Psych - Part 1 Flashcards
Section 2
Admit for ASSESSMENT
28 days
- Patient is suffering from MHD which requires hospitalisation
- Patient poses a risk to themselves or others
Non-renewable
Can appeal after 7 days
Treatment can be given under MCA
Section 3
Admit for TREATMENT
6 months
- Patient requires hospital treatment
- Treatment is in their best interests
May be renewed after 6 months, then annually
Treatment can be given under MHA
Who is required for a section 2
Section 2 - 2 doctors
- Section 12 approved
- AMHP
Section 3 - 2 doctors
- One is second opinion appointed doctor
Other sections
4 - Emergency assessment by doctor, admission required - No time to wait for a second doctor
5 - (2) 72 hours by doctor - (4) 6 hours by a nurse
135 - Home section by the police - 72 hours
136 - Removal from a public place by police - 72 hours
37 - Patient commits a crime - Sent to hospital not prison
41 - Conditional discharge - Live in the community under certain conditions
Treatment sections
T2 - Treatment under section 3
- NO capacity
+ Consent
T3 - Treatment under section 3
- NO capacity
- NO consent
Depression aetiology
Genetic
Childhood trauma
Life circumstances - Financial, relationships, etc.
Mediations
- BB
- Isotretinoin
Drugs and alcohol
Hypothyroidism
Chronic disease
Depression core symptoms / diagnostic criteria / severity
Low mood
Anhedonia
Fatigue
- Symptoms almost every day OR every day for 2 weeks
- Change in personality
- Interferes with ADLs
Mild = 2 core + 2 other Moderate = 2 core + 3 other Severe = 3 core + 4 other
Additional symptoms of depression
Biological
- Psychomotor
- Decreased concentration
- Change in appetite
- Decreased libido
- Change in sleep
Emotional
- Feelings of worthlessness
- Decreased confidence
- Thoughts of self-harm or suicide
Psychotic depression
Nihilistic delusions
Hypochondriac delusions
2nd person auditory hallucinations
Depression investigations
MSE
HAD - Hospital anxiety and depression
PHQ-9
Bloods
- TFT
- Toxicology
- LFTs - Gamma GT
Mild depression management
Self-help
Sleep hygiene
CBT
Interpersonal therapy
Moderate depression management
- SSRI
- Change SSRI
SNRI - Venlafaxine
NaSSA - Mirtazapine
TCA- Amitriptyline
MAOI - Moclobemide
+ ECT?
Severe depression management
CBT
ECT
Section?
Illusion
The false perception of a detectable stimulus
Hallucination
Experience in the absence of an external input
Types of hallucination
Hypnoponpic and hypnogogic - Falling in your sleep
Reflex - Stimulus in one sensory field, hallucination in another
Extracampine - Cannot possibly be experienced
Auditory
Pseudo - Patient recognises as unreal - E.g. talking to dead relative
Auditory hallucinations
2nd person - Speaking directly to the patient
“YOU are a bad person”
3rd person - Voices discussing the patient
“HE/SHE is a bad person”
Over-valued ideas
Non-shakable beliefs held outside social norms
Delusion
FIXED BELIEF
- Unshakable
- Held on illogical grounds
- Out of keeping with general culture
Types of delusion
Persecutory - They are being mistreated or someone plans to harm them
Grandiose - Over-inflated sense of worth, power, knowledge or identity
Self-referential - Believing innocuous events to have strong personal significance
Nihilistic - Believing themselves to be dead or the world to no longer exist
Misidentification - Somebody has been replaced with an imposter
Delusional perception - True perception to which patient attaches a false meaning
Thought disorders
Thought insertion Thought withdrawal Thought broadcast Thought echo Thought block
Concrete thinking
Taking things very literally
