Psychiatry Flashcards
1
Q
What 2 classification systems are used for psychiatric conditions?
A
- DSM5
- ICD10
2
Q
What can you ask the patient to recall in an abbreviated mental test?
A
- Recall an address
- Age and DOB
- What time is it?
- What year is it?
- Dates of WW2
- Name of present monarch
- Count backwards from 20
3
Q
What are the components of the Mental State Examination?
A
ASEPTIC:
Attitude
Appearance & Behaviour (body language, eye contact, rapport, facial expressions)
Speech (rate, rhyme, tone, volume)
Emotions (mood, affect)
Perceptions (dissociative symptoms, illusions and hallucinations)
Thoughts (stream, form, content)
Insight and compliance
Cognition (capacity)
4
Q
What is the Biopsychosocial formulation?
A
Takes biological, psychological and social factors to form a diagnosis.
4P’s:
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
5
Q
Name 10 examples of psychosocial therapies
A
- Psychotherapy
- CBT
- Counselling
- Cognitive analytic therapy
- Interpersonal therapy
- Dialectic behaviour therapy
- Family therapy
- Counselling
- Psychodynamic Therapy
- Electro-convulsive Therapy
6
Q
What is suicide?
A
Intentional self-inflicted death
7
Q
How could you breakdown the components of thought?
A
Stream
Form
Content
8
Q
What is deliberate self harm?
A
Intentional non-fatal self-inflicted harm
9
Q
What is an Illusion?
A
Misperception of real external stimulus
10
Q
What is a hallucination?
A
Disorder of perception
Perception experienced in absence of external stimuli
11
Q
What are the 5 types of Hallucinations
A
Auditory
Visual
Olfactory
Gustatory
Tactile
12
Q
What are the 5 subtypes of Hallucinations
A
Hypnogogic = on falling asleep
Hypnopompic = on waking up
Autoscopic = seeing oneself
Reflex = stimulation in one modality produces hallucination in other
Extracampine - hallucinations outside of sensory fields
Charles Bonnet = visual hallucinations associated with eye disease
13
Q
What is a Delusion?
A
Disorder of thought
A belief that is:
1) Firmly held
2) Not affected by rational argument/evidence
3) Not a conventional belief
14
Q
Name 8 types of Delusions
A
Persecutory (think someone is going to hurt them)
Grandiose (inflated self-importance e.g. I am God)
Reference (events/actions take on special significance to patient (e.g. black cars monitoring me)
Nihilistic (delusion of almost nothingness e.g. nothing in bank account)
Hypochrondriacal (firm belief they have a disease)
Guilt or worthlessness (has done something shameful based on an innocent error)
Control (controlled by an outside agency)
Possession of thoughts
15
Q
State the 5 types of possession of thoughts
A
Thought Insertion
Thought Withdrawal (someone removing their thoughts)
Thought Broadcast
Thought Echo
Thought Block (can’t continue idea)
16
Q
What is Psychosis?
A
Severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality
17
Q
What is an ‘over-valued idea’?
A
False or exaggerated belief beyond logic or reason
18
Q
Define loosening of association
A
A lack of logical association between thoughts
19
Q
What is perseveration?
A
Repetition
20
Q
Describe dissociation
A
Disconnection from surroundings
21
Q
What is depersonalisation?
A
Feelings of detachment from one’s own body
22
Q
Describe derealisation
A
A sense of one’s surroundings lacking reality
23
Q
What is Lilliputian?
A
Visual hallucinations of small animals
24
Q
What is Formication?
A
Insects crawling on skin
25
What is Neurosis?
Mild mental illness involving symptoms of stress, but not a radical loss of touch with reality
26
What is passivity Phenomena?
Actions are controlled by someone else
27
What is catatonia?
Significantly excited/inhibited motor activity
28
What is psychomotor retardation?
Slowing of thoughts/movements
29
What is concrete thinking?
Lack of abstract thinking
Most commonly in Aspergers
30
What is Confabulation?
False accounts to fill gap in memory
Most commonly in Korsakoff
31
What is a Neologism?
New word formation (to them it seems like it fits)
32
What is Anhedonia?
