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Phase 3A Conditions > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is ADHD?

A

Extreme end of hyperactivity and inability to concentrate.

Affects ability to carry out everyday tasks, develop normal skills and perform well in school.

Features must be consistent across various settings (both school and home).

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2
Q

What are the common features of ADHD?

A
  • Short attention span
  • Quick activity switching
  • Quickly losing interest in tasks/giving up
  • Constantly moving/fidgeting
  • Impulsive behaviour
  • Disruptiuve/rule breaking
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3
Q

How is ADHD managed?

A
  • Educating both child and parents about condition.
  • Healthy diet and exercise
  • Medication (methylphenidate)
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4
Q

What is depression?

A

Persistent feelings of:
- Low mood
- Low energy
- Reduced enjoyment of activities

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5
Q

What are the two core symptoms of depression?

A
  • Low mood
  • Anhedonia (lack of pleasure/interest in activities)
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6
Q

What are the emotional symptoms of depression?

A
  • Anxiety
  • Irritability
  • Low self-esteem
  • Guilt
  • Hopelessness about the future
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7
Q

What are the cognitive symptoms of depression?

A
  • Poor concentration
  • Slow thoughts
  • Poor memory
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8
Q

What are the physical symptoms of depression?

A
  • Low energy (TATT)
  • Abnormal sleep (difficulty waking in the mornings)
  • Poor appetite/overeating
  • Slow movements
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9
Q

What should a depression risk assessment include?

A
  • Self-neglect
  • Self-harm
  • Harm to others
  • Suicide
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10
Q

What is the questionnaire of choice to assess severity of depression?

What does the score indicate?

A

PHQ-9

5-9 mild depression
10-14 moderate depression
15-19 moderately severe depression
20-27 severe depression

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11
Q

What is the management for depression (based on the PHQ-9)?

A
  • Medication is only first line if PHQ-9 16 or more, or an antidepressant is preferred by the patient.

Lifestyle modifications:
- Exercise
- Self-help
- Therapy (CBT)
- Diet
- Reduce stress
- Reduce alcohol

If depression is severe (20 or more on PHQ-9) requires urgent specialist input and management.

Admission for patients with a high risk of self-harm, suicide or self neglect.

Also admit if there is a safeguarding issue.

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12
Q

What are is the first line medication for depression?

What medication options are there for severe or unresponsive depression?

A
  • SSRI (sertraline). Can also use mirtazapine, fluoxetine, paroxetine or citalopram.
  • Antipsychotics (olanzapine or quetiapine).
  • Lithium
  • ECT
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13
Q

What is psychotic depression?

What treatment options are there for psychotic depression?

A

Involves symptoms of psychosis:
- Delusions
- Hallucinations
- Thought disorder

  • Antipsychotics (olanzapine, quetiapine)
  • ECT
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14
Q

What screening tool is used for postnatal depression?

What score is indicative of postnatal depression?

A

The Edinburgh scale.
10 or more suggests postnatal depression.

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15
Q

What is the cutoff for baby blues?

A

2 weeks - beyond then postnatal depression can be diagnosed.

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16
Q

When should a mother be admitted to the mother and baby unit?

A

Puerperal psychosis.

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17
Q

What are the features associated with ASD?

A
  • Lack of eye contact
  • Delay in smiling
  • Avoiding physical contact
  • Unable to read non-verbal queues.
  • Difficulty establishing friendships/sharing toys.
  • Delay in language development.
  • Greater interest in objects, numbers and patterns
  • Stereotypical repetitive movements
  • Intense and deep interests.
  • Fixed routine/anxiety with breaks of routine.
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18
Q

What is the management of ASD?

A

MDT approach depending on severity.
- CAHMS
- Psychologists
- Social workers
- Specially trained educators at school.

Not “cureable”

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19
Q

What is bipolar disorder?

A

Recurrent episodes of depression and mania or hypomania.

High rate of suicide

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20
Q

What are the features of mania?

A
  • Abnormally elevated mood.
  • Significant irritability.
  • Increased energy.
  • Decreased sleep.
  • Grandiosity, ambitious plans, risk taking, excessive spending.
  • Sexually inappropriate behaviour.
  • Flight of ideas
  • Pressured speech
  • Psychosis
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21
Q

What is the difference between bipolar I and bipolar II?

