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My Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Define Psychosis

A

Acute condition where people lose contact with reality which usually includes hallucinations and delusions

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2
Q

Give 3 examples of pscyhoses

A
  1. Affective psychoses –> depression, bipolar
  2. Transient psychotic disorders –> substance misuse or withdrawal
  3. Due to medical disorder –> brain tumour, PD, HD, HIV/AIDS, syphilis, encephalitis
  4. Schizophrenia life non affective disorders –> brief psychotic disordered, delusional disorder
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3
Q

Give 2 positive symptoms of psychosis

A
  1. Hallucinations
  2. Delusions
  3. Thought disorder
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4
Q

Give 3 negative symptoms fo psychosis

A
  1. Flattened affect
  2. Cognitive difficulties
  3. Poor motivation
  4. Social withdrawal
  5. Poverty of speech
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5
Q

Define schizophrenia

A

A severe mental disorder, characterises by profound disruptions in thinking, affecting language, perception and sense of self
A type of psychosis

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6
Q

Briefly describe the pathophysiology of schizophrenia

A

Neurochemical abnormalities = excessive dopamine production

  • Overactivity of neurones = mesolimibic –> hallucination/disorders (+ve Sx)
  • Underactivity of neurones = mesocortical –> blunted, anhedonia, apathy (-ve Sx)
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7
Q

When is the onset of schizophrenia most typical?

A

2nd or 3rd decade

  • Mostly men in adolescence
  • Mostly omen in middle age
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8
Q

Name 3 subtypes of schizophrenia and briefly describe each

A
  1. Paranoid = most common –> paranoid delusions and auditory hallucinations
  2. Hebephrenic = adolescents/young adults –> mood changes, unpredictable behaviours, shallow affect, fragmentary hallucinations, outlook poor as -ve Sx rapid
  3. Simple = similar to hebephrenic but characterises by -ve Sx NEVER +ve Sx
  4. Catatonic = psychomotor features (posturing, rigidity, stupor)
  5. Undifferentiated = mixed Sx
  6. Residual = -ve Sx when +ve Sx have ‘burnt out’
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9
Q

What are the first rank symptoms of schizophrenia?

A
  1. Delusional perception
  2. 3rd person auditory hallucinations
  3. Thought disorder/alienation –> insertion, blocking, echo, withdrawal
  4. Passivity phenomena = being controlled by external energy/force
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10
Q

What are the second rank symptoms of schizophrenia?

A
  1. Delusions
  2. 2nd person auditory hallucinations
  3. Catatonic behaviour
  4. Negative symptoms
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11
Q

How is schizophrenia diagnosed?

A

ICD 10
At least 1 first rank symptom and 2 2nd rank symptoms present for over 1 month AND no other cause for psychosis (RULE OUT)

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12
Q

What is the non pharmacological management of schizophrenia ?

A

CBT
Working with families
Addressing housing, social care etc

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13
Q

What is the pharmacological treatment for Schizophrenia?

A
  • 1st Line = Oral atypical (2nd gen) antipsychotics = 5HT2A and D2 agonists –> Aripiprazole, olanzapine, quetiapine, risperidone
  • 2nd line = Oral typical (1st get) antipsychotics = dopamine agonists –> haloperidol, chlorpromazine
  • 3rd line = Clozapine (atypical antipsychotic)
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14
Q

What is the main side effect of olanzipine?

A

Weight gain –> 13.9kg in 1 year

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15
Q

What is a potential side effect of clozapine

A

Agranulocytosis –> FBC monitored regularly (neutrophil levels)

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16
Q

Give 3 possible side effects of antipsychotics

A
  1. QTc prolongation –> ECG
  2. DM/insulin resistance
  3. Anticholinergic SE = urinary mention, blurred vision, weight gina, hyper salivation, constipation
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17
Q

Give 4 extrapyramdial side effects of antipsychotics

A
  1. Acute dystonia = involuntary repetitive movements, neck, blinking, jaw –> treat with procyclidine
  2. Parkinsonism
  3. Akathisia = restlessness –> treat with propranolol and BDZs
  4. Tardive dyskinesia = slow movements, lip-smacking, sudden, involuntary, irreversible
    EPSE more common in TYPICAL antipsychotics
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18
Q

What is schizoaffective disorder?

