Psychiatry Flashcards

Question

What are dissociative disorders?

Answer 1

when people feel a sense of disruption between their consciousness, body, perceptions, memories, identity and emotions which normally people experience as connected and integrated

Answer 2

Depersonalisation-derealisation disorder Dissociative amnesia Dissociative identity disorder

Answer 3

abnormal movement., communication and behaviour which can look like unusual postures, performing odd actions, repeating sounds or words or remaining blank and unresponsive most often caused by severe depression and bipolar disorder, rarely physical health conditions like strokes or brain tumours can lead to catatonia

Answer 4

difficulty forming close relationships or attachments with poor response to affection or discipline as a result of severe neglect and trauma in early childhood

Answer 5

The importance of creating healthy consistent and secure attachments to at least one nurturing individual during early childhood, particularly for the first 2 years of life

Answer 6

where a conscious effort is made to fake illness and seek medical attention for personal gain symptoms are invented, exaggerated or induced to invoke attention, affection, relationships and care from others may have repeated presentations with inconsistent and dramatic symptoms which do not fit with examination and investigation findings

Answer 7

where the patient loses control of one of their hands so that it acts independently usually the result of an underlying brain lesion such as brain tumours, injuries, aneurysms or following surgery

Answer 8

The false belief that they are dead or actively dying also known as walking corpse syndrome most coften caused by psychiatric conditions like depression and schizophrenia but also can be caused by brain tumours and migraines

Answer 9

false belief that an identical duplicate has replaced someone close to them

Answer 10

also called erotomania false belief that a famous or high-social status individual is in love with them leading to inappropriate harassment of the individual by the patient frequently occurs without any other psychiatric or neurological disease

Answer 11

incorrectly perceiving the sizes of body parts or objects also associated with changes to the perception of time and symptoms of migraines causes include migraine, epilepsy, brain tumours

Answer 12

a false belief that the sex organs are retracting or shrinking and will ultimately disappear resulting in anxiety and panic attacks has been linked to cultural beliefs in asia

Answer 13

a strong feeling that a part of the body does not belong to them typically associated with a desire to removed that part of their body

Answer 14

sudden change in a person's voice most commonly caused by a stroke in the left hemisphere

Answer 15

a severe long-term mental health disorder characterised by psychosis often presents between age 15-30 and earlier in men than women symptoms must be present for at least 6 months before schizophrenia is diagnosed

Answer 16

a combination of the symptoms of schizophrenia with bipolar disorder so patients have psychosis with symptoms of depression and mania

Answer 17

presents with the same features as schizophrenia but lasts less than 6 months

Answer 18

mania psychotic depression drugs stroke brain tumours cushing's syndrome hyperthyroidism huntington's disease

Answer 19

thought to be a combination of genetic and environmental factors

Answer 20

a prodrome phase with subtle symtpoms like poor memory, reduced concentration, mood swings, sleep disturbance etc. then the positive symptoms of psychosis including delusions, hallucinations and thought disorder lack of insight

Answer 21

auditory hallucinations somatic passivity thought insertion or withdrawal thought broadcasting persecutory delusions ideas of reference delusional perceptions

Answer 22

affective flattening alogia (reduced speech) anhedonia avolition (lack of motivation in working towards goals or completing tasks)

Answer 23

continuous episodic single episode only

Answer 24

used the DSM-5 criteria symptoms must have been present for at least 6 months with active phase symptoms present for at least one month

Answer 25

antipsychotic medications cognitive behavioural therapy

Answer 26

chlorpromazine haloperidol quetiapine aripiprazole olanzapine risperidone

Answer 27

helpful where adherence may be an issue aripiprazole flupentixol paliperidone risperidone

Answer 28

agranulocytosis myocarditis or cardiomyopathy constipation seizures excessive salivation

Answer 29

Weight and waist circumference Blood pressure and pulse rate Bloods, including HbA1c, lipid profile and prolactin ECG

Answer 30

Weight gain Diabetes Prolonged QT interval Raised prolactin Extrapyramidal symptoms

Answer 31

Akathisia (psychomotor restlessness, with an inability to stay still) Dystonia (abnormal muscle tone, leading to abnormal postures) Pseudo-parkinsonism (tremor and rigidity, similar to Parkinson’s disease) Tardive dyskinesia (abnormal movements, particularly affecting the face)

Answer 32

False perception of real, existing sensory stimulus

Answer 33

False sensory experience when there is no stimulus present, can be visual, auditory, olfactory, tactile or gustatory

Answer 34

A false belief that is firmly held despite contradictory evidence.

Answer 35

An unreasonable and sustained belief that is maintained with less than delusional intensity (i.e. the person is able to acknowledge the possibility that the belief may or may not be true)

Answer 36

A symptom of psychosis which occurs when someone feels that their thoughts are no longer under their control. Can include thought insertion, broadcasting, withdrawal

Answer 37

When a person feels that thoughts are being spoken to them or are occurring outside of their mind, but they recognize that they are the one thinking them

Answer 38

When a person feels that their thoughts have been taken out of their mind and they have no power over this.

Answer 39

A type of thought alienation where the person believes that others are able to read their thoughts.

Answer 40

A symptom of psychosis where someone hears their own thoughts being spoken aloud, shortly after thinking them.

Answer 41

A neuropsychological symptom expressing a sudden and involuntary silence within a speech, and eventually an abrupt switch to another topic.

Answer 42

Reasoning which is based on what you can see, hear, feel and experience in the here and now. Also called literal thinking, because it focuses on physical objects, immediate experiences and exact interpretations.

Answer 43

Also known as derailment. A thought process disorder which is characterised by a lack of connection between ideas. Speech is vague and confusing.

Answer 44

Circumstantiality is circuitous and non-direct thinking or speech that digresses from the main point of a conversation but is still linked to the topic. Whereas tangentiality is where the person strays very far from the main point they're trying to make and don't reach a main point or answer questions.

Answer 45

The repetition of a particular response (word, phrase or gesture) regardless of the absence or cessation of a stimulus.

Answer 46

A neuropsychiatric disorder wherein a patient generates a false memory without realising it's not true. Sometimes called "honest lying".

Answer 47

Experience of bodily sensations (thoughts, actions, emotions) imposed by external agency. e.g. voices commenting on one's actions

Answer 48

A mental state of confusion and disorientation which can develop suddenly and is often temporary

Answer 49

A state of apparent unresponsiveness to external stimuli and apparent inability to move normally in a person who is apparently awake.

Answer 50

Mutism (absence of speech) Negativism (performing actions contrary to the commands of the examiner) Echopraxia (repeating the movements of others) Echolalia (repeating the words of others) Waxy flexibility (slight, even resistance to positioning by examiner) Withdrawal (absence of responses to the environment)

Answer 51

The slowing down or hampering of mental or physical activities

Answer 52

A thought disorder which refers to rapid and erratic speech that jumps from one topic to another.

Answer 53

Also known as alogia, a speech disturbance which involves a reduction in the amount and quality of speech.