Inability to experience pleasure
33
What is Akathisia?
Inner restlessness and always in motion (rocking)
34
What does the Mesolimbic pathway cause?
Positive symptoms
35
What does the Mesocortical pathway cause?
Negative symptoms
36
What is Echolalia?
Meaningless repetition of another persons spoken words
37
What is Incongruity of affect?
Emotional responses that don't match the situation
38
What is flat affect?
No emotional expression
39
What is Mannerism?
Repeated involuntary movements
40
What is Belle indifference?
Lack of concern for implications of symptoms
41
What is Pharmacodynamics?
What the drug does to the body (receptor sensitivity or agonism/antagonism)
42
What is Pharmacokinetics?
What the body does to the drug: ADME
Absorption
Distribution
Metabolism
Elimination
43
What are examples of anti-depressants?
Selective Serotonin Reuptake Inhibitors (**SSRIs**):
- **Fluoxetine**
- **Sertraline**
Tricyclic Antidepressants:
- **Amitriptyline**
- Clomipramine
Serotonin-noradrenaline reuptake inhibitors **(SNRIs)**:
Noradrenaline and specific serotonergic antidepressants **(NASSAs)**:
Monoamine oxidase inhibitors **(MAOIs)**
44
What are 3 side-effects of SSRIs?
- Headache
- Nausea
- Insomnia
45
What are the causes of Serotonin syndrome?
SSRIs
MAOIs
Ecstasy
46
What is the clinical presentation of Serotonin syndrome?
INCREASED ACTIVITY:
- Clonus/myoclonus
- Hypereflexia
- Tremor
- Muscle rigidity
- Dilated pupils
- Autonomic dysfunction (tachycardia/ unstable BP)
47
What investigations would you perform for Serotonin Syndrome?
Similar to NMS:
- CK: elevated
- FBC: elevated WCC
- LFTs: deranged
- ABG: Metabolic acidosis
48
What is the management of serotonin syndrome?
Benzodiazepines
5HT-2a antagonist (Cyproheptidine)
49
Define Dependance
Cluster of physiological, behavioural and cognitive phenomena in which a substance takes on a higher priority than other behaviours that once had greater value
50
What are 10 risk factors for Dependance?
- Male
- Low standard of education
- Unemployment
- Younger age of usage
- Mental illness
- Peer pressure
- Low self esteem
- High stress
- FHx of alcoholism / substance addiction
- Genetics
51
What is the clinical presentation of dependence?
Compulsion to drink
Tolerance (need more to get same effect)
Difficulties controlling alcohol consumption
Physiological withdrawal
Neglect of alternatives to drinking
Persistent use of alcohol despite harm
52
How can you assess alcohol dependance?
CAGE (cut down, annoyed, guilt, eye-opener)
Audit
53
What does Tweak stand for in alcohol dependence?
Tolerance (>6 drinks = 2pts)
Worried (yes = 2pts)
Eye-opener = 1pt
Amnesia = 1pt
Cut down = 1pt
>3 = problem with alcohol
54
How would you investigate alcohol dependence?
Raised MCV: macrocytic anaemia
Vitamin B12 + folate deficiency
Deranged LFTs: GGT, AST/ALT
Thrombocytopenia: reduced platelets
Breath test
Screening
55
How would you manage Alcohol dependance?
Acomprosate: reduces craving
Disulfiram: gives hangover SE if alcohol consumed
Naltrexone: reduces pleasure alcohol brings
Support groups
CBT
Motivational interviewing
56
What is the clinical presentation of alcohol withdrawal?
Tremors
Sweating
Nausea/vomiting
Sound sensitivity (hyperacusis)
Insomnia
Mood disturbance (anxiety, on edge, depression)
Autonomic hyperactivity (tachycardia, HTN, pyrexia and mydriasis (pupil dilation))
Seizures seen -(at 36hrs)
57
How would you manage alcohol withdrawal?
Chlordiazepoxide (Benzodiazepine)
IV Pabrinex 5 days (vitamin B+C)
Thiamine 100mg BD
Inpatient: e.g. seizures with medical assisted detox
58
What is Wernicke's encephalopathy?
