Psychiatry Flashcards

1
Q

defne
Othello Syndrome

Cotard’s Syndrome

Capgras Syndrome

De Cleram​bault’s syndrome

Charles bonnet

A

Othello Syndrome

Belive partner is chating on them

Cotard’s Syndrome

Belive their body is dead ro decaying - in severe depression

Capgras Syndrome

Delusion belief that reiefn or relative has been repplaced by an exact double

De Cleram​bault’s syndrome

Belief that another is deeply in love with them but hiding it

Charles bonnet

recutring hallucination in those with ipaired vision

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2
Q

define
Hallucination

Illusion

Delusion

Psychosis

Neurosis

A

Hallucination

Experance of sensng things that do not exist but with no external stimulus

Illusion

Misinterpriting stimulus into something that doesn’t exist.

Delusion

A fixed false belief held to 100% certainty that does not align with cultural or social norms. (for example that soup will make you better if you have a cold).

Psychosis

Perceive or interpret reality in a very different way from the people around you.

Neurosis

Heightened emotions that everyone has - overyly anxious, sad ect…

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3
Q

defne acute dystoniia

A

Acute dystonia

Sudden, sustained contraction of the neck mouth and tounge and eye muscles - medical emergancy

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4
Q

managamenet of ADHD

A
  • Parental education of behaviour
  • Healthy diet and exercise routine
  • Methylphenidate
  • Dexamphetamine
    Atomoxetine
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5
Q

what are teh symptoms of depresson

A
  • Low mood
  • Hopelessness
  • Tearful
  • guilt ridden
  • Suicidal thoughts
  • Changes in appetite
  • Changes in libido
  • Changes in sleep
  • Lack of energy
  • Constipation
  • Moving or speang slower than ussua
  • Avoiding Hobbes ntrests abd socal stations
    Lasting longer than 2 weeks
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6
Q

tests for depression

A
  • Clincal diagnosis
  • PHQ-9 patioen health questionaire 9
  • Edenborough post-natal depression scale

Can consider B12 and folic acid tests

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7
Q

treatement of depression

A

Mild to moderate -
* Antidepressant - SSRIs (sertroline, fluoxatine)
* With SSRIs they have t be feeling better for 6 months before being weened off. Will take 2-4 weeks to start feeling better.
* Follow up appointment 2 weeks and then every 3 months
* Psychotherapy - CBT
* Advice on wellbeing - yoga, exercise, healthy diet.

* Antidepressants should eb contibues fro at least 6 months even if the person feels better, and then weaned off 
* Mirtazapine  - increased appetite and drowsiness - think sam lol  Triptns for migranes shouldb be avoided in SSRI takers due to increased risk of seratonin syndreom
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8
Q

complications of depression, protective factors ad final acts meaning

A

Check they rare not suicidal.
Check about self harm
SSRIs can causes hyponatremia.

* Protective factors  - children, pets, family upset 
* Final acts  - seeing friends to say goodbye, going to the bank, finialising the will, buring the medications, buying a rope ect
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9
Q

define and key presentations of autism

A

People defect n social interactions, communications and flexible behaviour.

Social interaction:
* Lack of eye contact
* Delayed smiling
* Avoid physical contaact
* Unable to read non verbal cues
* Difficulty making frends
* No desre to share attention

Communication:
* Delay or absece oin language development
* Lack of non verbal communication
* Difficulty with imaginative o imitative behaviour
* Repetative sue of phrases and words

Behaviour
* Greater interests n objects number or patterns than people
* Repetve movements - hand flappng or rocng
* Ntensve and deep intrests
* Repetative behaviour
* Anxiety and diseress being ouside the nroal rouine
* Restricted food preferences

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10
Q

mnumonicfor characteristics oof manaia

A

DIG FAST

* Distractible
* Indiscresion 
* Grandiosity 
* Flight of ideas 
* Activity increase 
* Sleep defecit  Takativeness
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11
Q

define manic and hypomanic episode

A
  • Manic episode - persistently elevated, expansive or irritable mood lasting a week accompanied by 3 other symptoms which is severe enough to impact social or occupational functioning
    Hypomanic episode - similar to manic but only last for 4 days and don’t markedly impact social functioning
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12
Q

treatment of bipolar

A
  • Hospital admission - volutary or sectioning
  • Refer to psychiatry
  • Assess risk of suicide

ACUTE:
Mana:
* Oral antipsychotics such as haloperidol, olanzapine, quetpne, risperidone, aripiprazole
* Benzodiazapines: lorazapam and diazepam

Depression:
* Fluoxetine + olanzapine
* Quetiapine alone
* Olanzapne alone
* Lamotrigine alone
* CBT

Long term management:
* Lithium - increased risk of suicide though
Valproate

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13
Q

dfne and ey presentatons of anxety

A

Daly feelings of disproportional anxiety for months at a time which impacts a person’s everyday activity.