Answer 54

a thought disorder characterised with a reduction in thought spontaneity and productivity, and vague or repetitive speech sometimes called intellectual impoverishment

Answer 55

A symptom of many mental health conditions which refers to the inability to feel pleasure or joy

Answer 56

A clinical sign where the person has reduced or absent displays of emotion

Answer 57

When the person's emotional demeanor doesn't match what's happening around them.

Answer 58

decreased ability to express emotion through facial expressions, tone of voice and physical movements.

Answer 59

A paradoxical absence of psychological distress despite a serious medical illness or symptoms of a health condition.

Answer 60

When the person feels disconnected from their body, feelings and environment

Answer 61

A mental state where you feel detached from your surroundings and people and objects may seem unreal.

Answer 62

Conversion is a defense mechanism by which individuals reduce acute anxiety by converting psychological suffering into physical symptoms.

Answer 63

A mental process where a person disconnects from their thoughts feelings, memories or sense of identities

Answer 64

a seemingly purposeful, coordinated, but involuntary, repetitive, ritualistic gesture, mannerism, posture, or utterance e.g. repetitive grimacing, lip smacking etc.

Answer 65

Strange or bizarre ways of carrying out normal activities

Answer 66

a persistent, unwanted, and intrusive thought, urge, or image that causes anxiety, distress, or unease.

Answer 67

a repetitive behaviour or mental act that a person feels driven to perform in response to an obsession

Answer 68

1. Hyperactivity. 2. Inattention. 3. Impulsivity. (HII) These symptoms occur in every child from time to time but when they are persistent and impact on daily functions, more investigation is needed

Answer 69

1. Blurts out answers. 2. Interrupts. 3. Difficulty waiting turns. 4. When older, pregnancy and drug use.

Answer 70

1. Easily distracted. 2. Not listening. 3. Mind wandering. 4. Struggling at school. 5. Forgetful. 6. Organisational problems. Does not appear to be listening when spokento directly Makes careless mistakes Looses important items

Answer 71

**ADHD definition <17 Years** 6/9 inattentive symptoms and 6/9 hyperactivity/impulsivity. Present before 12 years Developmentally inappropriate Several symptoms in 2 or more settings Clear evidence symptoms interfere/reduce the quality of social/academic/occupational function .

Answer 72

1. Education. 2. Parenting programmes and school support. Behavioural interventions, e.g. encouraging realistic expectations, positive reinforcement of desired behaviours (small immediate rewards), consistent contingency management across home and school, break down tasks, reduce distraction. Implementing Routines Evidence base for fish oils in diet Learning support

Answer 73

Methylphenidate (ritalin, concerta, Equasym) Atomoxetine (Strattera®) A non-stimulant NE reuptake inhibitor licensed for the treatment of ADHD.

Answer 74

headache, insomnia, loss of appetite, stomach ache, dry mouth, nausea Can stunt growth Need to Monitor weight, height and BP Methyphenidate is Not recommended to take during pregnancy

Answer 75

They can be categorised as deficits in social interaction, communication and behaviour

Answer 76

NO DESIRE TO INTERACT WITH OTHERS BEING INTERESTED IN OTHERS TO HAVE NEEDS MET LACK OF MOTIVATION TO PLEASE OTHERS AFFECTIONATE ON OWN TERMS Touches inappropriately Poor Eye contact Plays alone Finds it stressful to be with other people

Answer 77

Repetitive use of words or phrases Delay, absence in language development Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others, and sharing interest Lack of desire to communicate at all PEDANTIC LANGUAGE, VERY LITERAL, POOR OR NO UNDERSTANDING OF IDIOMS AND JOKES

Answer 78

USING TOYS AS OBJECTS INABILITY TO PLAY OR WRITE IMAGINATIVELY RESISTING CHANGE PLAYING SAME GAME OVER AND OVER OBSESSIONS/RITUALS There may be self-stimulating movements that are used to comfort themselves, such as hand-flapping or rocking. Extremely restricted food preferences

Answer 79

- Education and games to encourage social communication. - Visual aids and timetables. - Parenting workshops and school liaison. Manage Comorbidity There are no medications available for ASD Diagnosis should be made by a specialist in autism. This may be a paediatric psychiatrist or paediatrician with an interest in development and behaviour. A diagnosis can be made before the age of 3 years. It involves a detailed history and assessment of the child’s behaviour and communication..

Answer 80

Prior depression Family Hx depression Female Hx abuse Drug and alcohol use Low socioeconomic status Recent bereavement, stress or medical illness, traumatic life event Co-existing medical conditions (chronic disease)

Answer 81

Low mood Loss of energy (anergia) Anhedonia (loss of enjoyment of formerly pleasurable activities)

Answer 82

Carry out mental state examination - **Appearance may be normal**, or evidence of self beglect. substnace abuse, tearfulllness, anxious, fidegty **Speach may be monotonic and slow** - patient may appear distracted **Psychotic features** - eg auditory hallucinations, loss of insight Baseline tests for FBC and TFT may be useful for ruling out anaemia and hypothyroidism, that can lead to depression

Answer 83

The Patient Health Questionnaire-9 (scored out of 27) is used to grade depression – It asks patients to report over the last 2 weeks how often they have been experiencing symptoms – Made of 9 items which is scored from 0-3 – Mild = 5-9 – Moderate = 10-14 – Moderate/Severe = 15-19 – Severe = >19

Answer 84

Mild depression * Watchful waiting (GP monitoring progress post diagnosis) * Guided self-help: workbook/online course + therapy support * Exercise * Talking therapies - CBT, interpersonal therapy (IPT), psychodynamic psychotherapy ○ CBT: § Aim to help understand thoughts/behaviour + how they affect you § Recognises events in past but concentrates on how can change thinking/feeling/behaviour in present § Available on NHS for depression/mental health problems ○ IPT: § Focus on relationships with others and problems within them § E.g. issues with communication, coping with bereavement

Answer 85

Moderate/severe depression * Antidepressants (SSRIs, TCAs) - continued for 6+ mths after Sx stop * Combination therapy e.g. meds + talking therapy SSRI - Selective serotonin reuptake inhibitors eg Sertraline, paroxetine, fluoxetine, citalopram *Fluoxetine 1L in children* TCAs (Tricyclic antidepressants): Imipramine, amitriptyline SNRIs (Serotonin-noradrenaline reuptake inhibitors): Venlafaxine, duloxetine, Mirtazapine

Answer 86

Resistant depression Tx w/ combo of antidepressants + Lithium Atypical antipsychotic Another antidepressant ECT very effective in severe cases (Electroconvulsive Therapy)

Answer 87

Bipolar affective disorder - recurrent episodes of altered mood and activity Involving upswings and downswings (hypomania/mania + depression) Hx of **2 mood disorders,** at least one: Hypomania < 4d Mania >7 d

Answer 88

Lasts about 4 days Elevated mood Increased energy, talkativeness Poor concentration Mild reckless behaviour (overspending) Sociability/overfamiliarity Increased libido/sexual disinhibition Increased confidence Decreased need to sleep Change in appetite