A

Patients experience both schizophrenia and a mood disorder (affective) at the same time (within days) with the same intensity without a medical disorder or substance misuse cause

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19
Q

What is Neuroleptic malignant Syndrome?

A

Life threatening reaction in response to neuroleptic or antipsychotic (haloperidol, chlorpromazine) medications

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20
Q

Give 3 clinical features of neuroleptic malignant syndrome

A
  1. Slower onset (Days to weeks)
  2. Fever
  3. Autonomic instability
  4. Muscle rigidity = lead pipe
  5. Tremor
  6. Seizures, coma
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21
Q

What would you see on investigations in someone with neuroleptic malignant syndrome?

A
  • Raised CK
  • Leucocytosis
  • Metabolic acidosis
  • Prolonged QT
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22
Q

What is the management of neuroleptic malignant syndrome?

A
  • IV hydration
  • Benzodiazepines (diazepam)
  • Bromocriptine = dopamine agonist
  • Dantrolene = muscle relaxants
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23
Q

What are affective disorders?

A

Illnesses which affect the way you feel and think

Most common = depression, bipolar

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24
Q

What are the 3 core symptoms of depression?

A
  1. Low mood
  2. Anhedonia = loss of enjoyment
  3. Anergia = low energy
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25
Q

Give 5 other symptoms of depression

A
  1. Sleep disturbance
  2. Changes in appetite
  3. Reduced libido
  4. Reduced concentration
  5. Negative perception self
  6. Diurnal variation of mood
  7. Feelings of guilt and worthlessness
  8. Psychomotor agitation/retardation
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26
Q

What investigations would you do for someone with suspected depression?

A 
TFTs --> hypothyroid 
FBC --> anaemia 
Urine drug screen --> substance misuse 
Medication review 
HAD scale or PHQ-9
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27
Q

What is needed for a diagnosis of Depression?

A

2 core symptoms everyday for >2 weeks

  • MILD = 2 core + 2 others
  • MODERATE = 2 core + 3 others
  • SEVERE = 3 core + 4 others
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28
Q

What are the non-pharmacological treatment of depression?

A
  • Self help groups
  • Guided sleep help
  • CBT –> computerised, individualised
  • Psychotherapy
  • Lifestyle medications = sleep hygiene, manage anxiety, physical activity
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29
Q

What is the medical treatment for depression and give examples of the medications?

A 
1st line = SSRI (sertraline for >18s, fluoxetine for <18s, citalopram, paroxetine) 
2nd line = alternative SSRI 
3rd line = NaSSA (mirtazipine) OR SNRI (venlafaxine, duloxetine) 
4th line = TCA (amitriptyline, clomipramine) 
5th line (resistant depression) = MAO-I (moclobemide, rasagiline, selegiline)
Lithium, atypical antipsychotic, ECT = very severe depression
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30
Q

Give 2 side effects of SSRIs

A
  1. Headache
  2. nausea
  3. Insomnia
    Citalopram = QT prolognation
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31
Q

Give 2 side effects of NaSSA

A
  1. Sedative
  2. Weight gain
    - Can be useful in those who have lost weight due to depression or those with eating disorder
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32
Q

Give 2 side effects of SNRIs

A
  1. Cardiovascular effects
  2. Nausea
  3. Constipation
  4. Loss of appetite
  5. Loss of libido
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33
Q

Give 3 side effects of TCAs

A
  1. Anticholinergic effect = dry mouth, blurred vision, constipation, drowsy
  2. Adrenergic = postural hypotension
  3. Decreased libio
  4. Weight gain
    - CI in heart failure due to arrhythmia risk
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34
Q

Give 2 side effects of MAO-Is

A
  1. Weight gain
  2. Insomnia
  3. Anxiety
  4. Postural hypotension
    - Risk of Hypertensive crisis
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35
Q

What should you avoid when on an MAO-I?