A

BP1 - Involves at least one episode of mania.

BP2 - Involves at least 1 episode of major depression and at least one episode of hypomania.

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22
Q

What is the difference between mania and hypomania?

A

Mania - More severe than hypomania, with an extremely elevated mood and major effects on daily life.

Hypomania - Milder than mania, with still elevated mood and reduced need for sleep. Often can continue as normal with daily life.

Summary - mania is more severe than hypomania, with a greater impact on daily life.

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23
Q

What is the acute management for an episode of mania?

A
  • Antipsychotics (olanzapine, quetiapine, haloperidol) is first line.
  • Lithium and valproate
  • Taper and stop antidepressants.
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24
Q

What is the acute management for an episode of depression?

A
  • Olanzapine and fluoxetine
  • Antipsychotics
  • Lamotrigine
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25
Q

What is the long term management used for bipolar disorder?

What monitoring is required?

A

Lithium is the usual option.

Requires monitoring of serum lithium levels at 12 hours post-dose.

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26
Q

What are the alternatives to lithium when treating bipolar?

A
  • Olanzapine and sodium valproate.
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27
Q

What are the potential adverse affects of lithium?

A
  • Fine tremor
  • Weight gain
  • CKD
  • Hypothyroidism
  • Hyperparathyroidism
  • Hypercalcaemia
  • Nephrogenic diabetes insipidus (polyuria, polydipsia and dehydration).
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28
Q

What is generalised anxiety disorder?

A

GAD - Excessive and disproportional anxiety and worry that negatively impacts the person’s every day activities.

Symptoms should occur most days for at least 6 months.

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29
Q

What are the emotional and cognitive symptoms of GAD?

A
  • Excessive worrying
  • Unable to control worrying
  • Restlessness
  • Difficulty relaxing
  • Easily tired
  • Difficulty concentrating
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30
Q

What are the physical symptoms of GAD?

A
  • Muscle tension
  • Palpitations
  • Sweating
  • Tremor
  • GI symptoms
  • Headaches
  • Disturbed sleep
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31
Q

What is a panic attack?

A
  • Sudden onset of intense physical and emotional symptoms of anxiety.
  • They come on quickly and then the symptoms gradually fade away.
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32
Q

What is phobia?

A
  • An extreme fear of certain situations or things, causing symptoms of anxiety and panic.
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33
Q

What is the screening tool used to assess severity of anxiety?

How does score relate to severity?

A

GAD-7

7 questions:
5-9 is mild
10-14 is moderate
15-21 is severe.

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34
Q

What is the management for MILD anxiety (GAD-7 of 5-9?

A

Mild (5-9 on GAD-7) - self-help strategies and lifestyle changes:
- meditation
- healthy sleep habits
- Improve diet
- Avoid alcohol and caffiene

Moderate to severe

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35
Q

What is the management for moderate/severe anxiety (GAD-7 of 10-21?

What is first line medication?

What are the other medication options?

A
  • CBT
  • Medication (sertraline is first line)

Other medication options are:
- SNRI (venlafaxine)
- Pregabalin
- Propanolol (not for asthmatics)
- Benzodiazepam NOT offered unless for acute episodes of anxiety.

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36
Q

What is OCD?

What is an obsession?

What is a compulsion?

A

Struggle with obsessions and compulsions.

Obsession - unwanted and uncontrolled thoughts and intrusive images that are very difficult to ignore.

Compulsion - Repetitive actions a person feels they must do, with anxiety if they are not done. Often associated with the obsessions.

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37
Q

What is the cycle of OCD?

A
  • Obsessions
  • Anxiety
  • Compulsion
  • Temporary relief.

The obsession will then reappear, causing the cycle to continue.

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38
Q

What scale is used to assess the severity of OCD?

A

Yale-Brown Obsessive Compulsive Scale

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39
Q

What is the management for OCD?

A

Mild OCD:
- Education and self-help

Moderate/severe OCD:
- CBT with exposure and response prevention (ERP)
- SSRI (sertraline)
- Clomipramine (tricyclic antidepressant)

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40
Q

What is ERP?

A

Exposure and response prevention:
- Facing the obsessive thoughts and anxiety without completing the associated compulsions.