Answer 89

Cyclothymia - chronic mood fluctuations over 2+ yrs, episodes of depression and hypomania (not mania). Rapid cycling, episodes only lasting few days **presence of psychotic Sx e.g. auditory hallucinations/grandiose delusions differentiates mania from hypomania

Answer 90

Substance abuse (amphetamines, cocaine) Endocrine disease - Cushing's, steroid-induced psychosis Schizophrenia Schizoaffective disorder - Dx when affective and first rank schizophrenic Sx equally prominent Personality disorders - emotionally unstable, histrionic ADHD in younger people

Answer 91

L - leukocytosis I - insipidus diabetes (nephrogenic) T - tremors (if coarse, think toxicity) H - hydration (easily dehydrates, need to drink lots, is renally cleared) I - increased GI motility U - underactive thyroid M - metallic taste (warning of toxicity), mums beware - teratogenic Lithium + diuretics -> dehydration Lithium + NSAIDs -> kidney damage & weight gain, hypothyroidism

Answer 92

depression and obsessive compulsive disorder Hyperthyroidism - do TFTs Pheochromocytoma Lung disease - excessive salbutamol use Congestive HF - heart meds -> anxiety Hypoglycaemia Do Bloods, and BP

Answer 93

Family Hx anxiety Physical/emotional stress Financial, bereavement etc Hx physical/sexual/emotional trauma (in childhood) Excessively pushy parents in childhood Other anxiety disorder - coexisting depression Chronic physical health condition Worries about physical health Female 2:1 Male Environmental triggers/contributors: family relationships, friendships, bullies, school pressures, alcohol and drug use e.g. benzodiazepines

Answer 94

Mild anxiety can be managed with watchful waiting and advice about self-help strategies (e.g. meditation), diet, exercise and avoiding alcohol, caffeine and drugs. Moderate to severe anxiety can be referred to CAMHS services to initiate: Counselling Cognitive behavioural therapy

Answer 95

animals (spides, snakes, worms) Blood/injection/injury Situational (lifts, flying, enclosed space) Natural environment (storms, heights, water) Other: choking, vomiting, clowns Amygdala, anterior cingulate cortex and insula hyperactivity involved in underlying mechanism of action

Answer 96

Simple phobia Inappropriate anxiety in the presence of ≥1 object/situation, e.g. flying, enclosed spaces, spiders Social phobia Intense/persistent fear of being scrutinized or negatively evaluated by others leads to fear and avoidance of social situations (e.g. using a telephone, speaking in front of a group). Agoraphobia fear of fainting and/or loss of control are experienced in crowds, away from home, or in situations from which escape is difficult. Avoidance results in patients remaining within their homes where they know symptoms will not occur.

Answer 97

For simple phobias - Treatment is only needed if symptoms are frequent, intrusive, or prevent necessary activities. Exposure therapy is effective. For social and agoraphobia - drug therapy SSRIs, and TCAs eg **Clomipramine** Psychological therapies CBT (cognitive restructuring) +/- exposure

Answer 98

Low levels of GABA, contribute to anxiety. Been seen that frontal cortex and amygdala undergo structural remodelling induced by the stress of maternal separation and isolation, which alters behavioural and physiological responses in adulthood. * Heightened amygdala activation occurs in response to disorder-relevant stimuli in post-traumatic stress disorder, social phobia and specific phobia Basically overfiring/activation of the amygdala

Answer 99

SSRI (sertraline is first-line SSRI) – Be careful in young people as the SSRI increases anxiety initially and can lead to suicidal thoughts Pre-gabalin – If acutely anxious –> Benzodiazepine (but not for > 4 weeks) Beta blockers e.g. bisoprolol for physical Sx

Answer 100

Post traumatic stress disorder Develop (immediately/delayed) post exposure to stressful event/threatening, catastrophic situation

Answer 101

Serious accident e.g. RTA Witness of violence - school, domestic, torture, terrorist attack, rape Combat exposure Natural disaster Sudden death of loved one Multiple major life stressors

Answer 102

Symptoms – These must be present >1 month – Persistent intrusive thoughts and re-experiencing –> flashbacks, nightmares and intrusive images – Autonomic hyperarousal –> persistent activation gives startle, hypervigilance, insomnia – Avoidance –> patient avoids situations and stimuli associated with the event – Emotional detachment –> feeling detached from people and lack of ability to experience feelings – Higher risk of depression, substance misuse, unexplained physical symptoms

Answer 103

CBT - eg education about the nature of PTSD, selfmonitoring of symptoms, anxiety management, breathing techniques Eye movement desensitization and reprocessing (EMDR): Using voluntary multi-saccadic eye movements to reduce anxiety associated with disturbing thoughts Stress management Hypnotherapy

Answer 104

SSRIs (e.g. paroxetine 20–40mg/day; sertraline 50–200mg/day) are licensed for PTSD, It may be helpful to target specific symptoms: * Sleep disturbance (including nightmares): may be improved by mirtazapine (45mg/day), * Anxiety symptoms/hyperarousal: consider use of BDZs (e.g. clonazepam 4–5mg/day), buspirone, antidepressants, propranolol. * Intrusive thoughts/hostility/impulsiveness: some evidence for use of carbamazepine, valproate, or lithium. * Psychotic symptoms/severe aggression or agitation: may warrant use of an antipsychotic (some evidence for olanzapine, risperidone etc)

Answer 105

Fear/anxiety about falling asleep Change of environment (adjustment disorder) Inadequate sleep hygiene Idiopathic insomnia (rare, lifelong inability to sleep) Behavioural insomnia of childhood

Answer 106

Sleep-related breathing disorder e.g. sleep apnoea Circadian rhythm disorders Shift work REM behavioural disorder e.g. Lewy body dementia, PD Medication conditions causing pain -> awake Psychiatric disorders - depression (early morning waking), anxiety (early/middle insomnia) Drugs/alcohol - steroids, antidepressants, stimulants

Answer 107

Encourage good sleep hygiene, routines Remove noise, light, and distractions Wind down before bed Avoid caffeine/stimulation Sleep restriction Prevent naps during day to promote sleeping @ night

Answer 108

Medication (once good sleep hygiene proved unsuccessful) Z drugs 1L - zopiclone, zolpidem, zapeplon Sedating antidepressants - mirtazepine Melatonin

Answer 109

psychotic illness characterized by delusions and hallucinations, without changes in affect (although there may be reactive anxiety), a form of thought, or personality. it's the most common form of psychosis in old age - aka late-onset schizophrenia

Answer 110

*no evidence of dementia w/ later onset cases - no memory problems Delusions, hallucinations - often about neighbours Paranoid - often re. neighbours spying, taking things can also be misidentification, hypochondraical, religious Partition delusion - believe people/objects can go through walls Less -ve Sx (blunting/apathy) and formal thought disorder compared to early onset

Answer 111

Relieve isolation and sensory deficits. Low-dose atypical antipsychotics preferred as elderly are very sensitive to side-effects, but non-compliance secondary to lack of insight is often an issue.

