psych review Flashcards
AMTS
- “What is your age?”
- “What is the time to the nearest hour?”
- Give the patient an address, and ask them to repeat it at the end of the test (e.g. “42 West Street”)
- “What is the year?”
- “What is the name of this place?” or “What is your house number?”
- Can the patient recognise two persons (e.g. doctor, nurse)?
- “What is your date of birth?” (day and month sufficient)
- “In what year did World War 1 begin?”
- “Name the present monarch”
- “Count backwards from 20 down to 1”
key fts of different types of dementia
Alzheimer’s disease (>65yo) - amnesia (recent memories lost), aphasia (difficulty finding words), agnosia (difficulty recognising faces), apraxia (difficulty dressing)
VD (HTN, DM, smoking) - step wise decline, personality change (labile emotion)
DLB - gradual decline (2 or more) fluctuating confusion with marked variation in alertness (may have lucid intervals), vivid visual hallucinations, parkinsoniasm (shuffling gait, amimia, bradykinesia, rigidity), frequent falls
FTD (40-60yo) - disinihibition/ social personality change –> progressing loss of understanding of verbal and visual meaning –> naming difficulties/mutism
memory affected last (death in 5-10yrs)
NPH - incontinence, dementia, gait instability - can get seizure, haemorrhage, infections, MRI show big 4th ventricle, do a VP shunt
bad prognostic indicator of dementia
male, depression, behavioural problems, severe focal cognitive deficit
risk assessment for dementia
- issues wandering off and getting lost
- driving
- worried about hurting themselves?
depression»_space; dementia
gradual, biological Sx (loss of sleep, weight loss), patient worried about poor memory, reluctant to take test and disappointed, MMSE is variable, global mem loss (whereas dementia is recent)
RF for suicide
previous self harm, male, occupation (vet, doctor), live alone, mental illness, substance misuse, lower social class, unmarried
indicators for high risk of suicide after DSH
preplanning, attempts to hide, final acts (e.g. finances), stated wish to die, lack of seeking help after, ongoing intent, will/suicide not, belief that the act will be fatal
protective factors
married, no substance misuse, lithium med, faith in a religion
mx for paracetamol OD
IF 1) PARACETAMOL OD >150 mg/kg or 2) JAUNDICE OR HEPATIC TENDERNESS or 3) OD >24hrs, give acetylcysteine straightaway
OTHERWISE IF ASYMPTOMATIC
<1hr - activated charcoal
wait until 4hrs - measure serum paracetamol and LFTs
4-24 hrs - supportive care/monitoring + anti-emetic (ondansetron), wait for serum paracetamol before giving acetylcysteine
risk assessment for self harm
- how do you feel about the situation - regrets?
- do you feel as if you want to end it all?- how do you feel about the future?
- would you be willing to try medication to help you get better?
- do you think there is anything to live for?
- anyone trying to harm you?
before consultation regarding self harm
Anything that’s said here today will, of course, be confidential* and I appreciate that some questions may be difficult to answer – if there’s anything you don’t want to answer right now, we can come back to it another time. However, having this talk will help us to help you as much as we can. Does that all sound ok?
*be confidential — “but if a child’s safety is at risk, I may need to share this information.”
safety netting self harm
“If you do feel like this again then please make all use of your support. Of course you have your family and friends you can talk to but if they aren’t contactable, then call 999 and tell them how you are feeling and come to A&E. There are more specific contact numbers like the Samaritans, who are there 24/7 to talk and support folks feeling similarly to you. We will review you within a week to see how things are going on. I was also wondering if you would find it useful if we sent one of our team members over to you on a periodic bases to see how you are getting on”
CAGE and dependence Qs
do you feel that you have to cut down // do you feel annoyed when people tell you, you drink too much // do you feel guilty about your drinking // do you feel like you need alcohol first thin in the morning
do you crave a drink // do you miss out on things because of alcohol // has alcohol caused you any difficulties // what happens when you don’t drink alcohol // do you need more to have the same effect // do you feel you’ve lost control of your drinking
key risk assessment
drink and drive? co-dependents - drink around children?
counselling somatisation disorder
1)results of exams and tests show that there is no cause of the symptoms you are experiencing. sometimes people do experience Sx that are not medically explained, but it does not mean that it’s not there. for example headaches are induced by stress or we have conditions called fibromyalgia to refer to pain all over the body.
2) there is no cure for this but i will help to help deal with the symptoms better. although you may want additional tests and medication, having tests that keep showing you negative findings may actually induce more anxiety and could have risks associated with it
3) important to that time to relax, avoid reading up on conditions online, good sleep hygiene, exercise
we have anti-depressants, talking therapies, schedule a visit once a month for continuity of care