Used in management of moderate/severe OCD.

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41
Q

Baby blues vs postnatal depression vs puerperal psychosis?

A

Baby blues - depressive symptoms in the first two weeks after giving birth.

Postnatal depression - Depressive symptoms that last over two weeks in the postnatal period.

Puerperal psychosis - Full psychotic symptoms, occurring 2-3 weeks after giving birth.

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42
Q

What is the treatment required for baby blues?

A

None - symptoms will resolve on own.

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43
Q

What screening tool is used for postnatal depression?

What score is suggestive of postnatal depression?

A

Edinburgh postnatal depression scale.

10 or more indicates postnatal depression.

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44
Q

What is the treatment for mild, moderate and severe postnatal depression?

A

Mild - Self-help, GP followup

Moderate - SSRI (sertraline), CBT.

Severe - Specialist referral, mother and baby unit.

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45
Q

What is the treatment for puerperal psychosis?

A
  • Admit to mother and baby unit.
  • CBT
  • ECT
  • Antidepressants (e.g. sertraline) and antipsychotics (e.g. olanzapine, quetiapine etc.)
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46
Q

What is PTSD?

What is the timeframe for diagnosis?

A

Ongoing distressing symptoms and impaired function as a result of traumatic experience.

Diagnosed after 4 weeks following the traumatic event. Up till 4 weeks, it is an acute stress reaction rather than PTSD.

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47
Q

How does PTSD present?

A
  • Intrusive thoughts relating to the event.
  • Re-experiencing (flashbacks, images, nightmares)
  • Hyperarousal
  • Avoidance of triggers
  • Negative emotions and beliefs
  • Difficulty with sleep
  • Depersonalisation (feeling separated/detached)
  • Derealisation (world around them doesn’t feel real)
  • Emotional numbing.
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48
Q

What screening tool is used to diagnose PTSD?

A

Trauma screening questionnaire.

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49
Q

What is the management used for PTSD?

A

Tailored to the individual. Options include:
- Psychological therapy (trauma-focused CBT)
- Eye movement desensitisation and reprocessing (EMDR).
- Medication (SSRI, venlafaxine or antipsychotics).

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50
Q

Sertraline:
Drug class?
Other useful information?

A

SSRI (can cause GI disruption)
- Anti-anxiety too
- Less risk of heart-related side effects than other SSRI.

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51
Q

Citalopram:
Drug class?
Other useful information?

A

SSRI (can cause GI disruption)
- Can prolong QT interval (torsades de pointes).
- Least safe SSRI for those with heart disease (along with escitalopram).

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52
Q

Fluoxetine:
Drug class?
Other useful information?

A

SSRI (can cause GI disruption)

Long half life (4-7 days). First line choice in children and adolescents.

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53
Q

Paroxetine:
Drug class?
Other useful information?

A

SSRI (can cause GI disruption)

More likely to cause weight gain.

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54
Q

Venlafaxine:
Drug class?
Other useful information?

A

SNRI

Contraindicated in uncontrolled hypertension (all SNRIs)

Used when inappropriate response to other antidepressants.

Causes more discontinuation symptoms and has a higher risk of overdose suicide.

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55
Q

Duloxetine:
Drug class?
Other useful information?

A

SNRI

Can be used for neuropathic pain/stress incontinence.

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56
Q

Amitriptyline:
Drug class?
Other useful information?

A

TCA

Commonly used for neuropathic pain relief.

High association with cardiac arrhythmias - makes them extremely risky in overdose so not used for depression commonly.

Cause sedation so often taken at night. Also can cause dry mouth, constipation, urinary retention due to the anticholinergic effects.

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57
Q

Mirtazapine:
Drug class?
-Other useful information?

A

Atypical antidepressant (technically a TCA)

Causes increased appetite, weight gain and sedation. This makes it useful in the elderly, if there is evidence of poor sleep and reduced appetite.

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58
Q

How quickly do patients need reviewing following start of an antidepressant?

A
  • within 2 weeks
  • if between 18-25, one week due to increased suicide risk.
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59
Q

Within what timeframe is there normally a noticeable response to a course of antidepressants?