Answer 112

Minor problems w/ cognition - mental abilities: memory, thinking Not severe enough to interfere w/ everyday life Mild cognitive impairment = pre-dementia condition in some people

Answer 113

Depression, anxiety, stress Sleep apnoea and other sleep disorders Physical illness (constipation, infection) Poor eyesight/hearing Vitamin/thyroid deficiencies e.g. Vit B12 SE of medication: CCBs, anticholinergics, benzodiazepines Drug/alcohol abuse Uncontrolled health conditions like high BP, high cholesterol, diabetes, obesity

Answer 114

Not severe enough to interfere w/ daily life -> not defined as dementia (dementia Dx = 2/more of problems with: memory, reasoning, language, coordination, mood, behaviour) Memory - forgetting recent events/repeating same question Reasoning, planning, problem solving - struggling to think things through Attention - v easily distracted Language - taking longer than usual to find right word for something Visual depth perception - struggling to interpret 3D object, judge distances, navigate stairs

Answer 115

Take a thorough, collateral history Review of medications MSE Input from family/collateral Hx Bloods/urine if suspect infection/another clinical cause

Answer 116

Prophylaxis/Mx of precipitative Sx: Poorly controlled heart condition/diabetes/strokes -> ^ risk MCI So control e.g. prevent high BP Medication management of depression/anxiety Good sleep hygiene Preparation for the future when memory may get worse Power of attorney etc

Answer 117

Bipolar disorder – often may present with symptoms of schizophrenia Psychotic Depression Alcohol hallucinations, due to withdrawal Drugs - **especially Cannabis**, Cocaine, LSD, magic Mushrooms (Psilocybin) Dopamine Agonists, like Levo Dopa in Parkinsons Other health conditions, like Encephalitis Epilspeys (temporal lobe seizure,) Dementia, and Parkinsons B12 def, hypoglycaemia, Trauma Brief Psychotic disorder – symptoms are present for less than a month, then disappear.

Answer 118

Atypical anti-psychotics – work by blocking dopamine and serotonin: Quetiapine Olanzapine Risperidone Clozapine Aripiprazole Atypical are first line now (other than clozapine)

Answer 119

Typical anti-psychotics – work by dopamine blockade (D2 receptors): Haloperidol Chlorpromazine

Answer 120

If two other anti-psychotics have not been effective, then clozapine should be considered. Second line – Clozapine – atypical antipsychotic – this is not included as a first line treatment, as requires close monitoring as it has a tendency to cause **aplastic anaemia,** which can be fatal. **If two other anti-psychotics have not been effective**, then clozapine should be considered. CPMS – Clozepine monitoring system. A national service in the UK, that gives advice on the drug dosage to use, depeninding on the blood test results you send to them. Compulsory for anyone on clozepine. Only consultant psychiatrists can prescribe clozapine

Answer 121

ECG – as QTC prolongation can occur Glucose and lipids – antipsychotics can lead to diabetes and metabolic syndrome If on CLOZAPINE – regular FBCs to check for AGRANULOCYTOSIS

Answer 122

Diabetes/insulin resistance and dyslipidaemia QT segment changes on ECG Agranulocytosis – clozapine Extra-pyramidal side effects due to the dopamine blockade - Urinary retention Blurred vision Dry mouth Weight gain Hyperprolactinaemia (due to dopamine blockade and dopamine down regulates prolactin)

Answer 123

Acute dystonic reaction (hours) Muscle spasm, acute torticolis, eyes rolling back Parkinsonism (days) Tremor, bradykinesia Akathisia (days to weeks) “inner restlessness, pacing and agitated, often intolerable. They literally can’t stop moving e.g. shaking legs, touching table Massive RF for suicide in young males with schizophrenia Tardive dyskinesia (months to years) Grimacing, tounge protrusion, lipsmacking Very difficult/impossible to treat as you’ve upregulated all the D2 receptors These side effects are worse and more common in the older antipsychotics Treat with Procyclidine, an anticholinergic drug

Answer 124

Individual CBT: normally consists of at least 16 one-on-one sessions. It helps patients create links between their thoughts, feelings and actions with their experience of schizophrenia. Family intervention: should include the patient suffering from schizophrenia if possible as well as their main carer. Normally consists of 10 sessions over 3 months - 1 year. Art therapies can be particularly helpful for negative symptoms. Self-help groups and forums (e.g. Hearing Voices groups) enable people with psychosis to share experiences and ways to cope with symptoms This should be done alongisde antipyscotic

Answer 125

Factitious, symptoms are fabricated and not experienced as real by the patient Somatoform disorder - Symptoms are unconsciously generated by the mind, but experienced as real by patient Undiagnosed - symptoms are arising from a physical cause that hasn't been identified yet

Answer 126

The characteristics and relatively permanent sets of behaviours, cognitions, and emotional patterns that evolve from biological and environmental factors ‘Characteristic lifestyle and mode of relating to others’ (ICD – International Classification of Diagnosis)

Answer 127

Complex visual hallucinations in a person with partial or severe blindness (macular degeneration, diabetic retinopathy) Patients understand that the hallucinations are not really and often have insight compared to other disorders For those experiencing CBS, knowing that they have this syndrome and not a mental illness seems to be the most comforting treatment so far, as it improves their ability to cope with the hallucinations.

Answer 128

This is a condition where patients will produce physical or psychological symptoms to attain a patient’s role – Patients can feign the symptoms, exaggerate them or deliberately hurt themselves to produce symptoms – Typically, patients take hallucinogens, inject faeces to make abscesses and contaminate urine samples.

Answer 129

Malingering (FINANCIAL GAIN) This is when a patient feigns or exaggerates their symptoms purely for a financial reward or other gain. – Unlike Munchanhausen syndrome, it is not to play a patient’s role but to **receive compensation, personal damages or get off work** – It is not a medical diagnosis, but can lead to a large economic burden on health care systems

Answer 130

Erotomanic - believe another person (often famous/important) is in love with them, may attempt to contact/stalking behaviour Grandiose - overinflated sense self worth, power, identity, believe have talent/made important discovery Jealous - spouse/sexual partner unfaithful without any concrete evidence Persecutory - believe someone/something is mistreating/spying on/attempting to harm them, may repeatedly contact legal authorities Somatic - physical issue/medical problem e.g. parasite, bad odour

Answer 131

unwarranted tendency to interpret the actions of others as demeaning or threatening Thinks the world is – a conspiracy Think people are – devious Acts as if – always on guard, suspicious

Answer 132

pervasive pattern of indifference to social relationships and a restricted range of emotional experience and expression ***aloof*** Thinks the world is – uncaring Thinks people are – pointless, replaceable Thinks they are the only person they can depend on Commonest behaviour – withdrawal Least likely to be – emotionally available and close Schizoi**D** - = **Distant**

Answer 133

pervasive pattern of deficits in interpersonal relatedness and peculiarities of ideation, experience, appearance and behaviour Strong desire to have relationships, unable to maintain them - poor at gauging others perception of them Schizo**T**ypical - magical **t**hinking

Answer 134

Similarities - can have paranoia, and will experience the negative symptoms - of flat affect, and blunted emotions *indeed, maybe a genetic link between the two?* ask about FH of one in relatives when taking a history for the other* Differences - Paranoia is more intense in schizophrenia, and in schizophrenia, you have delusions, as well as positive symptoms like hallucinations and racing thoughts

Answer 135

**Bad** borderline (emotioanlly unstable) antisocial, histrionic narcissist, BAHN

Answer 136

Aka emotionally unstable - intense joy <--> rage Most common type Definition = pervasive pattern of instability of mood, interpersonal relationships and self-image * Self-damaging impulsivity (spending, sex, substance abuse, reckless driving, binge-eating) Thinks people are – untrustworthy Ashamed of themselves Commonest behaviour – self-harm Terrified of abandonment - might do extreme things to keep from leaving Least likely to be – able to show self-compassion Charlotte from Strike?

