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Phase 3a Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Mental Health Laws:

What is a Section 2?

A

A section 2 is an admission to hospital for up to 28 days. Requires 1 doctor and 1 AMHP

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2
Q

What is a Section 3?

A

A Section 3 is detainment for treatment. This requires 2 doctors and a AMPH and can be up to 6 months duration

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3
Q

What is a Section 4?

A

A section 4 is EMERGENCY treatment. Only for 72 hours to be seen etc. Normally happens when a doctor can not get to a patient in time

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4
Q

What is a Section 5 (2)?

A

A section 5 (2) is a detainment if a patient is already in hospital for 72 hours

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5
Q

What is a 5(4)?

A

A 5(4) is a psychiatric nurse holding power for up to 6 hours.

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6
Q

What is a Section 135?

A

A section 135 is when the police are able to access a home. Under a magistrate’s warrant

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7
Q

What is a Section 136?

A

A Section 136 is police in a public place to an area of safety.

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8
Q

What are the 3 components of neuroses category?

A
  • Panic Disorder
  • Generalised Anxiety
  • Phobia
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9
Q

What is Generalised Anxiety :

A

This is a condition that seems to have no stimulus. It is constant and not set off by anything in particular

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10
Q

What is a Phobia ?

A

A phobia is a severe eversion to a situation that can do no harm. I.e. Spiders or mice

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11
Q

What is a Panic Disorder?

A

A panic disorder is a condition that is used to describe recurrent acts of extreme panic (panic attacks) that seem not to be related to anything in particular. It can be very dehabiliating

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12
Q

What are some symptoms of Neuroses conditions?

A
  • Chest Pain, Shortness of Breath
  • Sweating, Hot flushes and a dry mouth
  • Nausea
  • De personalisation, De realisation
  • Muscle ache, numbness and tingling
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13
Q

What is the 3 stage management plan for Neuroses?

A
  1. Education that this is not a life threatening condition. the chest pains are not a heart attack
  2. Start CBT
  3. Start patient on medication such as a SSRI like sertraline
  4. In patient referral and use of tranquillisers
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14
Q

What is PTSD?

A

PTSD: is post traumatic stress disorder. Normally happens up to 6 months after a traumatic event (physical, sexual abuse, war, being a victim of abuse etc).

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15
Q

What symptoms are characteristic of PTSD?

A

PTSD is characterised by:

  1. Relieving of the event
  2. Inability to recall key details from the event in question
  3. Emotional detachment or blunting
  4. Avoiding situations that remind them of the event
  5. Hyper vigilance or on edge.
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16
Q

How do you treat PTSD?

A
  1. Mild
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17
Q

Give 6 symptoms of Depression:

A

D epressed mood
E nergy reduced
A reduction in joy in activity
D ecreased sleep

S uicidal ideation
W orthlessness
A petite reduction 
M ental retardation/control 
Psychomotor retardation
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18
Q

What are some possible treatments for Depression. Give a drug example:

A
  1. SSRI: sertraline and fluoxetine
  2. SNRI: duloxetine and Venlafaxine
  3. TCA: amitriptyline
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19
Q

What is a potential complication of the following medication:

  • Lithium
  • Lamotrigone
  • Sodium Valproate
A
  • Lithium: Epstein Phenomenon
  • Lamotrigine: Steven Johnson Syndrome
  • Sodium Valproate: teratogenic
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20
Q

What are some symptoms of lithium toxicity?

A
  • Tremors
  • D and V
  • Anorexia
  • Ataxia
  • Delirum
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21
Q

How does lithium work as a medication?

A

It works by inhibiting cAMP production
CAMP inhibits monoamines

As lithium inhibits cAMP it increases the amount of monamines !

22
Q

What is an Acute Dystonic Reaction?

A

This happens soon after starting an anti-psychotic medication
Or soon after increasing the dose of anti-psychotic medication
Duration: normally a week

Symptoms include:

  • Normally affects the head and neck
  • Means that the patient will have a grimaced face and protrusion of the tongue.
  • Can also lead to dysphagia

Management:

  • Stop anti-psychotic medication
  • Start on IM anti-cholinergic medication (procyclidine)
23
Q

What are some of the most prevalent MH conditions?

A

Depression
Anxiety (PTSD, OCD, generalised anxiety)
Panic Disorder
Delirium
Psychosis (Schizophrenia, Organic or Substance abuse)

24
Q

Who is Depression more common in?
What are the 3 Core symptoms?
Name 5 non core symptoms?

Name 3 lines of treatment:

A 
It is more common in females 
3 Core Symptoms: 
- Low Mood
- Anhedonia: low interest in things 
- Low energy/Bad sleep 
5 other symptoms:
- Appetite loss 
- Feeling suicidal 
- Feelings of worthlessness 
- Irritability 
- Problems with concentration 
- Psychomotor agitation

Treatment:

  • CBT
  • SSRI: sertraline
  • SNRI: venflaxine
25
Q

How long does depression need to be happening for to get a diagnosis?

A

At least two weeks

26
Q

What is the typical duration of mania and depressive symptoms in bipolar?

A

Mania: 1 week of symptoms (hypomania is generally a week)
Depression: a lot long more like a month

27
Q

Give some symptoms of Mania?

