Psychiatry 🧠 Flashcards
PTs with lewy body dementia are highly sensitive to what type of medication?
what happens if they take it?
neuroleptics
increased Parkinsonism - leading to falls
first line treatment for paranoia schizophrenia
atypical antipsychotics - risperidone
why would someone prefer atypical to typical antipsychotics like haloperidol
typical antipsychotics have higher risk of extra-pyramidal side effects
what are extra-pyramidal symptoms
inability to sit still
involuntary muscle contractions
tremors
stiff muscles
involuntary facial movements
classic triad of hydrocephalus
urinary incontinence
dementia
gait abnormality
if nutritional intake is resumed too rapidly after a period of low calorie intake the patient is at high risk of ?
refeeding syndrome
signs of refeeding syndrome
tachycardia
pedal odema
confusion
occurs 24-72 hours after refeeding begins
section 2 MHA
Admission for assessment for up to 28 days, non-renewable
The application for admission is made by an Approved Mental Health Professional (AMHP) or the patient’s nearest relative
Requires the recommendation of 2 doctors, one of whom must be ‘approved’ under Section 12(2) of the MHA
section 3 MHA
Used in emergencies where a section 2 would cause “an undesirable delay”
It requires the recommendation of only one doctor and either an AMHP or the nearest relative
Allows a person to be detained for up to 72 hours, whereby it is usually converted to a section 2
section 5(2) MHA
A voluntary patient in hospital may be legally detained by a doctor for 72 hours
section 5(4) MHA
A section 5(4) is similar to a section 5(2) but is used by nurses and only lasts for 6 hours.
section 17 MHA
A Supervised Community Treatment (also known as a Community Treatment Order)
section 135 MHA
A court order that allows the police to enter a property to remove a person to a Place of Safety (either the police station or more commonly A&E)
section 136 MHA
The police can bring someone from a public place who appears to have a mental disorder to a Place of Safety (either the police station or more commonly A&E)
For a patient to be treated under the Mental Health Act (MHA) what criteria must they meet?
They must have a mental disorder
There must be a risk to their health/safety or the safety of others
There must be a treatment (however this can include nursing care, not just drugs)
what is munchausens syndrome
patients intentionally fake signs and symptoms in order to gain attention and play the patient role
first line treatment for ADHD (meds)
methylphenidate
what is methylphenidate
first line medication for adhd in children aged 5 or over
it is a CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor
what needs to be monitored when children are on methylphenidate
weight and height every 6 months
if there is inadequate response from methylphenidate what do you do
switch to lisdexamfetamine
then those who can’t tolerate its side effects should switch to dexamfetamine
clinical features of autism
impaired social communication and interaction
repetitive behaviours, interests and activities
often associated with intellectual or language impairment
clinical features of anorexia nervosa
low BMI
hypotension
bradycardia
enlarged salivary glands
lanugo hair
amenorrhea
typical serum chemistry results include ? for anorexia nervosa patients
hypokalaemia
low sex hormone levels
ketoacidosis
hypomagnesaemia
hypophosphataemia
hypocalcaemia
hypoglycaemia
what serum chemistry would you see with an anorexic patient who purges
hypokalaemia
metabolic alkalosis
what serum chemistry would you see with an anorexic patient who uses laxatives
hypokalaemia
hyponatraemia
metabolic acidosis
what investigations should you perform on a patient with anorexia
FBC
U+E
TFTs
LFT
urinalysis
ECG - prolonged QT - hospital admission
Bone densitometry - after 1 year diagnosis
what is fatal about a QT syndrome in anorexia patients
increases risk of arrhythmias such as ventricular fibrillation
alternative causes when diagnosing anxiety
hyperthyroidism
cardiac disease
medication-induced anxiety
what medications may trigger anxiety
salbutamol
theophylline
corticosteroids
antidepressants
caffeine
NICE step 1 approach to GAD
education about GAD and active monitoring
NICE step 2 approach to GAD
low intensity psychological interventions
NICE step 3 approach to GAD
high intensity psychological interventions or drug treatment
NICE step 4 approach to GAD
highly specialist input
first line NICE drug treatment to GAD
sertraline SSRI
after sertraline what should be offered for GAD
alternative SSRI or SNRI
if these aren’t tolerated then consider pregabalin
b-blockers effected for somatic anxiety symptoms
low dose anti-psychotics can also be used
Busipirone - 5HT1A agonist - is suitable for short term
features of panic disorder
recurrent attacks of severe anxiety not restricted to situations/circumstances
between attacks minimal anxiety symptoms
attacks last for minutes
clinical features of panic disorder
breathing difficulties
chest discomfort
palpitations
tingling or numbness in hands, feet, mouth
shaking, sweating, dizziness
psychological management of panic disorder
reassurance
CBT - first line
education
cognitive restructuring
drug management of panic disorder
SSRIs are first line but 2nd line to CBT
clomipramine
What is the underlying cause of Korsakoff’s syndrome
Untreated Vitamin B1 (thiamine) deficiency
Management of alcohol withdrawal
Long acting benzodiazepines e.g chlordiazepoxide or diazepam
MOA of amitriptyline
Inhibits uptake of monoamines at the presynaptic membrane
What is Korsakoff’s syndrome
Marked memory disorder often seen in alcoholics
Anterograde amnesia and retrograde amnesia that leads to confabulation
