Psychiatry Flashcards
Eating disorder management
Biopsychosocial approach
Consider admission
Family therapy
CBT (eating disorder focussed)
MANTRA therapy
Can give fluoxetine for bulimia
Talk to eachother with group therapy as well as watched meals, sit and wait for food to settle
Core Sx of depression
Low mood
Anergia
Anhedonia
RF for depression
Poor coping strategies Female>male Stressful life events Poor support network Chronic health problems Poor insight
FAPS Female/FH Alcohol/adverse events Past depression, physical illness Social support lacking/low socioeconomic status
What is De-Clerembaut’s syndrome?
Pt believes someone is in love with them
Symptoms of depression
DEADSWAMP
Depressed mood Energy loss Anhedonia Death (Suicidal thoughts) Sleep disturbance Worthlesness Appetite or weight change Mental (concentration loss) Penis (libido) and psychosis (severe depression)
Difference between mild, moderate and severe depression
Presence and severity of symptoms
Mild = 2 core
Severe = all 3 core Sx
Questions to help Ix depression
How has your mood been recently?
Do you still enjoy the things you used to enjoy?
Do you find you don’t have much energy at the moment?
How do you feel about the future?
RISK
Have you had any thoughts about harming yourself or taking your own life?
DDx for depression
Organic causes such as dementia, bipolar disorder, thyroid dysfunction, anaemia, hypercalcaemia, chronic disease!
Components of MSE
ASEPTIC Appearance Speech Emotion Perception Thought Insight Cognition
Ix for depression
PHQ9 questionnaire Blood tests (anaemia, calcium, thyroid, CRP) Imaging if personality change and headache for example
Check that they dont have episodes of feeling ecstatic! (same goes for the other way around)
Mx of depression
BIOPSYCHOSOCIAL
Bio = antidepressants Psycho = CBT, self help, physical activity, counselling (getting them to explore their problems) Social = support groups
Features of bipolar
At least one episode of mania and a further episode of mania or depression
Types of bipolar
Bipolar 1 = big highs and big lows
Bipolar 2 = milder highs and lows
Rapid cycling = fast changes
Also hypomania and mania with psychosis (severe)
The overarching disease can change aswell as the severity of the swings within it
Symptoms of bipolar disorder
DIG FASTER Disinhibition Insight impaired and irritable (80%) Grandiose delusions Flight of ideas Activity increased Sleep decreased Talkative Elevated mood Reckless behaviour and reduced attention span
RF of bipolar
Young adult
Family Hx
Substance abuse
Anxiety disorders
Questions for bipolar disorder
How would you describe your mood?
Have you felt on top of the world?
Have you been able to concentrate on your normal activities?
Do you have anything that is unique to you?
DDx for bipolar
Depression with psychosis
Organic (tumour, stroke, hyperthyroidism)
Personality disorder
Schizophrenia
Mx of bipolar
BIOPSYCHOSOCIAL
Bio = mood stabilisers like lithium
Psycho = CBT and psychoeducation
Social = suport groups, self help
Consider hospitilization if unable to look after themselves
Drug used in severe mania acutely?
Haloperidol or another anti-psychotic
Physiological Sx of anxiety
Tremor Palpitations Chest pain Breathlessness Sweating Butterflies
Ways to categorise anxiety
Continuous = GAD
Situation dependent = phobic (diff types)
Situation independent = panic disorder
Organic causes of anxiety
Hyperthyroidism
Drugs
Caffeine
Features of generalised anxiety disorder
> 6mo duration, present most days
Ongoing, uncontrollable, widespread worry
The patient recognises these worries as inappropriate and excessive
RF for generalised anxiety disorder
Genetic predisposition
Stressful events
History of anxiety
Features of autonomic arousal
Sweating Headache Tremor Restlessness Tension in muscless Concentration difficulty
Questions to try and determine type of anxiety
When do you get these episodes?
Could you briefly walk me through a typical day and when you might get worried
Important conditions to screen for in GAD
Depression
Substance misuse
Thyroid disease
These are strongly linked with GAD
Management of GAD
BIOPSYCHOSOCIAL
SSRI (sertraline)
Psychoeducatinal groups and CBT
Relaxation and mindfulness
Self help methods and support groups as well as exercise
Mx of anxiety disorders (agoraphobia, social phobia and specific phobia)
CBT
SSRI
Graduated exposure techniques (bit better each time)
Exposure therapy for specific
Features of panic disorder
Generally OK then episodes of panic (autonomic arousal)
Unpredictable (e.g. at an airport)
Feeling of not being able to breathe
Mx of panic disorder
SSRI are first line
Self help apps
CBT
How long should you keep taking SSRI after your mood has improved?
6 months, reduces rate of recurrence
Things associated with poor schizophrenia prognosis
Gradual onset No clear trigger Hx of social withdrawal Strong FH Poor social support network Low socioeconomic status Low IQ
What key feature can help you determine between bullaemia and anorexia?
BMI is usually preserved in bullaemia
Personality change, brain autopsy shows TAU proteins, Dx?
Picks disease (fronto-temporal dementia)
Management of heroin/opiod withdrawal
Supportive measures only
Onset can be quick (6hours)
Peaks at 36-72hr
Anti-psychotic with reduced side effect profile
Aripiprazole
First line Mx of autoimmune encephalitis
Methylprednisolone
Mx of autoimmune encephalitis
Methylprednisolone
Rituximab
Plasma exchange
First line Mx for post-partum depression
CBT
Features of Alzheimers on CT
Widespread cortical atrophy
Blood results in anorexia
Hypokalaemia
Low sex hormone levels (FSH, LH, oestrogen and testosterone)
Raised growth hormone and cortisol levels
Hypercholesterolaemia
Symptoms of anorexia
Low BMI Hypotension Bradycardia Enlarged salivary glands Lanugo hair (fine hair covering the skin) Amennorhea
Congenital RF for autism
Down’s syndrome
What are delusional perceptions?
