrenia

A
  • Typical antipsychotic (haliperidol, chlropromazine)
  • Atypical antipsychotic (quetapine, olanzapine(~13.9kg weight gain 1yr), risperidone, aripriprazole, clozapine (last line- look out for constipation and agranulocytosis)
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59
Q

Name types of psychoses

A
  1. Schizophrenia
  2. Delusional disorder
  3. Schizotypal disorder
  4. Depressive psychosis
  5. Manic psychosis
  6. Organic psychosis
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60
Q

What is schizoaffective disorder?

A

Major depressive, manic or hypomanic episodes that come before or after psychotic symptoms. Mood overshadows psychotic symptoms

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61
Q

Describes some symptoms of BPD/(EUPD)

A
  1. Emotional instability
  2. Difficult, intense relationships
  3. Feelings of emptiness
  4. Impulsive
  5. Self injurious behaviour
  6. Fear of abandonment/rejection
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62
Q

Why might someone with Borderline Personality Disorder self-harm?

A
  • Relieve psychic pain
  • Express anger
  • Reduce anxiety
  • Feel in control
  • Feel something when numb
  • Communicate how they feel

They are much more likely to have a successful suicide attempt even though their intention was not to kill themselves, as they are impulsive and often make mistakes

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63
Q

Treatment for personality disorders

A
  1. Psychological therapies- dialectal behaviour therapy
  2. Structured clinical management

Medication is not mainstay

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64
Q

What are Cluster A PD?

A
  • Paranoid PD
  • Schizoid PD
  • Schizotypal PD
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65
Q

What are Cluster B PD?

A
  • Antisocial PD
  • BPD (EUPD)
  • Histrionic PD
  • Narcissistic PD
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66
Q

What are Cluster C PD?

A
  • Avoidant PD
  • Dependant PD
  • Obsessive Compulsive PD
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67
Q

What are some symptoms of PTSD?

A
  • Nightmares
  • Flashbacks
  • Intrusive thoughts
  • Avoidance of situations/environments
  • Hyper vigilance
  • Hyperarousal > trouble sleeping
  • General instability
  • Emotional outbursts
  • Children often act out their memories in play
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68
Q

Diagnosis of PTSD

A
  • Exposure to traumatic event
  • Intrusive symptoms
  • Recurrent, distressful, dissociative
  • Avoidance of stimuli
  • Negative changes in thoughts and feeling
  • ^ Sensitivity to event
  • Disturbances > 1mnth > distress in other areas of life
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69
Q

Treatment of PTSD

A
  • 1st line- TF-CBT or eye movement desensitisation and reprocessing therapy (EDMR)
  • 2nd line- SSRI or venlafaxine
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70
Q

What is delusional disorder?

A

> 1 delusion over >1 month, without meeting schizophrenia criteria
- Hallucinations can occur
affects day to day functioning
- Not caused by other condition/substance

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71
Q

Treatment of delusional disorder

A
  • Anti-psychotics, anti-depressants, psychotherapy
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72
Q

What is psychotic depression

A
  • When depression is accompanied by psychotic features

- Only happens in major depressive episodes

73
Q

What is postpartum depression

A
  • Extreme sadness, decreased energy, anxiety, crying episode, irritability
  • Onset 1wk-1mth
  • Can negatively affect newborn
74
Q

Treatment of postpartum depression

A

Antidepressants (for severe) - can have adverse effects on baby is breast feeding

75
Q

What is postpartum psychosis

A
  • Depressive or manic symptoms
  • First rank symptoms of schizophrenia
  • Emotional lability
76
Q

Who is at risk for postpartum psychosis

A
  • 1st time moms
  • Previous psychosis
  • Instrumental delivery
  • FHx
77
Q

Treatment for postpartum psychosis

A
  • Hospitalise- baby stay with mom
  • Antipsychotics
  • ECT
78
Q

What are the S&S for GAD?

A
  • Unpleasant/fearful emotional state
  • Bodily discomfort
  • Palpitations, tachycardia, sweating, tremor, chest pain, N&V, abdo pain, dizzy, chills, hot flushes, feeling of choking
  • Increased vigilance
  • Sleeping difficulties
79
Q

What are the risk factors for GAD?

A
  • alcohol, BDZ, stimulants (withdrawal) , co-existing depression, FHx, child abuse, neglect, excessively pushy parents, life stresses, physical health problems
80
Q

What assessment tools are used in GAD?

