Psychiatry Flashcards
1
Q
Define Psychosis
A
Acute condition where people lose contact with reality which usually includes hallucinations and delusions
2
Q
Give 3 examples of pscyhoses
A
- Affective psychoses –> depression, bipolar
- Transient psychotic disorders –> substance misuse or withdrawal
- Due to medical disorder –> brain tumour, PD, HD, HIV/AIDS, syphilis, encephalitis
- Schizophrenia life non affective disorders –> brief psychotic disordered, delusional disorder
3
Q
Give 2 positive symptoms of psychosis
A
- Hallucinations
- Delusions
- Thought disorder
4
Q
Give 3 negative symptoms fo psychosis
A
- Flattened affect
- Cognitive difficulties
- Poor motivation
- Social withdrawal
- Poverty of speech
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
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)
7
Q
When is the onset of schizophrenia most typical?
A
2nd or 3rd decade
- Mostly men in adolescence
- Mostly omen in middle age
8
Q
Name 3 subtypes of schizophrenia and briefly describe each
A
- Paranoid = most common –> paranoid delusions and auditory hallucinations
- Hebephrenic = adolescents/young adults –> mood changes, unpredictable behaviours, shallow affect, fragmentary hallucinations, outlook poor as -ve Sx rapid
- Simple = similar to hebephrenic but characterises by -ve Sx NEVER +ve Sx
- Catatonic = psychomotor features (posturing, rigidity, stupor)
- Undifferentiated = mixed Sx
- Residual = -ve Sx when +ve Sx have ‘burnt out’
9
Q
What are the first rank symptoms of schizophrenia?
A
- Delusional perception
- 3rd person auditory hallucinations
- Thought disorder/alienation –> insertion, blocking, echo, withdrawal
- Passivity phenomena = being controlled by external energy/force
10
Q
What are the second rank symptoms of schizophrenia?
A
- Delusions
- 2nd person auditory hallucinations
- Catatonic behaviour
- Negative symptoms
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)
12
Q
What is the non pharmacological management of schizophrenia ?
A
CBT
Working with families
Addressing housing, social care etc
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)
14
Q
What is the main side effect of olanzipine?
A
Weight gain –> 13.9kg in 1 year
15
Q
What is a potential side effect of clozapine
A
Agranulocytosis –> FBC monitored regularly (neutrophil levels)
16
Q
Give 3 possible side effects of antipsychotics
A
- QTc prolongation –> ECG
- DM/insulin resistance
- Anticholinergic SE = urinary mention, blurred vision, weight gina, hyper salivation, constipation
17
Q
Give 4 extrapyramdial side effects of antipsychotics
A
- Acute dystonia = involuntary repetitive movements, neck, blinking, jaw –> treat with procyclidine
- Parkinsonism
- Akathisia = restlessness –> treat with propranolol and BDZs
- Tardive dyskinesia = slow movements, lip-smacking, sudden, involuntary, irreversible
EPSE more common in TYPICAL antipsychotics
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
19
Q
What is Neuroleptic malignant Syndrome?
A
Life threatening reaction in response to neuroleptic or antipsychotic (haloperidol, chlorpromazine) medications
20
Q
Give 3 clinical features of neuroleptic malignant syndrome
A
- Slower onset (Days to weeks)
- Fever
- Autonomic instability
- Muscle rigidity = lead pipe
- Tremor
- Seizures, coma
21
Q
What would you see on investigations in someone with neuroleptic malignant syndrome?
A
- Raised CK
- Leucocytosis
- Metabolic acidosis
- Prolonged QT
22
Q
What is the management of neuroleptic malignant syndrome?
A
- IV hydration
- Benzodiazepines (diazepam)
- Bromocriptine = dopamine agonist
- Dantrolene = muscle relaxants
23
Q
What are affective disorders?
A
Illnesses which affect the way you feel and think
Most common = depression, bipolar
24
Q
What are the 3 core symptoms of depression?
A
- Low mood
- Anhedonia = loss of enjoyment
- Anergia = low energy
25
Give 5 other symptoms of depression
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
26
What investigations would you do for someone with suspected depression?
```
TFTs --> hypothyroid
FBC --> anaemia
Urine drug screen --> substance misuse
Medication review
HAD scale or PHQ-9
```
27
What is needed for a diagnosis of Depression?
2 core symptoms everyday for >2 weeks
- MILD = 2 core + 2 others
- MODERATE = 2 core + 3 others
- SEVERE = 3 core + 4 others
28
What are the non-pharmacological treatment of depression?
- Self help groups
- Guided sleep help
- CBT --> computerised, individualised
- Psychotherapy
- Lifestyle medications = sleep hygiene, manage anxiety, physical activity
29
What is the medical treatment for depression and give examples of the medications?