  • Tense muscles
  • Palpitations
  • Sweating
  • GI issues
  • Chest pain
  • Panic attacks
  • Difficulty sleeping
  • Sense of suspense
  • Tired easily
  • Irritable
  • Difficulty concentrating
  • Cant let go of worries
  • Worrying affects daily life
  • Avoidance od activitys
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14
Q

treatmen for anxety

A
  • Mild: waiting, advive about self help (meditations ect), diet, exercise, avoiding alcohol caffien and drugs
  • Moderate- sever - counselling, CBT, sertraline
  • Can prescribe propanalol for the physical symptoms of anxiety, especially as a one off tablet or can take one every day.
  • SERTRALINE is first kie for GAD
  • SNRI can be used second lie - duloxatine
  • For SSRIs, build up the dose, they should be n it and feeling for better for at least 6 months before starting to ween off.
    Feeling worse, butterflies, nausea, stomach upset
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15
Q

treatment fo phobas

A
  • Education and monitoring
  • CBT with exposure therapy
    Benzodiazapines as last line
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16
Q

OCD defntons

A
  • Obsessions are uncontrolled intrusive thoughts that the person finds difficult to ignore.
  • Compulsions are repetitive actions the person does to handle the obsessions.

Obsessions lead to anxiety which leads to compulations to sooth the anxiety, these then become more engrained in the persons behaviour. It has strong links with anxiety, depression, eating disorders and autism.

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17
Q

treatment of OCD

A
  • Mild - education and self-help resources
  • Significant - CAMHS, education, CBT, SSRIs.
  • First line is CBT and exposure and respinse prevention
  • Fluoxatine can be used
    Clomipramine is a tricyclic one thatcan be used if others arent effectve
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18
Q

acute stress reacton defne and symtpms

A
  • Anxiety low mood
  • Poor concentratoin
  • Wanting to be alone
  • Poor sleep
  • Irritability
  • Recurrent dreams
  • Flashbacks
  • # avoidance of people, conversatios and stuations
  • Emotional umbness
  • Palpitations
  • Nausea
  • Chest pain
  • Abdo pain
    Breathing difficulties

symtpms ex[eranced after a dscrete event t happens n teh frst 4 wees afterths ts {TSD

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19
Q

treatmet of acute stress reacton

A
  • Normally goes away by itself in a few days
  • Conunselling
  • Self care
  • Beta bloker
    Sleeo medications
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20
Q

ey rpesentatojs of PTSD

A
  • Experience of truamatic event
  • intrusve recolections
  • Avoidance behaviours of places or events that remind people of the event
  • Hyperarousal
  • Nightmares
  • Sleep problems
  • Flashbacks
  • Jumpy and anxious
    Avoidance behaviour of triggers
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21
Q

treatment of PTSD

A
  • CBT
  • EMDR
  • SSRIs - sertralne and paroxitne
    TCA
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22
Q

causes of schizophrenia

A

genetics
drugs
intense emotons
stress

excessve dopamnergc actvty

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23
Q

key presentationsof schizophrenia

A

loss of ntests
socal withrawl
depression
anxiety
self neglect

positive symptoms:
- delusions
hallucinatins
thought diorders
strane mannerisim

negative changes
- social withdrawl
- speech poverty
- low self worth
- weigth changes
- sleep problems

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24
Q

management of schizophrenia

A
  • Antipsychotics - typical or atypical
  • Atypical are the first line - risperidone, olanzapine, queitpaine, aripiprazole
  • Typical - haloperidol and chlorpromazine
  • Start at low doses and titrate up
  • Clozpine is second line but can causes aplastic anaemia!!!!
  • It can only be prescribed by consultant psychiatirs and must be moniterd
  • It also reduces the seizure threshold and makes them more likely
  • Arapiprazole has the least side effects
  • CBT
  • Psychotherapies
  • Family therapy
    Social care
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24
Q

DSM 5 schiaophrenia criteria

A

DSM 5:
Two or more of the following, present for at least one month, for most days
* Hallucinations
* Delusions
* Disorganised speech
* Negative symptoms
* Grossly disorganised or catatonic behaviour
* At least one of the first three must be present, PLUS
* Social or occupational dysfunction
* No evidence of other causes for psychosis
* Not attributable to medication (illicit or otherwise)

