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Y4 medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

what is the definition of psychosis?

A

an individual is experiencing a reality different to everyone else (the individual does not realise they are psychotic)

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2
Q

name some symptoms of psychosis.

A
  • hallucinations
  • delusions
  • formal thought disorder
  • disorders of one self
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3
Q

what is a hallucinations?

A

the perception of an object in the absence of an external stimulus (in clear consciousness) that others cannot percieve

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4
Q

what type of hallucination is most common in psychosis?

A

auditory hallucination

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5
Q

what can olfactory halucination indicate?

A

frontal lobe pathology

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6
Q

what is pseudohallucination ?

A

‘hearing voice in my head’ - not psychosis!!

hallucinations are external, not internal

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7
Q

what is the likely diagnosis when someone is visually hallucinating?

A

delirium - usually a organic pathology

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8
Q

what is a delusion?

A

fixed, firmly held beleif that is false , that cannot be reasoned away, that is held despite evidence to the contrary is out of keeping with the persons sociiocultural norms

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9
Q

what are teh types of delusions?

A

persecutory (believe ppl coming after you)
grandiose (think your’e amazing)
reference (about urself)
erotomanic (think someones in love with you)
hypochrondriacal (health anxiety)
nihilistic (feeling you are dead)
bizarre (absolute not possible )
control (think someone/thing is controlling you)

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10
Q

what is formal thought disorder?

A

a problem of speech (+ flow of thought) which means each sentence doesnt follow on from the next

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11
Q

what is disorders of the self?

A

when an individual can no longer distinguish between themself and the world
icnludes:
- thought insertion
- thought broadcasting
- passivity phenomena

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12
Q

what organic disorders must you rule out in psychosis?

A
  • delirium
  • dementia
  • infection
  • endocrine disorders
  • TLE
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13
Q

name the three types of functional psychosis?

A
  • schizophrenic (bizarre, persecutory, 3rd person)
  • manic (graniose, 2nd person)
  • depressive (guilt, poverty, nihilism, 2nd person)
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14
Q

what is shcizophrenia?

A

a disorder or group of disorders charatcerised by psychotic episodes (positive symptoms) and negative symptoms

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15
Q

symptoms seen in schizophrenia (5 a’s)

A

Autism
flat Affect (or incongruous)
Ambivalence
loosening of Associations (thought disordeR)
Amotivation or Apathy

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16
Q

name schneiders first rank symptoms for schizophrenia

A
  • hearing ones own thouhgts spoken alou d
  • hallucinatory voices in form of statment + reply, pt hears voices speaking about them in 3rd person
  • hallucinatory voices in running commentary
  • thought broadcasting
  • thought withdrawal , thought insertion
  • influence of others on feelins, drive and volition of common events
  • delusional perception
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17
Q

prevalence of schizophrenia in Uk?

A

1%

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18
Q

name some causes ??? of schizophrenia

A
  • role of family/upbringing
  • obstetrics complications (forcep delivery)
  • winter births
  • illicit drugs (amphetamines, cannabis)
  • genetics (higher incidence in genetic twins)
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19
Q

how to know whether to treat a pt with schizophrenia informally or section them ?

A
  • dependds on risk and insight

low or high risk
if they understand they have schizophrenia then more likely to take drugs

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20
Q

how to do a biopsychosocial assessment of schizophrenia??

A

bio: blood tests, drug tests, CT - rule out organic problem, check compliance
psycho: MSE, collateral Hx
social: carers and housing

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21
Q

biopsychosocial Tx of schizophrenia?

A

bio: antipsychotics
psycho: supportive counselling, family therapy
social: debts, benefits, housing, CPN, social worker

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22
Q

name the types of mood disorders

A
  • depressive disorder
  • bipoalr disorder
  • persistant mood disorder
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23
Q

what are the core symptoms of depression?

A
  • continuous low mood for at least 2 wks
  • lack of energy
  • lack of enjoyment/interest (anhedonia)
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24
Q

what are the somatic/biological symptoms of depression?