  • What are the next steps?
A
  • Within 2-4 weeks.
  • Consider switching or upping dose.
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60
Q

Which antidepressant classes can be directly switched between?

Which is the exception?

A

SSRI –> SNRI.

Not fluoxetine as it has a longer half life.

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61
Q

When stopping antidepressants, what is recommended?

A
  • A gradual stop to minimise the discontinuation symptoms.
  • Should be done slowly at least over 4 weeks.
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62
Q

What are the typical symptoms when stopping antidepressants?

A
  • Insomnia
  • Vivid dreams
  • Irritability
  • Electric shock-like symptoms.
  • Flu-like symptoms
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63
Q

How long do discontinuation symptoms typically last for when stopping antidepressants?

A

Resolve within 1-2 weeks.

Commence after 2-3 days of stopping treatment.

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64
Q

What is serotonin syndrome?

A

Excessive serotonin activity - occurs with high dose antidepressants or multiple antidepressants being used at once.

65
Q

What are the common symptoms of serotonin syndrome?

A
  • Altered mental state (agitation and anxiety)
  • Autonomic nervous system hyperactivity (tachy, high BP, hyperthermia)
  • Hyperreflexia, tremor and rigidity
66
Q

What is the management of serotonin syndrome?

A

Medical emergency:
- sedation with benzodiazepam.
- Withdrawal of causative agent.

67
Q

What are the potential complications of serotonin syndrome?

A
  • Seizures
  • Severe hyperthermia (over 40 degrees)
  • Respiratory failure.
68
Q

What can the interaction between a triptan and an SSRI potentially cause?

A

Serotonin syndrome.

69
Q

How long should antidepressants be taken before stopping? (first time depression vs recurrent depression)

A
  • 6 months for first time depression.
  • 2 years for recurrent depression.
70
Q

What is cotard syndrome? What is it associated with?

A

Belief that they/a part of them is dead or doesn’t exist.

Associated with severe depression.

71
Q

What are the symptoms of alcohol withdrawal? What timeframes do they occur within?

A

Alcohol withdrawal
- symptoms: 6-12 hours (tremor, sweating, tachycardia, anxiety)
- seizures: 36 hours
- delirium tremens: 72 hours (confusion, delusions, hallucinations, fever, coarse tremor)

72
Q

What is psychosis?

A

Acute mental state resulting in delusional beliefs and hallucinations.

73
Q

Other than schizophrenia, what is psychosis associated with?

A
  • Depression
  • Bipolar
  • Drug and alcohol abuse
  • Neurological disorders
74
Q

What is a delusion?

A

Fixed strange and irrational belief which is firmly held and out of context for the individual’s cultural background.

75
Q

What is a delusion of grandeur?

A
  • Exaggerated ideas of importance (e.g. they are an important historical figure)
76
Q

what is paranoia (delusion)?

A

Belief in a plot against them

77
Q

What is a somatic delusion?

A

Belief they have an incurable illness

78
Q

What is a hallucination?

A

A sensory perception - can be auditory, visual, touch or smell based - without an obvious real world stimulus.

79
Q

What is the most likely demographic for psychosis?

A

16-30 yo males.

80
Q

What is the management for psychosis?

A
  • Most acute psychosis requires admission to a mental health facility.
  • Antipsychotics (olanzapine, quetiapine, risperidone)
  • Haloperidol used in certian circumstances.
81
Q

What is schizophrenia?

A

Severe, long term mental health condition characterised by psychosis.

Requires symptoms for at least 6 months before diagnosis.

82
Q

What is schizoaffective disorder?

A

Combines schizophrenia with bipolar disorder.

psychosis, mania and depression.

83
Q

what is schizophreniform disorder?

A

Same features as schizophrenia but for less than 6 months.

84
Q

What are the other potential causes of psychosis other than schizophrenia?

A

Mania
Psychotic depression
Drugs
Stroke
Brain tumours
Hyperthyroidism
Huntington’s disease

84
Q

What is the prodrome phase (schizophrenia)?

A

A period of subtle symptoms prior to full psychosis:
- Poor memory
- Reduced concentration
- Mood swings
- Suspicion of others
- Loss of appetite
- Social withdrawal
- Difficulties with sleep

85
Q

What are the three key positive symptoms for psychosis?

