Psychiatry Flashcards
What are the risk factors for self harm? 3 things
Psychiatric condition
Victims of domestic violence
Socioeconomic disadvantage
Eating disorders
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
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)
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)
What is section 4, how long does it last and who is required?
Emergency admission from community
72 hours
Doctor and ASW
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
What is section 5.4, how long does it last and who is required?
Detain pt. in emergency
6hrs
Nurse
What is section 136?
Section done by the police when there is suspicion of mental illness
Pt. held in place of safety until assessment
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
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
What are Schneiders first rank symptoms of schizophrenia?
Delusional perception
Delusions of thought control
Delusions of control
Hallucinations
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
Give one thing that could precipitate schizophrenia?
Stress
Drug abuse
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
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
What are the typical side effects of antipsychotics?
EPSE Tardive dyskinesia Dystonia Akasthisia (restless leg) Parkinsonian symptoms
Which antipsychotic needs regular monitoring and why?
Clozapine due to agranulocytosis
What are the core symptoms in depression?
Low mood
Low energy
Anhedonia (lack of enjoyment)
How is depression diagnosed?
2 core symptoms and additional symptom for >2 weeks
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
What are the potential side effects of ECT?
Loss of memory Confusion Headache Nausea Muscle pains
What are the risk factors for depression? 4 things
Stress Emotional distress Close one death Adverse life event Family history Alcohol/drug misuse
What is the difference between Mania and Hypomania?
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?
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