- Lack of abstract thinking
- Normal in childhood
- Schizophrenia or organic brain disease
Loosening of association
Sequence of unrelated or only remotely related ideas
Circumstantiality
Non-linear thought pattern
- Conversation drifts but returns to the point
Perseveration
Repetition of a particular response
- Associated with brain injury or organic disease
Confabulation
Filling memory gaps with made up stories
Unintentional
Seen with alcohol abuse
Somatic passivity
Sensations imposed upon the body by an outside force
Flight of ideas
Rapidly skipping from one thought to distantly related ideas
Relation may be as tentative as rhyming
Pressure of speech
Rapid frenzied speech
Difficult to interrupt
May be too erratic to understand
Anhedonia
Inability to feel pleasure in normally pleasurable activities
Apathy
Lack of interest, enthusiasm or concern
Incongruity of affect
Mismatch between emotion and expression
Blunting of affect
Loss of expression
Conversion
Focal neurological symptoms which cannot be explained by organic disease - Usually follows life stress or trauma
Belle indifference
Patient unconcerned with symptoms of conversion disorder
Depersonalisation
Feeling unreal, detached and unable to feel emotion
Derealisation
Watching themselves from the outside
- In a film
- Disconnected from body and emotions
Dissociation
Disconnected from the world or themselves
Usually in response to stress
ECT indications
Severe depression
Psychotic depression
Catatonia
Prolonged manic episode
ECT side effects
Tongue biting Headache Short-term memory loss Confusion Myalgia
ARRHYTHMIAS
Suicide risk
SAD PERSONS score
Sex - Male
Age < 19 or > 45
Depression
Previous attempt Ethanol / substance misuse Rational thinking loss - Schizophrenia? Single or unemployed Organised No social support Sickness
Paracetamol overdose investigations
ABG - Metabolic acidosis
Glucose - Hypoglycaemia
Serum paracetamol levels every 4 hours
Toxicology
LFTs
Clotting profile - Prothrombin time
Paracetamol overdose management
ABCDE
- IV fluids
- Treat acidosis
- Treat hypoglycaemia
N-acetylcysteine - Dose dependent on paracetamol level @ 4 hours
Arrange psych review
Bipolar disorder causes
Genetics
Childhood trauma
Sleep deprivation
Post-partum
Drugs
- Steroids
- Statins
- Recreational
- Antidepressants
Organic
- Tumour
- Infection
- Hyperthyroidism
Bipolar disorder investigations
MSE
Rule out other causes
- Toxicology
- TFTs
- EEG
- CT
Acute bipolar management
Second generation antipsychotic
- Olanzapine
- Quetiapine
- Clozapine
CBT
Secondary bipolar management
Mood stabiliser
- Lithium
- Valproate
- Antipsychotics
Schizophrenia non-organic causes
Genetics - FHx
Life circumstances - Migrants?
Illicit drugs
Schizophrenia organic causes
Neuro
- Injury
- Infection
- Tumour
Recreational drugs and alcohol
Hypernatraemia
Hypocalcaemia
Hyperthyroidism
Cushing’s
Schizophrenia diagnostic criteria
1 month of symptoms
+ 1 first rank symptom
Schizophrenia 1st rank symptoms
Delusions
Hallucinations - Auditory 3rd person
Thought disorder - Broadcast, insertion and removal
Passivity phenomena
Schizophrenia 2nd rank symptoms
Hallucinations
Catatonic behaviour
Negatives
- Under-activity
- Low motivation
- Social withdrawal
- Self-neglect
- Anhedonia
- Flattening of affect
- Speech poverty
- Thought poverty
Schizophrenia investigations
Rule out other causes
- FBC
- U/E
- LFT
- Toxicology
- TFT
- OGTT
- EEG - Temporal lobe epilepsy??
- CT
Schizophrenia management
Second generation antipsychotic
- Olanzapine
- Quetiapine
- Clozapine
CBT
2nd line - Change antipsychotic?