A
  • sleep changes
  • appetite and weight changes
  • diurnal variation of mood (mornings are worst)
  • psychomotor retardation/agitation (dont bother getting up)
  • loss of libido
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25
Q

what are the cognititve symptoms of depression>

A
  • low sefl esteem
  • guilst/self blame
  • hopelessness
  • hypochondrical thoughts
  • poor concentration/attention
  • suicidal thoughts
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26
Q

diagnosis of depression (mild, moderate, severe, severe with psychotic symptoms)

A

mild - 2 core + 2 others (abel to function)
moderate - 2 core + 3/4 others
severe - 3 core + at least 4 others
severe with psychotic symptoms (auditory hallucinations, delusions)

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27
Q

what is the incidnece of PND?

A

10-15% within 1-2 months post partum

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28
Q

symptoms of hypomania?

A
  • mildly elevated, expansive or irritable mood
  • increased energy/activity
  • increased self esteeem
  • sociability, talkativeness over familiarity
  • increased sex drive
  • reduced need for sleep
  • difficulty in focussing on one task alone
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29
Q

what is hypomania?

A

periods of over-active and excited behaviour that can have a significant impact on your day-to-day life. Hypomania is a milder version of mania that lasts for a short period

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30
Q

symptoms of mania?

A
  • elevated/expansive/irritable mood (1 week)
  • icnreased energy/activity
  • gradiosity//increased self-esteem
  • pressure of speech
  • flights of ideas/racing thoughts
  • distractibility
  • reduced need to sleep
  • increased libido
  • psychotic symptoms (extreme)
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31
Q

what are teh two types of persistant mood disorder?

A

cyclothymia: mild periods of elation/depression, early onset, chronic cause (less severe bipolar disease)

dysthymia: chronic low mood not fulfilling the criteria of depression (less severe depression)

** both must be present for 2 yrs to make a diagnosis

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32
Q

what is mixed affective state?

A

characterised by either mixture or a rapid alternation of hypomanic, manic and depressive symptoms

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33
Q

what is the definition of bipolar I and bipolar II?

A

bipolar I: 1 or moe manic episodes or mixed episodes, +- 1 or more depressive episodes

bipolar II: 1 or more depressive episodes with at least 1 hypomanic episode

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34
Q

causes of mood disroders? (biopsychosocial)

A

bio: genetic, brain illnesses, physical illnesses,

psycho: childhood experiences, view of yourself and the world, personality traits

social: work, housing, finances, relationships, support etc

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35
Q

Tx of mood disorders?

A

bio: pharm , ECT (electroconvulsive tx) , rTMS (Repetitive transcranial magnetic stimulation), tDCS (Transcranial direct current stimulation)

psycho: psychoeducation, CBT, IPT, psychodynamic, mindfulness

social: family, housing, finance, employment, general coping strategies

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36
Q

what pharm tx is used in psychiatry

A
  • antidepressants (e.g. SSRIs)
  • mood stabilisers (lithium, valproate, carbamazepine, lamotrigine)
  • antipsychotics
  • anxiolytics
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37
Q

what are teh indications for ECT?

A
  • severe depressive illness
  • life threatening illness
  • prolonged and severe manic episode
  • catatonia
  • high suicide risk
  • stupor
  • severe psychomotor retardation
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38
Q

what is ECT?

A

treatment that involves sending an electric current through the brain to trigger an epileptic seizure

occurs twice a week, max of 12 treatments

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39
Q

what are personality disorders?

A

conditions in which a idnividual differs significantly from an average person in terms of how they think, percieve, feel or relate to others

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40
Q

how many types of personality disorders are they?

A

10

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41
Q

what are the cluster A group of personality disorders?

A

paranoid: suspicious and mistrustful, misintepreting events as persecutory, bearing grudges, strong sense of personal rights

schizoid: detached, solitary, little interest in ppl or sex

schizotypal: eccentric, odd behaviour and thinking, unconventional beliefs

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42
Q

what are the cluster B group of personality disorder?