Answer 137

* Gross irresponsibility * Incapacity for maintaining relationships * Irritability - Disregard for moral values, - manipulative - Often charming * Low threshold for frustration and aggression * Incapacity for experiencing guilt * Deceitfulness * Disregard for personal safety *Have to be over 18 to get the diagnosis of this, with a history of conduct disorder* *Overrepresented in the prison population*

Answer 138

Definition = pervasive pattern of excessive emotionality and attention seeking Thinks the world is – their audience Thinks people are – in competition for attention Thinks they are vivacious (attractively lively and animated) Commonest behaviour – exhibitionism Least likely to be – able to listen to others Few meaningful relationships, v superficial

Answer 139

pervasive pattern of grandiosity, lack of empathy and hypersensitivity to the evaluation of others Thinks the world is – a competition Thinks people are – inferior Thinks they are – special Commonest behaviour – competitiveness Least likely to be – humble

Answer 140

Obsessive-Compulsive Personality Disorder (ICD), or Anankastic (DSM) Anxious (ICD) or Avoidant (DSM) Dependant PD OAD

Answer 141

Depression Bipolar Substance abuse disorder

Answer 142

pervasive pattern of perfectionism and inflexibility * Excessive doubt, caution, rigidity and stubbornness * Preoccupation with details, rules, lists, order * Perfectionism interfering with task completion

Answer 143

Structure, consistency and clear boundaries (i.e. agreement of behaviour that is acceptable and unacceptable) help with housing and other social matters Drugs are sometimes used to treat specific PD traits, e.g. mood stabilisers for impulsivity (not generally recommended because of lack of evidence). Continuity of care very important – changes in doctors etc. may invoke strong emotional reactions

Answer 144

Medications – mood stabilisers, sedatives during borderline PD crises Mood stabilising medication Topiramate Lithium Valproate Lamotrigine Adapted CBT for borderline PD

Answer 145

SSRIs inhibit the reuptake of serotonin. As a result, the serotonin stays in the synaptic gap longer than it normally would, and may repeatedly stimulate the receptors of the recipient cell

Answer 146

Nausea, indigestion Worsening of sexual dysfunction Weight gain Suicidal thoughts in younger people Serotonin syndrome

Answer 147

NSAIDs, Aspirin and Heparin - give a PPI cover NB - fluoxetine and paroextine have higher risk of interaction, as particulary good at inhibiting Liver enzymes

Answer 148

Linezolid Monoamine oxidase inhibitors (MAOIs) Lithium MDMA Tramadol St. John's wort Tricyclic antidepressants (TCAs) Serotonin-norepinephrine reuptake inhibitors (SNRIs) NB - fluoxetine and paroextine have a higher risk of interaction, as particularly good at inhibiting Liver enzymes

Answer 149

Serotonin syndrome (SS) is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. Diagnosis is based on a person's symptoms and history of medication use. Other conditions that can produce similar symptoms such as neuroleptic malignant syndrome, malignant hyperthermia, anticholinergic toxicity, heat stroke, and meningitis should be ruled out

Answer 150

The symptoms are often present as a clinical triad of abnormalities: Cognitive effects: headache, agitation, mental confusion, hallucinations, coma Autonomic effects: shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diarrhea. Neuromuscular hyperactivity : myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.

Answer 151

Venlafaxine Duloxetine

Answer 152

Sertraline Citalopram Fluoxetine

Answer 153

Leads increased concentration of norepinephrine in the synaptic cleft. - Inhibits 5HT reuptake pumps and NAd transporter At low doses, they act like an SSRI - noradrenaline changes don’t occur much at low doses

Answer 154

aise BP, contraindicated in heart disease Similar to SSRIs Similar to SSRI = Sweating Dose-dependant hypertension

Answer 155

Amitriptyline Imipramine Clomipramine Dosulepin Higher Dose **depression, lower dose - used for pain**

Answer 156

CNS Modulates thermoregulation, behaviour and attention PNS Regulates GI motility, vasoconstriction, bronchoconstriction, uterine contraction Other Promotes platelet aggregation (combined use with antiplatelet can increase bleeding risk

Answer 157

Action on the presynaptic neurone - inhibit the uptake of monoamines at the presynaptic membrane (bind to ATPase monoamine pump) Increase serotonin, noradrenaline Decrease acetylcholine, histamine, sodium and calcium

Answer 158

Dangerous in overdose due to It affecting sodium and calcium - very cardiotoxic CHECK ECG IF THE PATIENT IS ON THESE Look for - **Wide QRS - more than 3 small squares** - **Sinus tachycardia** Anticholinergic side effects: Blurred vision - pupil dilation Urinary retention Dry mouth Constipation Confusion agitation

Answer 159

MAOIs are seldom used, and then only in treatment - resistant depression or atypical depression **old fashioned** (depression with increased sleep, increased appetite, and phobic anxiety). Basically, in atypical depression

Answer 160

MAOIs inactivate monoamine oxidase enzymes that oxidise the monoamine neurotransmitters, such as **dopamine, noradrenaline, serotonin (5 - HT), and tyramine.** - more of them in the CNS

Answer 161

Can cause v. v. high BP if taken with tyramine (aged cheese, cured meats, broad beans). **Tyramine reaction crisis** can lead to SAH anticholinergic side - effects, weight gain, insomnia, postural hypotension, tremor, paraesthesia of the limbs, and peripheral oedema eg Selegiline, Phenelzine

Answer 162

the direct investigation and description of phenomena as consciously experienced by an individual, namely a patient Pysch, emphasises that psychiatric symptoms should be diagnosed according to their form rather than according to their content. This means, for example, that a delusion is a delusion not because it is deemed implausible by a person in a position of authority, such as a doctor, but because it is ‘ an unshakeable belief held in the face of evidence to the contrary, and that cannot be explained by culture orreligion ’ <3 xxxx

Answer 163

acute manic episodes and in the long-term prophylaxis of Bipolar affective disorder Lithium should only be started if there is a clear inten ion to continue it for at least three years, as poor complince and intermittent treatment may lead to rebound mania. The starting dose of lithium should be cautious

Answer 164

Drowsiness Weight gain

Answer 165

Side effects - at lower doses 0.4-1 mmol/L * Nausea * Fine tremor * Weight gain * Oedema * Polydipsia and polyuria * Hypothyroidism

Answer 166

Above 1.0 mmol/L Signs of toxicity * Vomiting * Diarrhoea * Coarse tremor * Slurred speech * Ataxia * Drowsiness and confusion Lithium **is Teratrogenic!!**

Answer 167

Bipolar, prophylactically They are **Teratrogenic!!**

Answer 168

Lamotrigine Skin reactions (including Stevens– Johnson syndrome) aseptic meningitis drowsiness diplopia leucopenia insomnia Sodium valpoarate Nausea Gastric itrartaion diarrhoea Weight gain They are **Teratrogenic!!**

Answer 169

1 Supportive therapy *Explorative pyschotherapies=* 2 Cognitive and Behavioural therapies 3 Psychodynamic therapies

Answer 170

Explanation and reassurance establishing rapport, facilitating emotional expression, reection, reassurance * Non-directive problem-solving, e.g. for adjustment disorders, stress, bereavement * Mild depression or anxiety Counselling is similar to supportive therapy in that it involves explanation, reassurance, and support.