A

Tyramine containing foods –> cheese, alcohol, avocado, pickles, cured meats

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36
Q

What is serotonin syndrome?

A

Toxic serotonin poisoning, abrupt onset

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37
Q

Give 2 causes of serotonin syndrome?

A
  1. SSRIs
  2. MAO-Is
  3. Ecstasy
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38
Q

How does serotonin syndrome present?

A

CAN

  • Cognitive changes = agitation, confusion, hallucinations
  • Autonomic dysfunction = tachycardia, HTN, fever, diaphoresis, diarrhoea
  • Neuromuscular abnormalities = myoclonus, tremors, hyperreflexia
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39
Q

What is the management of serotonin syndrome?

A

Benzodiazepines

Cyproheptadine = 5H2-a antagonist

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40
Q

Give 2 differences between serotonin syndrome and neuroleptic malignant syndrome

A

Serotonin = increased activity + acute onset
Neuroleptic = Reduced activity + insidious onset (4-11 days)
Similar signs = metabolic acidosis, CK, WCC, LFT

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41
Q

Define Bipolar Disorder

A

Chronic mental health disorder characterised by periods of mania and hypomania along with period of depression

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42
Q

How is Bipolar Disorder classified?

A

Type 1 = mania and depression
Type 2 = Hypomania and depression
Cyclothymia = subclinical depression and hypomania (doesn’t meet BPD criteria)

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43
Q

Give 3 causes/risk factors of BBipolar Disorder

A
  1. Postpartum female
  2. Substance misuse
  3. Chronic illness
  4. Past trauma/mental health problems
  5. Genetic
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44
Q

How does Mania present?

A

> 1 week

  • Uncontrollable elation
  • Overactivity
  • Pressur elf speech
  • Impaired judgement –> spending lots of money
  • Risk taking
  • Social disinhibition
  • Grandiosity
  • Psychotic symptoms
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45
Q

How does hypomania present?

A

> 4 days

  • Elevated mood –> angry, irritable usually
  • Increased energy/talking
  • Poor concentration
  • Mild reckless behaviour
  • Overfamiliarity
  • Increased libido and confidence
  • Decreased need for sleep and eating
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46
Q

What is need for a diagnosis of Bipolar Disorder?

A

History of 2 mood disorders, at least 1 hypomania (>4days) or mania (>7 days)

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47
Q

What is the treatment for Bipolar Disorder?

A

Long term - mood stabilisers
- Lithium (1st line), sodium valproate, lamotrigine
Antipsychotics or BDZs short term
Management of depression –> talking therapies, fluoxetine is antidepressant of choice
Psychoeducation, promoting social functioning

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48
Q

What are the 5 main anxiety disorders?

A
  1. Generalised anxiety (GAD)
  2. Panic disorder
  3. Obsessive compulsive disorder (OCD)
  4. Post traumatic stress disorder (PTSD)
  5. Phobic disorder
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49
Q

What is GAD?

A

Anxiety not specific to environmental circumstance –> excessive worry about everyday events/problems

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50
Q

Give 4 risk factors for GAD

A
  1. Alcohol
  2. Benzodiazepines
  3. Stimulants (withdrawal)
  4. Co-existing depression
  5. FHx
  6. Child abuse
  7. Neglect
  8. Excessive pushy parents
  9. Life stresses
  10. Physical health problems
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51
Q

What are the clinical features of GAD?

A
  • Restless/on edge
  • Unpleasant/fearful emotional state
  • Slepe disturbance
  • Somatic –> tension, hyperventilation, trembling, headaches, sweating, palpitations, nausea
  • Avoidance or dependence behaviours
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52
Q

What are the diagnostic features of GAD?

A
  • Anxiety is heard to control
  • Excessive anxiety more days than not over last 6 months (90 days at least)
  • Adults 3 or more clinical features, children 1 or more
  • Impairment in daily life
  • No medication or drug abuse
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53
Q

What investigations and assessment are done for GAD?