A neurological emergency resulting from thiamine deficiency (vit B1)
Acute, reversible stage
Triad:
1. Ophthalmoparesis with nystagmus
2. Ataxia
3. Confusion
59
What triad is found in Korsakoff's Syndrome?
▪ Anterograde amnesia
▪ Confabulation
▪ Psychosis (Lilliputian/formication)
60
What is Wernicke's–Korsakoff syndrome?
A combination of Wernicke's encephalopathy and alcoholic Korsakoff syndrome.
Chronic, irreversible stage
Severe memory impairment
61
What is the clinical presentation of opiate intoxication?
Drowsy
Mood change
Bradycardia
HTN
Pupil constriction
Respiratory depression
Decreased body temperature
62
What is the clinical presentation of opiate withdrawal?
Muscle cramps
Low mood
Insomnia
Agitation
Diarrhoea
Shivering
Flu like symptoms
63
What is the treatment for Wernicke's encephalopathy?
IV Pabrinex (high potency B1 replacement)
Chlordiazepoxide
Alcohol abstinence
64
What is the management of Opioid overdose/dependance?
IV/IM naloxone (rapid)
Opioid dependance: detoxification (4 weeks in residential/12weeks in community)
Methadone
Buprenorphrine
65
What are the complications of Opioid misuse?
Infection: sharing needles
VTE
Overdose: respiratory depression
Crime/prostitution
66
What is delirium?
An acute confusional state often with changes in consciousness
Medical emergency
Often reversible
67
What are the causes of delirium?
PINCH ME
Pain
Infection/Intoxication
Nutrition (vit deficiency: thiamine, B12, folate)
Constipation
Hypoxia/hydration
Medication/substance abuse (benzodiazepines, anticholinergics, opiates, anticonvulsants)
Environmental
68
What is the clinical presentation of delerium?
Inattention
Disorientated
Visual hallucinations
Paranoia
69
What are the 3 clinical syndromes seen in delirium?
1) Hypoactive
* Apathy
* Withdrawal
* Quiet confusion
* Easily missed (often misdiagnosed as depression)
2) Hyperactive
* Agitation
* Lack of co-operation
* Delusions
* Disorientation
* Confused with schizophrenia
3) Mixed
70
How can you differentiate delirium from dementia?
Delirium vs Dementia
Acute vs gradual
Outside of brain vs brain pathology
Can improve vs can't improve
Inattention vs still alert
Impaired consciousness vs conscious
Fluctuating symptoms vs stable
Treatable vs untreatable
71
How would you manage delirium?
**Treat precipitating cause**
Educate family and make environment safe
Anti-psychotics:
- Haloperidol
- Olanzapine
BDZs = Chlordiazepoxide (ONLY in alcohol withdrawal otherwise worsens delirium)
Regular follow ups
72
What is generalised anxiety disorder?
Anxiety not specific to an environmental circumstance
Excessive worry about every day events/problems
73
What is the clinical presentation of generalised anxiety disorder?
≥3:
- Restlessness/on edge
- Easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
74
What are somatic symptoms of anxiety?
Chest tightness
Dyspnoea
Palpitations
‘Butterflies’
Tremor
Tingling of fingers
Aches and pains
N&V
75
What are risk factors for generalised anxiety disorders?
- Female
- 35-54
- Divorced/alone
76
What are investigations for generalised anxiety disorders?
Rule out physical illness:
- Thyroid
- B12/folate
- Medication
- Alcoholism (withdrawal symptoms)
77
What is the management of a generalised anxiety disorder?
Step 1:
- Educate
- Exercise
- Stop smoking/drinking
Step 2:
- Psychological support/groups
Step 3:
- High intensity support CBT
- Medication
- Rapid response:
- Benzodiazepine
- Long term:
- Sertraline/SSRIs
- Clomipramine
78
What must you never prescribe anxiety patients?
Benzodiazepine for sleep: can cause delirium if they are abruptly stopped
79
What is a panic attack?
Period of intense fear characterised by a group of symptoms that develop rapidly, peak at 10min and last <30min
80
What are the risk factors for panic disorders?
