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Progress test packs > Psychiatry > Flashcards

Psychiatry Flashcards

0
Q

HISTORY: depression

A

Mood - dep, worth, guilt, hope

Pleasure
Energy
Sleep
Appetite
Concentration
Slowness

Suicide
Pattern (everyday?)
Triggers + impact (how are things at home/work)

ASK ABOUT MANIC EPISODES

Alco drugs
Personal family history

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1
Q

Components of mental state examination

A
  1. Appearance and behaviour
  2. Speech (tone, rate, vol, paucity, pressure)
  3. Thought form and content
    - flight, block, delusion,
  4. Mood (subjective) and affect (objective)
  5. Perception (delusions, hallucinations etc)
  6. Cognition
  7. Insight
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2
Q

Differentials depression

A 
bipolar affective disorder
schizophrenia 
seasonal affective disorder
bereavement 
substance abuse 
hypothyroidism 
dementia
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3
Q

Investigations person suspected depression

A

Screening tools

  • HAD
  • PHQ-9
FBC
U+Es
TFTs
Folate + B12
LFTs- alcohol/drugs/cancer
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4
Q

EXPLAN: Treatment depression

A

CBT
exercise

SSRIs

  • se: GI upset (pain, n/v, diar), headache
  • take in morning (cause sleep disturbance)

TCA
- se: wg, drowsy, dry eye/mouth, constipation

long term - review and support
lag time
don’t stop suddenly

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5
Q

SSRI

Fluoxetine
Citalopram
Sertraline - used if anxious

A

se:
GI upset, headache, wg
Anticholinergic
sleep disturb - so take in morning

Considerations
lag - 4 weeks for effect
dont stop suddenly (w/drawal)
long term but review

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6
Q

HISTORY: suicide and self harm

A

1) Event
- what, where, who
- intoxicated?

something you’d thought about
- spec plan, note? told? discov?
or impulse
- what trigger

as happ

  • think die or disc?
  • panic or relief?

what then?
now: guilt? anger? relief?

2) past
- prev attempts - prev psych - gen mood

3) future
- try again - why not? - feel about future?

4) social
***alcohol and drug use
support at home?

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7
Q

HISTORY: anxiety

A

hx of physical complaint

  • what are you concerned about
  • what makes you think/worry about this
  • do you think you are someone who worries about things a lot

things in life causing stress

do you

  • feel on edge
  • irritable
  • difficulty concentrating

experience

  • fatigue
  • sleep
  • muscle tension

physical panic:

  • palp/cp/SOB
  • sweat, tremor, tingle, dizzy, h/a

ASK ABOUT LOW MOOD - suicide
ASK ABOUT ELATED MOOD

other: past psych, fh, alc drugs meds

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8
Q

Definition generalised anxiety disorder

A

Persistent anxiety and worry that patient recognises is out of proportion to actual events or circumstances

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9
Q

symptoms assoc w anxiety

A

Worry anxiety

On edge
Irritability, overreaction
Diff concentraing

Fatigue
Muscle tension
Sleep disturbance

Physical

  • palp, sweat, tremor
  • sob, cp, sick/abdo
  • dizzy, tingly
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10
Q

Treatment GAD

A

CBT - good

1) Sertraline (ssri)
2) Venlafaxine (snri)
3) Pregabalin

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11
Q

Treatment panic disorder

A

psychological intervention

  • relaxation training,
  • cognitive techniques
  • exposure

antidepressants

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12
Q

condition that often goes alongside panic disorder

A

Agoraphobia- fear about being in places or situations from which escape may be difficult
leads to avoidance many social situations, eventually can lead to imprisonment in person’s home

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13
Q

Definition obsession

A

sterotypical thoughts, phrases and words that people find difficult to control or put out of his/her mind

In OCD thoughts are usually unpleasant, concerned with dirt, contamination

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14
Q

Definition compulsion

A

Senseless and repeated rituals

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15
Q

Treatment OCD

A

CBT
graded exposure + response prevention to trigger
antidepressants- SSRIs

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16
Q

3 main types PTSD symptoms

A
  1. Recurrent + obtrusive thoughts, images, dreams relating to event
  2. persistent avoidance stimuli associated with trauma
  3. persistent symptoms of increased arousal (sleep disturbance, irritability, poor concentration, increased startle response)
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17
Q