* Increased lateral ventricel size 
* Reduced breain size Negative symptoms - reduced blood flow in the frotnal xortex
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25
Q

side effects of anti

A
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26
Q

what are poor prognostic indicators of shcizohenia

A

Poor prognostic indications:
* Pre morbid social withdrawal
* Low IQ
* Family History
* Gradual onset
* No obvious precipitant
Male

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27
Q

5 causes of psychosis

A
  • Schizophrenia
  • Depression
  • Bipolar
  • Drug and alcohol abuse
    Neurological disorders
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28
Q

define schizoaffectve disorder

A
  • Schizophrenia with a mood component (normally depression)!!!!!
  • Combination of psychotic and bipolar disorder symptoms
  • Schizoaffective disorder depressive type - psychotic and depressive symptoms at the same time
    Schizoaffective disorder mixed type - psychotic, manic and depressive symptoms
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29
Q

key presentaios of schizoaffectove disprder

A
  • Hard to concentrate
  • Thoughts feel muddied
  • Someone is adding or removing thoughts from your head
  • People can hear your thoughts
  • Belief you are being controlled
  • Hallucination
    Delusions
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30
Q

management of schizoaffective disorder

A
  • Atypical antipsychotics include Olanzapine, Risperidone, Quetiapine and Amisulpride.
  • SSRIs
  • CBT
  • Family therapy
    Supportive therapy - self-help, art,
31
Q

what is somatisation disorder and its symptoms and treatment

A

The patient has a significant focus on physical symptoms such as pain, weakness, shortness of breath to level that results in major distress and problems functioning. They have excessive thoughts feeling and behaviours relating to the physical symptoms.

  • One or more physical symptoms that are distressing or cause disruption in daily life
  • Excessive thoughts, feelings or behaviours related to the physical symptoms or health concerns with at least one of the following:
  • Ongoing thoughts that are out of proportion with the seriousness of symptoms
  • Ongoing high level of anxiety about health or symptoms
  • Excessive time and energy spent on the symptoms or health concerns
  • At least one symptom is constantly present, although there may be different symptoms and symptoms may come and go
  • Support and reassurance
  • Psychotherapy
  • Antidepressants
32
Q

what are teh three key parts of personality disorders

A
  • Persistant - presents for more than 2 years
    • Problamatic - leads to personal distress, difficulties maintiaing relationships
      Pervasive - various personal and social situations, multiple settings
33
Q

what are the driop A personality disorders

A

suspicious

Paranoid
* Suspicious
* Mistrustful
* Sensitive to setbacks
* Unforgiving to insults
* Tenacious personal rights
* Hidden meanigns in remarks
* Pathological jealousy

Schizoid
* Introverted
* Emotionally cold and detatched
* Withdral from affection
* Limited capacity to experience pleasure

Schizotypical
* Magical thinking
* Social anxiety
* Unusual perceptions

34
Q

what ar teh group b personalty dsordes

A

emotional

Borderline -
* strong fluctuating emotions
* Difficulty maintain healthy relationships

Histrionic
* Need to be centre of attention
* Theatrical
* Inappropriately seductive

Narcissistic
* Feelings that they’re special
* Others need to recognise this or they get upset

35
Q

grop c personalty dsroders

A

anxious

Antisocial/avoidant
* Severe anxiety about rejection
* Avoidance of social situations

Dependant
* Heavily reliant on others
* Unwilling to make demands
* Helpless alone
* Fear of abandonment

Obsessive
* Unrealistic expectations of how things should be done
* Catastrophising what will happen
* Stubborn
* Overcautious

36
Q

what is Psychodynaimc

Cogntive anylitical theryapy

Dialecical behaviour

Family therapy

EMDR

A
  • freud based, becoming aware of unconscious past trauma causing present symptoms .
  • mixed cbt and psychoaylitical aproaches

Dialectical behaviour therapy - learnt to understad and regulate emotions, manage distress and realathionshitps - for PDs.

family togetehr to manage interactions and behaviours

  • PTSD, use rapid eye mmovement to recode memories
37
Q

trcyclc antdepressants name mechansm condtons and sde effects

A
  • Amitryptiline
  • Amoxapine
  • Desipramine (Norpramin)
  • Doxepin
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Protriptyline
  • Trimipramine

nhibiting serotonin and norepinephrine reuptake within the presynaptic terminals also block muscernici receptors leading to anticholinergic affects

