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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

State the mechanism of action of SSRIs

A

Selective inhibition of serotonin reuptake. Increases availability of serotonin and enhances mood regulation.

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2
Q

State indications of SSRIs

A

1st line for:

  • Depression
  • Generalised anxiety disorder (GAD)
  • Panic disorder
  • Obsessive - compulsive disorder (OCD)
  • PTSD
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3
Q

State cautions for SSRIs

A
  1. Omitted for mania
  2. Sertraline best for IHD patients
  3. Avoid in patients taking warfarin
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4
Q

State common side effects of SSRIs

A
  1. GI upset
  2. Anxiety + agitation
  3. QT interval prolongation (especially with citalopram)
  4. Sexual dysfunction
  5. Hyponatraemia
  6. Gastric ulcer
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5
Q

State common SSRIs

A
  1. Citalopram
  2. Fluoxetine
  3. Sertraline
  4. Paroxetine
  5. Escitalopram
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6
Q

Describe important considerations for monitoring patients on SSRIs

A
  1. Increased risk of impulsivity and suicide in people aged 18-25. Require review 1w post treatment commencement. With >25 can do 2-4w post.
  2. Continuation of antidepressants for at least 6m post remission to mitigate relapse risk.
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7
Q

Aetiology of serotonin syndrome

A
  1. SSRIs
  2. SNRIs
  3. MAOIs
  4. Tricyclic antidepressants
  5. MDMA and cocaine
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8
Q

Sx of serotonin syndrome

A
  1. Mental status changes
    • Anxiety
    • Agitation
    • Restlessness
    • Disorientation
  2. Autonomic hyperactivity
    • Hyperthermia
    • Tachycardia
  3. Neuromuscular abnormalities
    • Tremor
    • Clonus (abnormal reflex response to muscle stretch)
    • Myoclonus (twitch)
    • hyperreflexia
    • Seizures
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9
Q

Ddx of serotonin syndrome

A
  1. Neuroleptic Malignant Syndrome
    • Same presentation but slower onset and longer duration
  2. Anticholinergic toxicity
    • same presentation but decreased bowel sounds and urinary retention
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10
Q

Management of serotonin syndrome

A
  1. Discontinuation of offending drug + supportive care
  2. Extreme case: Cyproheptadine
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11
Q

State the mechanism of action of SNRIs

A

Increase serotonin and norepinephrine (adrenaline)

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12
Q

State indications for use of SNRIs

A
  1. First line for depression is SSRI not indicated or unsuccessful
  2. Licensed for use in GAD and panic disorder
  3. Contraindicated with history of heart disease and hypertension
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13
Q

Side effects of SNRIs

A
  1. Nausea
  2. Insomnia
  3. Tachycardia
  4. Agitation
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14
Q

State common SNRIs

A
  1. Duloxetine
  2. Venlafaxine
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15
Q

What is the mechanism of action for Noradrenergic and specific serotonergic antidepressant (NASSA)

A

Norepinephrine and serotonin level modulation in the brain

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16
Q

What is the indication for NASSA

A
  • Mirtazepine is 2nd line for management of depression.
    • Preferred in cases with concern of weight loss and sleep
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17
Q

Side effects of NASSA

A
  1. Sedation
  2. Increased appetite
  3. Weight gain
  4. Constipation/diarrhoea
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18
Q

State the mechanism of action (Tricyclic Antidepressants) TCAs

A
  • Block reuptake of serotonin and noradrenaline
    • Also used as antimuscarinic
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19
Q

State common TCAs

A
  1. Amitriptyline
  2. Clomipramine
  3. Imipramine
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20
Q

State cautions for use of TCAs

A
  1. Previous heart disease
  2. Exacerbate schizophrenia
  3. Exacerbate long QT syndrome
  4. Urinary retention (avoid men with enlarged prostate)
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21
Q

State side effects of TCAs

A

Anticholinergic activity:
- Urinary retention
- Drowsiness
- Blurred vision
- Constipation
- Dry mouth

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22
Q

State signs of TCA toxicity

A
  1. Drowsiness
  2. Confusion
  3. Arrhythmias
  4. Seizures
  5. QT interval prolongation
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23
Q