- Loneliness
- Living in a city
- Poor education
- Early parental loss
- Sexual/physical abuse
81
Give 5 physical signs and 4 psychological signs of panic disorder
Physical:
1. Palpitations
2. Chest pain
3. Tachypnoea
4. Dry mouth
5. Dizziness
Psychological:
1. Feeling of impending doom
2. Fear of dying
3. Fear of losing control
4. Derealisation
82
What is the management of panic disorders?
CBT
1st: SSRIs (Sertraline)
2nd: Clomipramine
83
What is Agoraphobia?
Anxiety/panic over public places that are difficult to escape
84
What is the management of Agoraphobia?
Short term = BDZ
SSRIs
Relaxation and exposure training/techniques
85
What are obsessions?
Unwanted intrusive thoughts, images or urges that repeatedly enter the person’s mind
86
What are compulsions?
Repetitive behaviours or mental acts that the person feels drive to perform
87
What is the clinical presentation of OCD?
Must be present on most days for at least two weeks
- Not imposed by outside influences
- Repetitive and unpleasant/ excessive
- Interfere with individual functioning e.g. wasting time
88
What is the management of OCD?
CBT
Exposure + response prevention (ERP)
SSRI
TCA: Clomipramine (has specific non-obsessional action)
89
What is PTSD?
Delayed response to exceptional stressors months or years after trauma
90
What is the clinical presentation of PTSD?
- Re-experiencing (flashbacks, nightmares)
- Avoidance (avoiding people or circumstances resembling the traumatic event)
- Hyperarousal (exaggerates responses to small threats)
- Emotional numbing (feeling detached)
- Irritability
- Insomnia
91
How is PTSD diagnosed using ICD-10?
Symptoms arise within 6m of traumatic event
Symptoms present for at least 1 month → significant distress/impaired daily functioning
92
What is the management of PTSD?
1st line: trauma-focused CBT
SSRIs or BDZs: for anxiety
Carbamazepine: intrusive/impulsive thoughts
Anti-psychotics
EMDR: Eye movement desensitisation and reprocessing
Mirtazapine: for sleep
93
What are eating disorders?
An unhealthy and distorted obsession with body image and food
94
What is anorexia nervosa?
An eating disorder where an individual feels that they are overweight despite evidence of normal/low body weight.
95
What is the clinical presentation of Anorexia Nervosa?
Excessive weight loss
Amenorrhoea
Lanugo fine hair
Soft body hair
Hypokalaemia
Hypotension
Hypothermia
Changes in mood, anxiety and depression
Solitude
96
What is the diagnostic criteria for anorexia nervosa?
Weight <85% of predicted
BMI <17.5
Intense fear of gaining weight
Feeling fat when actually underweight
97
What is the SCOFF questionnaire in anorexia nervosa?
Used to assess eating disorders: ≥2 =anorexia nervosa or bulimia
1) Sick (make yourself)
2) Control (lost over eating)
3) One stone lost in 3 months
4) Feel fat
5) Food (dominates life)
-
1) Do you make yourself Sick because you feel uncomfortably full?
2) Do you worry you have lost Control over how much you eat?
3) Have you recently lost more than One stone in a 3 month period?
3) Do you believe yourself to be Fat when others say you are too thin?
4) Would you say that Food dominates your life?
98
What are red flags seen in anorexia nervosa?
BMI <13 or <2nd centile
Weight loss >1kg / week
Temperature <34.5°
BP <80/50
Sa02 <92%
Long QT, flat T waves
Weakness in muscles
99
What is the management of anorexia nervosa?
Restore nutritional balance
Involve carers
Eating disorder focussed CBT (ED-CBT)
Maudsley anorexia nervosa treatment for adults (MANTRA)
Admission
100
What is bulimia nervosa?
Bing eating followed "purging" (often involving laxatives or induced vomiting to prevent calories being absorbed)
101
What is the management of Bulimia Nervosa?