  • Depression resistant to SSRI
  • Neuropathic pain relif
  • IBS
  • Drowsiness
  • Blurred vision
  • Constipation
  • Dry mouth
  • Postural hypotention
  • Urine retention
  • Increased appetite leading to weight gain
  • Excessive sweating
  • Tremor
  • Sexual problems
37
Q

what is ect

A

ECT

  • Sending electric shocks through the brain to relive symptoms
  • It is last resort - mania, catatonia, depression to the point of not eating an ddriking, other therapies and medications havent helped
38
Q

SSRI Drug name

Mechanism

What for

Side effects

A
  • Sertraline
  • Fluoxetine
  • Paroxetine
  • Ctalopram
  • Fluvoxamne
  • Vortoxetne

Block seratonins reuptake

  • Depression
  • Anxiety
  • Hyponatirema
  • Nausea
  • Headache
  • GI upset
  • Insomnia
  • Sexual dysfunction
39
Q

SNRI Drug name

Mechanism

What for

Side effects

A
  • Duloxetine
  • Venlafaxine

Blc setatonin and neuroepinephrine reuprtek in the brain

  • Depresson
  • Anxety
  • Nerve pan
  • feeling agitated, shaky or anxious.
  • feeling and being sick.
  • indigestion and stomach aches.
  • diarrhoea or constipation.
  • loss of appetite.
  • dizziness.
    *
40
Q

typrical antipsycjotcs Drug name

Mechanism

What for

Side effects

A
  • chlorpromazine (Largactil)
  • flupentixol (Depixol)
  • haloperidol (Haldol)
  • levomepromazine (Nozinan)
  • pericyazine.
  • perphenazine (Fentazin)
  • pimozide (Orap)

Inhibit dopamine neutrotransmission

Pscyhcosis

  • dry mouth.
  • dizziness.
  • weight gain that can lead to diabetes.
  • blurred vision.
  • movement effects (for example, tremor, stiffness, agitation)
  • sedation (for example causing sleepiness or low energy)
  • loss of menstrual periods in women.
  • fluid retention
41
Q

atypcal antpsychotcs Drug name

Mechanism

What for

Side effects

A
  • Aripiprazole
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Ziprasidone
  • Clozapine
  • Cariprazine
  • Paliperidone
  • Lurasidone

nhibit dopamine neutrotransmission and modulate serotonin (5-HT), norepinephrine, and/or histamine neurotransmissio

Pscyhcosis

f weight gain, hyperlipidemia, diabetes mellitus, QTc prolongation, extrapyramidal side effects, myocarditis, agranulocytosis, cataracts, and sexual side effects

42
Q

barbtuates Drug name

Mechanism

What for

Side effects

A

Barbituates

amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal)

ncreaes GABA levels

  • Insomnia
  • Seizures
  • rouble breathing (dyspnea).
  • Confusion or trouble thinking.
  • Passing out or fainting.
  • Slow pulse (bradycardia); however, barbiturate overdose can also cause a fast, weak pulse.
  • Dizziness and vertigo.
  • Nausea and vomiting.
  • Low body temperature (hypothermia).
  • Muscle weakness.
43
Q

benzodazapnes Drug name

Mechanism

What for

Side effects

A
  • Valium (diazapam)
  • Xanax
  • Halcion
  • Ativan
  • Klonopin
  • Librium (chlordiazepoxide)
  • Lorazapam

facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS.

  • Anxity
  • Insomnia
  • Alchol withdraw
  • rowsiness.
  • light-headedness.
  • confusion.
  • unsteadiness (especially in older people, who may fall and experience injuries)
  • dizziness.
  • slurred speech.
  • muscle weakness.
  • memory problems.
44
Q

lthum Drug name

Mechanism

What for

Side effects

A

Lithium salts

Lithium - ncreases adenylate cyclase activity, and inositol monophosphatase. This affects the PI signalling pathway (PI = phosphoinositide). The result of this is a stablising effect on aminergic and cholinergic activity. This results in stabilised intracellular signalling pathways – the pathways have increased basal activity – but respond less strongly to stimuli.