A
  • Delusions
  • Hallucinations
  • Thought disorder
86
Q

How does insight relate to psychosis?

A

Lack of insight, meaning the patient is unaware that the delusions and hallucinations are not based on reality.

87
Q

What are the key positive symptoms of schizophrenia?

A
  • Auditory hallucinations. (hearing voices)
  • Somatic passivity (an external entity is controlling sensations and actions)
  • Thought insertion/withdrawal (an external entity is inserting/withdrawing their thoughts)
  • Thought broadcasting (belief that others are overhearing their thoughts)
  • Persecutory delusions (a false belief that a person or group is going to harm them)
  • Ideas of reference (unconnected events or details in the world directly relate to them)
  • Delusional perception (an ordinary and unremarkable perception triggers a sudden delusion.
88
Q

What are the negative symptoms of schizophrenia?

A

The 4 “A”s
- Affective flattening (minimal emotional reaction to emotive subjects/events)
- Alogia (poverty of speech)
Anhedonia (lack of interest in activities)
- Avolition (lack of motivation to complete tasks/work towards goals).

89
Q

What is the diagnostic criteria for schizophrenia?

A

Symptoms (inc. predrome phase) lasting for at least 6 months with symptoms of active phase lasting for at least one month (or less if treatment has been successful).

90
Q

What is the treatment for schizophrenia?

A
  • Antipsychotics (no first line - typical drugs include quetiapine, olanzapine, risperidone)
  • CBT
91
Q

When should clozapine be used for psychosis?

A

If other agents have not been successful.

92
Q

What are the key complications of clozapine?

A
  • Agranulocytosis (low neutrophils)
  • Myocarditis or cardiomyopathy
  • Constipation
  • Seizures
  • Excessive salivation.
93
Q

What monitoring is required during the use of antipsychotic drugs?

A
  • Weight and waist circumference.
  • Blood pressure and pulse
  • Bloods (HbA1c, lipids, and prolactin)
  • ECG
94
Q

What are the key symptoms of neuroleptic malignant syndrome?

A
  • Muscle rigidity.
  • Hyperthermia
  • Altered consciousness
  • Autonomic dysfunction
95
Q

What are the key bloodtest findings for neuroleptic malignant syndrome?

A
  • Raised creatine kinase
  • Raised WCC
96
Q

What is the management for neuroleptic malignant syndrome?

A
  • Stop causative medications
  • Supportive care.
  • Bromocriptine may be used (dopamine agonist)
97
Q

What causes neuroleptic malignant syndrome?

A

Complication of antipsychotic treatment.

98
Q

What should be prescribed alongside an SSRI + NSAID?

A

PPI

99
Q

What is the diagnostic criteria for chronic insomnia?

A

Must be present for at least 3 months with a minimum of 3/7 nights per weeks.

100
Q

What is catatonia?

A

Stopping of voluntary movement or staying still in an unusual position.

101
Q

Which drug class increases the risk of VTE in elderly patients?

A

Atypical antipsychotics

102
Q

What is the management of a patient with hypomania/mania who takes an antidepressant?

A

Stop the antidepressant and start an antipsychotic.

103
Q

What is the difference between:

Somatisation disorder

Hypochondriasis

Factitious disorder (Munchausen’s syndrome)

Conversion disorder (same as functional neurological disorder)?

A

Somatisation disorder - Multiple physical SYMPTOMS present for at least 2 years.

Hypochondriasis - Persistent belief in an underlying serious disease (typically cancer)

Factitious disorder (Munchausen’s syndrome) - Intentional production of physical and psychological symptoms.

Conversion disorder - neurological symptoms that cannot be explained by a known mental or physical health condition.

104
Q

What is cotard syndrome?

A

False belief/delusion that the person is dead or actively dying.

105
Q

What is De Clérambault’s Syndrome?

A

Belief that a famous or high-social-status individual is in love with the patient.

A type of delusional disorder.

106
Q

What are the three categories of personality disorder?

A

Cluster A - suspicious
Cluster B - Emotional or impulsive
Cluster C - Anxious

107
Q

What is paranoid personality disorder?
What category disorder is this?

A

Difficulty trusting or revealing personal information to others.

A - suspicious

108
Q

What is schizoid personality disorder?
What category disorder is this?

