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
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?
- Appearance + behaviour: physical appearance (cleanliness, grroming),
- Speech: spontaneous/not, fuency, rate, volume, tone
- Mood: Predominant mood over last weeks, 0-10 scale
- Affect: observed emotional state: type, range, reactivity, appropriateness
- Thoughts: stream, form, content
- Perception: altered bodily experiences, passivity phenomenon,
- hallucinations
- Cognition: LOC, orientation, attention, memory, ability
- Insight and judgement Insight into perception disrders, (problem-solving)
define delirium
why is it different to dementia?
transient mental disorder characterised by impaired cognition and in the inability to focus or maintain attention
dementia is gradual and overtime where as delirium is acute and sx can fluctuate. hallmark of delirium is inattention
Oral
Olanzapine 10mg SL
diazepam 2.5mg-10mg
parenteral
Droperidol
Midazolam
what are the criteria for involuntaty treatment
has mental health disorder
no less restrictive methods
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 effects of 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 – arrhythmias, signs of heart failure,
hypotension - 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
- 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
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**