81
Q

What physical health conditions can cause GAD?

A
  • Hypothyroidism
  • Phaechromocytoma
  • Lung disease
  • CHF
  • Hypoglycaemia
82
Q

Diagnosis of GAD

A
  • Use PHQ, GAD7 tools

- Excess anxiety and worry about >1 thing, for at least 3 weeks, difficult to control worry

83
Q

Treatment for GAD

A
  • CBT, Therapy

- SSRIs(paroxetine), or SNRIs, pregabalin, BDZ(short term), BB(for physical s/e)

84
Q

What is OCD?

A
  • Obsessions (intrusive, unwelcome, unpleasant thoughts/images/doubts)
  • Compulsions (repetitive, purposeful, physical or mental behaviour performed in response to obsession)
85
Q

Causes or RF for OCD

A
  • Genetics- FHx of OCD or tic disorder
  • Parental over protection
  • May occur after strep infection (PANDAS)
86
Q

Symptoms of OCD

A
  • Time consuming (>1 hr/day at least 2wks)
  • Distressing and interfere with ADLs
  • Avoidance of stimuli
87
Q

Treatment of OCD

A
  • Psychoeducation
  • CBT, Exposure therapy
  • SSRI (even if no depression)- fluoxetine
88
Q

What is Somatisation Disorder?

A
  • Physical symptoms without physical explanations
  • Persistent >2 yrs
  • More common in women
  • GI and skin complaints most common
  • Refuse to believe no organic cause
  • Impact ADLs and family life
  • Often results in needles ops
  • Tx- rule out all possible causes
89
Q

What is Conversion Disorder?

A
  • Neurological SIGNS eg paralysis, weakness, amnesia
  • Examination is inconsistent
  • Patient not consciously faking it but no evidence of underlying pathology
90
Q

What is described as alcohol abuse?

A
  • Sufficient to cause physical, neurological, psychiatric or social damage
91
Q

What is the recommended weekly alcohol intake?

A

14 units a week

10ml=1 unit

92
Q

What is dependance?

A

The inability to control intake of a substance to which one is addicted. They also use the substance to avoid withdrawal.

93
Q

What are the signs of alcohol abuse?

A
  • CANT STOP
  • Compulsion to drink
  • Aware of harm but persists
  • Neglect of other activities
  • Tolerance of alcohol
  • Stopping causes withdrawal
  • Time preoccupied with alcohol
  • Out of control use
  • Persistent, futile wish to cut down
94
Q

Investigations into alcohol abuse?

A
  • CAGE screen- do they want to or are they
  • Cut down?
  • Annoyed by criticism?
  • Guilty?
  • Eye opener drink?
95
Q

Treatment to alcohol dependance

A
  • Motivational interviewing
  • Psychological therapies
  • Self help groups
  • Prevention measures
96
Q

What medication is used in alcohol withdrawal?

A
  • Disulfram- blocks alcohol metabolism- gives s/e
  • Acamprostate- reduce cravings
  • Naltrexone - opioid receptor antagonist
97
Q

What is involved in an alcohol detox?

A
  • BDZ- prevent seizures and control withdrawal
  • Rehydrate
  • Thiamine (Pabrinex)
  • Correct electrolytes
98
Q

What is delirium tremens

A
  • Acute confusional state secondary to alcohol withdrawal
  • EMERGECNY
  • Occurs 1-7 days after last drink (48-72hr peak)
  • Clouding of consciousness, disorientation, amnesia from recent events , pscyhomotor agitation, tremors, hallucinations, fluctuations in severity hours, risk fo CV collapse
99
Q

Treatment of delirium tremens

A
  • Pabrinex

- Lorazepam or antipsychotics (haloperidol or olanzapine)

100
Q

What is Korsakoffs Psychosis?

A
  • Short term memory loss and confabulation

- Occurs in heavy drinkers due to thiamine def

101
Q

Causes of Korsakoffs Psychosis?

A
  • Heavy Drinkers
  • Head injury
  • Past anaesthesia
  • Basal/temporal lobe encephalitis
  • Carbon monoxide poisoning
  • Anorexia
102
Q

Treatment of Korsakoffs Psychosis

A
  • Oral thiamine and multi vit
  • Treat psychiatric comorbidities
  • OT assessment
  • Cognitive rehab
103
Q

What is Wernickes Encephalopathy?