Same as anorexia +
- NORMAL WEIGHT
- Oesophagitis (vomiting)
- Russell's sign (callouses on back of hands)
- Swollen salivary glands
- Cardiomyopathy (laxatives)
- Alkalosis: HLC from vomiting
- Erosion of teeth
- Mouth ulcers
- Russell’s sign (Calluses on the knuckles where they have scraped teeth)
102
What can laxatives and vomiting cause metabolically in Bulimia Nervosa?
Metabolic alkalosis = vomiting (hypochloraemia/ hypokalaemia)
Metabolic acidosis = laxatives
103
What is the management of Bulimia Nervosa?
Anorexia treatment+
EDU for severe
104
What are complications of eating disorders?
Refeeding Syndrome
Cardiac complications:
- Arrhythmia
- Cardiac atrophy
- Sudden cardiac death
105
What is depression?
Persistent core symptoms: low mood, anergia and anhedonia
106
What is the clinical presentation of depression?
DEADSWAMP:
* Depressed low mood)
* Energy low
* Anhedonia
* Death thoughts (suicide)
* Sleep disturbance (insomnia /hypersomnia)
* Worthlessness/guilt/hopelessness
* Appetite/weight change
* Mentation decreased (lack of concentration)
* Psychomotor agitation / retardation
107
What is the criteria for depression being:
Mild?
Moderate?
Severe?
Mild = 2 core + 2 other
Moderate = 2 core + 3 other
Severe = 3 core + 4 other
108
How is depression investigated?
PHQ-9
HADs (Hospital Anxiety and Depression Scale)
109
What is the management of depression?
Sleep hygiene
Anxiety management
Exercise
Computerised CBT
IAPT
SSRI's (switch to another SSRI BEFORE changing antidepressant class)
ECT (SEVERE ONLY)
Rapid specialist mental health assessment + admission (SEVERE)
110
What are the side effects of Anti-cholinergics/muscarinics?
- Tachycardia
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
- Drowsiness
111
Define Bipolar disorder
Periods of elevated mood (hypo/mania) and depression
Requires at least two episode- one must be mania/hypomania for a diagnosis
112
Describe the types of Bipolar Disorder
Bipolar I = Mania + Depression
- Psychotic symptoms
Bipolar II = Hypomania
- Depression
- No psychosis
113
What is hypomania?
Does not meet full criteria of mania
114
What is Cyclothymia?
Cyclic mood swings with subclinical features
115
What is the diagnostic criteria of Mania?
>1 week elevated mood + >3 of:
I DIG FASTER
Irritability
Disinhibited (sexual, financial)
Insight impaired
Grandiose delusions
Flight of ideas
Activity/Appetite increased
Sleep decreased
Talkative (pressure of speech)
Elevated mood/energy increase
Reduced concentration/risk taking (Distractibility)
116
What are possible causes of bipolar disorder?
- Post-partum female
- Substance misuse
- Chronic illness
- Hx trauma/mental health
117
What is the acute and long-term management of bipolar disorder?
Acute:
Antipsychotics/ BDZs due to delayed effect:
- Risperidone
- Olanzapine
- Haloperidol
Long-term
Lithium (check TSH, U&Es, hydration every 6m)
2nd = Valproate/Lamotrigine if not tolerated
CBT
ECT: SEVERE mania
118
What are 7 side-effects of lithium?
N&V
Diarrhoea
Confusion
Excessive Sleeping
Seizures
Myoclonic Jerks
Coarse Tremors
119
What is schizophrenia?
Disorder of thinking, perception and affect
120
Name 6 subtypes of schizophrenia
- Paranoid
- Hebephrenic
- Catatonic
- Undifferentiated
- Residual (low intensity)
- Simple (progressive)
121
What are the main dopamine and serotonin receptors seen in schizophrenia?
D = D2
S = 5HT2a
122
What is the pathophysiology of schizophrenia?
Excess dopamine production
Neuronal overactivity → Mesolimbic → Hallucinations/delusions
Neuronal underactivity → Mesocortical → Blunted/anhedonia/apathy
123
What does dopamine inhibit?
Prolactin
Dopamine inhibition → hyperprolactinaemia
Side Effects:
- Galactorrhoea
- Amenorrhoea and infertility
- Sexual dysfunction
124
What is the strongest risk factor for schizophrenia?