A

borderline: emotional instability, impulsivity, chronic feelings of emptiness, parasuicidal acts, intense and unstable relationships , fear of abandonment

narcissistic: present as grandiose, self-important, degrading others

antisocial: present wiht unconcern for the feelings of others, disregard rules, impulsivity, low tolerance to fustration, failure to take responsibility

historionic: present as theatrical, dramatic, exhibit superficial emotionality, seductiveness, suggestibility

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43
Q

what is in cluster C group of personality disorders?

A

obsessive compulsive: present as rigid, perfectionistic, preoccupied with rules, order and routine, higher snese of morality

dependent: present as needing others to make decisions for them, fear abandonment, unable to cope alone, need for resassurance

anxious-avoidant: present with persistent anxiety, sensitive to rejection, tend to avoid relationships unless acceptance is guarenteed

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44
Q

what is attachment theory?

A

the emotional bond between parent + child is crucial for childs survival
experience of consistent + responsive caregiver gives sense that world is safe and they are loved

helps brain develop and enables necessary wiring and chemical connection to allow regulation of feelings

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45
Q

Mx for personality disorders?

A
  • harm minimisation (elastic bands or ice cubes on wrists)
  • emotional management
  • boundaries (explain expectations of the service user + be consistent and reliable)
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46
Q

Tx for personality disorders?

A
  • psychotropic medication only to treat comorbidities
  • group Tx/therapeutic community
  • DBT (dialectical behaviourhal therapy)
  • mentalisation base therapy
  • transferance focused therapy
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47
Q

are children allowed to refuse life saving treatment?

A

No, they cannot

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48
Q

are children allowed to consent to procedures

A

yes they are - if they have capacity

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49
Q

what is the mental capacity act 2005

A

single test of capacity

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50
Q

principles of MCA 2005?

A

presumption of capacity at all times
a new legal right to support individuals in making their own decisions
pts have the right to make unwise decisions

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51
Q

if a pt is unconcsious and need an op, can you operate?

A

yes - if its in their best interest
- try and consult with next of kin
- try to regain pt consciousness beofre op

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52
Q

what is the two stage capacity test?

A
  1. is there an impairment of or disturbance in the functioning of a persons mind
  2. has it made the person unable to make a particular decision
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53
Q

what are the parts of capacity test to understand if a pt has capacity

A
  • understand the information
  • retain the information
  • use or weigh up info
  • communicate decision
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54
Q

what are advance decisions?

A

they are anticipatory refusals
only relate to medical tx
person must be >18 and have capacity when making AD

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55
Q

what are lasting power of attorney?

A

enables a mentally capable person to plan to incapacity
can extend to property, welfare, healthcare matters
still have to make decisions in pts best interest

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56
Q

what is deprivation of liberty safeguards (DOLS)?

A

for patients in hospital or care homes who lack capacity - allows pts who are not allowed to leave wards have some freedom e.g. supervised walks
MDT assessment

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57
Q

what is section 5(4) of the mental health act?

A

power granted to RMNs to detain an inpatient fro up to 6 hours for medical assessment where mental illness in suspected
(cannot be used in ED, need to be admitted to hosp)

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58
Q

what is section 5(2) of mental health act?

A

the consultant or nominated deputy can detain an inpatient for up to 72 hrs under MHA
-> to allow fuller assessment and MHA to be completed
(cannot be used in ED, need to be admitted to hosp)

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59
Q

what is section 2 of the MHA?

A

2 doctors (1 of whom shld be section 12(2) approved) & 1 AMHP
in community or inpatient (not prison) section for max 28 days for assessment + treatment of mental disorder
(pt can appeal within first 14 days)

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60
Q

what is section 3 of the MHA?

A

2 doctors (1 of whom shld be section 12(2) approved) & 1 AMHP
in community or inpatient (not prison) section for max 6 months for treatment of mental disorder
(pt can have 1 appeal)

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61
Q

what is section 136 of the MHA?

A

police power to remove to a place of safety from a public place for an assessment by an AMHP and 1 Dr
help up to 72 hrs to allow assessment
police to stay with person

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62
Q

what is section 17/117 of MHA?

A

section 17 - whilst detained in hopsital under S2 or S3 a pt may leave under S17 (go on walks, go home)
section 117 - anyone whos been under S3 is entitled to S117 aftercare from local authority

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63
Q

what is a community treatment order?

