Psychiatry Flashcards
What are the domains of the MSE?
Appearance Behaviour Speech Mood and affect Thought form Thought content Perceptions Cognition Insight Risk assessment
What are some extra areas in a psychiatric history?
Personal history - school, employment, relationships
Forensic history
Pre-morbid personality
Informant history
What are the three key features of depression?
Low mood
Fatigue
Anhedonia
Must have 2 over 2 weeks
What are some psychological symptoms of depression?
Reduced self esteem
Guilt or worthlessness
Poor concentration
Thoughts of self-harm/suicide
What are some physical symptoms of depression?
Sleep disturbance and early morning waking
Decreased libido
Decreased appetite
What investigations should be done for depression?
FBC, UEs, LFTs, TFTs, HbA1c
BP and HR
BMI
ECG
What is the treatment for depression?
Mild - sleep hygiene, self-help, exercise
Moderate - talking therapies
Severe - antidepressant and talking therapy
What are some side effects of SSRIs?
Nausea, headache, dry mouth, erectile dysfunction
What are some side effects of TCAs?
Dry mouth, constipation, urinary retention, drowsiness
What should be done for relapse prevention in depression?
Continue effective treatment for 6-9 months after remission
Over 5 episodes or 2 recent episodes - continue for at least 2 years
When should depression be referred to psychiatry?
Treatment resistant Increased risk suicide, harm to others or self-neglect Psychotic symptoms ?Bipolar Under 18 years
What are some features of hypomania and mania?
Increased self-esteem
Reduced need for sleep
Increased talking, flight of ideas, distractibility
Goal directed activity
Need 3 or more
Mania if over 1 week or needs hospitalisation
What is the treatment of bipolar?
- Atypical antipsychotic or mood stabiliser - haloperidol, olanzapine, quetiapine or risperidone
What are delusions and hallucinations?
Delusions = unshakeable false beliefs Hallucinations = perceptions with no external stimulus
What are some differentials for psychosis?
Schizophrenia Encephalitis Thyroid disease Brain tumour Dementia
What should be done for a first episode of psychosis?
Check for prodrome of unusual behaviour
Assess for PTSD
FBC, LFTs, TFTs, UEs, bone profile
What are the negative symptoms of schizophrenia?
Blunted mood
Reduced speech
Poor self care
Lack of volition
What is the treatment of schizophrenia?
Oral atypical antipsychotic
CBT
Family intervention
PRN lorazepam
What are the criteria for starting clozapine?
Tried 2 other atypical
Agranulocytosis and myocarditis
Need to have regular FBC
What are the police MHA sections?
136 - can be taken from public place
135 - can be taken from residence, magistrates order
What are the features of a section 5?
5 (2) - detention of inpatient by doctor
5 (4) - detention of inpatient on psychiatric ward by nurse
Up to 72 hours
Not renewable
What are the features of a section 2?
Assessment section
Doctor + independent doctor + AMHP
Lasts up to 28 days
Can treat but no ECT
What are the features of a section 3?
Treatment section - known patient, established treatment, presenting as normal
Doctor + independent doctor + AMHP
Up to 6 months then renewable
Must be approved by nearest relative
What are the features of a section 4?
Emergency assessment
Psychiatrist + AMHP
Up to 72 hours
What is a section 17?
Responsible clinician can authorise leave