A

Rule out physical illness –. TFTs, B12/folate, medication, alcohol/benzo use
Tools = GAD7 and PHQ

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54
Q

What is the non-pharmacological treatment for GAD?

A

Exercise
Relaxation training
Meditation
CBT

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55
Q

What is the pharmacological management of GAD?

A

1st line = SSRI
2nd/3rd line = SNRI (venlafaxine), pregabalin, TCA
Benzodiazepines = short term
BB for symptomatic control

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56
Q

What is Panic disorder?

A

Period of intense fear characterised by a group fo symptoms that develop readily, reach their peak at 10 mins and generally don’t last longer than 20-30 minutes
Can occur unpredictably and not in response to a stimulus

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57
Q

Give 4 symptoms of panic disorder

A
  1. Intense fear and dread/anxiety
  2. Palpitations, chest pain
  3. SOB, tachypnoea
  4. Trembling, shaking, numbness, pins and needles
  5. Dizziness
  6. Chills, hot flushes
  7. Sense of impending doom
58
Q

What is the management of panic disorder?

A

CBT and SSRI (sertraline)

59
Q

What is OCD?

A 
Obsessions = unwanted, intrusive thoughts, imaged or urges 
Compulsions = Repetitive, purposeful rituals often performed in response to obsessions
60
Q

Give 2 causes or risk factors for OCD

A
  1. Genetics –> FHx of OCD or tic disorder
  2. Parental over protection
  3. May occur after strep infection (PANDAS)
61
Q

Give 2 symptoms of OCD

A
  1. Time consuming = >1hr/day for at least 2 weeks
  2. Distressing and interfering with ADLs –> no pleasure from compulsions
  3. Avoidance of stimuli
    - Often good insight but do compulsions to feel more relaxed
62
Q

What is the treatment for OCD?

A

CBT and exposure therapy

SSRI (fluoxetine) or TCA (clomipramine)

63
Q

What is PTSD?

A

Anxiety disorder following an exceptionally stressful, life threading or catastrophic event

64
Q

What are the main clinical features of PTSD?

A
  • Re-experiencing = nightmares, flashbacks
  • Avoidance –> avoiding people or circumstances resembling event
  • Hyperarousal and hypervigilence
  • Emotional numbing
  • Panic attacks
  • Can manifest as depression, drug/alcohol misuse, anger
65
Q

How is PTSD diagnosed?

A

ICD10

  • Exposure to significant event and experience persistent remembering
  • Symptoms arise within 6 months of a traumatic event
  • Symptoms present for at least 1 month with significant distress/impairment in daily functioning
66
Q

What is the treatment for PTSD?

A

1st line = CBT, eye movement desensitisation and reprocessing (EMDR)
2nd line = SNRI (venlafaxine) or SSRI (sertraline)

67
Q

What are phobias?

A

Strong irrational fear of something that pose little or no real danger

68
Q

Give 2 examples of phobias

A

Social phobias = fear of social situations, exposure to unfamiliar places
Agoraphobia = fear of crowded places/going outside
Simple phobia = numerous phobias restricted to specific situations

69
Q

What is the treatment for phobic disorder?

A

CBT and exposure therapy

70
Q

What is a 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
71
Q

Give some examples of types of delusions

A

Of control = others control one’s actions/thoughts
Of broadcasting = can hear one’s thoughts
Of thought withdrawal = thoughts being stolen
Persecutory = others conspiring against/following
Jealous = one’s partner is unfaithful
Of guilt = feeling guilty
Of reference = message directed to them
Somatic = body is diseased/changed
Erotomanic = another is in love with oneself
Grandiose = special talents/beliefs
Religious = Involving spiritual aspects

72
Q

What is the treatment of delusional disorder?

A

Antipsychotics
Antidepressants
Psychotherapy

73
Q

What are personality disorders?