A

patient on S3 can be considered for a CTO
pt is well enough to leave hsopital but MUST take tx under supervision of nurses otherwise can be recalled to hospital

64
Q

definiton of suicide

A

a fatal act of self-injury, udnertaken with more or less conscious self-destructive intent, however vague and ambiguous

65
Q

definition of para-suicide?

A

similar to suicide - but for whatever reason the victim survived the attempt

66
Q

defintion of deliberate self-harm?

A

an act of self-harm where the action was not the intention of death, but to cause harm

67
Q

why are men more successful to die from suicide than women?

A

the way they choose to commit suicide is mroe aggressive therefore higher chance to be successful

68
Q

why are people most likely to commit suicide in the 14 days post discharge from psychiatric hsopital?

A
  • unplanned idscharge
  • lack on continuity of care
  • unemployment
  • suicidal behaviour prior to admission
69
Q

risk factors for suicide

A
  • living alone
  • Hx of mental illness/suicidal behaviour
  • unemployment
  • chronic physical illness
  • alcohol abuse
  • drug abuse
  • FHx
  • hopelessness
  • certain professions e.g. vets, soldiers, farmers, doctors
70
Q

what do you ask in a Hx of someone you as attempted suicide

A
  • triggers
  • preparation e.g. planning in advance, final acts
  • circumstances e.g alone , precautions against discovery, alcohol, the acts itself, what did they think/want to happen?
  • after the act e.g. didnt seek help, regret failure, intent
  • psychiatric Hx + collateral Hx
  • what do they think now? guilt? ongoing thoughts?
  • MSE
71
Q

which mental health illnesses have a higher associaition with homicide?

A
  • DSPD
  • alchohol drug/alcohol misuse
  • schizophrenia (specific persecutory delusions or hallucinations, command auditory hallucinations)
72
Q

what is anxiety?

A

feeling on unease, worrying, fear with physiological arousal
becomes a problem when someones brain is not able to dsitinuish between physical and psychological threat e.g. false alarm

73
Q

what effect does anxiety have?

A

physiological arousal
racing thoughts
inability concentrate
cognitive bias - attentional focus

74
Q

what are teh anxiety disorders?

A
  • panic disorder
  • social anxiety disorder
  • specific phobias
  • health anxiety
  • OCD/BDD
  • PTSD
  • GAD
75
Q

definition of specific phobias?

A

marked fear of specific object or situation e.g. spiders
marked avoidance of such object or situations

76
Q

what is panic disorder?

A

a fear of you own physiological and psychological reactions
impending collapse, insanity or death

77
Q

symptoms of panic disorder?

A
  • sense of dread
  • shaky
  • feel faint
  • choking
  • rapid heart beat
  • wobbly legs
78
Q

what is GAD?

A

specific content of (type 1) worries varies
included “worries about worries” (type 2 worries)
usually accompanied with low level physical symptoms ( insomnia, msucel tension, GI problems, headahce)
often maintained by the belief that worry is useful (e.g. motivation, prepares for problems)

79
Q

definition of social anxiety disorder (social phobia)?

A

fear of negative evaluation by others
can lead to avoidance of feared situations, use of safety behaviours, with unhelpful ‘port mortems’ following social encounters

80
Q

definition of OCD?

A

unwanted recurring distressing intrusive thoughts or images (=obsessions)
e.g. being contaminated, causing harm, aggression impulses, sexual imagery

to manage the stress cuased by intrusiosn the pt conducts neutralising behaviours (= compulsions) e.g. washing, checking, praying, counting, repeating words

81
Q

definition of BDD?

A

characterised by preoccupation with an imagined defect in apperance
-> conusuming behviours e.g. mirror gazing, comparing to others

82
Q

definition of PTSD

A

caused by exposure to event of situation of exceptionally threatening or catastrophic nature which would be likely to cause pervasive distress in almost anyone
e.g. warfare, car crash, terrorism

83
Q

3 mian features of PTSD?

A
  • re-experiencing
  • avoidance
  • hyperarousal - scan for threats, jumpy
84
Q

common PTSD cormorbities?