A

I rritable/elevated mood

D ecreased sleep
I nhibition lost
G randiose delusions

F light of ideas
A ctive (+++)
S exual disinhibition
T alkative

You can also get hallucinations and loss of insight!

28
Q

What are some symptoms of depression?

A

D epressed mood
E nergy levels reduced
A nhedonia
D isturbed sleep

S uicial ideation 
W orthlessness
A ppetite loss
M ental retardation 
P sychomotor retardation
29
Q

What do you need to diagnose Bipolar?

A

You need 2 or more episodes lasting over 2 weeks :

You need 3 symptoms of mania or depression

30
Q

How do you treat Bipolar?

A

You give a mood stabiliser: Lithium
If that doesn’t work start them with an anti-psychotic like sodium valproate or lamotrigine

If major depression. Think of adding an antidepressant!

31
Q

What are the first rank symptoms of schizophrenia?

A
  1. 3rd person auditory hallucinations
  2. Somatic passivity
  3. Thought Disorder
  4. Lack of insight
  5. Delusional perceptions
32
Q

How do you make a schizophrenia diagnosis?

A

1 first rank symptom

or TWO other symptoms

33
Q

What are the other symptoms of shcizophrenia?

A

These include:

  • Delusions
  • Persistent hallucinations
  • breaks in train of thought
  • Catatonic behaviour
  • Any negative symptoms
34
Q

What are some examples of positive symptoms?

A

Overactive mesolimbic pathway
- Hallucinations
Delusions
Thought disorder

35
Q

What are some examples of negative symptoms?

A 
Underactive mesolimbic pathway: 
Loss of functioning by ... 
- Passivity 
- Blunting of affect 
- Poverty of speech 
- Catonic symptoms: like a stooped posture etc.
36
Q

What is the 1st line treatment for schizophrenia?
2nd line treatment?
What is the treatment if the patient is resistant?

A
  1. Haloperidol
  2. Risperidone
  3. Clozapine as blocks both D1 and D2 receptors
37
Q

What is an acute dystonic reaction?
What symptoms do you get?
How do you treat it?

A

This happens a week or so after introducing an anti-psychotic drug or after increasing dose
It causes the patient to have a facial and neck muscle rigidity. The patient may also get tongue spasms and protrusion.
Discontinue
Give anti-cholinergic! Procyclidine

38
Q

What is neuroleptic malignant syndrome?
WHAT CAUSES IT?
What symptoms to get?
How do you treat it?

A

It is caused by haloperidol and chlorpromazine
More common in men. RF include injection, high dose and done quickly.

YOU GET: hyperthermia, muscle rigidity, altered mental status and autonomic dysfunction (hypotension and incontinence)

Treatment: 
Stop current medication 
Cooling device 
IV benzos
Give muscle relaxants!
39
Q

What is Serotonin Syndrome:
What are the symptoms?
What is management?

A

Caused by SSRI medications. It leads to symptoms such as:

  • Agitation, coma and confusion
  • Rigidity, Tremor and hyperreflexia
  • Autonomic hyperactivity: hyperthermia, dilation of pupil, tachycardia and hypertension

Management:

  • Stop Medication
  • Control with Benzodiazepines
40
Q

What causes the extrapyramidal side effects?

What symptoms do you get?

A

Haloperidol and chlorpromazine

Physical symptoms: tremor, slurred speech, dystonia and anxiety

41
Q

What makes up a MMSE?

A 
Appearance Behaviour 
Affect
Speech 
Thoughts and Delusions 
Hallucinations 
Cognition and Insight
42
Q

What are 3 positives

What are 3 negatives of a mental health diagnosis?

A

3 positives:
- Better understanding from work/society
- Better treatment/Management options
- Good knowledge for patient and their family
3 negatives:
- Over generalised
- Can cause negative stigma
- Medicalised variation in human behaviour

43
Q

What are some negative SE of anti-psychotic medication?

A
  • Pseudo parkinson
  • Acute dystonia
    Akathisia: restlessness
    Tardive dyskinesia: protrusion/rolling of the tongue
44
Q

What is a delusional disorder?

A

persistent delusions without hallucinations

The delusions normally are about theft, persecution and mistaken identity.

More distressing to the public than the patient

45
Q

What is toxic stress?

A

The experiences particularly in childhood that affects brain architecture and chemistry

46
Q

What are some consequences of toxic stress?

A 
- substance abuse (alcohol and drugs in the future)
Depression 
Suicide 
MH issues 
and increased sexual partners 
Obesity
47
Q

What is attachment theory?

A

Attachment Theory: is the idea that children need to develop relationships with at least one primary caregiver to have a successful social and emotional development.
Allowing them to successfully manage their emotions in future.

48
Q

What is the purpose of the biopsychosocial model of treatment?

A

It is made so that a patient gets their life back and allows their life to have more meaning.

49
Q

What does a formulation consist of?

A 
4 Ps 
Predisposing 
Precipitating 
Prolonging 
Protective
50
Q

What is CBT?

A

CBT: cognitive behavioural therapy is the idea that the psychologist looks into the patient’s thought pattern and tries to look at the thoughts –> feel –> how they make you act. And how this cycles.

51
Q

What is DBT?

A

Dialect Behavioural Therapy. Looks at the management of emotion in people that struggle to this. This is done by the person accepting themselve and being up for change.

Phase 3a Medicine (9 decks)

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