```
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
```
30
Give 2 side effects of SSRIs
1. Headache
2. nausea
3. Insomnia
Citalopram = QT prolognation
31
Give 2 side effects of NaSSA
1. Sedative
2. Weight gain
- Can be useful in those who have lost weight due to depression or those with eating disorder
32
Give 2 side effects of SNRIs
1. Cardiovascular effects
2. Nausea
3. Constipation
4. Loss of appetite
5. Loss of libido
33
Give 3 side effects of TCAs
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
34
Give 2 side effects of MAO-Is
1. Weight gain
2. Insomnia
3. Anxiety
4. Postural hypotension
- Risk of Hypertensive crisis
35
What should you avoid when on an MAO-I?
Tyramine containing foods --> cheese, alcohol, avocado, pickles, cured meats
36
What is serotonin syndrome?
Toxic serotonin poisoning, abrupt onset
37
Give 2 causes of serotonin syndrome?
1. SSRIs
2. MAO-Is
3. Ecstasy
38
How does serotonin syndrome present?
CAN
- Cognitive changes = agitation, confusion, hallucinations
- Autonomic dysfunction = tachycardia, HTN, fever, diaphoresis, diarrhoea
- Neuromuscular abnormalities = myoclonus, tremors, hyperreflexia
39
What is the management of serotonin syndrome?
Benzodiazepines
| Cyproheptadine = 5H2-a antagonist
40
Give 2 differences between serotonin syndrome and neuroleptic malignant syndrome
Serotonin = increased activity + acute onset
Neuroleptic = Reduced activity + insidious onset (4-11 days)
Similar signs = metabolic acidosis, CK, WCC, LFT
41
Define Bipolar Disorder
Chronic mental health disorder characterised by periods of mania and hypomania along with period of depression
42
How is Bipolar Disorder classified?
Type 1 = mania and depression
Type 2 = Hypomania and depression
Cyclothymia = subclinical depression and hypomania (doesn't meet BPD criteria)
43
Give 3 causes/risk factors of BBipolar Disorder
1. Postpartum female
2. Substance misuse
3. Chronic illness
4. Past trauma/mental health problems
5. Genetic
44
How does Mania present?
>1 week
- Uncontrollable elation
- Overactivity
- Pressur elf speech
- Impaired judgement --> spending lots of money
- Risk taking
- Social disinhibition
- Grandiosity
- Psychotic symptoms
45
How does hypomania present?
>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
46
What is need for a diagnosis of Bipolar Disorder?
History of 2 mood disorders, at least 1 hypomania (>4days) or mania (>7 days)
47
What is the treatment for Bipolar Disorder?
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
48
What are the 5 main anxiety disorders?
1. Generalised anxiety (GAD)
2. Panic disorder
3. Obsessive compulsive disorder (OCD)
4. Post traumatic stress disorder (PTSD)
5. Phobic disorder
49
What is GAD?
Anxiety not specific to environmental circumstance --> excessive worry about everyday events/problems
50
Give 4 risk factors for GAD
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
51
What are the clinical features of GAD?
- Restless/on edge
- Unpleasant/fearful emotional state
- Slepe disturbance
- Somatic --> tension, hyperventilation, trembling, headaches, sweating, palpitations, nausea
- Avoidance or dependence behaviours
52
What are the diagnostic features of GAD?
- 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
53
What investigations and assessment are done for GAD?
Rule out physical illness --. TFTs, B12/folate, medication, alcohol/benzo use
Tools = GAD7 and PHQ
54
What is the non-pharmacological treatment for GAD?
Exercise
Relaxation training
Meditation
CBT
55
What is the pharmacological management of GAD?
1st line = SSRI
2nd/3rd line = SNRI (venlafaxine), pregabalin, TCA
Benzodiazepines = short term
BB for symptomatic control
56
What is Panic disorder?
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
57
Give 4 symptoms of panic disorder
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
What is the management of panic disorder?
CBT and SSRI (sertraline)
59
What is OCD?
```
Obsessions = unwanted, intrusive thoughts, imaged or urges
Compulsions = Repetitive, purposeful rituals often performed in response to obsessions
```
60
Give 2 causes or risk factors for OCD
1. Genetics --> FHx of OCD or tic disorder
2. Parental over protection
3. May occur after strep infection (PANDAS)
61
Give 2 symptoms of OCD
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
What is the treatment for OCD?
CBT and exposure therapy
| SSRI (fluoxetine) or TCA (clomipramine)
63
What is PTSD?
Anxiety disorder following an exceptionally stressful, life threading or catastrophic event
64
What are the main clinical features of PTSD?
- 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
How is PTSD diagnosed?