Definition post traumatic stress disorder

A

characteristic set of psychological symptoms following exposure to serious traumatic event

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18
Q

treatment PTSD

A

CBT including anxiety management

antidepressants may be helpful

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19
Q

HISTORY: psychosis

A

tell me whats been happening/going on/why here?

can see v distressed
sounds like been through a lot
you’re safe, I’m here to help
talk through more

investigate delusion
thought disorder
passivity
hallucination

mood

***THOUGHTS OF HARMING SELF OR OTHER

***ALCOHOL AND DRUG USE

psych hist, fh

20
Q

First rank symptoms of schizophrenia

A

Hallucinations:

  • thought echo
  • 3rd person auditory hallucinations

Formal thought disorder: insertion, withdrawal, braodcasting

Somatic passivity (someone controlling my thoughts, feelings or actions)

Delusional peception- real perception gives rise to a false meaning eg saw you open the door, means your going to kill me

21
Q

negative symptoms of schizophrenia

A

self-neglect
blunted affect, mood, anhydonia

–> poverty or slowness of thought/motivation/speech

other symptoms

  • neologism
  • catatonia
22
Q

Differential diagnosis schizophrenia

A

Schizoaffective disorder

  • Severe depression with psychosis
  • Bipolar disorder with psychosis
  • Schizoid personality disorder
  • Drug induced psychosis
23
Q

prognosis schizophrenia

A

20% have only one episode psychosis
70% will recover from episode but relapse in future with increased negative symptoms between episodes
10% will never recover from first episode

Small inc risk in family members

24
Q

mental health act sections

A

2 - assessment 28 days
2 docs 1 amhp

3 - treatment 6 months
2 docs 1 amhp
- approval of relative

4 - emergency 72 hours
1 doc

25
Q

treatment psychosis

A

atypical antipsychotic drug
- minimum 6 weeks - slow build up of effect

eg
First line: - olazepine - risperidone
Others - quetiapine, zotapine, clozapine, aripiprazole

(also haloperidol is first gen antipsychotic - more extrapyramidal se)

26
Q

Side effects of antipsychotic drugs

A

Sedation - drowsy (driving, machinery)
Anticholinergic activity (dry eye, mouth, constip)
Hypotensive effects - postural
Extrapyramidal activity - parkinsons, dyskinesia (head,eye,mouth) - more w first gen

Also weight gain
Hormonal - impot, gynec, periods
Heart rhythm

Neuroleptic malignant syndrome
- delirium, rigidity, tachy/sweaty

27
Q

EXPLAN: Olanzapine

A

se: wg, sedation, antichol
look out for dyksinesia

lag
do not stop suddenly
will be long term
- but regularly reviewed

***monitor ECG

prognosis in schizophrenia

  • 20% 1 episode
  • 70% recover but relapse in future, -ve sx between
  • 10% don’t fully recover
28
Q

when is clozapine used?

A

Used in treatment resistant schizophrenia only after min 2 drugs have failed to work
- olanzapine and risperidone and first line

risk: neutropenia in 4% of users
»weekly blood tests for first 6 months treatment

29
Q

Support for patients with schizophrenia

A

Care programme approach (CPA)
Key worker

MDT: psychiatrist, CPN, social worker

30
Q

Typical features manic episode

Mania vs hypomania

A
  • elated mood, tinged with irritability
  • pressure of speech + flight of ideas
  • loss of insight with delusions of grandeur
  • hyperactive behaviour with sexual inhibition, excessive spending etc
  • hallucinations (not present in hypomania)

In mania have psychotic symptoms (delusions, halluc)

Cyclothymia - rapidly changing mood
Hyperthymia - periods of elated mood

31
Q

Treatment acute attack MANIA

A

Aim to control abnormal mood + behaviour as soon as possible with either:

  • sedative eg diazepam
  • atypical antipsychotic eg olanzapine
  • older neuroleptics - haloperidol

mood stabiliser (lithium) given alongside but usually takes about 5 days to get effective dose

32
Q

Considerations w lithium

Alternatives: sodium val, carbamez

A

weight gain
N+V
tremor, ataxia
diabetes insipidus - polydip, polyuria

signif:

  • renal toxicity
  • thyroid
  • toxicity

toxicity:

  • coarse tremor, unstead, confused, unwell (cerebellar)
  • watch w ace, nsaids, diuretics, any illness causing dehydration
33
Q