A

TRIAD-

  • Confusion/intellectual impairment
  • Ataxia
  • Ophthalmoplegia (eye muscle paralysis) nystagmus
104
Q

Treatment of Wernicke’s Encephalopathy

A
  • IV Pabrinex
  • and Vit if high risk
  • IMMEDIATE Tx
105
Q

What is alcohol related dementia?

A
  • Accounts fo 10% of dementia
  • Generalised brain damage leading to cognitive decline
  • Caused by alcohol XS
106
Q

What are the symptoms of Behavioural and Psychological Symptoms of Dementia?

A
  • Anxiety
  • Depression
  • Agitation
  • Psychosis
  • Disinhibition
107
Q

Management of BPSD

A
  • Rule out PINCH ME- - treatable causes
  • Address underlying cause
  • Educate
  • OT
108
Q

What is insomnia?

A
  • 3 days a week for 1 month
  • Trouble falling asleep
  • Maintaing sleep
  • Poor quality of sleep
109
Q

Causes of insomnia

A

Fear, idiopathic, shift work, sleep related breathing disorder, REM disorder, depression, steroids

110
Q

Treatment of insomnia

A
  • Good sleep hygiene
  • Sleep restriction
  • Medication- zopiclone, zolpidem, zopeplon, mirtazapine, quetiapine, melatonin
111
Q

What are S&S of Anorexia Nervosa?

A
  • Dieting, denial, dread of weight gain, disturbed beliefs about weight, doesn’t want help, dual effect- diet and overexercising/diuretics/laxatives, v. disinterested.socially withdrawn, decline in weight= rapid,
  • Weight below 85% (<17.5 adults)
  • Refusal to maintain normal
112
Q

Physical signs of Anorexia Nervosa

A
  • Dry skin
  • Hypercarotenemia (yellow skin)
  • Body hair
  • Acrocyanosis
  • Breast Atropy
  • Swelling of parotid and submandibular glands
  • Thinning hair
113
Q

What happens to bloods in Anorexia Nervosa

A
  • C and GH go up the rest go down
  • Cortisol, Beta - Caratone, GH, Cholesterol up
  • T3, glucose, oestrogen, testosterone, LH, FSH, phosphate down
114
Q

Investigations in Anorexia Nervosa

A
  • DXA (if underweight for a year)
  • ECG - bradycardia, prolonged QT (if severe), T wave changes - hypokalaemia
  • Squat test
115
Q

What is MARISPAN

A
  • Guidlines for management of people with anorexia nervosa
116
Q

Treatment for Anorexia Nervosa

A
  • CAHMS- anorexia based family therapy
  • CBT- 2nd line
    adult
  • CBT-ED
  • MANTRA (Maudsley anorexia nervosa treatment for adults)
  • SSCM (specialist supportive clinical management)
  • food diary
  • SSRI - fluoxetine
117
Q

What is Bulimia Nervosa

A
  • Binge eating followed by intentional vomiting or other purgative behaviours like laxative or diuretics or exercising
118
Q

What changes happen in Bulimia Nervosa due to vomiting

A
  • Metabolic alkalosis on ECG
  • Low Cl- - loss to stomach
  • ECG- hypokalaemia
119
Q

Features of Bulimia Nervosa

A
  • Recurrent binge eating
  • Lack of control during episode
  • Recurrent compensatory behaviours
  • Once a week for 3 months
  • Self evaluation- by body and shape
120
Q

Give some examples of opiates

A
  • Codeine
  • Diamorphine
  • Loperamide
  • Methadone
  • Dihydrocodeine
  • Morphine
  • Fentanyl
  • Heroin
  • Oxycodone
  • Tramadol
121
Q

Symptoms of an opiate overdose

A
  • Acute= drowsiness, resp depression > resp acidosis (retain co2), hypotension, tachycardia, pin point pupils
  • Chronic- constipation
122
Q

Treatment of opiate overdose

A
  • ABCDE
  • naloxone IV if coma or resp depression ( IM if shit veins)
  • Oral activated charcoal if have ingested a load ( Nacetylcysteine)
123
Q

Heroin withdrawal symptoms

A
  • Goose flesh (piloerection)
  • Pupil dilation
  • Yawning
  • Sweating
  • Abdo cramps
  • Insomnia
124
Q

What is Munchausen’s Syndrome?