Organic causes of visual hallucinations
I’M SPACED Out
Infection
Migraine
SOL Parkinson's Alcohol withdrawal Charles Bonnet Epilepsy Drugs
Optic nerve palsy
Serotonin syndrome systems affected
CAN you diagnose it
Cognitive
Autonomic
Neuro
Serotonin syndrome cognitive features
Agitated Confused Euphoric Manic Hallucinating
Serotonin syndrome autonomic features
Tachycardia Tachypnoea Hypertension Fever Sweating Mydriasis Arrhythmias
Serotonin syndrome neurological features
Tremor Ataxia Incoordination Clonus Hyper-reflexive
Serotonin syndrome causes
SAME OA
SSRI
Amphetamines
MAOIs
Ecstasy
Opioids
Antipsychotics
- Lithium
- Olanzapine
- Risperidone
Serotonin syndrome management
Supportive
Benzodiazepines
Serotonin antagonist - Cyproheptadine
Neuroleptic malignant syndrome presentation
After starting or increasing dose of antipsychotic
Hyperthermia Sweating Tachycardia Rigidity Seizures Hyporeflexia Coma
Neuroleptic malignant syndrome investigations
KALE
^ CK
ABG - Metabolic acidosis
Leukocytosis
ECG - Prolonged QT
Neuroleptic malignant syndrome management
Fluids Stop cause Diazepam Dantrolene - Muscle relexant Bromocriptine - Dopamine agonist
Serotonin syndrome vs neuroleptic malignant syndrome
SS
- Abrupt onset, rapidly peaking
- Myoclonus and tremor
- Increased reflexes
- Mydriasis
NMS
- Gradual and prolonged
- Rigidity
- Decreased reflexes
- Normal pupils
Generalised anxiety disorder diagnostic criteria
Anxiety
+ 3 or more symptoms for 6 months
GAD symptoms for diagnostic criteria
RED SIM
Restlessness
Easily fatigued
Difficulty concentrating
Sleep disturbance
Irritability
Muscle tension
Other GAD symptoms
Hyperventilation Sweating Tachycardia Goosebumps Lump in throat
Needs constant reassurance
Dependent on someone
Avoidance of triggers
GAD symptoms in paediatrics
Nail biting
Bed wetting
Thumb sucking
Causes of GAD
Drugs
- Salbutamol
- Theophylline
- Caffeine
- Antidepressants
- Corticosteroids
Genetics
Stressors and events
Medical illness
GAD non-pharmacological management
Education and monitoring
Self-help
CBT
Psych referral
GAD pharmacological management
SSRI - Sertraline
Pregabalin
Benzodiazepines
Beta-blockers
Causes of PTSD
Biological - GABA
LIFE TRAUMA
PTSD protective factors
Male
Caucasian
^ IQ
^ Social class
PTSD diagnostic criteria
Within 6 months of event
Interferes with ADLs
+ TRIAD
- Can’t recall some of the event
- Avoids circumstances associated with the event
- Constantly relives the experience
PTSD symptoms
Hyper…
- Vigilant
- Arousal
- Exaggerated startle response
Physical NEGATIVES
- Decreased concentration
- Decreased sleep
Mood
- Guilt
- Depression
- Anger
- Emotional outbursts
PTSD management
Watchful waiting
< 3 months
- CBT
- Medication for sleep disturbance
> 3 months
- Eye Movement Desensitising and Processing
- SSRI - Paroxetine
- NaSSA - Mirtazapine
OCD criteria
- Obsessions or compulsions for 2 weeks
- Interferes with ADLs
- Originate from the mind
- Subject tries to resist them
- Repetitive and unpleasant
- Action carried out is not pleasurable
OCD causes
Genetics
Immune - B-haemolytic Strep
What are compulsions
Repetitive rituals
E.g. washing and checking
What are obsessions
Recurrent thoughts of a distressing nature
- Words
- Ideas
- Phrases
- Numbers
OCD management
CBT
Exposure and response
Psychodynamic therapy
Pharmacology
- TCA - Cloripramine
- SSRI - Sertraline
What is panic disorder
Frequent panic attacks present for 1 month
Period of intense fear…
- Rapid onset
- Peaks at 10 minutes
- Spontaneous or situational
Panic disorder physical symptoms
Tachycardia
Palpitations
Chest pain
Dizziness
Blurred vision
Paraesthesia
Dry mouth
Abdo pain
Choking sensation
Sweating
Trembling
Panic disorder psychological symptoms
Feeling of impending doom
Fear of dying
Fear of losing control
Depersonalisation
Derealisation
Panic disorder management
CBT
SSRI
Review in 12 weeks
TCA - Clomipramine
Refer
What is a phobia
Strong irrational fear of something which poses little or no danger
Phobia management
CBT
Benzos
SSRI