A

A lack of interest or desire to form relationships with others/feels this is of no benefit to them.

A - suspicious

109
Q

What is schizotypal personality disorder?
What category disorder is this?

A

Unusual beliefs thoughts and behaviours, with social anxiety that makes forming relationships difficult.

A - suspicious

110
Q

What is antisocial personality disorder?
What category disorder is this?

A
  • Reckless and harmful behaviour, with a lack of concern for the consequences. Associated with criminal misconduct.

B - Emotional and impulsive.

111
Q

What is borderline personality disorder?
What category disorder is this?

A

Fluctuating strong emotions and difficulty with identity and maintaining healthy relationships.

B - Emotional and impulsive.

112
Q

What is histrionic personality disorder?
What category disorder is this?

A

Need to be centre of attention.

B - Emotional and impulsive.

113
Q

What is narcissistic personality disorder?
What category disorder is this?

A

Feels they are special and needs others to recognise this or gets upset. Always puts themselves first.

B - Emotional and impulsive

114
Q

What is avoidant personality disorder?
What category disorder is this?

A

Severe anxiety about rejection or disapproval, so avoids social situations or relationships.

C - anxious

115
Q

What is dependent personality disorder?
What category disorder is this?

A

Heavy reliance on others to make decisions and take responsibility for their life.

C - anxious

116
Q

What is obsessive-compulsive personality disorder?
What category disorder is this?

A

Unrealistic expectations of how things should be done by themselves or others. Catastrophises about what will happen if these expectations are not met.

117
Q

What is the main management for personality disorders?

A

Risk management

CBT or DBT

NOT usually medication.

118
Q

Tangentiality vs circustantiality?

A

Tangentiality - off on a tangent with no return to the original topic.

Circumstantiality - patient answers the question with an unnecessary amount of detail, but eventually answers the question asked.

119
Q

What is used to treat tarditive dyskinesia (repetitive body movements)?

A

Tetrabenazine

120
Q

What is used to treat acute dystonia (involuntary muscle contractions)?

A

Procyclidine

121
Q

What is the most common demographic for self harm?

A

Females under 25.

122
Q

What is the most common demographic for suicide?

A

Males around 50.

123
Q

What presenting features may increase the risk of suicide?

A
  • Previous attempts.
  • Escalating self-harm.
  • Impulsiveness.
  • Making plans.
  • Writing a note.
124
Q

How is a paracetamol overdose treated?

A

Acetylcysteine.

125
Q

How is an opioid overdose treated?

A

Naloxone

126
Q

How is a cocaine overdose treated?

A

diazepam.

127
Q

What is alcohol dependance?

A

daily alcohol consumption with strong urges and cravings for alcohol. Withdrawal symptoms when stopping.

128
Q

What is the formula for calculating units of alcohol?

A

Volume (ml) x alcohol percentage / 1000

129
Q

What is the recommended weekly alcohol consumption?

A

No more than 14 units per week:
- Spread evenly over 3 or more days.
- No more than 5 units in a single day.

130
Q

What is defined as a binge drinking session?

A

6 or more units for women, 8 or more for men.

131
Q

What are some common complications of excess alcohol consumption?

A
  • Alcohol related liver disease.
  • Cirrhosis
  • Alcohol dependance.
  • Wernicke-Korsakoff syndrome.
  • Pancreatitis
  • Alcoholic cardiomyopathy
  • Alcoholic myopathy
  • Increased risk of CVD
  • Increased risk of cancer.
132
Q

What screening tool is used to quickly screen for harmful alcohol use?

What questions does this include?

A

CAGE questions.

  • Cut down? Do you ever think you should cut down?
  • Annoyed? Do you ever get annoyed at others commenting on your drinking?
  • Guilty? Do you ever feel guilty about the amount you drink?
  • Eye opener? Do you ever drink in the morning to help your hangover/nerves?
133
Q

What blood results are indicative of excess alcohol use?

A
  • Raised MCV
  • Raised ALT and AST
  • Raised GGT
134
Q

What are the symptoms of delirium tremens?

A
  • Acute confusion
  • Severe agitation
  • Delusions/hallucinations
  • Tremor
  • Tachycardia
  • HTN
  • Hyperthermia
  • Ataxia
  • Arrhythmia
135
Q

What time window does delirium tremens usually occur within?