A

A group fo disorders characterised by rigid, maladaptive traits that cause distress or an inability get along with others

74
Q

What are Cluster A personality disorders and briefly describe each

A
  • Paranoid –> suspicious, preoccupied with conspirational explanations, disrupts others, hold grudges
  • Schizotypal –> weird, magical, circumstantial, bizarre, peculiar
  • Schizoid –> emotionally cold, lack of interest in others, rich fantasy world
75
Q

What are Cluster B personality disorders and briefly describe each

A
  • Antisocial –> aggrieve, easily frdsutartaed, lack of concern for others, impulsive, <18 y/o
  • Borderline (BPD/EUPD) –> feeling of ‘emptiness’, unclear identity, intense and unstable relationships, unpredictable affect, threats or acts of self harm
  • Histrionic –> over dramatise, shallow, sexually inappropriate, labile mood
  • Narcissistic –> grandiosity, egotistical, lacks empathy, takes advantage
76
Q

What are Cluster C personality disorders and briefly describe each

A
  • Avoidant –> tense, apprehensive, social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
  • Dependent –> excessive need to be taken care of, submissive, clingy, fear of separation, indecisive
  • Anankastic (OCD) –> stubborn, perfectionism, egosytonic, inflexibility, OCPD, judgemental
77
Q

What is EUPD usually the result of?

A

Result of insecure attachment/domestic violence/childhood sexual abuse

78
Q

Give 4 clinical features of EUPD

A
  • Low self esteem
  • Intense feelings of rejection, abandonment, being unloved
  • Develops very intense feeling for people very quickly but also 1 bad move could destroy their image of someone
  • Hard to control emotions
  • Difficult to cope with life stresses, especially friends and relationships
  • Often self-harm/OD or have risky behaviours
  • Associated with depression, alcohol abuse
79
Q

What is the treatment for personality disorder?

A
  1. Psychological therapies - dialectal behaviour therapy
  2. Structured clinical management
    Medication is not a mainstay
80
Q

What is involved in a suicide risk assessment?

A

SAD Persons Score

  • Sex, male
  • Age: <19, >45
  • Depression; present?
  • Previous siucide attempt
  • Ethanol (or other substance abuse)
  • Rational thinking loss –> psychosis, psychotic depression
  • Single or separated
  • Organised –> well thought through, no impulsive
  • No social support
  • Sickness –> chronic illness
81
Q

Define anorexia

A

Serious mental disorder where there is a severe compulsion to control earring and body image

82
Q

How is anorexia diagnosed?

A

DSM5 Criteria

  • Restriction of energy intake relative to requirements leading to significantly low body weight
  • Intense fear of gaining weight or becoming fat even thought underweight
  • Disturbance in the way which one’s body weight or shape is experiences or denial of seriousness of low body weight
83
Q

How does anorexia clinically present?

A
  • Psychological –> depression, anxiety, low self esteem
  • Fatigue, decreased concentration
  • Altered sleep cycle
  • Constipation
  • Amenorrhoea
  • Osteoporosis
  • Arrhythmias
  • Dry skin, brittle hair
84
Q

Give 2 red flags in someone with anorexia

A
  1. BMI <13 or below 2nd percentile or weight loss >1kg/week
  2. Temperature <34.5
  3. BP <80/50, pulse <40, SaO2 <92%
  4. Muscle weakness –> unable to get up without using arms for leverage
  5. ECG –> long QT, fast T waves
85
Q

What happens to bloods in anorexia nervosa?

A

C and G go up, the rest go down
Raised = cortisol, beta-carotene, GH, cholesterol
Decreased = T3, glucose, oestrogen, testosterone, LH, FSH, phosphate

86
Q

What is the SCOFF questionnaire?

A

Screening tool for eating disorder

  • make your self Sick?
  • lost Control over eating
  • lost more than One stone in 3 months
  • believe you are Fat even through thin
  • Food dominates life
87
Q

What is the management of anorexia nervosa?

A 
MARSIPAN = guideline 
- CAHMS = anorexia based family therapy 
- CBT = 2nd line 
Adults 
- CBT - ED 
- MANTRA (maudsley anorexia nervosa treatment for adults)
- SSCM (specialist supportive clinical management) 
- Food diary 
- SSRI (fluoxetine)
88
Q

What is bulimia nervosa?

