Psychiatry Flashcards by Chenjerai Gutu

What are the risk factors for self harm? 3 things

Psychiatric condition
Victims of domestic violence
Socioeconomic disadvantage
Eating disorders

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What state must a patient be in to section them?

A danger to themselves
Or
A danger to others
Or
Deteriorating to the point that they will become one of the above

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What is section 2, how long does it last and who is required?

Assessment and treatment 
28 days
Consultant psychiatrist
GP who knows the pt. 
Approved social worker (ASW)

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What is section 3, how long does it last and who is required?

Treatment ONLY
6 months but can be extended 
Consultant Psychiatrist
GP who knows pt.
Approved Social Worker (ASW)

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What is section 4, how long does it last and who is required?

Emergency admission from community
72 hours
Doctor and ASW

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What is section 5.2, how long does it last and who is required?

Emergency to detain pt. in hospital
72 hrs. Allows assessment from professionals.
Any doctor

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What is section 5.4, how long does it last and who is required?

Detain pt. in emergency
6hrs
Nurse

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What is section 136?

Section done by the police when there is suspicion of mental illness

Pt. held in place of safety until assessment

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What is dementia?

Chronic generalised psychological impairment of intellect, memory and personality with NO effect on consciousness

Usually irreversible occurring 65+ y/o

Symptoms present >6 months

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In schizophrenia, give 2 symptoms each of positive and negative?

Positive-
Thought disorder
Reality distortion

Negative-
Social withdrawal
Decreased emotional response
Cognitive dysfunction and dementia

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What are Schneiders first rank symptoms of schizophrenia?

Delusional perception
Delusions of thought control
Delusions of control
Hallucinations

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What is the criteria for diagnosing schizophrenia?

1 or more 1st rank symptoms/strong characteristic symptoms
Or
2 or more less characteristic symptoms

> 1 month after all other possible causes have been excluded

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Give one thing that could precipitate schizophrenia?

Stress

Drug abuse

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You suspect a pt. to have schizophrenia, what investigations will you do? 2 things

Drug screen-rule out organic cause
CT/EEG-rule out organic cause
Collateral history

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How do you manage schizophrenia using a bio psychosocial model?

Bio-antipsychotic medication 1-2yrs
Psycho-CBT, family therapy
Social-relationships, occupation, social skills training

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What are the typical side effects of antipsychotics?

EPSE
Tardive dyskinesia
Dystonia
Akasthisia (restless leg)
Parkinsonian symptoms

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Which antipsychotic needs regular monitoring and why?

Clozapine due to agranulocytosis

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What are the core symptoms in depression?

Low mood
Low energy
Anhedonia (lack of enjoyment)

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How is depression diagnosed?

2 core symptoms and additional symptom for >2 weeks

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How do you manage depression in a bio psychosocial model?

Bio-Antidepressants, ECT
Psycho-Counselling, CBT, self help groups
Social-OT, home help, social skills training

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What are the potential side effects of ECT?

Loss of memory
Confusion
Headache
Nausea
Muscle pains

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What are the risk factors for depression? 4 things

Stress
Emotional distress
Close one death
Adverse life event
Family history
Alcohol/drug misuse

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What is the difference between Mania and Hypomania?

Study These Flashcards

Mania is an elated mood lasting >1-2 weeks WITH psychotic symptoms

Hypomania is elated mood for >4 days WITHOUT psychotic symptoms

Give 2 common side effects of lithium?

Study These Flashcards

Tremor
Thinning of hair
Acne
Weight gain
Diabetes insipidus

What is the first line treatment for an acute manic episode?

Atypical antipsychotic

Give 2 physical symptoms of depression?

Sleep disturbance Loss of appetite Weight loss Loss of libido

Give 3 epidemiological risk factors for suicide?

``` Male Elderly Unemployed Low socioeconomic status Loneliness/homeless ```

Give 3 ways of determining the severity of suicidal intent?

Whether there is a wish to die Any note or will written Any planning Methodology

In paracetamol overdose, how will you manage it?

Activated charcoal within the hour Or N acetylcysteine Bloods-LFT, drug levels, FBC Refer to Psychiatry team

Pt admits to hearing voices. Give 3 further questions you would ask?