  • Bipolar disorde, prophylaxis of mania
  • Severe depression
  • Lithium
    • Affcte bone and thryroid
    • Can be reabsobed in the kidneys and casues toxicity
    • Very narrow theraputic index
    • Diabeties insipidus
    • Renal damage
    • Drug interactions
45
Q

mood stabalsers Drug name

Mechanism

What for

A

valproate, gabapentin, carbamazepin

Carbamazapine and valproic acid - Modulate GAGergic neurons

46
Q

methylphednate Drug name

Mechanism

What for

Side effects

A
  • Eqasym
  • Retanil

act as a norepinephrine and dopamine reuptake inhibitor (NDRI),

  • ADHD
  • Narcolepsy
  • Headache
  • Irritability
  • Dizziness
  • Fast heartbeat
  • Less appetite
  • Diarrhea
  • Hives
  • Tics
  • Tremors
47
Q

lthum toxcty all

A
  • Too much lithium
  • Dehydration and fluid shits
  • Issues with excretion
  • Acute: ingest too much lithium at once or have too little salt I your body
  • Acute on chronic - you normally take lithium but this time you take too much ri have too little water in your body
  • Chronic - take lithium every day but long term it builds up to be too much,
  • Arly symptoms are GI related
  • N&V, diarrhoea
  • Abdo pain ad bloating

Neurologica:
* Confusion or delerium
* Tremors
* Muscle twitches
* Atxia
* Dysarthria
* Hypereflexi
* Nystagmus
* Hyperthermia
* Seizures
* Coma

Chrnic toxixity (kidney damage):
* Dehydration
* Diabeties insipius
* #polyusria
* Muscle cramps
* Mental state changes
* Fatigue
* Foamy pee
* Oedema
* Hyperlipidemia
* Loss of appetien
* Hypothyroidism
* Hyperthyroidism
* Hyperparathyroidism

  • Mild toxicity: 1.5 to 2.5 mmol/L (millimoles per liter).
  • Moderate toxicity: 2.5 to 3.5 mmol/L.
  • Severe toxicity: Higher than 3.5 mmol/L.
  • U&Es
  • TSH
  • Urinanalysis
  • Kidney function tests
  • Stomach pumping
  • Activated charcole
  • Bowel irrigation
  • Heamodialysis
  • IV fluids

It can induce serotonin syndrome!!!!!

48
Q

seratonn syndrome all

A
  • SSRI
  • SNRI
  • Tricyclic antidepressants
  • Tramadil
  • St johns wart
  • Stimulants - MSD, LSD, Amphetaamine, cocain

Normally occurs when a new medication is added to a patients regeime, within 2 weeks.

  • Agitation
  • Confusion
  • Hypomania
  • Seizures
  • Increased muscle tone
  • Tremor
  • Shaking
  • Hyperreflexia
  • Clonus
  • Hyper/otension
  • Tachycardia
  • Fever
  • Diarrhoea

Clinicla diagnosis
Increaed WCC
Increaed CK

  • Stop all serotonergic drugs
  • Send to tertiary care
  • May need ICU admission
  • Cyproheptadine (seratonin antagonist)
  • Hyperthermia is the main complication
  • Use ice packs and cooling sprays to keep cool, ocassionaly may reqire intubation
  • ARDS
  • Rhabdomyalysis
  • Renal faliure
49
Q

acute extrapyrmdal side effcts all

A

Antipsychotics

  • D2 blockedge in the nigrostriatal pathways
  • Less likely ith atypical antipsychotics
  • Don’t havppen with clozapine
  • Dystonia - Incolutanry ,ovements
  • Tremors
  • Muscle contractions
  • Akathesia - restlessness
  • Parkinsonism - rigidity, bradykinesua, tremor, mask face
  • Stop the drug and it normally stops yt can be permanent change
  • Sart with low doses and titrare up
50
Q

neuroepilpetic synrome all

A

Antipsychotics

  • Happens in 3%
  • Typical antipsychotics
  • Occurs in the first 2 weeks after starting the antipsychotics
  • Idiosyncratic reaction - unpredictable and not doose dependant
  • Confusion, catatonia , altered mental state
  • Fever
  • Rigidity
  • Dysautomia - autonmic instability - tachcaydia, weird blod pressure, profuse swating and arrhythmias
  • Electrolyte
  • Kidney tests
  • LFTs
  • CK
  • CT/MRI head
  • Lumbar puncture to rule out cereberal infection
  • Stop medication
  • Cardiac monutering #
  • Intubation, heamofiltration and ICU
  • Maintain a euvolemic state
  • Dantrolene: ryanodine receptor antagonist (causes skeletal muscle relaxation). Helps treat hyperthermia and rigidity.
  • Bromocriptine: dopamine agonist. Prescribed to restore ‘dopaminergic tone’.