A

72 hours of alcohol withdrawal.

136
Q

What is the treatment for alcohol withdrawal?

A
  • Chlordiazepoxide.
137
Q

What is Wernicke-Korsakoff syndrome?

What are the symptoms?

A

A combination of Wernicke’s encephalopathy and Korsakoff syndrome due to thiamine deficiency.

Wernicke’s:
- Confusion
- Oculomotor disturbance
- Ataxia

Korsakoff:
- Memory impairment
- Behavioural changes

138
Q

What is the treatment/prevention for Wernicke’s Korsakoff syndrome?

A

Thiamine supplementation and abstaining from alcohol.

139
Q

What are the 3 main types of eating disorder?

A
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
140
Q

What is anorexia nervosa?

What is the mortality like?

A
  • Person feels they are overweight despite evidence to the contrary.
  • Obsessively restricting calorie intake to lose weight.
  • Excessive exercise and/or laxatives to lose weight.

Highest mortality of any psychiatric condition.

141
Q

What is bulimia nervosa?

A

Binge eating and then purging (either via vomiting OR LAXATIVES)

Often normal body weight compared to anorexia nervosa.

Key examination findings are knuckle calluses and erosion of teeth (due to purging).

142
Q

What is binge eating disorder?

A

Person has episodes of excessive overeating.

Patient likely to be overweight.

143
Q

What is the management for eating disorders?

A

Self-help
CBT
Addressing other psychosocial factors

If severe, admission may be required for refeeding and to monitor for refeeding syndrome.

144
Q

What is refeeding syndrome?

A

Someone with an extended severe nutritional deficit begins to eat again.

145
Q

What are the blood findings for refeeding syndrome?

A
  • Low magnesium
  • Low potassium
  • Low phosphate
146
Q

How can risk of refeeding syndrome be limited?

A
  • Slowly reintroducing food with limited calories.
  • Monitor Mg, K, phosphate and glucose.
  • Fluid balance monitoring
  • ECG if severe
147
Q

What is the mental health act?

A

A legal framework for keeping patients in hospital against their will for assessment and treatment of a mental health disorder.

148
Q

Who is involved in a mental health act assessment?

A
  • Approved mental health professional. This is the primary person making the application and organising the admission.
  • Section 12 doctor. This is someone qualified to undertake a mental health act assessment (usually a psychiatrist).
149
Q

What is the requirement for a person to be sectioned against their will?

A

The decision to be recommended by two registered doctors.

  • One MUST be a section 12 doctor.
150
Q

What is a section 2 admission?

How long does it last?

Who is required?

A

Compulsory admission for a maximum of 28 days following a MHA

It cannot be renewed. Must then be discharged or changed to a section 3.

Requires AMHP/nearest relative and two doctors (one section 12 approved)

151
Q

What is a section 3 admission?

A

Compulsory admission for treatment for a maximum of 6 months.

This CAN be renewed.

Requires AMHP/nearest relative and two doctors (one section 12 approved)

152
Q

What is a section 4 admission?

A

Used to detain a patient for up to 72 hours in urgent scenarios. NOT ALREADY IN HOSPITAL/IN OUTPATIENT SERVICES (SEE SECTION 5(2)).

Requires an AMHP and one doctor

153
Q

What is a Section 5(2) admission?

A

Used to detain a patient who is already an inpatient for a maximum of 72 hours.

Requires one doctor.

154
Q

What is a section 5(4)?

A

Nurse can detain a patient for up to 6 hours for assessment.

155
Q

Section 135?

A

Court order allows police to enter a private property and remove person with a mental disorder to a place of safety for 24 hours (extendable by 12 hours)

156
Q

Section 136?

A

Police can detain a person from a public place to place of safety for up to 24 hours for assessment without a warrant.

157
Q

Section 17a?

A

Patient under section 3 can receive community treatment if well enough. Can be recalled to hospital for non-compliance and detained for up to 72 hours for reassessment if recalled.

Decision made by responsible clinician and AMHP.

158
Q

What is a common side effect of ECT?

A

Cardiac arrhythmia.

Phase 3A Conditions (4 decks)

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