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Y4 - Finals Edition > Psych CBLS > Flashcards

Psych CBLS Flashcards

1
Q

Who is involved in a mental health act assessment:

A
  1. Approved mental health professional (AMHP)
  2. Section 12 approved docto
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2
Q

What physical health monitoring is recommended for any patient prescribed anti-psychotic medication:

A

Set baseline before giving medication, at 12 weeks, at 1 year then annually.

Check

  • weight, waist circumference
  • Full set of observations: BP, HR etc.
  • ECG (risk of long QT)
  • HBA1C level
  • serum cholesterol
  • Lipid profile
  • Serum prolactin (risperidone particularly bad for prolactinaemia)
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3
Q

Key components of metabolic syndrome

A
  1. Essential HTN
  2. Truncal obesity
  3. Insulin resistance
  4. Low glucose tolerance
  5. Dyslipidaemia
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4
Q

What is schizophrenia:

A
  • long term mental health problem
  • affects thinking, perception and affect
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5
Q

Early Intervention in Psychosis Team

A
  • accept referrals between 14-65 who are felt to be at risk of developing first episode of psychosis
  • may remain under team for up to three years
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6
Q

Positive symptoms of schizophrenia

A

Hallucination
- visual
- audible

Delusional thinking

Disorganised thinking

Agitated or repetitive movements

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7
Q

Negative symptoms of schizophrenia

A

Alogia
- Poverty of speech, doesn’t engage in anything

Anhedonia
- Inability to derive pleasure

Incongruity
- Blunting of affect

Avolition
- Poor motivation

Apathy
- Don’t care about anything

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8
Q

Summarise extrapyramidal side effects

A
  1. Acute dystonia
    - uncontrolled muscle spasms
  2. PARKINONISM
    - rigidity
    - bradykinesia
    - tremor
  3. Akathisia
    - restlessness
  4. NEUROLEPTIC MALIGNANT SYNDROME
    - muscle rigidity
    - fever
    - unstable BP
    - myoglobinaemia
  5. Tardive dyskinesia
    - involuntary painless movements of face and upper limbs
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9
Q

When might Clozapine be given

A

If patient has failed to respond to two different anti-psychotic’s of an adequate trial (4-6 weeks)

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10
Q

Side effects of clozapine

A
  1. BLOCKS serotonin receptors
    - causes anticholinergic effects
    —> sedation
    —> dizziness
    —> tachycardia
    —> feeling hot
    —> decreased sweating
    —> dry mouth
    —> dry throat
    —> constipation
  2. BLOCKS histamine H1 receptors
    —> DROWSINESS
  3. Blocks ADRENERGIC A1 receptor
    —> orthostatic hypotension
  4. EXCESSIVE SALIVATION
  5. INCREASED APPETITE
  6. CONSTIPATION
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11
Q

What blood monitoring is required and why for a patient on clozapine

A
  1. Immediate risk —> myocarditis
  2. Risk of agranulocytosis (very low neutrophils)
  3. Troponin also gets checked

Every week for 18 weeks. Then every 2 weeks for the rest of the year. Then every 4 weeks.

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12
Q

Section 5(2)

A

72 hours holding powers of a doctor

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13
Q

Section 5 (4)

A

detained by nurse for up to 6 hours

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14
Q

Section 4

A
  • admission for assessment in emergency
  • 72 hours
  • can be made by AMHP, nearest relative, requires support of 1 doctor
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15
Q

Section 135

A

Section 135is a court order that allowspolice officersto enterprivate property, by force, to remove a person suffering from amental health disorderand place them in aplace of safety

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16
Q

Section 136

A

allowspolice officersto detain someone suspected of suffering from a mental health disorder, from apublic placeto a place of safety without a warrant, for up to24 hoursto allow them to be assessed by a medical practitioner.

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17
Q

Section 17a

A
  • patients who are on a section 3 can leave hospital for treatment in the community
  • will be recalled if there is non-compliance or if they do not attend appointments
18
Q

Be aware of the numerous rating scales for depression

A
  1. Hamilton depression rating scale (HRDS)
  2. BECKS depression inventory
  3. Montgomery Asbery Depression rating scale (MADRS)
19
Q

Rating scales for MANIA

A

Young mania rating scale

Altman self rating mania scale (ASRM)

20
Q

Rating scale for suicide

A

Beck’s scale for suicidal ideation

Columbia scale for suicide rating (C-SSRS)

21
Q

Side effects associated with lithium toxicity:

A

L-leukocyte

I-increase

T-tremors

H-hypothyroidism

I-increase

U-Urine

M-mothers —> Ebstein anomaly (congenital tricuspid atresia)

22
Q

How does the ICD-10 classify mild, moderate and severe depressive episodes:

A

2 weeks needed to diagnose depression

  • low mood
  • anhedonia
  • lack of energy

Symptoms should be present for a month or more and every symptom should be present most of the day.