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
What is the treatment for PTSD?
1st line = CBT, eye movement desensitisation and reprocessing (EMDR)
2nd line = SNRI (venlafaxine) or SSRI (sertraline)
67
What are phobias?
Strong irrational fear of something that pose little or no real danger
68
Give 2 examples of phobias
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
What is the treatment for phobic disorder?
CBT and exposure therapy
70
What is a delusional disorder?
>1 delusion over >1 month, without meeting schizophrenia criteria
- Hallucinations can occur
- Affects day to day functioning
- Not caused by other condition/substance
71
Give some examples of types of delusions
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
What is the treatment of delusional disorder?
Antipsychotics
Antidepressants
Psychotherapy
73
What are personality disorders?
A group fo disorders characterised by rigid, maladaptive traits that cause distress or an inability get along with others
74
What are Cluster A personality disorders and briefly describe each
- 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
What are Cluster B personality disorders and briefly describe each
- 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
What are Cluster C personality disorders and briefly describe each
- 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
What is EUPD usually the result of?
Result of insecure attachment/domestic violence/childhood sexual abuse
78
Give 4 clinical features of EUPD
- 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
What is the treatment for personality disorder?
1. Psychological therapies - dialectal behaviour therapy
2. Structured clinical management
Medication is not a mainstay
80
What is involved in a suicide risk assessment?
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
Define anorexia
Serious mental disorder where there is a severe compulsion to control earring and body image
82
How is anorexia diagnosed?
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
How does anorexia clinically present?
- Psychological --> depression, anxiety, low self esteem
- Fatigue, decreased concentration
- Altered sleep cycle
- Constipation
- Amenorrhoea
- Osteoporosis
- Arrhythmias
- Dry skin, brittle hair
84
Give 2 red flags in someone with anorexia
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
What happens to bloods in anorexia nervosa?
C and G go up, the rest go down
Raised = cortisol, beta-carotene, GH, cholesterol
Decreased = T3, glucose, oestrogen, testosterone, LH, FSH, phosphate
86
What is the SCOFF questionnaire?
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
What is the management of anorexia nervosa?
```
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
What is bulimia nervosa?
Episodes of binge eating followed by intentional vomiting or other purgative behaviours (laxatives, diuretics, exercise)
89
Define binge eating
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
How is bulimia diagnosed?
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
How does Bulimia clinically present?
- 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
How is bulimia managed?
CBT, food diary
| SSRI = fluoxetine --> decreases binges and purging
93
What is refeeding syndrome?
Metabolic abnormalities that occur on feeding a patient following a period of starvation/>10 day period of undernutrition
94
How does refeeding syndrome present?
- Rhabdomyolysis
- Respiratory or cardiac failure
- Hypotension
- Arrhythmias
- Seizures
95
What metabolic disturbances does refeeding syndrome cause?
- Hypophosphateaemia
- Hypokalaemia
- Hypomagnesaemia
- Hyperglycaemia
- Abnormal fluid balance
96
Give 3 groups of people at higher risk
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
How is refeeding syndrome treated?
- Slow refeeding
- Thiamine/vit B and multivitamins
- Monitor electrolytes
98
Define dependence
Cluster of psychological, behaviours and cognitive phenomena in which a substance takes on higher priority than other behaviours which once held greater value
99
What is the recommended weekly alcohol intake?
14 units a week, spread over at least 3 days
100
Give 2 risk factors of alcohol dependence
1. Male
2. Unemployment
3. Stress
4. Younger age of usage/mental illness
5. History of substance abuse
6. Genetics
101
What are the signs of alcohol abuse?
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
What is the CAGE Screening?
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
What investigations would you do for someone with suspected alcohol abuse?
```
Raised MCV = macrocytic anaemia
Deranged LFTs = GGT, AST, ALT
VIt B12 and folate deficiency
Thrombocytopenia
Breath test
CAGE Screening
```
104
What is the treatment for alcohol dependance?
- Motivational interviewing
- Psychological therapies
- Self help groups
- Prevention measure
- Medications to help with withdrawal and maintaining stopping
105
What is medication given to someone with alcohol dependency to help with withdrawal symptoms?
When >20 units a day or they have previously experienced withdrawal symptoms
106
Name 3 medications used for alcohol withdrawal and how they help
1. Disulfram = gives hangover SE if alcohol is consumed
2. Acamprosate = reduces carvings
3. Naltrexone (opioid receptor antagonist) = reduces pleasure alcohol brings
107
Give 3 possible complications of alcohol dependancy
1. Wernicke's encephalopathy
2. Korsakoff's syndrome
3. Alcohol induced Dementia
108
When do symptoms start, peak and last in alcohol withdrawal?