FHx
125
What are 4 First Rank symptoms seen in schizophrenia?
Passivity phenomena
Thought disorders: insertion, broadcast or withdrawal
Hallucinations: 3rd person auditory
Delusions: passivity, influence or control
126
How does the ICD-10 define schizophrenia?
≥1:
- Passivity phenomena
- Thought disorders
- Hallucinations (3rd person auditory)
- Delusional perception
OR
2≥:
- Any hallucination
- Catatonic behaviour
- Negative symptoms ( no talking, acting incorrectly, no pleasure/motivation)
- Breaks in train of thought
- Change in behaviour
- Impaired insight
- Neologisms (coining words)
127
What investigations would you order for schizophrenia?
Rule out drugs = urine screen
Rule out alcohol = LFTs, FBC, macrocytosis, thrombocytopenia
Rule out syphilis = sero test
Rule out brain lesion = CT head
128
What is the Psychosis risk assessment?
Risk to:
Self
Others
From others
Criminal damage to property
129
What is the management of schizophrenia?
CBT: early in 3rd person hallucinations
1st line: Atypical
2nd line: Typical
3rd line: Clozapine
130
What are atypical anti-psychotics and when are they indicated?
1st episode
Aripiprazole
Olanzapine
131
What are examples of typical anti-psychotics?
2nd line: haloperidol
132
What medication is used for treatment resistant schizophrenia?
3rd line treatment: clozapine (atypical)
133
What are the side-effects of clozapine?
Agranulocytosis (high risk of infection)
Reduced seizure threshold
Sedating
Postural Hypotension
Toxic Megacolon
Cardiomyopathy
Extreme salivating
134
What is Schizoaffective disorder?
Schizophrenia + mood disorders
Mania and depression symptoms in small time frame
135
What is the management of schizoaffective disorder?
Mood stabilisers (e.g. lithium) + antipsychotics
136
What are the different features between paranoid and simple schizophrenia?
Paranoid = positive symptoms
Simple = negative symptoms + psychosis
137
What is hebephrenic schizophrenia?
Predominated by thought
138
What extra pyramidal side effects (EPSEs) can anti-psychotics cause?
Acute dystonic reaction Parkinsonism
Akasthesia (inner restlessness)
Tardive dyskinesia
139
What is the treatment of EPSEs from anti-psychotics?
Procycladine
140
What are personality disorders?
Severe disturbance of a persons characteristics and behavioural tendencies that interfere with everyday functioning
141
What is the diagnositc criteria for personality disorders?
- Inhibition of self and social functioning
- 1≥ pathological personality traits
- Stable impairments
- Impairments are not "normal" for the individual's developmental stage or socio-cultural environment
142
What are risk factors for personality disorders?
- Past abuse
- Bullying
- Childhood trauma
- Self-harm
143
What is the main type of personality disorder?
Emotionally unstable personality disorder (borderline)
Cluster B
144
Give 6 symptoms of borderline type personality disorder
1. Emotional instability
2. Difficult, intense relationships
3. Feelings of emptiness
4. Impulsive
5. Self injurious behaviour
6. Fear of abandonment/rejection
145
What is the management of personality disorders?
Dialectical behavioural therapy (DBT): especially borderline/cluster B personalities
Medication is not mainstay: Benzos for short term
146
What are Cluster A, B and C personalities?
A = Eccentric MAD
B = Flamboyant BAD
C = Fearful/anxious SAD
147
Name 3 cluster A personalities
- Paranoid (delusional, jealousy, conspiracies)
- Schizotypal (weird and magical, circumstantial, bizarre, peculiar)
- Schizoid (voluntarily withdraws from social interaction)
148
Name 4 cluster B personalities
- Antisocial (impulsive, lack of guilt, low anger tolerance)
- Borderline
- Histrionic (dramatic, shallow, extrovert, sexually inappropriate)
- Narcissistic (grandiosity, egotistical)
149
Name 3 cluster C personalities
- Avoidant (tense and apprehensive)
- Dependant (need to be cared for, can't make own decisions)
- Anankastic (stubborn, perfectionism, egosyntonic, inflexibility) OCPD
150
What is the difference between Avoidant and Schizoid personalities?
