Psychiatry Flashcards

Question

mental health act sections

Answer 1

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

Answer 2

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)

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

Care programme approach (CPA) Key worker MDT: psychiatrist, CPN, social worker

Answer 7

- 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

Answer 8

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

Answer 9

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

Answer 10

weekly until therapeutic dose - Li level - every 3m - kidney and thyroid - every 6m

Answer 11

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)

Answer 12

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

Answer 13

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

Answer 14

``` memory confusion visuospatial concentration language behaviour/ emotion ``` later: neglect, motor, req care

Answer 15

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

Answer 16

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

Answer 17

understand and retain weigh up to make decision communicate decision specific to decision

Answer 18

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

Answer 19

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

Answer 20

``` 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

Answer 21

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

Answer 22

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

Answer 23

2-3 units/day men | 1-2 units/day women

Answer 24

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

Answer 25

Starts within month Peaks at 3month (Baby blues - few days) Edinburgh score Avoid fluoxetine