A

Episodes of binge eating followed by intentional vomiting or other purgative behaviours (laxatives, diuretics, exercise)

89
Q

Define binge eating

A

Eating, in a discrete amount of time (e.g. 2 hours), an amount of food that is definitely larger than what most people would eat in a similar period of time and under similar circumstance and lack of control over eating during the episode

90
Q

How is bulimia diagnosed?

A

DSM 5 Criteria

  • Recurrent episodes of binge eating characterised by uncontrolled overeating
  • Regular use of mechanisms to prevent weight gain –> vomiting, laxative, over exercise
  • Episodes occur at least once a week for 3 months
  • Self evaluation is unduly influenced by body shape and weight
  • Binging or purging does no occur exclusively during episodes of behaviour that would be common in those with anorexia nervosa
91
Q

How does Bulimia clinically present?

A
  • Same as anorexia
  • Oesphagitis
  • Russell’s sign = callouses on back of hands
  • Cardiomyopathy
  • Oedema –> laxative, diuretics
  • Vomiting –> metabolic alkalosis = hypokalaemia, hypochloraemia
  • Laxative abuse = metabolic acidosis
92
Q

How is bulimia managed?

A

CBT, food diary

SSRI = fluoxetine –> decreases binges and purging

93
Q

What is refeeding syndrome?

A

Metabolic abnormalities that occur on feeding a patient following a period of starvation/>10 day period of undernutrition

94
Q

How does refeeding syndrome present?

A
  • Rhabdomyolysis
  • Respiratory or cardiac failure
  • Hypotension
  • Arrhythmias
  • Seizures
95
Q

What metabolic disturbances does refeeding syndrome cause?

A
  • Hypophosphateaemia
  • Hypokalaemia
  • Hypomagnesaemia
  • Hyperglycaemia
  • Abnormal fluid balance
96
Q

Give 3 groups of people at higher risk

A
  1. Prolonged fasting
  2. Significant weight loss
  3. Anorexia nervosa m
  4. History of alcohol abuse, drug therapy (insulin, chemo, diuretics, antacids)
  5. Hypophosphataemia, hypokalaemia, hyomagnesaemiea prior to feeding
97
Q

How is refeeding syndrome treated?

A
  • Slow refeeding
  • Thiamine/vit B and multivitamins
  • Monitor electrolytes
98
Q

Define dependence

A

Cluster of psychological, behaviours and cognitive phenomena in which a substance takes on higher priority than other behaviours which once held greater value

99
Q

What is the recommended weekly alcohol intake?

A

14 units a week, spread over at least 3 days

100
Q

Give 2 risk factors of alcohol dependence

A
  1. Male
  2. Unemployment
  3. Stress
  4. Younger age of usage/mental illness
  5. History of substance abuse
  6. Genetics
101
Q

What are the signs of alcohol abuse?

A

CAN’T STOP

  • Compulsion to drink
  • Aware of harm but continues
  • Neglect to other activities
  • Tolerance of alcohol
  • Stopping causes physiological withdrawal
  • Time preoccupied with alcohol
  • Out of control use
  • Persistent, futile wish to cut down
102
Q

What is the CAGE Screening?

A

Screen for possible alcohol dependency

  • C = have you ever felt you should Cut down on your drinking?
  • A = have you ever become Annoyed by criticism of your drinking?
  • G = have you ever felt Guilty about your drinking?
  • E = have you ever had a morning Eye opener?
103
Q

What investigations would you do for someone with suspected alcohol abuse?

A 
Raised MCV = macrocytic anaemia 
Deranged LFTs = GGT, AST, ALT
VIt B12 and folate deficiency 
Thrombocytopenia 
Breath test 
CAGE Screening
104
Q

What is the treatment for alcohol dependance?

A
  • Motivational interviewing
  • Psychological therapies
  • Self help groups
  • Prevention measure
  • Medications to help with withdrawal and maintaining stopping
105
Q

What is medication given to someone with alcohol dependency to help with withdrawal symptoms?