Answer 171

This is a therapy with works on the interplay between thoughts, emotions and behaviours. Its aim it to tackle both negative the cognitive thinking and behaviour in mental illness. a) Cognitive –> Aim is to help people identify and challenge automatic negative thoughts and abnormal beliefs b) Behaviour –> This is based on learning theory of operant condition (positive and negative reinforcement) – If people have habitual wrong behaviours (e.g. avoidance in anxiety) it teaches people relaxation techniques and gradual exposure with positive reinforcement to change their behaviour.

Answer 172

CBT is used to treat depression, anxiety, eating disorders and some personality disorders. It can also be used to treat psychosis

Answer 173

psychoanalysis stems from the work of Sigmund Freud. - views human behaviour as determined by unconscious forces derived from primitive emotional needs. Therapy aims to resolve longstanding underlying conflicts and unconscious defence mechanisms (e.g. denial, repression). Helping the person to become more aware of the unconscious processes which are giving rise to symptoms or to difficult repeating patterns Helping the person construct a narrative of their life and give meaning to symptoms

Answer 174

– The patient explores their subconscious by using free association (says whatever is on their mind) – The therapist interprets these statements to **link the patient’s past experience with their current life** and their relationship with the therapist. This uses 2 skills: – Transference –> when the **patient re-experiences strong emotions from early relationships** with the therapist – Counter-transference –> When the therapist experiences strong emotions towards the patient **The relationship heals!!!!!!**

Answer 175

Short time, cheaper pyschological treatment – It looks at the ways an individual think and feels and the events and relationships underlying experiences. – They key of this therapy is reflection after – therapist writes a goodbye letter and asks patient to respond - **gets patients to find new nad better ways of coping with established problems** Used in 'Personality Disorder’, Eating disorders

Answer 176

similar to CBT and also provides group skills training to equip the individual with alternative coping strategies Skills such as mindfulness (bringing one’s attention back to thepresent moment), which is **derived from Buddhist meditation.** Used for those with Boarderline personality disorders, eating disorders

Answer 177

– Patients then recall the disturbing events and the emotion they felt at the time (e.g. sexual abuse and feeling powerless – They then work together to create a positive belief about the event (“I am stronger now and so not powerless”) – The therapist then activates both sides of your brain using Dual Activation Stimulation (DAS) by making they do eye movements usually involves the therapist directing the patients’ lateral eye movements by asking them to look first one way then the other (saccadic eye movements) – This allows the brain to reprocess the upsetting memories by removing the old emotion and replacing it with the more positive, empowering emotion – This means the memory is no longer experienced as a traumatic.

Answer 178

IPT is a talking treatment that helps people with depression identify and address problems in their relationships with family, partners and friends. The idea is that poor relationships with people in your life can leave you feeling depressed, it gets the patient to view their emotions in terms of their interpersonal network e.g. a close member may have died (causing grief) The rest of the session then involves work on how to cope and change their views of these events and transform their relationship into a positive one used for moderate and severe depression IPT is usually offered for 16 to 20 sessions.

Answer 179

Electroconvulsive Therapy - uses electrodes to induce a modified cerebral seizure Severe depression Prolonged or severe episode of mania that has not responded to treatment Cataonia ECT should be used to induce fast and short-term improvement of severe symptoms after all other treatment options have failed, or when the situation is thought to be life-threatening (because of high risk of suicide or not eating and drinking).

Answer 180

This is a treatment option which uses electrodes to induce a modified cerebral seizure in the brain – This leads to massive amounts of neurotransmitter release, hormone secretion and a transient increase in blood brain barrier permeability. – It is used to induce fast improvement after all other treatment options have failed

Answer 181

Patient gives informed consent (before every treatment) The patient lacks capacity, and it does not conflict with advance decision AND It’s an emergency, and the independent consultant has not yet assessed (Section 62 of Mental Health Act) OR An Independent Consultant (appointed by Mental Health Act Commission) agrees to it **IF A PATIENT HAS CAPACITY AND REFUSES, IT CANNOT BE GIVEN**

Answer 182

Procedure: – Patient is nil-by-mouth for 4 hours before intervention – Patient is given short-acting anaesthetic + muscle relaxant drug – Preoxygenation is given to increase SpO2 – A shock is delivered to the scalp either bilaterally or unilaterally – This evokes a 20-60s seizure within the brain

Answer 183

– Raised intracranial pressure (absolute) – Stroke and MI (relative contraindication

Answer 184

Patients have reported that ECT causes cognitive impairment. Therefore cognitive function should be assessed prior to, during and after a course of treatment. Assessment should include: * orientation and time to reorientation after each treatment, * new learning, * retrograde amnesia, * subjective memory impairment. * dysrhythmias due to vagal stimulation, postictal headache, * confusion, * retrograde and anterograde amnesia with difficulties in registration and recall that may persist for several weeks

Answer 185

IV fluids, cooling measures Benzodiazepines Stop offending agent If Sx persist after stimulus removed, consider cyproheptadine (serotonin antagonist)

Answer 186

Psychiatric emergency caused by excess of neuroleptic medication (aka both typical and atypical antipsychotics) or acute withdrawal from Parkinson's medication Cocaine and ectasy can also cause it

Answer 187

NMS results from as dopaminergic hypothalamic spinal tracts are blocked, so they can't tonically inhibit preganglionic sympathetic neurons as usual Occurs over hrs-days (within 10d) - gradual Hyperpyrexia Hyporeflexia Fluctuating consciousness Diffuse rigidity Raised CK - Rhabdomyolysis can occur

Answer 188

The mainstay of treatment involves stopping the drug and supportive measures such as oxygen, IV fluids, and cooling blankets Drugs - **dantrolene and lorazepam** may also be used to decrease muscle rigidity.

Answer 189

Acute presentation = drowsiness Respiratory depression -> resp acidosis CO2 retention) Hypotension Tachycardia Pinpoint pupils Chronic = constipation

Answer 190

ABCDE approach * Methadone (opioid agonist) or buprenorphine (opioid partial agonist) are first line; they are less euphoriant and have a relatively long half-life than opioids of abuse. * Lofexidine is sometimes used for short detoxification treatments or where abuse is mild or uncertain Naltrexone (opioid antagonist) blocks the euphoric effects and is occasionally used to help prevent relapse.