State mechanism of action for Monoamine Oxidase Inhibitors (MAO-IS)

A
  1. Monoamine oxidase metabolises serotonin and noradrenaline.
  2. Inhibition -> elevation of serotonin
  3. Similar structure to amphetamines so also affects uptake and release of dopamine, noradrenaline and serotonin.
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24
Q

State cautions for use of MAO-IS

A
  1. Cerebrovascular disease
  2. Manic phase of bipolar disorder
  3. Severe cardiovascular disease
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25
Q

State side effects of MAO-IS

A

Hypertensive reactions: tyramine-containing foods to be avoided (cheese, marmite, salami, etc)

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26
Q

State common MAO-IS

A
  1. Moclobemide
  2. Phenelzine
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27
Q

What are typical antipsychotics?

A
  • 1st gen
  • Acts as antagonist on:
    • D2 receptor
    • Cholinergic receptor
    • Adrenergic receptor
    • Histaminergic receptor
  • Haloperidol
  • Chlorpromazine
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28
Q

What are the D2 receptor blockade side effects

A
  1. Extrapyramidal symptoms
    • Acute dystonia: involuntary muscle contractions
    • Akathisia: Restlessness
    • Parkinsonism: tremors, rigidity, bradykinesia
    • Tardive dyskinesia
  2. Hyperprolactinemia
    • Menstrual irregularities in women
    • Gynecomastia
    • Sexual dysfunction
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29
Q

What are the H1 receptor blockade side effects?

A

Sedation

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30
Q

What are the adrenergic receptor blockade side effects?

A

Orthostatic hypotension: drop in BP from standing

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31
Q

What are the cholinergic receptor blockade side effects?

A

Anticholinergic effects
- Dry mouth
- Constipation
- Blurred vision
- Urinary retention

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32
Q

What are atypical antipsychotics?

A
  • 2nd gen
  • act as antagonist on:
    • D2
    • D3
    • 5-HT2A
  • As effective as typical antipsychotics
  • More favourable side effect profile
  • Reduced extrapyramidal effects
  • Increased metabolic side effects
  • 1st line for new-onset psychosis
  • Risperidone
  • Quetiapine
  • Olanzapine
  • Aripiprazole
  • Clozapine
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33
Q

What are the serotonin (5-HT2A) receptor blockade side effects?

A
  • Reduced risk of EPS
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34
Q

What are the other misc. side effects with atypicals?

A
  • Mild H1 receptor blockade symptoms
  • Mild adrenergic receptor symptoms
  • Mild anticholinergic symptoms
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35
Q

What are the metabolic side effects of atypicals?

A
  1. Weight gain
  2. Dyslipidemia and glucose metabolism
  3. Prolactin elevation
  4. Seizures
  5. QT prolongation
  6. Increased risk of VTE in elderly
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36
Q

What monitoring should be undertaken when administering atypicals to a patient?

A
  1. Measure weight at start of therapy then weekly until week 6
    • Then at week 12
    • Then at year 1
    • Then yearly
  2. Measure prolactin conc
  3. HbA1c
  4. ECG
  5. BP
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37
Q

When is clozapine indicated for treatment?

A
  • Failure of treatment of 2 other antipsychotics (treatment resistant schizophrenia)
  • Treats both +ve and -ve symptoms; more effective than other antipsychotics
  • SE:
    • Agranulocytosis
    • Neutropenia
    • Constipation
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38
Q

What are the important monitoring factors for clozapine?

A
  1. weekly FBC (for wbc check) for first 18w
  2. Blood lipids and weight every 3m
  3. Blood glucose after 1m
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39
Q

What is Neuroleptic Malignant Syndrome?