CORE SYMPTOMS
- Persistent sadness / low mood
- Loss of interest / pleasure
- Fatigue or low energy

OTHER SYMPTOM
- Disturbed sleep
- Poor concentration
- Low self confidence
- Poor or increased appetite
- Suicidal thoughts or acts
- Agitation or slowing of movements
- Guilt or self blame

Not depressed < 4

Mild 4 symptoms (2 core and 2 other)

Moderate 2 core and 3 other

Severe 3 core, 5 others
- suicidal ideations

23
Q

Management of severe depressive episode with psychotic symptoms

A
  1. Antidepressant + antipsychotic
    • Quetiapine, olanzapine, Risperidone or Aripiprazole
      - Short term use of a regular benzodiazepine (e.g. Diazepam) if patient is very distressed / agitated
      - Consider short term use of hypnotic (Zopiclone) to aid sleep
24
Q

ICD-10 diagnostic criteria for a manic episode

A
  1. elevated mood
  2. increase in quantity and speed of physical and mental activity
  3. decreased need for sleep

Manic episode atleast 7 days

25
Q

Pharmacological treatment for episode of acute mania:

A
  • oral antipsychotic: olanzapine, risperidone
  • benzodiazepine if agitated (depot)
  • stop anti-depressants
  • short term hypnotic (zopiclone for sleep)
26
Q

Once the patients manic episode is treated what treatment might you consider:

A

consider initiation of oral mood stabiliser (Lithium carbonate) or possibly carbamazepine

27
Q

How does treatment differ for bipolar vs unipolar depression:

A

Bipolar

  • most effective treatment = olanzapine + fluoxetine
  • lithium carbonate
  • anti-depressant mediation can precipitate manic/hypomanic episodes
28
Q

Side effects of Lithium Carbonate:

A
  • Polydipsia
  • Polyuria
  • Weight gain
  • Peripheral oedema
  • Fine resting tremor
  • Worsening or precipitation of skin complaints, such as psoriasis
29
Q

Clinical signs and symptoms of lithium toxicity

A

SERUM LEVEL 1.5-2

  • nausea
  • vomiting
  • apathy
  • coarse tremor
  • ataxia
  • muscle weakness

SERUM LEVEL > 2

  • nystagmus
  • dysarthria (difficulty speaking caused by brain damage)
  • impaired consciousness
  • hyperactive tendon reflexes
  • oliguria
  • hypotension
  • convulsions
  • coma
30
Q

Treatment for acute lithium toxicity

A
  • supportive management
  • stop lithium carbonate
  • ensure adequate hydration with IV fluids
  • monitor renal function and electrolyte balance
  • If acute renal failure: haemodialysis
31
Q

What classes of medications should be avoided in patients prescribed lithium due to risk of causing lithium toxicity?

A
  • NSAIDS
  • DIRUETICS
  • ACEi / ARB
32
Q

Clinical indications for ECT

A
  • severe depressive illness not responsive to medication
  • schizophrenia
  • catatonia (marked changes in muscle tone or activity)
  • mania (elated, euphoria or irritable mood and increased energy)
33
Q

anti-social personality disorder characterised by:

A
  • lack of remorse
  • callous disregard for feelings of other
  • incapacity to maintain enduring relationships
  • low tolerance to frustration and aggression
34
Q

What are the three clusters of personality disorder

A

Cluster A - MAD

Cluster B - BAD

Cluster C - SAD

35
Q

CLUSTER A personality disorders

A

PSS he’s MAD

Paranoid

Schizoid
- emotional coldness, prefers solitary activities
- doesn’t enjoy close relationships
- like a roboid

Schizotypal
- eccentric behaviours, odd beliefs
- magical thinking
- unusual

36
Q

CLUSTER B - BAD

A

Emotionally unstable
- unstable, intense relationships, impulsivity, fluctuations in mood, abandonment anxiety, transient paranoia

Anti-social
- AKA dissocial, repeated unlawful or aggressive behaviour, deceitfulness, lying, reckless irresponsibility

Histrionic
- Dramatic, exaggerated expressions of emotion, attention seeking. Seductive behaviour.

Narcissistic
- Grandiose sense of self importance, need for admiration

37
Q

CLUSTER C

A

Dependent
- Excessive need to be cared for, submissive clinging behaviour.

Avoidant / Anxious
- Hypersensitivity to critical remarks or rejection.

OCD
- preoccupation with orderliness, perfectionism and control

38
Q

Management of borderline personality disorder

A

Drug treatment SHOULD NOT BE USED specifically for BORDERLINE PERSONALITY DISORDER.

  1. Dialectical behavioural therapy (DBT)
    • used combination of cognitive and behavioural therapies with some relaxation techniques.
    • involves individual and group work
    • long term therapy (12-18 months)
  2. Mentalisation-based therapy (MBT)
    • allowing individual to better understand what is going on in his and her mind and in the minds of others.
  3. Therapeutic community
    • residential form of therapy
    • group setting
    • individual stays for weeks or months
39
Q

What is the preferred approach for supporting behaviour that challenges?

A

Positive behavioural support plan
- values led
- patient centred
- about relationships and communication
- function based
- data led decision making
- adding new skills and opportunities
- teamwork

40
Q

Fragile X syndrome

A

Caused by increase in number of CGG repeats on the Fragile X mental retardation (FMR1) gene on the X-chromosome

Associated with autism spectrum disorder

41
Q

What assessment tool may show a patient meets the criteria for childhood autism?

A

DISCO assessment tool

Y4 - Finals Edition (40 decks)

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