Psych peer teaching Flashcards
What is section 2 of the MHA
Admission for assessment.
28 days
2 doctors and an AMHP
What is section 3 of MHA
Admission for treatment
6 months
Can be renewed
2 doctors and an AMHP
What is section 4 of MHA
Emergency treatment.
Prior to 2 or 3
72 hours
1 doctor 1 AMHP
What is section 5(2)
Detention fo a patient already in hospital.
72 hours
Doctor looking after patient
What is section 5(4)
Nurses holding powers
6 hours
Section 135
Force entry into house for MHA assessment. Requires magistrates court warrant and AMHP or doctor present
Section 136
Arrest someone in public place who is suffering from a mental health disorder
Generalised anxiety disorder
Generalised anxiety persistent but not restricted to any particular environmental settings
Phobic disorders
Group of disorders where anxiety is evoked only in well defined situations that are not currently dangerous
Panic disorder
Recurrent attacks of severe anxiety, which are unpredictable and not restricted to any particular situation
Autonomic arousal symptoms
Palpitations
Tachycardia
Sweating
Dry mouth
Physical symptoms of neuroses (anxiety)
Breathing difficulties, choking sensation, chest pain, nausea, hot flushes, numbness, tingling
Mental state symptoms of neuroses
Depersonalisation, fear of losing control, concentration difficulties
Symptoms of tension present in neuroses
Muscle aches/pains, restlessness/inability to relax
Anxiety treatment
Education then IAPT then CBT or SSRI then inpatient
Which SSRI for anxiety
Sertralline
Define PTSD
Delayed or protracted response to a stressful event of a threatening or catastrophic nature
PTSD presentation
Reliving of the stressor Emotional blunting Hypervigilence Avoidance of things associated Inability to recall aspects of the event
PTSD management
Watchful waiting at first
Trauma focussed CBT
Eye movement desensitisation and reprocessing
Antidepressants (paroxetine)
Acronym for depression symptoms
DEAD SWAMP
What are the symptoms of depression
Depressed mood
Energy levels reduced
Anhedonia
Disturbed sleep
Suicidal ideation Worthlessness Appetite reduced Mentation decreased Pscyhomotor retardation
Depression treatment
Eductation, IAPT and medications, CBT, then inpatient MDT
Examples of SNRI
Duloxetine
Venlafaxine
Examples of SSRIs
Sertralline
Fluoxetine
Citalopram
Examples of TCAs
Amitriptylline, clomipramine
Examples of NaSSA
Mirtazapine
Examples of MAO inhibitors
Phenelzine, moclobemide
What is the pharmacological treatment of depression
SSRI then SNRI then TCA
how do ssris work
Increase free serotonin by blocking reuptake pumps, stopping serotonin from being recycled in the synapse
SSRI prescribing info
Start low dose and titrate up, continue for 6 months after recovery
Sertralline fun fact
Most cardio or neuroprotective
Fluoxetine fun fact
Has a long half life
How do SNRIs work
Inhibit reuptake of serotonin and noradrenaline.
Fun fact about venlafaxine
Needs monitoring (ECG and BP) for cardiovascular side effects as can exacerbate arrythmias
How do tricyclic antidepressants work
Inhibit reuptake of serotonin and noradrenaline but act as anticholinergics
Anitcholinergic side effects
Dry mouth, blurred vision, urinary retention
TCA side effects
anticholinergic, overdose and arrythmias
Mirtazepine mode of action
Noradrenergic and specific serotonergic antidepressant
MAO inhibitors (phenelzine) special precautions
Dietary as hypertensive criss with tyramine
Bipolar 1 definition
One or more manic episodes with or without a history of depressive episodes
Bipolar 2 definition
One or more depressive episodes with at least one hypomanic episode
Acronym for mania symptoms
I DIG FAST
Mania symptoms
Irratibility/elevated mood
Distractibility
Inhibition loss
Grandiosity
Flight of ideas
Activity increased
Sleep not needed
Talkative
Name three mood stabilisers
Lithium
Valproate
Lamotrigine
Other treatments for bipolar
Antipsychotics (haloperidol, olanzapine) and antidepressants (fluoxetine)
Lithium fun fact
Ebsteins phenomenon- cardiac anomaly in babies if mother has taken lithium
Lamotrigine fun fact
Can cause steven johnsons syndrome- hypersensitivity
Valproate fun fact
Terratogenic
How does lithium work
inhibits cAMP which inhibits Monoamines
What is a safe level of lithium
0.6-1
What bloods for someone on lithium
Li, U and E, TFT, calcium
Toxicity level of lithium
> 1.5mmol/L
Symptoms of lithium toxicity
Tremor, anorexia, diarrhoea and vomitting, ataxia, dysarthria, delirium, fasiculations, hypotension, arrythmias, seizures, coma
First rank symptoms of schizophrenia
3rd person auditory halllucinations Thought withdrawal, insertion and broadcast Delusional perceptions Delusions of control Somatic passivity
Positive symptoms of schizophrenia
An excess or distortion of normal functioning e.g. delusions, hallucinations, thought disorder. Caused by overactivity of recepetors in the mesolimbic pathway
Negative symptoms
Decrease or loss of functioning e.g. blunting of affect, poverty of speech. Caused by underactivity of receptors in the mesocortical pathway
Paranoid schizophrenia
Paranoid delusions, auditory hallucinations and perceptual disturbances
Catatonic schizophrenia
Hyperkinesis or negativism
Hebephrenic schizophrenia
Fluctuating affect
Residual schizophrenia
Long term negative symptoms
Simple schizophrenia
Negative symptoms without psychotic symptoms
First generation antipsychotics
Chlorpromazine, haloperidol
How do first generation antipscyhotics work
Dopamine (D2) antagonists
How do second generation antipsychotics work
Dopamine (D2) antagonists and serotonin (5HT2A) antagonists.
Antipsychotics side effects
Extrapyrimidal- dyskinesia, parkinsonism, neuroleptic malignant syndrome
Second generation antipsychotics
Risperidone, olanzapine, clozapine
Clozapine
2nd gen for treatment resistnat. Blocks D1 and D4 and 5HT2A. Risk of agranulocytosis
Metabolic antipscyhotic side effects
Weight gain
Diabetes
Anticholinergic side effects
Dry mouth, blurred vision, difficulty passing urine, urinary retention, constipation
Antiadrenergic side effects
postural hypotension, tachycardia, sexual dysfunction
Antihistminergic side effects
Sedation
Cardiovascular antipscyhotic side effects
Prolonged QT interval
Hormonal antipscyhotic side effects
Increased plasma prolactin
Describe anorexia
Restricted diet Excessive exercise Induced vomiting and purging Use of appetite suppressants Diuretics
Describe bulimia
Repeated bouts of overeating
Pattern of overeating followed by vomiting or use of purgatives
Signs of eating disorders
Loss of muscle mass
Dry skin, brittle hair and nails
Russel sign
Lanugo hair
What is russel sign
Callused skin over interphalangeal joints
What is lanugo
Fine, downy body hair