A
  • Rare
  • Life threatening
  • Idiosyncratic reaction to antipsychotic medications
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40
Q

State the clinical features of NMS

A
  1. Hyperthermia
  2. Altered mental state - fluctuating levels of consciousness
  3. Autonomic dysregulation - flux in BP, tachycardia and diaphoresis (excessive sweating)
  4. Rigidity
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41
Q

Ddx for NMS

A
  • Serotonin syndrome: same presentation but with serotoninergic medication
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42
Q

Ix for NMS

A
  • FBC
  • CK
  • Renal function
  • LFTs
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43
Q

Management of NMS

A
  1. Discontinuation + supportive care
  2. Benzodiazepines: manage agitation + rigidity
  3. Dantrolene: muscle relaxant for severe cases
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44
Q

State side effects of Lithium

A

LITHIuM pneumonic
- Leucocytosis
- Insipidus
- Tremor (fine)
- Hypothyroid
- Increased weight
- u
- Metallic taste

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45
Q

State the indications for lithium

A
  1. Bipolar disorder and mania
  2. Depression
  3. Mood stabiliser for aggressive/ self harming behaviour
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46
Q

State the clinical features of lithium toxicity

A
  • Coarse tremor
  • Seizures
  • Cardiac arrhythmias
  • Visual disturbances
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47
Q

State the clinical features of lithium toxicity

A
  • Coarse tremor
  • Seizures
  • Cardiac arrhythmias
  • Visual disturbances
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48
Q

State the Ddx of lithium toxicity

A
  1. Neuro conditions: Parkinson’s
  2. Cardiac conditions
  3. Substance intoxication or withdrawal: alcohol or benzos
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49
Q

State the Ix for lithium toxicity

A
  1. Serum lithium levels
  2. Electrolytes
  3. TFTs
  4. Renal function test
  5. ECG
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50
Q

State clinical features of Alzheimer’s

A
  1. Memory impairment
  2. Language impairment
  3. Executive dysfunction: impaired ability to plan, organise and carry out tasks
  4. Behavioural changes
  5. Psych symptoms
  6. Disorientation
  7. Loss of motor skills
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51
Q

State Ddx of Alzheimer’s

A
  1. Vascular dementia
    • Sudden onset with history of cerebrovascular events
  2. Lewy body dementia
    • visual hallucinations and fluctuating cognitive impairment
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52
Q

State Ix of Alzheimer’s

A
  1. History (cognitive screen)
  2. Examination (full Neuro exam)
  3. Blood tests (rule out reversible causes)
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53
Q

State the management of Alzheimer’s

A
  1. Cognitive stimulation therapy
  2. Cholineesterase inhibitors: Donepezil
  3. NMDA receptor antagonists: Memantine
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54
Q

State the 5 types of anxiety disorders

A
  1. Generalised Anxiety Disorder (GAD)
  2. Specific phobias
  3. Panic disorder
  4. OCD
  5. PTSD
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55
Q

State the 5 types of anxiety disorders

A
  1. Generalised Anxiety Disorder (GAD)
  2. Specific phobias
  3. Panic disorder
  4. OCD
  5. PTSD
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56
Q

State the clinical features of anxiety

A
  1. Psychological: fears and worries
  2. Motor symptoms: Restlessness
  3. Neuromuscular: Tremor
  4. GI: Dry mouth
  5. Cardio: palpitations
  6. GU: ED, amenorrhea
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57
Q

Management of GAD

A
  1. SSRIs
  2. CBT
  3. Counselling
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58
Q

Define anorexia nervosa

A
  • Extreme dietary restriction
  • Intense fear of gaining weight
  • Distorted body image
59
Q

State clinical features of anorexia nervosa

A
  1. History
    • starvation via restricting intake, purging or excessive exercise
  2. Examination
    • BMI <17.5
    • Hypotension
    • Bradycardia
    • Lanugo hair
    • Amenorrhoea
60
Q

State Ix for anorexia nervosa

A

Bloods
- deranged electrolytes
- Low sex hormone (FSH,LH, oestrogen, testosterone)
- Leukopenia
- Raised cortisol
- Hypercholesterolaemia

61
Q

Management of Anorexia nervosa

A
  1. CBT-ED
  2. SSRIS
62
Q

State possible complications of anorexia nervosa

A
  1. Refeeding syndrome
  2. Cardiac arrhythmias
  3. Osteoporosis
63
Q

State Sx of refeeding syndrome

A
  1. Oedema
  2. Confusion
  3. Tachycardia
64
Q

What aspect of refeeding syndrome causes electrolyte imbalance?