Cardiac arrest
Cardiac arrhythmias
Acute kidney injury
Rhabdomyolysis
Disseminated intravascular coagulation
Seizures
Respiratory failure
Venous thromboembolism

Mortality of 5-20%.

51
Q

side effects of clozapine

A
  • Myocarditis generally occurs one to two months after commencing clozapine; cardiomyopathy usually presents later, at around nine months. Common presenting symptoms of myocarditis include chest pain, tachycardia, and flu-like symptoms. These warrant immediate investigation and withholding of clozapine
  • 80% of clozapine patients had gastrointestinal hypomotility
    Approximately 25% to 50% of the population is affected by this condition. A proposed hypothesis of clozapine induced agranulocytosis is that the toxic effects from the formation of a nitrenium ion on the leukocytes causes acceleration of the physiologic cell death cycle
52
Q

cataatonia all

A
  • Sitting very still and staring into space.
  • Holding unusual postures which would normally be uncomfortable.
  • Keeping their arms or legs in whatever position someone else moves them into.
  • Repeating the same movements for a long time.
  • Repeating the same movements as another person (known as ‘echopraxia’).
  • Repeating phrases or words that they hear (known as ‘echolalia’).
  • Holding strange faces.
  • Not speaking, eating or drinking.
  • Doing as they are told or directed without question.
  • Not doing something, or resisting doing something (known as ‘negativism’).
  • Becoming suddenly very agitated or restless. This is called ‘excited catatonia’.
  • EEG
  • Bloods
  • Brain scan
  • Treat underlying condition
  • Lorzazpam - benzodiazapine,
  • ECT - if lorazapm doesn’t work
  • Moniter nutrition

8/10 improve with lorazapam, once it has improved the medication shold be stopped as soon as possible.

53
Q

alcohol withdrawl pathopysiolgy, symptoms , tets sna dmanagemtn ent

A
  • Ethanol is a CNS depressant and enchaces GABA.
  • INTERACTS WITH METRONIDAZOLE and CHLORPORPAMIDE
  • Alcohol downregulater GABA recpetors
  • Benzodiazapines increased GABA by increased chloride ions

Few hours:
* Tremor
* Nausea
* Agitation
* Tachycadia
* Raised BP

24-28 hours
* Delusions
* Confusion
* Diarhoea
* Convulsions
* Auditory halucinations

  • Dya and a bit (36 hours) have a fit
  • Delerium temens (duex trois) day 2,3
  • AUDIT C questionare
  • CAGE questionaire
  • FBC
  • LFT
  • Heamanitics- B12 ad folate
  • TFT
  • If they drink over 30 units a day they need hospitl admission
  • Detox, slowly using specalsit alcohol services
  • Chlordiazepoxide - help in detox phase, benzodiazepine, stops withdrawl symptoms.
  • Naltrexone - opiate blocker that makes alcohol less enjoyable.
  • Acamprotase - increases GABA and reduced cravings
  • Disulfiram - inhibit acetaldehyde dehydrogenase leading to accumulations and unpleasant sympotoms upon drinking - flushing, sweating, N&V, arrhythmias. It can make people ver unwell, they even need to avoid perfumes with it n!
  • Give thiamine as well!
54
Q

elerium tremens presinttation and pathophysoiology

A

Happens 48 hours after alcohol withdrawl

  • Middle age men with many years drinking history
  • Only in 5% od withdrawals
  • 3-4 days after withdrawal
  • Restlessness
  • Fear] paranoia
  • Confusion
  • Terror stricke face
  • Ataxia
  • Tremor
  • Sweaty
  • Tachycardia
  • Visual hallucinations - terriying ones
  • Auditory hallucinations
55
Q

delerium tremens manage,emt adn complications

A
  • Medical emergancy!!!
  • Benzodiazapines - contiune for 10 nigths after symptoms have stopped
  • B vitamisnto reduce chance of encephalopathy
  • Fluid replacemnt
  • Dextrose
  • Infection and head injust checks
  • Symptmso should stop aafter 4 dyas but the anxety may remain for a few montsh
  • Death occurs in around 10-15% of cases (up to 35% if untreated).It results from epileptic seizure, heart failure, self-injury and infection.
56
Q

risk factors for suicude

A
  • Male
  • <35 YO
  • Old adolescent
  • Phx mental health
  • Childood truama
  • Low self esteem
  • Poor physical health
  • Life stress
  • Drug and alcohol abuse
  • Past suicide attempts
  • Sexual assult
  • Insomonia
  • Parental mental illness
    Lack of support system
57
Q

suicide risk assesment scores

A
  • HEADSS - home, educatoin, activities, srugs, sexualiy, suicide/self harm
    • Pathos score - adolescents in overdose -
      P – Problems – have you had problems for more than 1 month?
      A – Alone – were you alone at the time?
      T – Time – have you planned it for more than 3 hours?
      Ho – Hopeless – are you feeling hopeless about the future
      S – Sad – were you feeling sad for most of the time before the overdose?

