Psychiatry Flashcards
MSE
Appearance and behaviour
Speech
Mood: sleep, appetite, libido, concentration
Thought abnormalities: disorder, passivity, delusions
Hallucinations
Insight and mental capacity
Risk: to others, themselves, vulnerable adult, children at risk
increased suicide risk
Male
Elderly
Living alone
Separated, divorced or widowed
Unemployed or retired
Physical illness
Psychiatric illness
Alcoholism
Sociopathic personality disorder
Violent method of DSH
physical exam in psych exam
Thyroid
Substance withdrawal
Head injury
Epilepsy
Cerebrovascular diseases
Intracranial pathology
Focal neurological signs
Meningism
Organic confusional states
Intoxification
Injury
investigations in psych assessment
Obs
Blood glucose
Urinalysis
Breath alcohol
UE, FBC, CXR, CT scan
Urine drug screen
TFT
EEG
cognitive assessment features
Level of consciousness
Orientation
Attention and concentration
Registration of new information
Recall of recent and distant memories
Ability to interpret instructions and carry out tasks
anti-psychotic drugs
Oral tranquilization:
Psychotic context: lorazepam 1-2mg PO and haloperidol
No psychotic context: lorazepam 1-2mp PO
IV benzodiazapine or IV haloperidol
mental health act in A&E
Patient must be suffering from a mental health disorder
Patient must be requiring emergency hospital admission to protect health and safety of the patient or for the protection of othes
Section 2: 2 doctors and social worker, 28 days for assessment and treatment
Section 136: police officer can detain
organic causes of acute confusional state
Hypoglycaemia
Head injury
Hypoxia
Distended bladder
Post-ictal confusional states: epilepsy or drug overdose
Organic brain syndromes
psych causes of acute confusional state
Past history of violent behaviour
Schizophrenia and other psychoses: mania or paranoid disorders
Personality disorder: sociopathic, impulsive, explosive
Learning disability
CAM criteria for delirium
Confusion that has developed suddenly and fluctuates, and
Inattention — ask if the person is easily distracted or has difficulty in focusing attention, and either
Disorganised thinking — ask if the person’s thinking is disorganised, incoherent, illogical, or unpredictable (for example they have an unclear flow of ideas, change subject unpredictably, or have rambling or irrelevant conversation), or
Altered level of consciousness — ask about changes in level of consciousness from alertness to: lethargy (drowsy, easily aroused); stupor (difficult to arouse); comatose (unable to be aroused); or hypervigilant (hyper-alert).
DSM-5 criteria for delirium
A. Disturbance in attention (reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
B. The disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during a day.
C. An additional disturbance in cognition (such as memory deficit, disorientation, language, visuospatial ability, or perception).
D. The disturbances in Criteria A and C are not better explained by a pre-existing, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma.
E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication, or withdrawal (due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple aetiologies.
4ATs test features
This is a short, four-item tool designed for use in clinical practice.
The four items are alertness, cognition (a short test of orientation), attention (recitation of the months in backwards order), and the presence of acute change or fluctuating course.
