Psychiatry Flashcards
Which physical problem could you treat under the Mental Health Act?
Those that are DIRECTLY DIRECTLY caused by the mental condition
Ie. Feeding in anorexia or giving a fluid drip to someone with such extreme depression they can’t lift up a cup
Which section can be used to detain an inpatient by a doctor?
Section 5(2)
But you can’t detain a patient under the mental health act to treat their physical problem (have to use the capacity act to do so)
Management of generalised anxiety disorder?
Anxiety + 3 somatic symptoms for 6+ months
Regular exercise
Meditation
CBT
Drugs + psychotherapy: benzodiazepines, SSRIs
Differences between OCD and psychosis
OCD Know that thoughts originate from themselves + thoughts don’t make sense
What is OCD + Rx?
Obsessions- stereotyped words, ideas or phrases that come into mind
Compulsions- senseless repeated rituals
Rx: CBT
Clomipramine (TCA) or SSRIs
Diagnostic criteria of anorexia:
- Weight <85% of predicted or below 17.5 BMI
- Fear of weight gain leading to dieting, vomiting, excessive exercise
- Feeling fat when thin
- Amenorrhoea for 6 cycles of low libido
Screening questions for anorexia:
SCOFF:
Do you ever make yourself feel Sick?
Do you worry you’ve lost Control of eating?
Have you lost more than One stone in 3 months?
Do you believe you are Fat?
Does Food dominate your life?
Red flags for anorexia:
PC: BMI under 13, weight loss >1kg in a week
EHx: purpura (low plts), limbs blue + cold, unable to get out of chair without using arms for leverage
IHx: Temp <34.5, BP < 80/50, Sats <92% K+ <2.5, Na+ <130, PO4 <0.5
ECG- long QT, flat T waves
What are the signs of refeeding syndrome?
PC: arrhythmias, seizures, coma, resp/cardiac failure
IHx: falling PO4, high glucose, low K+, high Mg+
Features of fragile x syndrome:
Trinucleotide expansion on X chromosome
Epilepsy, mitral valve prolapse, otitis media
Intellectual disability, autism, ADHD, panic disorder
Rx of depression:
CBT (if mild, may be all that’s needed)
SSRIs- citalopram, sertraline, paroxetine
Omega 3 supplements
Electroconvulsive therapy
± antipsychotics if delusions/hallucinations
Medical causes of mania
Infections Hyperthyroidism, hyponatraemia SLE, TTP, stroke ECT Amphetamines, cocaine, venlafaxine Steroids, L Dopa
Rx of acute mania
Olanzepine
Atypical antipsychotic
What monitoring is required for patients taking lithium?
Lithium levels weekly until constant conc for 4 weeks
Then 6 x monthly, then 3 monthly
U+E, TSH every half year
Signs of lithium toxicity:
Reduced vision D+V LowK+ Ataxia Tremor Dysarthria Coma
Medical treatment of bipolar disorder?
Acute mania: antipsychotic (or valproate)
Mood stabiliser: lithium, valproate or carbemazepine
Depression: SSRIs
Refractory: add anticonvulsants or antipsychotics
3 groups of personality disorder:
A- paranoid, schizoid, schizotypal
B- antisocial (psychopathic), borderline, histrionic, narcisstic
C- avoidant, dependent, obsessive compulsive
Features of borderline personality disorder:
Unstable affect regulation
Poor impulse control
Poor interpersonal relationships/self image
Self injury + suicidality
Rx: dialectical behaviour therapy
What are the following sections used for: Section 2 Section 3 Section 5.2 Section 5.4 Section 135 Section 136
2- 28 days for assessment (needs two doctors, one ‘approved’)
3- 6 months for treatment (needs 2 doctors)
5.2- 72 hours from a ward by a doctor
5.4- 6 hours by a psychiatric nurse
Section 135- medical practitioner + police permitted to search premises once approved by a magistrate
Section 136- 72 hours by police, take to place of safety
Features of schizophrenia:
Psychotic symptoms- first rank includes auditory hallucinations, thought broadcast/insertion/withdrawal and delusional perception
Disorganisation symptoms- incongrous mood, abnormal speech
Negative symptoms- self-neglect, apathy, blunted mood, withdrawal, loss of motivation
Cognitive impairment- sometimes
In regards to schizophrenic symptoms what aspects are required to make a schizophrenia diagnosis?
Sx last 6 months, with Sx being present for most of the time during 1 month
AND
Marked impairment in work or home functioning
How do side effects differ between typical and atypical psychotics?
Typical (haloperidol, chlorpromazine)- D2 receptor blockade
Extrapyramidal SEs:
parkinsonism,
acute dystonia (muscle contraction),
akathisia (constant restless motion),
tardive dyskinesia (irreversible involuntary repetitive movements)
Hyperprolactinaemia
Atypical (olanzepine, quetiapine)
Metabolic syndrome side effects + weight gain
Sexual dysfunction from raised prolactin- quetiapine has least effect on this
Long QT
What is the risk of clozapine?
Given for refractory schizophrenia
Agranulocytosis- monitor FBC
Management of extrapyramidal side effects in typical antipsychotics?
Procyclidine for parkinsonism and dystonia (anticholinergic)
Propranolol for akathisia
Tetrabenazine for tardive dyskinesia