If they answer yes to any of these it is an indicator of future harm!

58
Q

section 2 - what is it, who is it by and how long for

A
  • Assessment order - must be signed by 2 doctors who agree the patient is unwell and require a fulfil psychiatric assessment
  • patient must have been examined by both doctors within 5 days of each other
  • Doctors are from different organisations
  • one of the doctors has to have previously known the patient
  • Patient can be treated against their well
  • Cannot be renewed
  • Approved social worker put in place
  • Appeal must be made in 14 days

2 doctors (normally GP and psychiatrist)

28 days

59
Q

135 what who how long

A

Police officer can enter somebodys home and remove a person to safety. Can use force. Can only be used if a social worker has obtained a warrant. Cant treat agais the persosn will.

Police officer

72 hours

60
Q

136 what who how long

A

Police offics may remove paient to a place of safety from a public place

Police officer

72 hours

61
Q

5.2 and 5.4 who what nd how long

A

5.2

  • Compulsory detention of patient who has come to hospital voluntarily and is on the ward untll they can be properly assesed.
  • They cannot be treated aganst ther wll under ths
  • HOWEVER you can treat them under the menatal capacity act if they lack the ability to weigh up and understand

Doctors over F2

72 hours starting from the initial nurses section being put in.

5.4

Compulsory detention of patient who has come to hospital voluntarily and is on the ward until they can be properly assessed

Nurses

6 hours

62
Q

secton 3 - who wha how long

A
  • Treatment orders -
  • Social worker must see consent of nearest relative and the patient cannot be detained if this relative objects
  • Doctor must state the category of mental illness the patient is suffering from
  • Treatment can be given but after 3 months they either have to consent or a third doctor has to review patient and consent for them
  • Discharged by registered medical officer, hospital manager
  • Patient can appela to mental health tribunal - must be done in 6 months

6 months

63
Q

sectioni 4 who how long what

A
  • Emergancy order
  • Must be signed by doctro and ASW
  • Cannot treat agaisnt persons will
  • Can be converted to a section 2 when in hospital and approved by another doctor

Doctor and social worker

Up to 72 hours

64
Q

section 37 what who

A

37

A hospital order given by eh crown court after conviction. Very similar to S3.

37/41

Similar to 37 but with added restrictions the patient must meet when they return to the community.

65
Q

gender dysphoria key presentations and treatment

A

Gender dysphora:
A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following:

* A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in
* young adolescents, the anticipated secondary sex characteristics).
* A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s
* experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex
* characteristics)
* A strong desire for the primary and/or secondary sex characteristics of the other gender.
* A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
* A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
  • Hormone therapy for trans men - blocker and testosterone
  • Hormone therapy for trans women - estradiol
  • Psychological support
  • Hair removal
  • Fertility preservation
  • Surgery
  • Top surgery too!
66
Q

key rpesentaitons for eating diorders

A
  • Overestimation fo actual weight and body size
    • Phobia or normla weight and size
    • Over excercies, vomiting, diuretics, reduced calorie intake.
    • Very low body weight
    • Contorll of weivht may give a sense fo power
    • Obsession with food and cooking
    • Low metabloic rate
    • Cold peripheris
    • Bradycardia
    • Alopecia
    • Osteopenia
    • Vitmain definancys and elctrolyte disturbances
    • Amenohrohea
    • Lanugo hair
    • Skin changes
    • Low T3 falesly
    • Low plasma protie - ankele oedema
  • Acid damage to teeth
  • Anaemia - Koilynchia, angular stomatitis, palpitations
    Lenugo hair - baby hair
    russles rign - callouses on knuckeles from makig self sick
67
Q

questonsare for bulemia

A

SCOFF questionnaire:
* S – Do you make yourself SICK because you feel uncomfortably full?
* C – Do you worry you have lost CONTROL over how much you eat
* O – Have you recently lost more than ONE STONE (6kgs) in a three month period
* F – Do you believe yourself to be FAT when other say you are thin?
* F – Would you say FOOD dominates your life?
Yes to tow of the above has a high sensitivity for bulimeia