A

When >20 units a day or they have previously experienced withdrawal symptoms

106
Q

Name 3 medications used for alcohol withdrawal and how they help

A
  1. Disulfram = gives hangover SE if alcohol is consumed
  2. Acamprosate = reduces carvings
  3. Naltrexone (opioid receptor antagonist) = reduces pleasure alcohol brings
107
Q

Give 3 possible complications of alcohol dependancy

A
  1. Wernicke’s encephalopathy
  2. Korsakoff’s syndrome
  3. Alcohol induced Dementia
108
Q

When do symptoms start, peak and last in alcohol withdrawal?

A

Start 6-12 hours post drinking
Peak at 48 hours
Last about 3-7 days

109
Q

How does mild/moderate alcohol withdrawal present?

A 
Mild = HTN, tachycardia, anorexia, anxiety, emotional lability, insomnia, irritability, diaphoresis, headache, fine tremor 
Moderate = worsening mild Sx + agitation and coarse tremor
110
Q

What is Delirium Tremens?

A

Severe alcohol withdrawal = acute confusional state secondary to alcohol withdrawal

  • Confusion/delirium
  • Generalised tonic-clonic seizures
  • Auditory, visual or tactile hallucinations
  • Hyperthermia subsequent to psychomotor agitation
  • Risk of CV collapse
111
Q

How is acute alcohol withdrawal managed?

A

Chloridiazepoxide hydrochloride or diazepam

IV pabrinex/thiamine

112
Q

What is Wernicke’s encephalopathy?

A

Acute neurological syndrome which is cause by a lack of thiamine
- Main cause = Excess alcohol usage

113
Q

What are the symptoms of Wernicke’s encephalopathy?

A

TIRAD:
1. Confusional/intellectual impairment
2. Ataxia
3. Ophthalmoplegia (eye muscle paralysis)
Can also have nystagmus, altered GCS, peripheral sensory neuropathy

114
Q

What is the treatment of Wernicke’s encephalopathy?

A

IV thiamine

115
Q

What is Korsakoff’s syndrome?

A

Thiamine deficiency causes damage and haemorrhage from mammillary bodies to the hypothalamus and medial thalamus

116
Q

Give 2 possible causes of Korsakoff’s syndrome

A
  1. Untreated Wernickes (alcohol abuse)
  2. Post anaesthesia
  3. Basal/temporal lobe encephalitis
  4. CO poisoning
  5. Head injury
117
Q

What are the symptoms of Korsakoff’s syndrome?

A

TRIAD

  1. Anterograde amnesia = inability to acquire new memories
  2. Confabulation = creation fo flash memories
  3. Retrograde amnesia = inability to recall past events
118
Q

What is the treatment of Korsakoff’s syndrome?

A

IV thiamine and multi vit
Treat psychiatric co-morbidities
OT assessment
Cognitive rehab

119
Q

Give 3 symptoms of opioid overdose

A
  1. Drowsy
  2. Mood change
  3. Bradycardia
  4. Hypotension
  5. Pupil constriction
  6. Respiratory depression
120
Q

What is the treatment of opiate overdose?

A
  • IV naloxone
  • Opioid dependance detoxification = 4-12 weeks
  • Methadone = long term
  • Buprenorphine
  • Haemorrhage reduction = needle exchange, offering testing for HIV, Hep B/C
121
Q

Give 3 possible complications of opioid misuse

A
  1. Infection due to needle sharing –> HIV, Hep B/C
  2. VTW
  3. Bacterial infection secondary to injection –> IE, septic arthritis, septicaemia, necrotising fasciitis
  4. Overdose –> respiratory depression
122
Q

Give 3 opioid withdrawal symptoms

A
  1. Muscle and abdo cramps
  2. low mood
  3. Insomnia
  4. agitation
  5. Diarrhoea
  6. Shivering/flu like symptoms
123
Q

What is insomnia?