A
  • Rapid increase in insulin level -> shifts K+, Mg2+, phosphate from extracellular -> intracellular
    • These electrolytes then need to be replenished
65
Q

Describe preventative measures for refeeding syndrome

A
  1. High dose vitamins before feeding commences
  2. Replenish electrolytes early + daily bloods
  3. Refeeding starts at no more than 50% of calorie requirement in Pt with little to no feed for >5d
66
Q

Define BPAD

A

At least 2 episodes including one hypomanic or manic episode
- BPAD Type 1: 1 or more manic episodes and one or more depressive episodes
- BPAD Type 2: recurrent major depressive episodes and hypomanic episodes

67
Q

What is hypomanic state and how do you differentiate it from a manic episode?

A
  1. Mania: severe functional impairment with psychotic symptoms for at least 7d
  2. Increased/decreased function without psychotic symptoms for at least 4d
68
Q

State Ix of BPAD

A
  • Rule our organic causes from substances
  • Rule out delirium from secondary causes such as: infection, thyroid, B12
69
Q

State management of BPAD

A
  1. Hypomania -> routine CMHT
  2. Mania/severe depression -> urgent CMHT
  3. New diagnosis
    • If SSRI recently started -> stop/taper
    • Mania + agitation -> benzodiazepine
    • Mania - agitation -> oral antipsychotic monotherapy (haloperidol). + lithium if unsuccessful
    • Acute depression -> mood stabiliser
  4. Chronic
    • 4w after resolution of acute episode
    • Maintenance therapy with mood stabiliser (Li 1st line)
69
Q

Define bulimia

A
  1. Eating disorder
  2. Recurrent binge eating with loss of control
  3. Followed by compensatory behaviours (vomiting, etc)
  4. Maintain normal/slightly above average BMI
69
Q

Clinical presentation of bulimia

A
  1. Binge eating
  2. Purging
  3. Dental erosion (from vomiting)
  4. Parotid gland swelling
  5. Russell’s sign: scarring on hand from vomiting
  6. Amenorrhea
69
Q

Ix for bulimia

A

Comprehensive history and examination

70
Q

Management of bulimia

A

Bulimia focused guided self-help

71
Q

Define delirium

A
  1. Acute and fluctuating disturbance in attention and cognition
  2. +/- change in consciousness
  3. Reversible
72
Q

State the 3 types of delirium

A
  1. Hyperactive
    • Increased psychomotor activity
    • Restlessness
    • Agitation
    • Hallucinations
  2. Hypoactive
    • Lethargy
    • Reduced responsiveness
    • Withdrawal
  3. Mixed
    • Mixture of hyperactive and hypoactive
73
Q

Aetiology of delirium

A

D: drugs and alcohol (anti-cholinergics, opiates, anti-convulsants)
E: Eyes, ears, emotional disturbance
L: Low output state (MI, PE, COPD)
I: Infection
R: Retention (urine/stool)
I: Ictal (seizure)
U: Under (hydration/nutrition)
M: Metabolic disorders
S: Subdural hematoma, sleep deprivation

74
Q

Sx of delirium

A
  1. Disorientation
  2. Hallucinations
  3. Inattention
  4. Memory problems
  5. Change in mood or personality (sundowning: worsening as EoD approaches)
  6. Disturbed sleep
75
Q

Ddx for delirium

A
  1. Dementia (gradual onset)
  2. Psychosis (preserved orientation and memory)
  3. Depression (stable consciousness level)
  4. Stroke (abrupt onset + neuro signs)
76
Q

Ix for delirium

A
  1. 4AT and CAM (tools)
  2. Bedside
    • Bladder scan
    • ECG
  3. Bloods
    • FBC
    • U+E
    • LFTs
    • TFTs
    • Blood cultures
  4. Imaging
    • CXR
77
Q

Management of delirium

A
  1. Treat underlying cause
  2. Comfortable environment for pt
  3. Haloperidol if severely agitated
78
Q

Define delirium tremens (DT)

A
  1. Alcohol withdrawal
  2. 72h after alcohol cessation
  3. Immediate medical attention
79
Q

Sx of DT

A
  1. Confusion + disorientation
  2. Hallucinations (visual or tactile; sensation of crawling insects under skin)
  3. Autonomic hyperactivity
  4. Seizures
80
Q

