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
A dependence syndrome of substances is defined by the presence of 3 of the following:
- Craving
- Difficulty controlling substance use
- Physical withdrawal state
- Tolerance
- Continuing despite harm
- Neglect of alternative pleasures and interests
What drugs are available to help in opiate detoxification?
Methodone
Disulfiram- blocks DA breakdown causing anxiety, restlessness if cocaine is taken
Buprenorphine
Naltrexone- mu recepor blocks, blocks euphoria
When asking about alcohol abuse, what does the TWEAK mneumonic stand for?
Tolerance Worry about your drinking Eye opener Amnesia from alcohol use Attempts to Cut down
2 points = +ve
Signs and management of delirium tremens?
Tachycardia, hypotension
Tremor, fits
Visual or tactile hallucinations- insects crawling under the skin
Rx: diazepam or chlordiazepoxide
Which pharmacological Rx may be tried for behaviour and psychological symptoms of dementia?
Risperidone