Start 6-12 hours post drinking
Peak at 48 hours
Last about 3-7 days
109
How does mild/moderate alcohol withdrawal present?
```
Mild = HTN, tachycardia, anorexia, anxiety, emotional lability, insomnia, irritability, diaphoresis, headache, fine tremor
Moderate = worsening mild Sx + agitation and coarse tremor
```
110
What is Delirium Tremens?
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
How is acute alcohol withdrawal managed?
Chloridiazepoxide hydrochloride or diazepam
| IV pabrinex/thiamine
112
What is Wernicke's encephalopathy?
Acute neurological syndrome which is cause by a lack of thiamine
- Main cause = Excess alcohol usage
113
What are the symptoms of Wernicke's encephalopathy?
TIRAD:
1. Confusional/intellectual impairment
2. Ataxia
3. Ophthalmoplegia (eye muscle paralysis)
Can also have nystagmus, altered GCS, peripheral sensory neuropathy
114
What is the treatment of Wernicke's encephalopathy?
IV thiamine
115
What is Korsakoff's syndrome?
Thiamine deficiency causes damage and haemorrhage from mammillary bodies to the hypothalamus and medial thalamus
116
Give 2 possible causes of Korsakoff's syndrome
1. Untreated Wernickes (alcohol abuse)
2. Post anaesthesia
3. Basal/temporal lobe encephalitis
4. CO poisoning
5. Head injury
117
What are the symptoms of Korsakoff's syndrome?
TRIAD
1. Anterograde amnesia = inability to acquire new memories
2. Confabulation = creation fo flash memories
3. Retrograde amnesia = inability to recall past events
118
What is the treatment of Korsakoff's syndrome?
IV thiamine and multi vit
Treat psychiatric co-morbidities
OT assessment
Cognitive rehab
119
Give 3 symptoms of opioid overdose
1. Drowsy
2. Mood change
3. Bradycardia
4. Hypotension
5. Pupil constriction
6. Respiratory depression
120
What is the treatment of opiate overdose?
- IV naloxone
- Opioid dependance detoxification = 4-12 weeks
- Methadone = long term
- Buprenorphine
- Haemorrhage reduction = needle exchange, offering testing for HIV, Hep B/C
121
Give 3 possible complications of opioid misuse
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
Give 3 opioid withdrawal symptoms
1. Muscle and abdo cramps
2. low mood
3. Insomnia
4. agitation
5. Diarrhoea
6. Shivering/flu like symptoms
123
What is insomnia?
3 days a week for 1 month
Trouble falling asleep
Difficulty maintaining sleep
Poor Quality of sleep
124
Give 2 possible causes of insomnia
1. Fear
2. Idiopathic
3. Shift work
4. Sleep related breathing disorder
5. REM disorder
6. Depression
7. Steroids
125
What is the treatment of insomnia?
- Good sleep hygiene = limit caffeine/alcohol/cigarettes, less noise/lights/screen use, reduce sleep, regular pattern
- Medications = zopiclone, zolpidem, zaleplon, mirtazapine, quetiapine, melatonin
126
Give 2 examples of hypnotics
1. Zopiclone
2. Zolpidem
3. Zaleplon
SE = drowsiness, GI upset
Used in insomnia, NEVER first line
127
What are benzodiazepines used for?
```
Insomnia
Severe anxiety
Status epilepticus
Agitation
Alcohol withdrawal
```
128
Give 2 side effects of benzodiazepines
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
What is buspirone used for?
GAD
- Safer than BDZs and less SE
SE = nausea, dizziness, headaches, fatigue, confusion
CI = alcohol, MAO-Is
130
What is postpartum depression?
Extreme sadness, decreased energy, anxiety, crying episodes, irritability
Onset 1 week to 1 month following birth
Can negatively affect newborn
131
What is the treatment for postpartum depression?
Antidepressants (for severe)
132
What is postpartum psychosis?
Depressive or manic symtoms
First rank symptoms schizophrenia
Emotional lability
133
Who is at risk of postpartum psychosis?
1st time mums
Previous psychosis
instrumental delivery
FHx
134
What is the treatment for postpartum psychosis?
Hospitalise = baby stays with mum
Antipsychotics
ECT
135
What are the principles that underly the mental health act?
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
Briefly describe Section 2 of the MHA
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
Briefly describe Section 3 of the MHA
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
Briefly describe Section 4of the MHA
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
Briefly describe Section 5(2) of the MHA
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
Briefly describe Section 5(4) of the MHA
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
Briefly describe Section 135 of the MHA
Needs court oder to allow police to take you from private property to safety (police station or hospital)
Up to 36 hours
142
Briefly describe Section 136 of the MHA
Police have power to take too from public place to safety (police station or hospital)
Up to 24 hours