Answer 191

Clinical features of withdrawals are mediated by noradrenaline overactivity: * Dilated pupil * Tachycardia + hypertension * Insomnia, restlessness, anxiety, irritability, tremor * Abdo pain, nausea, vomiting, diarrhoea * Watering eyes * Muscle aches Treatment **Lofexidine**

Answer 192

Addiction liability - depends on: How substance taken: orally, injection, inhaling Rate substance crosses blood brain barrier and triggers reward pathway in brain Time takes to feel effect of substance Substance ability to induce tolerance ± withdrawal symptoms Male Aged ~ 18-25 Mental health conditions: ADHD, bipolar, depression, GAD, panic disorder, PTSD Adverse childhood experiences: childhood abuse/neglect, witnessing domestic violence, family members with SUD

Answer 193

One unit of alcohol is equivalent to 10ml or 8g of pure alcohol

Answer 194

* Alcohol increases GABA function (GABA-A receptor activation) * GABA is the main inhibitory neurotransmitter in the brain - calming effect * Alcohol reduces glutamate function - inhibitory action at NMDA glutamate receptors ○ Glutamate is the major excitory neurotransmitter that is involved in brain processing such as learning and memory ○ Effects on glutamate lead to amnesia and sedation

Answer 195

CANT STOP C - compulsion to drink A - aware of harms but persists N - neglect of other activities T - tolerance to alcohol S - stopping causes withdrawal T - time preoccupied with alcohol O - out of control use P - persistent, futile wish to cut down Withdrawal Tremors Anxiety Nausea, vomiting Headache Tachycardia Irritability, aggression Delirium

Answer 196

ICD - 10 F10 Alcohol F11 Opioids F12 Cannabinoids F13 Sedatives or hypnotics F14 Cocaine F15 Other stimulants, including caffeine F16 Hallucinogens F17 Tobacco F18 Volatile solvents F19 Multiple drug use and other

Answer 197

ICD - 10 .0 Acute intoxication .1 Harmful use .2 Dependence syndrome .3 Withdrawal state .4 Withdrawal state with delirium .5 Psychotic disorder .6 Amnesic syndrome .7 Residual and late-onset psychotic disorder .8 Other mental and behavioural disorders

Answer 198

CAGE questionnaire screening C - do you ever think about cutting down A - do you get annoyed when others comment on drinking habit G - ever feel guilty about drinking E - ever drink in morning (eye-opener) AUDIT questionnaire Developed by WHO Multiple choice for harmful alcohol use screen

Answer 199

Bloods Raised MCV Raised ALT and AST (AST:ALT ratio above 1.5 suggests ALD) Raised GGT Raised ALP later in disease Raised bilirubin in cirrhosis Low albumin (reduced synthetic function of liver, reduced clotting factor production) Deranged U&Es in hepatorenal syndrome

Answer 200

Management – Patients are often referred to an alcohol dependence programme to help them quit. – They can use a mixture of behavioural interventions (e.g. CBT) and pharmacological treatment – Disulfiram –> this inhibits acetaldehyde dehydrogenase, so people feel hungover as soon as they drink alcohol (avoid in ischaemic heart disease) – Acamprosate –> this is a weak NMDA antagonist which is used to reduce alcohol craving

Answer 201

Alcohol boosts GABA, which inhibits the brain and dampens excitatory glutamate receptors. Over time, the brain adapts, becoming more sensitive to excitatory signals. When alcohol stops, the brain becomes overactive, causing symptoms like confusion and agitation.

Answer 202

Symptoms – Together they are called delirium tremens – Early on –> increased anxiety, with sweating and agitation – After 24 hours –> Seizures with visual hallucinations – From 48-72 hours –> Course tremors, agitation, delusions and severe visual hallucinations Management – 1st line is benzodiazepine chlordiazepoxide

Answer 203

The CIWA-Ar is used to guide the pharmacological management of alcohol withdrawal. Clinicians add up scores for all ten criteria. The total CIWA score can be used to assess the presence and severity of alcohol withdrawal: Absent or minimal withdrawal: score 0-9 Moderate withdrawal: score 10-19 Severe withdrawal: score > 20 The total CIWA score influences the frequency at which further observations are made: Initial score is ≥ 8: repeat hourly for 8 hours. Then if stable 2-hourly for 8 hours. Then if stable 4-hourly. Initial score < 8: assess 48-hourly for 72 hours and if score < 8 for 72 hours, discontinue assessment. The total CIWA score guides clinicians with regards to the need for pharmacological management of alcohol withdrawal: Symptom-triggered regimen (not prescribed regular withdrawal medication): give PRN medication when CIWA score is ≥ 8 Fixed-dose reducing regime with PRN medication (prescribed regular withdrawal medication): give additional PRN medication if CIWA score is ≥ 15

Answer 204

is a neurological emergency resulting from thiamine deficiency with varied neurocognitive manifestations.

Answer 205

Hypothalamic damage & cerebral atrophy due to thiamine (vitamin B1) deficiency (eg in alcoholics). Wernicke's encephalopathy is the acute, reversible stage of the syndrome, and if left untreated it can later lead to Korsakoff syndrome, which is chronic and irreversible.

Answer 206

It **block the phosphorylation of thiamine**, stopping it from being converted into its active form Ethanol **reduces gene expression of Thiamine transporter**, so can stop it getting absorbed in the duodenum. Alcoholic tend to have a poor diet, relying on alcohol for calories so will not get enough Thiamine (b1) anyway

Answer 207

- Thiamine deficiency impairs glucose metabolism and this leads to a decrease in cellular energy. - The brain is particularly vulnerable to impaired glucose metabolism since it utilises so much energy.

Answer 208

1 confusion 2 ataxia (wide-based gait; fig 2) 3 **ophthalmoplegia** (nystagmus, lateral rectus or conjugate gaze palsies).

Answer 209

- Mainly targets the limbic system, causing severe memory impairment: - **Anterograde amnesia:** inability to create new memories - **Retrograde amnesia:** inability to recall previous memories. - **Confabulation:** creating stories to fill in the gaps in their memory which they believe to be true. - **Behavioural changes**

Answer 210

- Diagnosis is typically made **based on clinical presentation** - **Bloods including LFTs**: measure thiamine levels, measure blood alcohol levels, liver function may be deranged in alcoholism - **Red cell transketolase test:** rarely done, thiamine is a co-enzyme to transketolases so transketolase activity will be low - **MRI/CT:** can confirm diagnosis by showing degeneration of the mammillary bodies Lumbar puncture to rule out other causes of the symptoms of wernickes

Answer 211

Urgent replacement to prevent irreversible Korsakoff’s syndrome (p718). Give thiamine (Pabrinex®) Oral supplementation (100mg OD) should continue until no longer ‘at risk’, *give other B vitamins as well* Correct Magnesium deficiency as well If there is coexisting hypoglycaemia, correct it