Management for DT

A
  1. Lorazepam (1st line)
  2. Maintenance
    • Chlordiazepoxide
    • Hydration
    • Anti-emetics
    • Pabrinex (vitamins)
81
Q

Define delusions

A
  1. Fixed false beliefs
  2. Maintained despite contradictory evidence
  3. Bizarre (very strange or highly unusual) or non-bizarre (plausible but incorrect)
82
Q

Sx of delusions

A
  1. Nihilistic delusions
  2. Grandiose delusions
  3. Delusion of control (external entity controlling thoughts/action)
  4. Persecutory delusions (being conspired against)
  5. Somatic delusion (convinced they have physical, medical or biological problem despite no medical evidence)
  6. Delusional perceptions (arise from real perception leading to delusion)
  7. Delusions of reference (mundane things meaning something special and directed at pt)
83
Q

Management of delusions

A
  1. Pharmacological
    • antipsychotics
  2. Psychotherapy
    • CBT
84
Q

Define dementia

A
  1. Chronic syndrome
  2. Impairment of multiple higher cortical functions
  3. MMSE of 24/30 or less = dementia
85
Q

Sx of dementia

A
  1. Gradual, progressive, impairment of higher cortical function
  2. Memory loss
  3. Difficulty with familiar tasks
  4. language problems
  5. Disorientation
  6. Poor judgement
86
Q

State the 4 common types of dementia

A
  1. Alzheimer’s
  2. Vascular
  3. Lewy body
  4. Fronto-temporal
87
Q

Define alzheimer’s

A
  1. Most common cause
  2. Neuropathological features: amyloid plaques and tau proteins
88
Q

Sx of Alzheimer’s

A

4 A’s
1. Amnesia (recent memories lost first)
2. Aphasia (muddled speech)
3. Agnosia (recognition problems)
4. Apraxia (inability to carry out skilled tasks)

89
Q

Management of Alzheimer’s

A
  1. Cholinesterase inhibitors
    • Galantamine
  2. NMDA inhibitor (severe)
    • Memantine
90
Q

Summarise vascular dementia

A
  1. 2nd most common cause
  2. Impaired blood flow to brain
  3. Step-wise progression (due to progressive infarcts)
  4. Clinical Dx
  5. Tx = manage underlying vascular condition
91
Q

Summarise lewy body dementia

A
  1. 3rd most common
  2. Abnormal protein deposits (lewy bodies) -> cognitive decline
  3. Sx
    • Parkinsonism (rigidity, tremor, bradykinesia)
    • Visual hallucinations (small creatures/children/figures; lilliputian bodies)
92
Q

State management difficulties with lewy body dementia

A
  1. Neuroleptics
    • Manage agitation/hallucination but trigger rigidity and parkinsonism
  2. Dopaminergic agents
    • Manage rigidity but worsen hallucinations
93
Q

Sx of fronto-temporal dementia

A
  1. Cognitive impairment
  2. Personality change
  3. Repetitive checking behaviour
  4. Disinhibition
  5. Construction apraxia (failure to draw interlocking pentagons)
  6. Memory loss = LATE FEATURE
  7. Presents at young age)
94
Q

What are the 3 main variants in fronto-temporal dementia

A
  1. Behavioural variant (60%)
    • Loss of social skills
    • Disinhibition
  2. Semantic dementia (20%)
    • Inability to remember words for things
  3. Progressive non fluent aphasia (20%)
    • Unable to verbalise
95
Q

Define depression

A
  1. 5/9 Sx for at least 2w
    • Low mood
    • Anhedonia (unable pleasure)
    • Weight change
    • Sleep and activity changes
    • Fatigue
    • Guilt
    • Poor concentration
    • Suicidality
96
Q

Ix for depression

A
  1. FBC
  2. TFTs
  3. U+E
    4 LFT
  4. Glucose
  5. B12
  6. Tox screen
97
Q

Management of depression

A
  1. Mild to moderate
    • CBT
  2. Moderate to severe
    • SSRI
  3. Severe
    • ECT
98
Q

Define Wernicke’s encephalopathy

A
  1. Thiamine (B1) deficiency
  2. Commonly from chronic alcohol abuse
99
Q

Sx of Wernicke’s encephalopathy

A

Classic triad of:
- Confusion
- Ataxia
- Opthalmoplegia/nystagmus (paralysis of eye muscle)