``` Content? 3rd and 2nd person? Running commentary? Voice is your own or different person speaking? Recognise voices? ```

Give 2 examples of typical and atypical antipsychotics?

Typical-Haloperidol or Chlorpromazine | Atypical-Quetiapine or Olanzapine

Give 3 criteria in diagnosing Anorexia Nervosa?

* Overestimation of actual body weight and size * Phobia of normal body * BMI <17.5 * Amenorrhea

Apart from restricting food intake, how else might an anorexic patient avoid weight gain? 2 things

* Over exercise * Laxatives * Vomiting * Diuretic usage

Give 3 clinical effects of Anorexia Nervosa?

``` Vitamin deficiencies and electrolyte disturbance Amenorrhea Bradycardia Alopecia Osteopenia Cold peripheries ```

Give 7 physical symptoms of anxiety disorders?

Motor tension-muscle stiffness, headaches, tremor, muscle aches Increased sympathetic drive-sweating, dizziness, frequent peeing, nausea, diarrhoea Hyper vigilance-irritability, insomnia

Name 2 pharmo and 2 non pharmo ways of treating generalised anxiety disorders?

Anxiolytics (benzodiazepines) Antidepressants CBT Psychotherapy

What are the 3 most common types of dementia?

Alzheimer's Vascular Lewy body

Below what MMSE score is a patient said to have dementia if repeated on multiple occasions?

23/30

Give 2 CT changes seen in Alzeheimers?

Widening of sulci | Enlargement of ventricles

Suggest 4 blood tests you would perform to exclude other causes of dementia?

FBC-WCC shows chronic infections U+E -electrolyte disturbances can cause confusion CRP-rule out autoimmune disease Vit B12 and folate-Wernicke's encephalopathy

What is delirium?

Acute and fluctuating reversible disturbance in level of consciousness, attention and cognition due to physical illness

Name 4 causes of delirium?

``` Stroke Brain tumour Alcohol Encephalitis Meningitis UTI Acid base disturbance ```

Give 2 ways you can differentiate between delirium and dementia?

Delirium is acute vs. Dementia insidious Delirium is fluctuating vs. Dementia is stable or progressive Delirium has impaired consciousness vs. Dementia normal consciousness

Give 5 features of Alcohol dependancy?

* Withdrawals * Cravings * Drinking despite negative consequences * Tolerance * Primacy-drinking before anything else * Rapid reinstatement * Narrowing of repertoire

Give the 4 areas used to assess mental capacity?

Understanding written or verbal information needed for decision making Retain the information long enough to make the decision Weigh up the pros and cons Communicate the decision

Give 3 drugs used in the treatment of alcohol dependence?

Benzodiazepine-Chlordiazepoxide, diazepam Thiamine and vitamin supplements (Vit B12) Disulfiram Fluid replacement

If vitamins are not replaced in a patient with alcoholic dependancy, what could occur?

Wernickes encephalopathy

Explain lithium monitoring in a manic patient?

Lithium can accumulate in cells and result in toxicity if in high levels. So regular monitoring of the plasma concentrations is needed.

What is the evidence of ECT efficacy?

2008 meta-analysis on the efficacy of ECT vs. a variety of treatment options

At what plasma level of lithium would you stop treatment?

1.5mmol/L

Give 2 other alternatives to the use of lithium as a mood stabiliser?

Carbamazepine (causes birth defects) and Valproic acid

Give a non pharmo method of treating mood disorders?

Mood diary

Name 3 presentations of depression where ECT use would be appropriate?

Depression unresponsive to medication Previous good response to ECT Depression associated with psychotic features, severe weight loss or early morning waking

Suggest 2 changes in ECT use from the 50's to now?

Sinusoidal current to Brief pulse ECT Unmodified (no muscle relaxant) to Modified (muscle relaxant)

Give 3 factors you would need to consider when interviewing young children?

Establishing a rapport Age and development appropriate questions Collateral history from parents/school Flexible and responsive to patient

Name 2 advantages and 2 disadvantages of interviewing families together?

AD - allows observation of family dynamics - allows everyone to be involved reducing chances of distortion - facilitates discussion over family issues DIS - time consuming - individuals may withhold info - conflicting interests of parents and child

What is the triad of impairement typically seen in autistic spectrum disorders?

Social interaction Communication Rigidity of thinking

Psychiatry Flashcards

(57 cards)