Pt sees something and makes an unreasonable leap
I saw the Queen on TV and I knew I was destined to save the world
Side effects of SSRI
Sick
Sexual dysfunction
Serontonin dysfunction
Sodium disregulation
RISK assessment components
HARMS
Hope for the future
Attempts at harming/suicide
Risk factors = unemployed, mental health disorders, male, depression
MSE
Support network
Mx of suicidal patient
Consider admission and ensure they are safe
Psychiatric treatment
Risk assessment
Management of patients with repeated suicide attempts
Crisis team
Detect and treat underlying disorders
Urgent hospitilisation
Building of support network
Management of baby blues
Reassurance, support network, repeat appointment to check up on them (also make sure they attend their midwife appointment!)
Management of post-partum depression
CBT
Consider admission
Management of pueperal psychosis
Alert the post-natal mental health crisis team
Admission
Management of dementia
BIOPSYCHOSOCIAL
Bio = donepezil or memantine (severe)
Psycho = memory clinic
Social = good support, adapting the home and home life
DDx for dementia
Alzheimers Lewy Body Fronto-temporal Vascular dementia Delirium Hypothyroidism SOL Depression CJD
ADHD management
Family therapy
Methylphenidate and regular growth measurements as well as dietician involvement
Features of ADHD
Inattentive
Lots of energy
Easily distractable
Impulsive (crossing roads without looking)
Categories of ADHD
Inattention
Hyperactive
Mixed
Features of anorexia
Weight loss Low BMI Pt doesnt like their body image (body dysmorphia) Lanuga hair Amenhorrea Anaemia Enlarged salivary glands Russel's sign (calused knuckles) Poor dentition (repeated vomiting)
Management of eating disorders
Bullaemia -> SSRI to reduce binging, CBT
Anorexia -> consider admission if severe (low weight, lost lots of weight recently), refeeding slowly (maybe with some phosphate), CBT, GROUP THERAPY, family therapy
Criteria to diagnose anorexia
FEED
Fear of weight gain
Endocrine disturbance Emaciated
Deliberate weight loss
Ix for anorexia
FBC (anaemia and leukopaenia) U&E LFTs Cortisol GH Amylase (pancreatitis is a complication of AN)
DDx for anorexia
Bulimia
Depression
OCD
Organic causes of weight loss
Typical Hx of bulimia
Binge eating
Fear of fatness
Purging behaviour
Sense of compulsion to eat = cyclical
Features of post-traumatic stress disorder
Intense, prolonged, delayed reaction following exposure to a traumatic event
Reliving the situation
Avoidance
Hyperarousal
Emotional numbing
When must PTSD occur to be PTSD
Within 6mo of the traumatic event
Cut off for normal berheavement response
6mo
What is acute stress reaction?
Exposure to an exceptional event or stressor, response in the immediate aftermath = disorientation, excessive grief, hopelessness
Management of acute stress reaction
Watchful waiting
Trauma focussed CBT
Short term drug treatment for things like sleep disturbance (e.g. zopiclone)
Risk assesment
Features of OCD
Recurrent obsessional thoughts or compulsive acts
What are obsessions? (in the context of OCD)
Unwanted, intrusive thoughts
Urges
What are compulsions
Repetitive, sterotyped behaviours that the patient feels driven to perfrom to reduce the obsessive thoughts
Key features of OCD thoughts/compulsions
Failure to resist
Originate in the patients mind
Repetitive and distressing
Carrying out is not pleasureable but reduces anxiety levels
Example obsessive thought and corresponding compulsion
“I am covered in germs”
“I must clean my hands 10 times”
Questionnaire for OCD
Yale Brown
DDx for OCD
Anxiety disorders
Depressive disorder
Mx of OCD
CBT SSRI (fluoxetine and paroxetine) Clomipramine can be added if severe Psychoeducation Self-help books
What is psychosis?
CRUCIAL
Distortion of reality
Unsure what is real and what is not!
What is a delusion?
Falsely held belief
Firmly held despite everything and background of patient
What is a hallucination?
A perception in the absence of a stimulus
What is a thought disorder?
An impairment in the ability to form thoughts logically
RF for schizophrenia
Black and other ethnic minorities Urban upbringing Family history Substance misuse Smoking cannabis
How long do you have to have Sx of psychosis for it to be Schizophrenia?
> 1mo
What are some features of schizophrenia?
Delusional perception
Third person auditory hallucinations
Thought interferanec (broadcast, insertion, withdrawal)
Passivity phenomenen
Great question to ask if worried about Schizophrenia?
Do you ever struggle to determine whats real and what is not?
Negative symptoms of schizophrenia
Anhedonia
Attention deficits
Alogia (poverty of speech)
Characteristics of hebephrenic schizophrenia
Child-like state
Characteristics of simple schizophrenia
Just the negative symptoms
How do you diagnose someone with schizophrenia often?
Palpable ‘loss of person’
Can be terrifying for the patient!
They dont know what is real and can have hallucinations aswell, scary
Ix for schizophrenia
Check for organic cause = anaemia and thyroid aswell as delirium
Toxicology screen
ECG because need to check before using anti-psychotics
Mx of schizophrenia
RISK assessment Admit the patient Antipsychotics Support groups Catatonic schizophrenia -> ECT CBT (reduces residual symptoms) Art therapy (reduce negative symptoms)
Last line medication after trying 2 different antipsychotics?
Clozapine
Categories of personality disorders
ABC Mad Bad Sad (MBS) Schizoid and Schizotypal Borderline Avoidant and dependent