100
Q

Sx of Korsakoff’s syndrome

A
  1. Profound anterograde amnesia (creating new memories)
  2. Limited retrograde amnesia (recall memories before injury)
  3. Confabulation (fabricate memories to mask lack of)
101
Q

State Ddx for Wernicke’s encephalopathy

A
  1. Alcohol withdrawal syndrome (includes tremors, agitation, nausea)
  2. Hepatic encephalopathy (changes in consciousness, asterixis)
  3. Stroke
  4. Cerebellar disorders (lacks confusion or opthalmoplegia)
102
Q

Ix for Wernicke’s encephalopathy

A
  1. Thiamine level
  2. Full bloods
  3. MRI (mamillary body atrophy in Korsakoff’s syndrome)
103
Q

Management of Wernicke’s encephalopathy

A
  1. Thiamine supplementation
  2. Address underlying condition
104
Q

Management of Korsakoff’s syndrome

A
  1. Ongoing thiamine supplementation
  2. Cognitive rehab
  3. Treat underlying causes
105
Q

Define OCD

A
  1. Recurrent obsessional thoughts or compulsive acts
  2. Cause significant functional impairment
  3. Time consuming
106
Q

Management of OCD

A
  1. Mild
    • CBT
  2. Moderate
    • CBT
    • SSRI
  3. Severe
    • CBT AND SSRI
107
Q

State the different types of PCM OD

A
  1. Acute
    • Excessive amounts in <1h
  2. Staggered
    • Excessive amount over >1h
  3. Therapeutic
    • Excess with intent to treat pain or fever (no self harm intent)
108
Q

Sx of PCM OD

A
  1. N+V
  2. Loin pain
  3. Haematuria & proteinuria
  4. Jaundice
  5. Abdo pain
109
Q

Ix for PCM OD

A
  1. Usual bloods
  2. Clotting screen
  3. VBG
  4. NOMOGRAM (plots pcm levels)
110
Q

Management of PCM OD

A
  1. <1h + dose >150mg/kg
    • Activated charcoal
  2. <4h
    • Wait until 4h to take level and treat with N-acetylcysteine
  3. 4-24h + dose >150mg/kg
    • N-acetylcysteine immediately
111
Q

What is the criteria for immediate liver transfer with PCM OD

A
  1. Arterial pH <7.3
    or ALL of:
  2. Serum creatinine > 3.4mg/dL
  3. Prothrombin time > 100s
  4. Grade III or IV encephalopathy
112
Q

Define postpartum depression

A
  1. Depressive disorder
  2. Develop up to one year following childbirth
  3. Interferes with daily functioning
113
Q

Sx of postpartum depression

A
  1. Low mood
  2. Low energy
  3. Biological symptoms of depression
    • poor appetite
    • Disturbed sleep pattern
  4. Concerns about baby bonding
114
Q

Ix of postpartum depression

A
  1. Edinburgh Postnatal Depression Scale (EPDS)
    • Screening tool
115
Q

Management of postpartum depression

A
  1. Self help + CBT
  2. Paroextine and sertraline (best with breastfeeding)
116
Q

Define postpartum psychosis

A
  1. Psychiatric disorder
  2. First 2w after childbirth
117
Q

Sx of postpartum psychosis

A
  1. Paranoia
  2. Delusions
    • Capgras delusions: misidentification syndrome where belief close person replaced by imposter
  3. Hallucinations
  4. Manic episodes
  5. Depressive episodes
  6. Confusion
118
Q

Management of postpartum psychosis

A
  1. Olanzapine & quetiapine (safe with breastfeeding)
  2. Li
119
Q

Define schizophrenia

A
  1. Chronic or relapsing/remitting form of psychosis
  2. +ve Sx
    • hallucinations
    • delusions
    • thought disorders
  3. -ve Sx
    • Alogia (decreased speech)
    • Anhedonia (decreased joy)
    • Avolition (decreased motivation)
120
Q

