Psychiatry Flashcards
1
Q
How would you treat Lewy Body Dementia?
A
- Anticholinesterase Inhibitors → donepezil (Aricept), rivastigmine (Exelon)
- Levodopa → this can help with movement problems
- Anti-Depressants
- Clonazepam → REM sleep problems
2
Q
Social management for Dementia?
A
Memory Cafes
- A good way to meet other people with dementia and their carers is to find a “memory cafe” near you. Memory cafes offer an informal setting for people who are affected by memory problems and their carers to get support and advice.
- Memory cafes operate on a drop-in basis, giving people the chance to exchange experiences and information, and receive practical and emotional support. Some memory cafes offer activities, as well as advice and refreshments.
- The cafes are run by trained volunteers with the support of health professionals, and usually meet monthly for a couple of hours, although some meet fortnightly. Memory cafes are different from a “memory clinic”, which is an NHS dementia service that involves assessing and diagnosing the condition, and requires a referral from a GP or hospital.
3
Q
Autism Treatment?
A
There’s no‘cure’ for autism spectrum disorder (ASD), but there are a range of specialist interventions that aim to improve communication skills and help with educational and social development
- CBT
- Aids to improve communication → pictures to help communicate
- Social skills training
- Sensory rooms
- Parent Support Group → EarlyBird programme provided by The National Autistic Society
4
Q
Conduct Disorder
A
- Positive Parenting Programmes
- Funtional Family Therapy
- Behavioural Treatment
- Multisystem Therapy (has v good outcomes)
5
Q
What are the different services for Psychiatry?
A
- IAPT - improving access to psychological therapies (mild depression) - assessment service to decide what treatment they will need (depression, anxiety and panic) –> CBT
- Community Mental Health Team - follow-up after being an in patient OR moderate depression
- Crisis Team - home treatment team (high risk) –> may need to admit
- EIS (early intervention service) - schizophrenia w 1st presentation < 35 years old –> help w their prognosis
6
Q
Delirium Questions?
A
DON’T FORGET TO ASK
- Recent trauma
- Signs of infection e.g. fever, UTI, meningitis
- Nutrition
- Drugs
- Medication
- MSE
CAUSES
- drug withdrawal
- toxins
- head injury
- post-operative
- renal disease/electrolyte disturbance
- dehydration
- stroke/vascular accident
7
Q
Undescended Testes
A
- pre-term
- 25% bilateral
- complications = infertility, cancer, torsion
- newborn baby check
- orchidopexy (refer @ 3 months –> surgeon appointment @ 6 months –> surgery @ 1 year)
8
Q
Testicular Torsion
A
- testis twists and traps the spermatic cord –> cuts off the blood supply
- teenage boys
- sudden onset and SEVERE pain (groin, hip and abdominal)
- Surgical Emergency – fix and unaffected testis will be secured so that it cannot have torsion in the future
9
Q
Hypospadias
A
- urethra opens on the ventral surface of the penis at different levels (should be at tips of glans penis)
- the abnormal ‘hooded’ prepuce (excess foreskin) during newborn check
- downward urinary spray
- assoc w cryptorchidism (undescended testis)
- corrective surgery @ 2 years
10
Q
Management in Personality Disorders?
A
Psychotherapy
- NICE do not recommend brief (less than 3 months duration) interventions
- CBT may be considered
- Psychodynamic Psychotherapy commonly used
- Dialectical Behavioural Therapy (DBT)
- Cognitive Analytical Therapy (CAT)
- Therapeutic Community
Medication
- Anti-Depressants, mood stabilisers, antipsychotics
- Used to treat Co-Morbid mental illness
- NICE guidelines advise using medication to treat co-morbid mental illness only (‘drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder’)
- Many clinicians however do still use psychotropics for symptoms such as mood instability and find these very helpful clinically. Often based on a mutual doctor and informed-patient decision.
11
Q
Borderline/Emotionally Unstable Personality Disorder?
A
- impulsive
- emotional instability/ unpredictable affect
- low self esteem
- body image/ identity disturbance
- threats or acts of self harm
- feeling of chronic emptiness inside
- history of unstable and sometimes abusive relationships
- may develop quasi-psychotic episodes when under stress
12
Q
Parkinson’s Disease Symptoms?
A
- Classic TRIAD –> resting tremor, rigidity, bradykinesia
- Other Symptoms –>
- monotonous speech
- micrographia (abnormally small, cramped handwriting)
- expressionless face
- march a petit pas
- depression
- dementia
- constipation
- Always ask about DRIVING –> Driver and Vehicle Licensing Agency (DVLA)
- Parkinson’s Nurse
13
Q
Parkinson’s Disease?
A
- Levodopa (usually combined with a decarboxylase inhibitor)
- Dopamine Receptor Agonists (bromocriptine, ropinirole, cabergoline)
- MAO-B (Monoamine Oxidase-B) inhibitors –> Selegiline
- Amantadine
- Pro-Cyclidine (anti-muscarinic for tremor and rigidity)
14
Q
ADHD Investigations?
A
- ADHD scale - Conner’s Rating Scale/Strength and Difficulties Questionnaire
- parents, school (N.B. ADHD is a clinical diagnosis and shouldn’t be based on these rating scales alone)
- Referral to specialist for assessment and diagnosis: CAHMS, specialist pediatrician, child psychiatirist
- Pulse, BP, psychiatric symptoms, appetite, BMI should be recorded at initiation of therapy, following each dose adjustment, and at least every 6 months there after
- Parent training and education
- Teacher education and behavioural interventions
- CBT or social skills training
-
Methylphenidate (Ritalin) – for moderate/severe or unresponsive to psychological therapy
- 2nd Line = Atomoxetine
• Treat co-exiting mental health conditions
15
Q
Conditions that co-exist with ADHD?
A
- Epilepsy
- Oppositional defiance disorder
- Learning disabilities
- Tourettes
- Dyspraxia