Schizoid:VOLUNTARILY withdraws
Avoidant: desires companionship but too afraid of rejection
151
What is the difference between OCPD and OCD?
Obsessive compulsive personality disorder = they're okay with how they are
OCD= do not like the obsessions/ compulsions (egodystonic)
152
Define Egosystonic
Consistent with self image
(likes their own thoughts/behaviours)
153
Define Egodystonic
Conflict with self image (does not like their own thoughts /behaviours)
154
Name 4 types of Sleep Disorders
Narcolepsy
Sleep apnoea
Circadian rhythm disorder
Parasomnia
155
What is Narcolepsy?
Sleepy throughout the day
156
What is sleep apnoea?
Intermittent upper air collapse during sleep
157
What is circadian rhythm disorder?
Mismatch between sleep-wake cycle and circadian rhythms (jet lag/shift work)
158
What is parasomnia?
State between sleep and wakefulness:
Restless leg syndrome
Nightmares/ night tremors
Sleep walking/talking
159
Name 4 pieces of advice for sleep hygiene
1) Limit caffeine, alcohol and cigarettes
2) Less noise/lights/screen use
3) Reduce sleep
4) Regular pattern
160
What medications can be used for sedation?
Benzodiazepine e.g diazepam
161
How would you assess suicide risk?
SADPERSONS:
Sex (males > females)
Age (peaks in young and old)
Depression
Previous attempts and severity of means
Ethanol abuse (alcohol)
Rational thinking loss (e.g. Schizophrenia)
Support network loss
Organised plans
No significant others
Sickness
Score:
0-2: no problems- keep watch
3-4: send home- but check frequently
5-6: consider hospitalisation- involuntary or voluntary
7-10: Hospitalise- involuntary or voluntary
162
In Section 2 of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?
28 days
Assessment
2 Drs + 1 AMHP
Patient suffers from disorder and detained for own and others safety
163
In Section 3 of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?
6 months
Treatment
2 Drs + 1 AMHP
Patient suffers from disorder and detained for own and others safety
164
In Section 4 of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?
72hrs
Emergency order: waiting for 2nd Dr would cause undesirable delay
1 Dr and 1 AMHP
Patient suffers from disorder and detained for own and others safety + not enough time for 2nd Dr
165
In Section 5 (4) of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?
6hrs
Patient admitted but wanting to leave
Nurse holding power
Cannot be coercively treated
166
In Section 5 (2) of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?
72hrs
Allows time for section 2 & 3
Doctors holding power
Cannot be coercively treated
167
In Section 136 of the Mental Health Act, what is the?
- Reason?
- Approved by?
Found in public space + brought into hospital for assessment
Police sections
168
In Section 135 of the Mental Health Act, what is the?
- Duration?
- Reason?
- Approved by?
- Evidence?
Mental disorder at home : brought to hospital for further assessment
Police sections
Needs court order to access and remove from patient home
169
What are the 5 Principles of the Mental Health Act?
1. Assume capacity
2. Individual supported to make own decision
3. Unwise decisions do not mean lack of capacity
4. Best interests
5. Least restrictive practice
170
What does having capacity mean?
Able to:
1) Understand
2) Retain
3) weigh up
4) Communicate decision
171
What are advanced statements and advanced decisions?
Statements: NOT legally binding. Person documents their wishes should they lack capacity in the future.
Decisions: LEGALLY binding.
Made with capacity + witness
172
What is a last power of attorney?
Person to make decisions for them if they lack capacity in future
173
What is the court of protection?
Makes decisions if no lasting power of attorney
174
What is DOLS?
Deprivation of Liberty Guards
Allows deprivation liberty in patients lacking capacity in hospital or care environment if its in their BEST interests
175
What are some indications for use of ECT?
- Severe depression
- Mania unresponsive to treatment
- Catatonia
- Moderate depression
- Unresponsive to treatment
176
What is a major contraindication for Electroconvulsive Therapy?
Raised ICP!
177
What is attachment disorder?
When a child is unable to develop relationships with parents/carers