State the subtypes of psychosis

A
  1. Paranoid
    • delusions
    • hallucinations
    • persecutory theme
  2. Catatonic
    • motor disturbance
    • Waxy flexibility
  3. Hebephrenic
    • disorganised thinking, emotion and behaviour
  4. Residual
    • residual Sx post major episode
  5. Simple
    • Gradual decline in functioning without prominent +ve Sx
121
Q

Sx of schizophrenia

A

+ve Sx (ABCD)
- Auditory hallucinations
1. Broadcasting of thoughts
2. Control issues
3. Delusional perception

-ve Sx
1. Alogia
2. Anhedonia
3. Avolition
4. Blunting

122
Q

Ix for schizophrenia

A
  1. Clinical diagnosis
  2. Excluding Ddx tests
    • Brain imaging
    • Bloods to exclude infectious or metabolic causes
    • Drug screen
123
Q

Management of schizophrenia

A
  1. Acute episode
    • Lorazepam (sedative)
    • Haloperidol (manage dangerous behaviour)
  2. Atypicals
    • Risperidone
  3. Resistant schizophrenia
    • Clozapine
  4. CBT
124
Q

Sx of opiate intoxication

A
  1. Drowsiness
  2. Confusion
  3. Decreased RR and HR
  4. Constricted pupils
125
Q

Sx of opiate withdrawal

A
  1. Agitation
  2. Anxiety + irritability
  3. Muscle aches
  4. Chills
  5. Runny nose
  6. Sweating
126
Q

Management of opiate use

A

WITHDRAWAL
1. Methadone (QTc prolongation)
2. Lofexidine (Alpha 2 receptor agonist)
3. Loperamide (for diarrhoea)
4. Anti-emetics
5. Benzos (for agitation)
DETOX
1. Methadone and buprenorphine
RELAPSE
1. Neltrexone post detox
OVERDOSE
1. Naloxone

127
Q

State the 5 key principles of the MCA

A
  1. Capacity unless proven otherwise
  2. Steps must be taken to help a person have capacity
  3. An unwise decision does not mean a person lacks capacity
  4. Any decision under MCA must be under patient’s best interests
  5. Decisions must be least restrictive to person’s rights and freedoms
128
Q

How is capacity assessed?

A
  1. Is there an impairment of or disturbance in the functioning of mind or brain?
  2. If yes:
    • Understand relevant info
    • Retain relevant info
    • Weigh up relevant info
    • Communicate a decision
129
Q

Summarise DoLS

A
  1. Deprivation of pt liberty due to lack of capacity
  2. Common in acute/geris
130
Q

State the conditions that must be met for DoLS to be applied

A
  1. > 18
  2. Mental disorder
  3. Patient in hospital or care home
  4. Lack capacity
  5. Proposed restrictions would deprive liberty
  6. Proposed restrictions in best interest
  7. Consider MHA
  8. No valid advance decision to refuse treatment or support that would contradict DoLS
131
Q

State the criteria for the MHA

A
  1. Must have mental disorder
  2. Risk to self or others
  3. Must be a treatment (including nursing care)
  4. Applies only to mental health disorders
    • Does not cover physical illness except anorexia for refeeding
132
Q

Describe the MHA assessment

A
  1. requires to 2 doctors ( at least 1 section 12(2) approved) + 1 approved AMHP
133
Q

Summarise Section 2

A
  1. Allows admission for mental health assessment and treatment
  2. 28 days
  3. Non-renewable
134
Q

Summarise Section 3

A
  1. Admission for treatment for upto 6m
  2. Renewable
135
Q

Summarise Section 4

A
  1. For emergencies when Section 2 would cause delay
  2. Recommendation of single doctor or AMHP or nearest relative
  3. 72h followed by Section 2
136
Q

Summarise Section 5(2)

A
  1. Holding power for voluntary patient
  2. 72h
137
Q

Summarise Section 5(4)

A
  1. Same as Section 5(2) but by nurses
  2. 6h
138
Q

Summarise Section 17a

A

Supervised community treatment (Community Treatment Order CTO)

139
Q

Summarise Section 135

A

Enables police to enter a property to escort a person to safety

140
Q

Summarise Section 136

A

Provides police authority to take mental disorder individual from public place to place of safety

Phase 3a (5 decks)

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