A
  • A mental illness where someone fakes an illness

- Can be be proxy, where they fake it for someone else

125
Q

What to look out for in Muchausens

A
  • Previous PD diagnosis
  • Usually physical symptology - extend to pain not flex
  • Sometimes psychiatric symptoms
  • Multiple A&E presentations
  • Frequent admissions
  • Multiple surgical procedures
  • Multiple aliases, no fixed address
  • When discovered- self discharge
126
Q

What are the symptoms of ADHD?

A
  • Inattentiveness
  • Hyperactivity
  • Impulsiveness
  • Restlessness
  • Poor concentration
127
Q

Treatment of ADHD

A
  • Methylphenidate (Ritalin)- need to monitor growth

- Psychotherapy

128
Q

What are some risk factors for Down’s Syndrome?

A
  • ^ Maternal age
  • Previous child with Down’s
  • If mother has Down’s
129
Q

What are some features of those with Down’s Syndrome?

A
  • Flat occiput
  • Oblique Palpebral fissures
  • Smooth mouth
  • High arched palate
  • Broad hands
  • ## Single Palmar transverse crease
130
Q

What problems are associated with Down’s Syndrome

A
  • Learning difficulties
  • Autistic traits
  • High risk developing Alzheimers
  • Hypothyroidism
  • Complete AVSD
131
Q

What is Charles-Bonnet Syndrome?

A
  • Complete visual hallucinations in person with partial or severe blindness (macular degeneration diabetic retinopathy)
  • Patients understood hallucination are not real and often have insight
132
Q

What are the triad of Autistic Spectrum Disorder features?

A
  • Impaired social interaction
  • Speech and language disorder
  • Imposition of routines- ritualistic and repetitive behaviour
133
Q

What are some other symptoms of ASD?

A
  • Poor eye contact
  • Failure to develop relationships
  • Abnormal playing/communication
  • Restricted interests or activities
  • Abnormal gaze
  • Motor tics
134
Q

What is the difference between Autism and Apsergers?

A
  • Aspergers has milder social features and near normal speech development
135
Q

What is Fragile X syndrome?

A
  • X linked dominant, inherited disorder
  • More common in males
  • Large head and ears, poor eye contact, abnormal speech, hypersensitivity to touch, auditory and visual stimuli, hand flapping and hand biting
  • Autism associated
136
Q

Tourette’s

A
  • Genetic association
  • Environmental factors- stress, gestational/perinatal insults, fatigue, PANDAS
  • Often co-morbid with OCD, ADHD, depression, anxiety, learning difficulties, ASD, migraines
137
Q

Treatment of Tourette’s

A
  • educate, liaise, reduce caffeine intake, reduce stress, consider meds if severe
    (antipsychotics, alpha adrenergic)
138
Q

What principles underly the Mental Health Act?

A
  1. Respect for the patients’ wishes and feelings
  2. Minimise restrictions on liberty
  3. public safety
  4. Patient well-being and safety
  5. Involving patients in planning, developing an delivering care
139
Q

Section 2 -

A

Purpose: Assessment, treatment can be given without consent
Duration: 28 days, can’t be renewed
Professionals involved: 2 doctors (one S12), AMHP
Evidence needed: a) suffering from a mental disorder that needs to be detained, b) obtained for own health or safety of them or others

140
Q

Section 3 -

A

Purpose: Treatment
Duration: 6 months, can be renewed
Professionals involved: 2 doctors, AMHP
Evidence- a), b), c) appropriate treatment must be available

141
Q

Section 4 -

A

Purpose: Emergency order
Duration: 72 hours (when waiting for 2nd doctor would lead to delay)
Professionals involved: 1 doctor and 1 AMHP
Evidence: a), b), d) not enough time for 2nd doctor to attend

142
Q

Section 5(4) -

A

Purpose: for a patient already admitted but wants to leave
Duration: 6 hours, can’t be coercively treated
Professionals: Nurse holding power until doctor attends

143
Q

Section 5(2) -

A

Purpose: for a patient already admitted but wants to leave
Duration: 72 hours, can’t coercively treated
Professionals: Doctors holding power
Allows for a section 2 or 3 assessment

144
Q

Section 135/136 -

A
  • Police sections
    136- Person suspected having mental disorder in public
    135- Needs court order to access patients home to move them
    To a place of safety (psych unit/ police cell)
    Further assessment?- need section 2 or 3
145
Q

Why should Lithium be used with care?