A

3 days a week for 1 month
Trouble falling asleep
Difficulty maintaining sleep
Poor Quality of sleep

124
Q

Give 2 possible causes of insomnia

A
  1. Fear
  2. Idiopathic
  3. Shift work
  4. Sleep related breathing disorder
  5. REM disorder
  6. Depression
  7. Steroids
125
Q

What is the treatment of insomnia?

A
  • Good sleep hygiene = limit caffeine/alcohol/cigarettes, less noise/lights/screen use, reduce sleep, regular pattern
  • Medications = zopiclone, zolpidem, zaleplon, mirtazapine, quetiapine, melatonin
126
Q

Give 2 examples of hypnotics

A
  1. Zopiclone
  2. Zolpidem
  3. Zaleplon
    SE = drowsiness, GI upset
    Used in insomnia, NEVER first line
127
Q

What are benzodiazepines used for?

A 
Insomnia 
Severe anxiety 
Status epilepticus
Agitation 
Alcohol withdrawal
128
Q

Give 2 side effects of benzodiazepines

A
  1. Drowsiness
  2. Calming effect/euphoria
  3. Condition
  4. Unsteadiness
  5. Muscle weakness
    Risks = increased risk of abuse and dependence, avoid in PD
    Interactions with opioids
129
Q

What is buspirone used for?

A

GAD
- Safer than BDZs and less SE
SE = nausea, dizziness, headaches, fatigue, confusion
CI = alcohol, MAO-Is

130
Q

What is postpartum depression?

A

Extreme sadness, decreased energy, anxiety, crying episodes, irritability
Onset 1 week to 1 month following birth
Can negatively affect newborn

131
Q

What is the treatment for postpartum depression?

A

Antidepressants (for severe)

132
Q

What is postpartum psychosis?

A

Depressive or manic symtoms
First rank symptoms schizophrenia
Emotional lability

133
Q

Who is at risk of postpartum psychosis?

A

1st time mums
Previous psychosis
instrumental delivery
FHx

134
Q

What is the treatment for postpartum psychosis?

A

Hospitalise = baby stays with mum
Antipsychotics
ECT

135
Q

What are the principles that underly the mental health act?

A
  1. Respect for the patients wishes and feelings
  2. Minimise restrictions on liberty
  3. Public safety
  4. Patient wellbeing and safety
  5. Involving patient in planning, developing and delivering care
136
Q

Briefly describe Section 2 of the MHA

A

Purpose = admission for assessment
Duration = 28 days, can’t be reviewed
Professionals involved = 2 doctors, 1 AMHP
Evidence needed =
a) Suffering form a mental disorder
b) Obtained for health and safety of them or others

137
Q

Briefly describe Section 3 of the MHA

A

Purpose = admission for treatment
Duration = 6 months, can be reviewed
Professionals involved = 2 doctors, 1 AMHP
Evidence needed =
a) Suffering form a mental disorder
b) Obtained for health and safety of them or others
c) Appropriate treatment must be available

138
Q

Briefly describe Section 4of the MHA

A

Purpose = emergency order
Duration = 72 hours (when waiting for 2nd Dr would lead to a delay)
Professionals involved = 1 doctors, 1 AMHP
Evidence needed =
a) Suffering form a mental disorder
b) Obtained for health and safety of them or others
d) Not enough time for 2nd Dr to attend

139
Q

Briefly describe Section 5(2) of the MHA

A

Purpose = For a patient already admitted but wants to leave
Duration = 72 Horus, can’t be coercively treated
Professionals involved = Doctors holding power
Allowed for a section 2 or 3 assessment

140
Q

Briefly describe Section 5(4) of the MHA

A

Purpose = For a patient already admitted but wants to leave
Duration = 6 hours, can’t be coercively treatments
Professionals involved = Nurse holding power until Dr attends

141
Q

Briefly describe Section 135 of the MHA

A

Needs court oder to allow police to take you from private property to safety (police station or hospital)
Up to 36 hours

142
Q

Briefly describe Section 136 of the MHA

A

Police have power to take too from public place to safety (police station or hospital)
Up to 24 hours

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