Psychiatry Flashcards
What are the components of MSE?
Appearance and Behaviour
Speech
- rate
- rhythm
- volume
- tone
- coherence
- flight of ideas?
- clanging?
Mood and affect
Thought form
- easy to follow
- extra detail
- do they answer questions
Thought content
- positive/ negative
- pre-occupied
- plans
Perception
- hallucinations
Cognition
Insight
Risk
What are the different types of anxiety disorders?
Phobias
Generalised anxiety
Agoraphobia
OCD
PTSD
Somatoform and dissociative
What are the drug managements for generalised anxiety disorder?
1st line:
- SSRIs
2nd line:
- SNRIs (venaflaxine, duolexitine)
Beta blockers can be given as well
**adherence for 1 year
What should be some differentials for generalised anxiety disorder?
hyperthyroidism
Cardiovascular disease
Medication induced anxiety
What is the management for PTSD?
CBT
Eye movement desensitisation and reprocessing
High does SSRIs `
Which drug class are not recommended for Panic disorders?
Benzodiazepines
What is OCD with definitions:
Obsessions:
- recurrent intrusive thoughts
Compulsions
- senseless ritualistic actions - usually motor in order to neutralise the activity
the person has such a desire to carry out the compulsion to release the stress of the obsession.
*the thoughts are egodystonic
the person must acknowledge it is abnormal
What is the treatment for OCD?
CBT
Clomipramine
SSRIs
What is the drug of choice for tranquilisation in general hospital if the history of the person is unknown or there is cardiac pathologies?
Lorazepam
- 1 to 2 mg IM
review in 30mins and repeat if needed
Haloperidol can be used if not neuroleptic naive and no contraindications for use.
What important things should be monitored in a patient after giving a neuroleptic agent?
Temperature
Pulse
Blood pressure
Respiratory rate + oxygen saturations
every 10mins for 1 hour.
When treating Wernickes, you give what drugs?
Pabrinex \+ Glucose \+ Magnesium
How could you carry out cognitive testing on a patient with alcohol withdrawal?
Addenbrookes cognitive examination - II (ACE - II)
MOCA
What is the term giving to symptoms that can not be explained by an underlying organic reason? and how are they treated?
Medically Unexplained Physical Symptoms
SSRIs
+
CBT
With regard to psychiatry, list some positive and negative symptoms:
Positive symptoms:
- Delusions
- Hallucinations
- Thought disorders
Negative symptoms:
- Avolition (decrease in motivation, purposeless)
- Poverty of thought
- Unresponsive
- Social withdrawal
What is the treatment for bulimia nervosa?
Adults:
- self help
- CBT - for 4 weeks then:
- CBT Eating disorder (CBT ED)
Children:
- Family focused therapy - (FT - BN)
What is the diagnostic criteria for anorexia nervosa?
Weight reduction due to significant nutritional restriction.
<17.5 BMI
Body dysmorphic
- seeing themselves as fat when they are not
Intense fear of being fat
*note that endocrinological effects have now been removed from diagnostic criteria. However amenorrhoea is often seen
What are some clinical features that may be seen in someone with anorexia nervosa:
Reduced BMI
Russel’s sign
Stained teeth
Bradycardia
Hypotension
Enlarged salivary glands
Lanugo hair - small hair across the body
What are the questions you wish to ask into anorexia nervosa?
SCOFF questionnaire:
Sick - every make yourself sick?
Control - need control over the food?
One stone loss in 3 months?
Fat - think you look fat?
Food - does food control your life?
What are some organic differential diagnosis’s to anorexia nervosa?
Addison’s disease
Crohn’s disease
Hypothalamic dysfunction
What is the management of anorexia nervosa?
Adults:
- Maudsley Anorexia nervosa treatment for adults -
(talking to therapist and guided weight gain)
Children/ Adolescents:
- Family therapy for Anorexia Nervosa
- the parents are initially in control of the food then this is slowly handed back to the adolescent/ child
- SSRIs can be used as well
Severe:
- Management of really sick patients with anorexia nervosa / MARISPAN
- admit to eating disorder unit
- care of dieticians
- mental health act can be used to refed
How is refeeding syndrome treated?
Dietician input for a slow refeeding input.
- 50% feeds to begin with
Monitoring electrolytes
- phosphate
- glucose
- Mg2+
- K+
**remember K+ and MG+ are pulled into the cell as well with increase in insulin.
Pabrinex Thiamine prescription
*often thiamine is low as well
Vitamin B complex
What are the various types of personality disorders?
Cluster A:
- paranoid
- Schizoid
Cluster B:
- Dissocial
- Emotionally unstable - borderline
- Histrionic
- Narcissistic
Cluster C:
- Anankastic
- Anxious
- Dependent
What are some organic causes of depression that should be investigated for?
Hypothyroidism Cushing syndrome Steroids/ beta blockers Brain tumour Parkinson's disease Autoimmune diseases - Polymyalgia rheumatica and SLE
What are some differentials for depression?
Physical illness
- Hypothyroidism
- Dementia
Drugs
- alcohol
- withdrawal
Grief
Cyclothymia / Bipolar
Psychotic depression
What questionnaire can be used to assess for postnatal depression?
The Edinburgh Postnatal Depression Scale - EPDS
What findings on a mental state examination would suggest depression:
Speech:
- poverty
- slow
Mood:
- Low mood, tearful
- irritability
- anhedonia
Thoughts:
- slow, pessimistic
Perception:
- pseudo-hallucinations
Cognition:
- poor memory
- poor concentration
List some cognitive and physical signs of depression:
Cognitive:
- Low self esteem
- poor memory
- Guilt
- Worthlessness
Biological:
- Sleep disturbance
- Reduced/ increased appetite
- Weight changes - usually gain
- Loss of libido
or CALS
- Concentration
- Appetite
- Libido
- Sleep