A
  • Lithium has a narrow therapeutic range which can lead to renal failure
  • Risk of lithium toxicity
  • Monitor- check weekly at first, once blood levels are stable, every 3 months, 12 hours after last dose
  • Interactions: thiazide diuretics, NSAIDs, ACEi, SSRI, Alcohol- can alter lithium (drowsiness) - can drink in moderation 1-2 units a day
146
Q

What is Lithium used for?

A
  • 1st line for bipolar disorder
  • Mood stabiliser
  • Works by decreasing aggressive or self harming behaviour
147
Q

Side effects of Lithium

A
  • GI disturbance
  • Polyuria
  • Polydipsia
  • Weight gain
  • Hypothyroidism
148
Q

What happens in lithium toxicity?

A
  • Coarse tremor, ataxia, hyperreflexia, LOC, muscle weakness, blurred vision, N&V
  • Avoid thiazide diuretics as can cause
  • Tx- stomach pumping, IV fluids, vital sign monitoring
149
Q

Alternatives to lithium for Bipolar Disorder: Sodium Valproate

A
  • Sodium Valproate, takes shorter time to work than lithium. Used short term when rapid mood stabilisation needed. s/e- GI upset, agitation, confusion. Risk- teratogenic > liver toxicity. Interactions - can potentiate antipsychotic effects, smoking cessation required
150
Q

Other alternatives to Lithium for Bipolar Disorder

A
  • Carbamazepine (treat mania if SV and lithium do not work, used in rapid cycling and manic depression)
  • Lamotrigine (in conjunction with valproate- targets depressive episodes)
  • Phenytoin
151
Q

What are Benzodiazepines used for

A

Insomnia= temazepam, lorazepam
Agitation= lorazepam (often IM)
Panic disorder= diazepam, alprazolam, short term only. in combo with antidepressants
GAD- lorazepam, diazepam for somatic Sx

152
Q

Side effects of BDZs and risks

A
  • Drowsiness, calming effect/euphoria, confusion, unsteadiness, muscle weakness
    Risks- ^ risk abuse and dependance. Avoid in PD.
    Interactions with opioids
153
Q

What is buspirone used for?

A

GAD
- safer than BDZs and less s/e. 4 weeks onset of action, safer long term
s/e- N, dizziness, headaches, fatigue, confusion
Risks- drowsiness
Contraindications- alcohol, MAOIs

154
Q

Give some examples of 1st gen antipsychotics

A

Chlorpromazine- s/e- anti-adrenergic s/e, sedation, anti-muscarinic effects, avoid in postural hypotension

Flupentixol and Zuclopenthixol- anti-dopimingeric s/e, available as depot

Haloperidol- PO or IM

155
Q

What are some risks of antipsychotics?

A

High risk of long QT, need ECG before starting and every 6 months
Low therapeutic window
Higher risk for EPSEs

156
Q

Give some examples of 2nd gen antipsychotics

A
  • Olanzapine
  • Quetiapine
  • Aripriprazole
  • Clozapine
157
Q

Side effects of Olanzapine

A
  • PO, Depot, IM
  • Mean weight gain 13.9kg
  • Sedation
  • Anticholinergic side effects- Constipation, urinary retention, blurred vision, dry mouth, cognitive impairment
158
Q

Side effects of Quetiapine

A

Anticholinergic side effects. Less cardiac side effects

Often used first line

159
Q

Side effects of Aripriprazole

A

Partial agonist so wider therapeutic window
No anticholinergic effects
Akathisia common

160
Q

Side effects of Clozapine

A
  • Only use if 2 don’t work
  • Agranulocytosis (MONITOR)
  • Hypersalivaiton
  • Constipation- biggest killer
  • Weight gain
161
Q

How do antipsychotic work

A
  • Dopamine antagonist
162
Q

Extra Pyramidal Side Effects from antipsychotics

A

(in time order)

  • Acute dystonia- Tx procyclidine 10mg IV
  • Parkinsonism - tremor, rigidity, bradykinesia, 1wk after initiation. Tx- Reduce antimuscarinic
  • Akathisia- restlessness >1mnth after initiation. Tx- propranolol + BDZs
  • Tardive dyskinesia- slow movements (lip smacking) sudden, involuntary and irreversible
163
Q