Lithium monitoring

A

weekly until therapeutic dose

  • Li level - every 3m
  • kidney and thyroid - every 6m
34
Q

EXPLAN Lithium

A

long term but reviewed and monitored

therapeutic window

  • is it working
  • is it causing se
  • is there risk of toxicity

SE:
polyuria/dip
wg
GI

sig: thyroid and kidney (monitor bloods)

toxicity: tremor, GI, unsteady, confus
»so will do blood test every week at first, then monthly
»need to be aware

also pregnancy (depend necessity) and new meds (especially diuretic)

35
Q

EXPLAN: dementia

A

brain gradually functioning less and less as normal
- progressive, irreversible

causes memory problems
- short term
also language, confusion, get lost
personality
unable to look after self

later require a lot of assistance
OT, social care
may require residential care eventually
- mention carer support

in alzheimers meds can be used to slow progression
- used in mod/mild - for 6 months

36
Q

HISTORY dementia/ memory loss

A

is it acute confusion
- infection, timescale, constipation

is it vascular

  • hx cvd disease inc tia
  • stepwise progression
  • shuffling gait

is it alz

  • family history
  • slow gradual progression

lewy body

  • tremor, rigid, slow
  • visual halluc
  • fluctuating consciousness

Picks (frontotemporal)
- personality, disinhibition

is it pseudodementia
- depression

other: alco, past psych, FH

37
Q

dementia sx

A 
memory
confusion
visuospatial
concentration
language
behaviour/ emotion

later: neglect, motor, req care

38
Q

MMSE

A

where
- coutnry, county, town, building, room

when
- year, season, month, day, date

repeat: ball, dog, pen
WORLD
recall: ball, dog, pen

name two objetcs
repeat: NIAB
task

read
write
draw

39
Q

what is depressive pseudodementia?

A

Important differential for dementia
Patient has cognitive disturbance due to depressive illness
px has prominent affective symptoms such as sadness, loss interest in activities, thoughts about death
Treat with antidepressives

40
Q

Capacity

A

understand and retain
weigh up to make decision
communicate decision

specific to decision

41
Q

Drugs used vs alzheimers

A

Acetylcholinesterase inhibitors

Can slow/delay decline for up to 6m in 40%
May also be helpful vs dementia of parkinsons, and LBD (rivastig)

Use if mmse between 10-20 (moderate)

DONEPAZIL
RIVASTIGMINE
GALANTAMINE

se: gi, headache

Memantine (nmda antag) reserved for mod-severe

42
Q

Causes of delirium

A

CONSTIPATION
UTI

Metabolic- hyponatraemia, hypercalcaemia
Endocrine- hyper/hypothyroid, addisons, hypoglycaemia

Drugs eg antidepressents, benzodiazepines, antiepileptics
Alcohol- acute ingestion or withdrawal
Infections- systemic or intracranial (encephalitis)
Trauma
Vascular- haemorrhage

43
Q

HISTORY: alcohol

A 
1) talk through normal 24 hours drinking
specifically:
- drink what (narrow)
- in morning
- alone
- vs withdrawal
getting worse?

2) do you think this is problem?
cut down? guilt? annoyed?

3) impact
- work, relationships, social act
- health

4) cutting down
- done before? pros cons

6) other subs, other psych, health

44
Q

Management acute alcohol

A

1) Pabrinex - vitamins B+C
2) IV fluids
3) LIBRIUM (chlordiazepoxide = benzodiazepine) every 4-6 hours, reduced after 2-4 days
4) monitor blood glucose levels, close obs, reassure

45
Q

Features of alcohol withdrawal syndrome

A 
N+V
coarse tremor 
paroxysmal sweats
anxiety 
increased arousal, agitation, restlessness 
headache
visual hallucinations
46
Q

Recommended safe drinking limits

A

2-3 units/day men

1-2 units/day women

47
Q

Electro convulsion therapy

A

For resistant depression
- especially where element of eating disorder, sleeping disorder, motor disorder

Twice a week 6-8 weeks
GA (nil by mouth), muscle relax, o2, atropine

CI: mi, stroke, arrhyth

SE: headache, memory

48
Q

Post natal depression

A

Starts within month
Peaks at 3month

(Baby blues - few days)

Edinburgh score

Avoid fluoxetine

Progress test packs (16 decks)

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