A

substance misuse
depression
other anxiety disorder

85
Q

problems associated with anxiety disorders?

A
  • icnreased autonomic arousal
  • alcohol and drug dependence
  • impaired sleep pattern
  • avoidance
  • worry
  • time consuming anxiety reducing behaviours
  • procrastination
  • reduced concentration
  • impact on functioning - work, social, health
86
Q

differentional diagnsis ofr anxiety

A
  • adjustment disorders or bereavement
  • other functional psychiatric illnesses
  • organic cuases: endocrine (thyroid), drug induced (steroids, antihypertensiveS) , neurological (MS, dementia, lupus), alcohol and illicit drug misuse, infection, anaemia,
87
Q

first line Tx of anxiety

A

CBT - graded expsoure/systematic desensitisation
(SSRIs cna be given first line if the pt wants it)

88
Q

side effects of adrenergics (adrenaline e.g.)

A
  • sweating
  • tremor
  • headaches
  • nausea
  • dizziness
89
Q

commone side effects of muscarinics (acetycholine e.g.)

A
  • dry mouth
  • difficulty urinatin, urinary retention
  • difficulty swallowing
  • thirst
  • hot and flushed skin
  • dry skin
90
Q

common side effects of histamine?

A
  • dry mouth
  • drowsiness
  • dizziness
  • N+V
91
Q

name the types of anti-depressants?

A
  • SSRIs (most common as fewer SE)
  • NSRIs
  • mirtazapine
  • tricyclics
  • MAOIs
92
Q

name some SSRIs

A

sertraline (first line)
citalopram
fluoxetine
paroxetine
vortioxetine

93
Q

commen SE of SSRIs

A
  • restlessness, agitation on initiation
  • nausea, GI disturbance
  • headache
  • weights changes
  • sexual dysfunction
    (- bleeding, suicidal ideation)
94
Q

what is the main SE of citalopram?

A

QTc prolongation

95
Q

what is serotonin syndrom ?

A

when switching from fluoxetine to another SSRI can get serotonin syndrome (increased serotonin) as fluoxetine has a very long half life

headaches
agitation
hypomania
confusions
coma
shiverin g
sweating
hyperthermia
tachycardia
hyperreflexia
tremor

96
Q

what is discontinuation syndrome?

A

caused when antidepressants are stopped too quickly (go slow!)

  • sweating
  • shakes
  • agitation
  • insomnia
  • headaches
  • irritability
  • n + v
  • paraesthesia
  • clonus

most commonly in paroxetine and venlafaxine

97
Q

name some NSRIs

A
  • duloxetine
  • venlafaxine
98
Q

SE of NSRIs?

A

similar to SSRIs, but greater potential for sedation, nausea and sexual dysfunction

99
Q

SE of mirtazapine?

A

major SE are sedation and weight gain

100
Q

name some tricyclics?

A

lofepramine
nortriptyline
amitriptyline

101
Q

SE of tricyclics?

A

muscurinic and histamine SE
+ can cuase QTc prolongatio n and arrythmias

102
Q

name the mian interaction of MAOIs

A

tyramine reaction = hypertensive crisis
therefore avoid foods like cheese, pickled meats, wine

103
Q

SE of antipsychotics?

A
  • sedation
  • extrapyramidal side effects
  • weight gain
  • acute dystonia
  • oculogyric crisis
104
Q

atypical antipsychotic SE?

A

weight gain
dyslipidaemia and diabetes

105
Q

typical antipsychotics SE?

A

extra-pyramidal SE
dizziness
sexual dysfunction

106
Q

name some typical antipsychotics

A

haloperidol
flupenthixol
zuclopenthixol
chlorpromazine

107
Q

name some atypical antipsychotics?

A

clozapine (common!)
olanzapine
risperidone
quetiapine

108
Q

name the extrapyramidal SE

A

bradykinesia
muscle stiffness
tremor
tardive dyskinesia
akathisia

(parkinsons symptoms basically)

109
Q

what monitoring is needed for antipsychotics?