What is Neuroepileptic Syndrome

A
  • Caused by dopamine antagonists
  • Tremor, muscle cramps, fever, autonomic instability, delirium, muscle rigidity, bradykinesia
  • Raised CK- can progress to rhabdomyolysis
  • slower onset (days-wks)
  • Idiosyncratic but increased risk in dementia with Lewy body
  • Tx- DA agonists eg Bromocriptine (resolution days-wks)
164
Q

What are SSRIs used for

A

1st line depression (selective serotonin reuptake inhibitor)

  • Fluoxetine- 1st line depression <18, OCD, bulimia
  • Sertraline- 1st line depression > 18 , OCD, PTSD
  • Paroxetine- depression, anxiety, OCD, panic disorder, PTSD, GAD. Wean off- flu like symptoms, Unsafe in pregnancy
  • Citalopram- depression, panic disorder- s/e QT prolongation
165
Q

When to stop antidepressants

A
  • Continue for 6 months after symptoms stop

If stopped abruptly > irritable, headache, insomnia

166
Q

Side effects of SSRI

A
  • Decreased sexual function
  • GI upset
  • N, D
  • Headache
  • Insomnia
  • (LOTS OF anticholinergic effects)
167
Q

Risks, interactions of SSRIs

A
  • Contraindicated if had manic episode, cant use with MAOIs,
  • Citalopram can cause QT prolongation
  • Serotonin syndrome
    Monitor- weekly initially as increase suicidal thoughts at start
  • Interactions: BB, alcohol, anticonvulsants, lithium,, methadone, MAOIs, smoking, warfarin
168
Q

Alarm bells with SSRIs

A
  • Hyponatraemia, GI bleeding, serotonin syndrome, neuromuscular hyperactivity (hyperreflexia, clonus, tremor, myoclonus). autonomic dysfunction (tachycardia, BP changes, hyperthermia, diaphoresis, shivering, D), altered mental state (agitation, confusion, mania)
169
Q

What is serotonin syndrome

A
  • within 24 hours of starting a serotonin agonist

- Hyperactivity, tremor, clonus, reflexes

170
Q

Treatment of serotonin syndrome

A
  • BDZs, cryptoheptadine

- resolution 24hrs

171
Q

What are TCAs used for

A
  • More severe depression- reserved for after SSRIs
  • inhibits reuptake of serotonin and noradrenaline and dopamine
  • Amitriptyline, clomiprmaine, imipramine
172
Q

Side effects of TCAs

A
  • Anticholinergic (dry mouth, blurred vision, constipation, drowsiness, confusion)
  • Adrenergic (drowsiness, postural hypotension)
  • 5HT2 (decreased sexual dysfunction)
  • Antihistaminergic (drowsiness, weight gain)
173
Q

MAOI

A
  • Used for treatment resistant depression
  • Avoid cheese, alcohol, avocado (dietary tyramine)
    s/e- weight gain, insomnia, postural hypotension, anxiety, ankle oedema
    risks- hepatotoxicity, HTN crisi,
174
Q

SNRIs

A
  • Serotonin and noradrenaline reuptake inhibitor
  • Depression, GAD
  • venlafaxine, duloextine
  • s/e- N, GI upset, constipation, loss of appetite, dry mouth, dizziness, agitation, insomnia, sexual dysfunction, headache, nervousness, sweating
175
Q

NASSA

A
  • depression with insomnia
  • Mirtazapine
  • Generally less GI s/e and less sexual dysfunction
    has anxiolytic effect
  • s/e - sedation, weight gain, tremor, myoclonus, N, GI upset
    risk- agranulocytosis, liver toxicity, jaundice
176
Q

What is ECT used for?

A
  • Major depression or bipolar or catatnoia or severe mania that doesn’t respond to other treatment
  • brief electrical stimulation of brain under anaesthesia
177
Q

Stimulants

A
  • eg methylphenidate
  • used to treat ADHD
    -s/e- aggression, anxiety, decreased appetite, mood disturbance
    risk- avoid abrupt withdrawal
178
Q

Hypnotics

A

Z drugs
- zopiclone, zolpidem and zaleplon
- insomnia which hasn’t improved without drugs. never 1st line
s/e- drowsiness, GI upset

Eggs 3a (4 decks)

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