Psychiatry Flashcards
Paracetamol overdose <1 hour + dose <150mg/kg - managament?
activated charcoal
Paracetamol staggered overdose or ingestion >15 hours ago - management?
Start N-acetylcysteine immediately
When do you consider a liver transplant for paracetamol overdose?
Arterial pH < 7.3, 24 hours after ingestion
OR
All of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
Patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol - management?
N-acetylcysteine
patients who present > 24 hours with paracetamol overdose if they are clearly jaundiced or have hepatic tenderness + high ALT - management?
N-acetylcysteine
Difference between type I and type II bipolar disorder?
Type I - mania and depression
Type II - hypomania and depression
Severe lithium toxicity management?
Haemodialysis
Criteria for anorexia nervosa?
DSM 5
Management of anorexia nervosa in young people?
‘anorexia focused family therapy - 1st line
CBT - 2nd line
Management of anorexia nervosa in adults?
one of:
- individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
- specialist supportive clinical management (SSCM).
Clinical features of anorexia nervosa?
- reduced body mass index
- bradycardia
- hypotension
- enlarged salivary glands
Physiological signs of anorexia nervosa?
- hypokalaemia
- low FSH, LH, oestrogens and testosterone
- raised cortisol and growth hormone
- impaired glucose tolerance
- hypercholesterolaemia
- hypercarotinaemia
- low T3
Criteria for bulimia nervosa?
DSM 5
- recurrent binge eating
- lack of control when eating
- compensatory behaviour - laxatives, vomiting
- at least once a week for 3 months.
Management of bulimia nervosa in adults?
bulimia-nervosa-focused guided self-help - 1st line
Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) - 2nd line
Management of bulimia nervosa in children?
bulimia-nervosa-focused family therapy
Pharmacological option for bulimia nervosa?
Fluoxetine
Difference between bipolar type 1 and type 2?
Type 1 - mania and depression
type 2 - hypomania and depression
How do you differentiate mania from hypomania?
psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations)
Management of bipolar disorder?
Lithium - mood stabiliser (valproate is an alternative)
mania - antipsychotics e.g. olanzapine or haloperidol
depression - talking therapies, fluoxetine
Acute stress disorder vs PTSD time frame?
first 4 weeks = acute stress
>4 weeks = PTSD
Management of acute stress disorder?
trauma-focused cognitive-behavioural therapy (CBT) - 1st line
Benzodiazepines - acute symptoms
Delirium tremens - how many hours after withdrawal?
48-72hours
Symptoms of delirium tremens?
coarse tremor
confusion
delusions
auditory and visual hallucinations
fever
tachycardia
Management of alcohol withdrawal?
- long-acting benzodiazepines e.g. chlordiazepoxide or diazepam (lorazepam in hepatic failure)
- carbamazepine
Classification of severity used for depression?
PHQ-9
score of <16 = mild depression
score of >/=16 = moderate/severe depression
Management of less severe depression?
guided self-help - 1st line
SSRI - only if patient preference
CBT
Management of moderate/severe depression?
a combination of individual cognitive behavioural therapy (CBT) and an antidepressant - first line
Investigation findings in neuroleptic malignant syndrome?
- raised CK - due to muscle rigidity
- raised WCC
- Deranged LFT
- acute renal failure
- metabolic acidosis
What is somatisation disorder?
Excessive worry about physical symptoms (for at least 2 years) which can’t be explained by any disease e.g. abdominal pain
(somatisation - symptoms)
what is conversion disorder?
Nervous system symptoms such as blindness which occur as a result of anxiety or stressful events and have no specific physical cause. (loss of motor or sensory function)
(Conversion - conduction)
What is delusions of passivity?
Delusions of being controlled (feelings, impulses, thoughts or actions) by an external force.
What is delusional perception?
When someone sees something in reality and attributes a false meaning to this (e.g. sees a stranger cough and thinks this means they are a spy.)
What is ‘running commentary’ in psych?
Auditory hallucination where the voices are commenting on the persons actions
What is somatic hallucination?
Tactile hallucinations e.g. bugs under the skin
What is thought broadcasting?
Thinking that people can read your thoughts
Management of ADHD?
1st line - methylphenidate (always 1st line in children)
2nd line - Dexamfetamine (also 1st line in adults)
Management of bipolar?
mood stabiliser - lithium (1st line) or sodium valproate (2nd line)
management of mania/hypomania - stop antidepressant + antipsychotic (e.g. olanzapine or haloperidol)
management of depression - talking therapy +/- fluoxetine
Personality disorder management?
dialectal behaviour therapy
which criteria is used for alcohol withdrawal?
AUDIT
What is catatonia?
Stopping of voluntary movement or staying still in an unusual position
What is Circumstantiality?
the inability to answer a question without giving excessive, unnecessary detail
What is Tangentiality?
wandering from a topic without returning to it.
What are Neologisms?
new word formations, which might include the combining of two words.
What are clang associations?
when ideas are related to each other only by the fact they sound similar or rhyme.
What is word salad?
describes completely incoherent speech where real words are strung together into nonsense sentences.
knights move of thinking - what is it?
a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another
What is ‘flight of ideas’?
a thought disorder where there are leaps from one topic to another but with discernible links between them.
What is Perseveration?
the repetition of ideas or words despite an attempt to change the topic.
What is Echolalia?
the repetition of someone else’s speech, including the question that was asked.
Management of bipolar presenting with mania/hypomania in community?
- mania or severe depression = urgent referral to CMHT
- hypomania or non-severe depression - routine referral to CMHT