A

at beginning: FBC, lipids, LFT, HbA1C, weight, ECG, BP, pulse

weekly: weight (they cuase weight gain and diabetes!)

three months; FBC, LFT, HbA1C, weight, ECG, BP, pulse

yearly:FBC, lipids, HbA1C, weight, ECG, BP, pulse

110
Q

what is the monitoring for ppl on clozapine due to the major SE?

A

significant potential for agranulocytosis (severe leukopenia)
therefore need monitoring of FBC weekly for first 18 weeks

111
Q

major clozapine SEs?

A

agranulocytosis
GI hypomobility = constipation = potentially fatal bowel obstruction
hypersalivation
urinary incontinence

112
Q

indication fro clozapine

A

used in schizophrenia after two antipsychotics have been prescribed (because of major SEs)

113
Q

what is neuroleptic malignant syndrome?

A

rare life threatening reaction to antipsychotics
characterised by fever, confusion, muscle rigidity, sweating, autonomic instability

death occurs by rhabdomyolysis, renal failure, seizures

114
Q

risk factors for neuroleptic malignant syndrome?

A

high potency typical antipsychotics in ppl who have never taken antipsychotics
high doses
young men

115
Q

what is the tx for neuroleptic malignant syndrome?

A
  • emergency referral to A+E,
  • stop antipsychotics
  • fluid resus
  • reduce temp
116
Q

what can be used to treat extra pyramidal side effects in use of antipsychotics?

A

anticholinergics e.g.
- procyclidine (most commonly useD)
- benzatropine
- trihexphenidyl

117
Q

name the anxiolytic drugs.

A

beta blockers
benzodiazepines
pregabalin
antidepressants

118
Q

most commonly used beta blocker in anxiety ?

A

propanolol (contraindicated in asthma !!)

not very effective in long term anxiety disorder (not used v often in secondary care, more often in priamry care)

119
Q

why do benzodiazepines have to be used cautiously?

A

significant potential for misuse, tolerance and dependence
use for no more than six wks at once
occasionally cause paradoxical disinhibition

120
Q

why is pregabalin being used more in anxiety?

A

as less potential for misuse and dependence than benzodiazepines
(still can be misused - should only be used fro max 6 wks)

121
Q

first line meds for OCD?

A

high dose antidepressants

122
Q

what drugs are hypnotics (used as sleeping tablets)?

A
  • benzodiazepines (temazepam, lormatazepam nitrazepam)
  • non benzodiazepines (zopiclone, zolpidem)
123
Q

how are hypnotics given to reduce misuse?

A

signigficant potential for misuse, dependence, rebound insomnia
threefore use for only 2 weeks, take for 5/7 days each week to reduce potential for tolerance

124
Q

what are mood stabiliser drugs?

A
  • lithium
  • anticonvulsants
  • second generation (atypical) antipsychotics
125
Q

what is common mental illness that mood stabilisers treat?

A

bipolar mood disorder

126
Q

SE of lithium?

A
  • GI disurbance
  • metallic taste and /or dry mouth
  • fine tremor
  • polydipsia
  • polyuria
  • weight gain
  • hypothyroidism
  • renal impairment
127
Q

monitoring on lithium?

A

U+Es and TFTs
because of renal impairments and hypothyroidism

128
Q

symptoms of lithium toxicity?

A

confusion
coarse tremor
n+v
ataxia
seizures

**ensure pts are well hydrated to reduce lithium toxicity

129
Q

what is the first line tx for bipolar mood disorder?

A

quetiapine (a second generation antipsychotic)

130
Q

name some anticonvulsants that can be used as mood stabilisers?

A
  1. sodium valproate (becareful in child bearing age females)
  2. carbamazepine
  3. lamotrigine
  4. pregabalin
131
Q

what drugs are used for cognitive symptoms of dementia?

A
  • acetylcholinesterase inhibitors (donepezil, rivastigmine)
  • memantine (NMDA receptor antagonist)
132
Q

what drugs are used to treat ADD and ADHD ?

A
  • methylphenidate (aka ritalin)
  • dextroamphetamine
  • atomexetine
133
Q

what are personality disorders?

A

A personality disorder is a condition that affects how you think, feel, behave or relate to other people

134
Q

what is dissocial personality disorder?

