Psychiatry Flashcards
what are the clinical features of mania?
more talkative
decreased sleep
flight of ideas
distractability
risky behaviour eg sexual promiscutiy, gambling
goal directed behaviour
What are the legislitative measure for keeping people against their will and their conditions?
Duty of care
* have a physical condition causing physical harm
* be danger to themselves
Mental Health Act
* Suspected mental health disorder
* no less restrictive options available
What are the steps in escalating aggressive patients?
- Verbal deescalation
2 offer oral sedation eg 10mg diaz - Show of force
- Physical restraint
- IV sedation eg drop/midaz
A 36 year old man with a history of heavy alcohol use is brought in to your department
by ambulance with general malaise.
On examination he is drowsy but rousable to voice, with slurred speech and
disorientation.
Temp 37.6
HR 95
BP 100/60
SpO2 97% RA
List 8 causes of confusion here
- Acute alcohol intoxication
- Alcohol withdrawal
- Post-ictal state (numerous causes)
- Head trauma – SDH/EDH/ICH
- Hepatic encephalopathy
- Infection – meningitis, encephalitis
- Korsakoff’s syndrome – from severe vitamin deficiency
- Wernicke’s encephalopathy
- Co-ingestion of other drugs of abuse, eg: opiates
- Thrombotic stroke,
what are the components of a MMSE?
ASEPTIC
A- Appearance/Behaviour
S - Speech
E - Emotion (Mood and Affect)
P - Perception (Auditory/Visual Hallucinations)
T - Thought Content (Suicidal/Homicidal Ideation) and Process
I - Insight and Judgement
C - Cognition
define delirium
why is it different to dementia?
Delirium - Acute transient mental disorder characterised by impaired cognition and in the inability to focus or maintain attention
dementia **- Chronic **gradual and overtime where as delirium is acute and sx can fluctuate.
What tool is used for suicide risk
SADPERSONS
Sex - Male
Age - Under 19 or over 45
Depression
Previous attempt
Excess alcohol or substance use
Rational thinking loss
Social support
Organized plan
No spouse
Sickness
what are the diagnostic criteria for anorexia
- BMI under 17.5
- self induced weight loss
One or more of:
* excessive exercise
* body image distortion
* self induced vomiting or purging
* associated endocrine disorder
what are the reasons for medical admission for eating disorders
- hr under 40 or over 120
- postural tachy
- BP under90/60
- K under 3
- symptomatic hypoglycaemia
- temp under 36
- dehydration
- ECG abnormalities
- low mag or phos
what are the long term effects of eating disorders
- osteoporosis
- short stature
- stress fractures
- renal calculi
- miscarriag
- cognition difficulties
what are the risks when refeeding
- low K, Ca, phosphate, mag, thiamine
- rabdo
- seizures
- haemolysis
- CCF
what are the principles of risk assessment when treating anorexia
- Presence of immediate life threats – the physical signs
- Patient’s capacity to consent/refuse treatment
- Likely compliance with treatment
- Active suicide risk
- Family/social/community support
what investigations may you perform for ?mania and why
- TFTs – thyrotoxicosis can present with similar mental state
- CT head – in first presentation of major mental health disorder
- Serum Na – where excessive water consumption, cause for delirium
- LP – to look to encephalitis if febrile, meningism
- BSL – hypoglycaemia as cause for delirium, hyperglycaemia if diabetic with intercurrent illness
- Urine drug screen – looking for amphetamine use as a precipitant for behavioural disturbance
what are the features of psychosis?
Positive Symptoms
* hallucinations
* delusions
* disorganised speech and behaviour
Negative symptoms
* blunted effect
* anhedonia
* functional decline
- Appearance
- Lack of insight
what are the pitfalls in the medical clearence process?
- History - hard to illicit info, no collateral
- Exam - location of patient, no vitals of MMSE, non compliance, no neuro exam
- over reliance on investigations
- no ongoing reviews
what may lead you to challenge the MH review of safe for discharge?
- first presentation
- history of self harm and suicide
- carer fatigue
- weekend so no easy follow up
what are the best tests/features of history for illiciting organic cause of psychosis over pysch
- fever and abnormal vitals
- drug and alcohol use
- neuro exam
- features of delrirum
- concurrent illness
what criteria must be met to be medically cleared without investigations?
- 16-55 and not first presentation
- GCS 15 with normal neuro exam
- Normal obs
- no acute physical problems
what criteria must be met to detain someone under MHA
- Must have mental illness
- witout patient there is risk to self or others
- patient does not have capacity
- treatment is appropriate and effective
- no less restrictive means
what are the complications of emergency sedation?
- depression of airway reflexes
- depression of ventilation
- depression of CV system
- drug interactions eg anapylaxis, acute dystonic reaction
What ED design featurds can mitigate violence
System wide features
- well lit areas
- open areas
- CCTV
- Duress alarms
- signs noting about zero tolerance
- swipe access to cards
- break room seperate from department
System wide
* hospital security
* adequate staffing
* duress codes
* code black policy
* support of staff taking legal action
- Mental state assessment including assessment for acute psychosis, depression
- Assessment of suicide risk
- Alcohol and drug use – current level of intoxication
- Assess for physical injury
- Assess for underlying medical condition that may be exacerbating behaviour
- Exclude pregnancy
- Social History including safety of child in the home
- Prior notifications to Department of Child Safety (or equivalent) for this child
what is the protocol for a high risk patient who has absconded
- security search building
- call patients mobile or NOK
- notify police
- notify psych unit
- document all of this
what are the significant complications of anorexia nervosa
CV
Hypotension
Bradycardia
Sudden cardiac death
CCF
GI
Hepatitis
Constipation
CNS
impaired cognition
delirium
Electrolyte
Low potassium, calcium, magnesium, chloride
Haem
anaemia
bone marrow suppression
clotting abnormalities
MSK
Osteoporosis
anorexia - what are the significant abnormalities
What is the patient at risk of?
St depression
T wave inversion
U waves
Severe hypokalaemia
Risk - VT, VF torsardes -** VENTRICULAR ARRTHYMIAS**
What are the main metabolic risks with refeeding
Hypo K, Mg, Phos, Ca