68
Q

tests management and complications of anorexia

A
  • History and exam
  • Weight and BMI
    check for reflexs
  • Exmain thyroid
  • FBC, U%E, ESRm CRP< LTF, TFT
  • CXR
  • Urinanalyss
  • Cancer
  • Diabeties
  • Parentl councelling
  • Weight gain
  • Psychatic help
  • Enourage weight ain of 500g a week, if this is nto met, admit to hosptial

Nervosa -
* 1/3 of patients make a complete recovery
* 1/3 make only partial recovery and have many relapses
* Anorexia nervosa has a mortality rate of 10-25%. This can be from suicide, pneumonia or hypokaleamia (leading to arrhythmias)
*

69
Q

when to admit anorexiato hospital

A
  • When to admit:
  • They’re fully stopped eating
  • % median BMI <70
  • Postural tachycarda >35 or drop ni BP >20
  • Hypothermia
  • Severe abdo pain
  • Parets are worried

Imagine an animal going to hubernation - conserving energy. Slow the heart rate, reduce the blood pressire, reduced body temperature,

70
Q

what s refeeding syndomre

A
  • Refeeding syndrome
  • 3-4 days after feeding begins
  • Change of metablosim
  • Protien especially can cause it
  • Electroltre imbalances due to massive cellular uptake of electrolytes causng all of them to deop n the extra cellular compartment
  • Ths s because th ntroducton of glucose causes nslun to be released whoch draws the electrolytes nto the cells
  • Confusion
  • Coma
  • Convulsions
  • Death
  • Thiamine and vit b supplements
    Bicochemistry should be closely monitored
71
Q

PMD path, key presentation tests and management

A
  • Psysiological, emotional and physicla symtoms tha occusr during the luteal phase of the menstural cycle.
  • Caused by fluctation of sex homones and the interaction on seratonin and GABA
  • Low mood
  • Anxiety
  • Mood swings
  • Irratibilty
  • Bloating
  • Fatigue
  • Headache
  • Breast paon
  • Cognitive impartment
  • Clumsiness
  • Reduced libido
  • Keep a symtom diary between menstura cycles
  • Cyclical structreu ti the symtoms
  • They an use GnHR analouge to stoop eh mensturaltion and see if the symptoms stop
  • General healthier living - alcohol, smoking, diet, exercise, stree, sleep
  • COPC
  • SSRI
  • CBT
  • Transdermal oestrogen patches (with preogesterone for protection)
  • Histerectomy with bilateral orichectomy
  • Spironolactone to manage water retention
  • Danazole and tamoxifen - options for cyclical breast pain
72
Q

key presentaitons and test of functional neurological disorders

A
  • Tremor
  • Functional dystonia - uncontrollable spasms
  • Functional myoclonus - uncontrollable movements and tics
  • Gait difficulties -
  • Functional tics
  • Limb and muscle weakness
  • Paralysis
  • Functional and dissociative seizures
  • Hypersensitivity to sense
  • Cognitive issues 0- memory loss, poor concentration, speech disturbance
  • Fleeting sensations – electric shock , twitching, skin crawling
  • It is not a diagnosis of exclusion and needs to be done by a neurologist
  • Medical examination
  • B12, and other blood tests
  • CT
  • MRI
  • EMG
  • EEG

Hoovers test -
hold teh bottom of teh ankles and get them to lidt teh affected leg up. if they dnt push down with teh other legat teh sam etme it is functional.

73
Q

treatment or functional disorder

A
  • Psychotherapy about emotions causing the symptoms
  • Neurophysiono therpay
  • MDT appreoach
  • Occupational therapy
  • Grounding tecnuiques for seizures
    Prognosis is worse if they cant admit its functional
74
Q

what arre teh 9 psychonamic defence mechanisms

A

Repression Threataning throughts are kept unconsious
Projection Seeing your own unnaceptable trains and desires in others
Displacement Redirectino of impule onto a powerless substitute target
Regression Become more childlike or primative
Sublimation Displace unacceptable emotions onto constructive and acceptabe ones such as art
Rationalisation Distrotion of the facts to make them less threatening
Reaction formation Behaves in the oposite way to what you feel, exaggeraed behaviout
Interjection Taking on personality traits of others that are good for conform - child becoming mum to dolls
Identification with aggressor Adopts behaviour of the aggressor to avoid abuse

75
Q
A