Answer 212

it’s important to normalise the thiamine levels first, because without thiamine pyrophosphate, **most of the glucose will become lactic acid and that can lead to metabolic acidosis.** (often the case in this group of patients), make sure **thiamine is given before glucose**, as Wernicke’s can be caused by glucose administration to a thiamine-deficient patient - ***NOT GIVING THIAMINE AS YOU JUST THINK ITS HYPOGLYCAEMIA IS A COMMON MISTAKE DOCTORS MAKE***

Answer 213

Pharmacological management of alcohol withdrawal and detoxification * Chlordiazepoxide - benzodiazepine commonly used in the UK (long acting) * Diazepam (long acting) * Lorazepam (short acting) - can be considered when there is liver injury Oxazepam (short acting)

Answer 214

These drugs block the reuptake of dopamine and noradrenaline (and 5-HT) increasing transmission at synapses

Answer 215

Main effect – Increased energy and concentration, euphoria and hyperactivity Side effects: – Cardiovascular –> Increased pulse, blood pressure, hyperthermia, can lead to aortic dissection – Heart –> QRS widening and QT prolongation – GI –> Reduced appetite and ischaemic colitis – Psychological –> Insomnia, agitation and hallucinations e.g. formication (sensation of ants under the skin) – If you take a prolonged large dose, the euphoria can turn to depression and anxiety – Can get psychosis –> delusions, visual and auditory hallucinations

Answer 216

– IV benzodiazepines + treat complications (heart attack, aortic dissections) + antipsychotics

Answer 217

i) A person is **assumed to have capacity** is assumed until it is established that the person lacks it ii) A person should not be treated as unable to decide **unless all practicable steps to help them have failed** iii) A person should **not** be treated as unable to decide **just because it is unwise** iv) Decisions made on **behalf of an incapable person must be in their best interests** v) Regard should be taken to **find the solution which is least restrictive of the person’s rights and freedom of action**

Answer 218

– If a valid advanced decision to refuse treatment exists – If a valid Lasting Power of Attorney for Health and Welfare exists – If neither exists, the person providing treatment should act in the patient’s best interests.

Answer 219

Under section 2 of the mental health act Need 2 Drs: one section 12 approved, one ideally previous contact w/ pt, and then approval from approved mental health professional (AMHP) to confirm the section. Patient suffering from mental disorder to degree that warrants detention in hospital for assessment Pt should be detained for own health/safety or the protection of others **Lasts 28 days, cannot be renewed**

Answer 220

Under section 3 of the mental health act Again, Need 2 Drs: one section 12 approved, one ideally previous contact w/ pt, and then approval from approved mental health professional (AMHP) to confirm the section. Patient suffering from mental disorder to degree that warrants detention in hospital for treatment. Pt should be detained for own health/safety or the protection of others The treatment needed cannot be effectively provided unless the patient is detained. Appropriate medical treatment is available to them. lasts 6 months, can be renewed

Answer 221

Patient suffering from mental disorder to degree that warrants detention in hospital for assessment Pt detained for own safety/safety of others Not enough time for 2nd Dr to attend i.e. due to risk 1 Dr (does not need to be section 12 approved) Can only last 72 hours

Answer 222

For pt already admitted (to psychiatric/general hospital) but wanting to leave section 5(4) says Nurses can detain patients in hospital (this is their holding power until a Dr can attend,) for **6 hours** Section 5(2) says Doctors (this is their holding power until section 2/3 can be put in place) NB - has to be Dr on a specific ward, cannot be done in A&E, for **72 hours**

Answer 223

135 - allows police to enter house and mreove a patient to a place of safety 136 allows police to take someone to a place of safety for an assessment Both can be done by a police, but the should try and confirm this with a doctor or nurse Both for a duration of 72 hours

Answer 224

Consent to Treatment As a general rule, once a patient is detained under S2, 3, 35, 36 or 37 of the MHA, consent is not required for the administration of psychiatric treatment. – The justification for treatment is provided by S63 which states that: “The consent of a patient shall not be required for any medical treatment given to him for the mental disorder from which he is suffering” Treatments are Covered by S63 All medical treatment for the mental disorder, including: Treatments for the disorder itself (e.g. antipsychotics for schizophrenia) Treatments for conditions causing the disorder (e.g. hypothyroidism causing depression) Treatments for the physical consequences of the disorder (e.g. NG in anorexia) Safe holds and physical control and restraint (when necessary)

Answer 225

Intentional non-fatal self-inflicted harm * a desire to interrupt a sequence of events seen as inevitable and undesirable * a need for attention * an attempt to communicate/express themselves * a true wish to die Used to express something hard to put into words, change emotional pain into physical pain, have a sense of being in control, punish themselves for feelings/experiences…

Answer 226

Unlike completed suicide, DSH is more frequent in women, the under-35s, lower socia l classes and the single or divorced. * Like suicide, DSH is associated with psychiatric illness, particularly depression and personality disorder

Answer 227

Cuts/scratches on arms/legs Picking at skin Burns Bruising Weight loss/weight gain Hair loss (pulling at hair)

Answer 228

Before During After

Answer 229

Precipitants - specific event/build up? Planned/impulsive? Precautions taken against discovery? (left the house, turned off phone etc) Alcohol/recreational drugs at time of event? - suggests more impulsive

Answer 230

Method (if drugs - what did they take, how much) Was pt alone Where was it - more remote = higher risk What went through mind at the time Did they think their self-harm would end their life? What did they do straight after the self-harm?

Answer 231

Did pt call anyone? Go to A&E? Who were they found by How they felt when help arrived Current mood Still feel suicidal? - would they attempt again

Answer 232

Warning signs: * Obsessive thinking about death * Feelings of hopelessness, worthlessness, helplessness * Behaviours suggestive of absolute death wish: ○ Put financial affairs in order ○ Visiting people to say goodbye in community, awareness of pts who: Frequently, repeatedly attend Disengaged w/ services Prescribed several antidepressants Heightened concern from family members

Answer 233

SAD PERSONS Sex (male) Age <19 or >45 Depression Previous suicide attempt Excess alcohol or substance use Rational thinking loss Separated or single Organised plan No social support Sickness

Answer 234

A good first step is to agree with patients what their problems are and what immediate interventions are both feasible and acceptable to them. * Ensure that they know who they can turn to if suicidal intent returns (e.g. A & E). * Crisis Resolution Team referral may be necessary if suicidal ideation is present. * Think about reducing access to means of suicide if possible – for example, by encouraging patients to dispose of unneeded tablets from the home, and by prescribing antidepressants of lower lethality (e.g. SSRIs rather than tricyclics) and in small batches. * Consider psychological therapy and encouraging engagement in self-help and community social and support organisations.

Answer 235

* Detect and treat psychiatric disorders. * Be alert to risk and respond appropriately to it. * Prescribe safely * Give urgent care at appropriate level of patients with suicide intent – refer to Crisis Resolution and Home Treatment Teams. - Can also admit for hospitalization (consider detention under the Mental Health Act) if patients considered unsafe outside hospital even with intensive support. *Provide careful management of deliberate self-harm (DSH) * Act at the population level, tackling unemployment and reducing access to methods of self-harm.