A

characterized by disregard for social obligations, and callous unconcern for the feelings of others, can become violent + tendancy to blame others

amoral
antisocial
asocial
psychopathic
sociopathic

135
Q

what is emotionally unstable personality disorder? (also known as borderline personality disorder)

A

tendency to act impulsively and without consideration of the consequences

aggressive
borderline
explosive

136
Q

Tx for personality disorders?

A

CPA (care programme approach)
psychotherapy
dialectal behaviour therapy
only treat iwrth drugs ifthere are co-morbidities (e.g. anxiety, depression)

137
Q

what is autism spectrum disorder?

A
  • persistent deficits to initiate and sustain social interaction and communication
  • restricted, repetitive and inflexible patterns of behaviour

+/- interests that are atypical or excessive for the individual’s age and sociocultural context
+/- Sensory differences

138
Q

name some comorbidities with ASD?

A
  • epilepsy
  • visual or hearign impairment
  • mental health (depression, anxiety, OCD)
  • learnign disability
  • sleep disorders
139
Q

Mx of autism?

A

bio: meds for comorbidities

psycho: early intensive behavioural intervention (EIBI)
- interventions for behaviour that challenges
- positive behavioural support (PBS)
- family therapy
- communications interventions (SALT)
- OT (sensory integration therapy)
(- music therapy)
(- advise from dietician)

social: social worker to work w family, school challenges, do they need to go to placements?

140
Q

name some important variables when assessing a patients risk (dynamic and static)

A

static: gender, personality disorders, genetics, previous history of self harm, adverse childhood event

dynamic risk factor - mental disorder, substance misuse, bereavement, unemployment, no social contact, comorbid physical conditions, age, marital status

141
Q

what sedative would you give to a patient who has delirium and de escalation methods havent worked

A

IM haloperidol

142
Q

what sedative would you give to a patient (with parkinsons or lewy body dementia) who has delirium and de escalation methods havent worked

A

IM lorazepam
as IM haloperidol can cause extrapyramidal SE

143
Q

what are teh highest causes of mortality due to alcohol?

A
  • fights and falls
  • lvier failure
  • pancreatitis
  • overdose
  • withdrawal
  • wernikes encephalopathy
144
Q

symptoms of alcohol toxicity?

A

head injury
confusion
shaking/seizures
hallucinations
vomit blood or coffee grounds
severe abdo pain
sudden yellow

145
Q

signs of early alcohol withdrawal?

A
  • tremor
  • sweating
  • nausea
  • anxiety
  • tachycardia
146
Q

signs of late alcohol withdrawal

A
  • delirium tremens
  • disorientation
  • hallucination -tremor
  • BP, pulse, fever, motor incoordination
147
Q

signs nd symptoms of wernickes encephalopathy?

A
  • ataxia
  • nystagmus
  • opthalmoplegia
  • altered consiousness
  • fever
  • hypothermia
  • ptosis
  • abnormal pupillary reflexes
148
Q

cause fo wernickes encephalopathy?

A

deficiecny of vitamin B1

149
Q

treatment of wernickes encephalopathy?

A

parenteral thiamine

150
Q

what is korasakoffs syndrome?

A

caused from long term thiamine deficiency (long term wernickes encephalopathy)
signs are same as wernickes plus short term memory loss - nroamlly need to go into care/need carer

151
Q

sign of opiate overdose?

A
  • pinpoint pupils
  • decreasing consciousness
  • slow breathing
  • death
152
Q

Tx of opiate overdose?

A

naloxone IM

153
Q

signs of opiate withdrawal?

A
  • sweting
  • rhinorrhea
  • tachycardia
  • restlessness
  • dilated pupils
  • lacrimation
  • goosebumps

later:
- N+V
- diarrhoea
- insomnia
- abdo cramps
- muscle pains

154
Q

tx for opiate withdrawal ?

A
  • methadone
155
Q

what is the tx for benzo withdrawl?

A

diazepam - as it is long acting

156
Q

which two antidepressants are used preferred for patients who are breastfeeding?

A

sertraline and paroxetine

Y4 medicine (18 decks)

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