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Week 2 paces cases > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Eating disorder management

A

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

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2
Q

Core Sx of depression

A

Low mood
Anergia
Anhedonia

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3
Q

RF for depression

A 
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
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4
Q

What is De-Clerembaut’s syndrome?

A

Pt believes someone is in love with them

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5
Q

Symptoms of depression

A

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)
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6
Q

Difference between mild, moderate and severe depression

A

Presence and severity of symptoms
Mild = 2 core
Severe = all 3 core Sx

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7
Q

Questions to help Ix depression

A

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?

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8
Q

DDx for depression

A

Organic causes such as dementia, bipolar disorder, thyroid dysfunction, anaemia, hypercalcaemia, chronic disease!

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9
Q

Components of MSE

A 
ASEPTIC 
Appearance
Speech 
Emotion
Perception
Thought 
Insight 
Cognition
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10
Q

Ix for depression

A 
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)

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11
Q

Mx of depression

A

BIOPSYCHOSOCIAL

Bio = antidepressants
Psycho = CBT, self help, physical activity, counselling (getting them to explore their problems)
Social = support groups
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12
Q

Features of bipolar

A

At least one episode of mania and a further episode of mania or depression

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13
Q

Types of bipolar

A

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

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14
Q

Symptoms of bipolar disorder

A 
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
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15
Q

RF of bipolar

A

Young adult
Family Hx
Substance abuse
Anxiety disorders

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16
Q

Questions for bipolar disorder

A

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?

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17
Q

DDx for bipolar

A

Depression with psychosis
Organic (tumour, stroke, hyperthyroidism)
Personality disorder
Schizophrenia

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18
Q

Mx of bipolar

A

BIOPSYCHOSOCIAL

Bio = mood stabilisers like lithium

Psycho = CBT and psychoeducation

Social = suport groups, self help

Consider hospitilization if unable to look after themselves

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19
Q

Drug used in severe mania acutely?

A

Haloperidol or another anti-psychotic

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20
Q

Physiological Sx of anxiety

A 
Tremor 
Palpitations
Chest pain 
Breathlessness
Sweating 
Butterflies
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21
Q

Ways to categorise anxiety

A

Continuous = GAD
Situation dependent = phobic (diff types)
Situation independent = panic disorder

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22
Q

Organic causes of anxiety

A

Hyperthyroidism
Drugs
Caffeine

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23
Q

Features of generalised anxiety disorder

A

> 6mo duration, present most days
Ongoing, uncontrollable, widespread worry

The patient recognises these worries as inappropriate and excessive

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24
Q

RF for generalised anxiety disorder

A

Genetic predisposition
Stressful events
History of anxiety

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25
Q

Features of autonomic arousal

A 
Sweating 
Headache 
Tremor 
Restlessness
Tension in muscless
Concentration difficulty
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26
Q

Questions to try and determine type of anxiety

A

When do you get these episodes?

Could you briefly walk me through a typical day and when you might get worried

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27
Q

Important conditions to screen for in GAD

A

Depression
Substance misuse
Thyroid disease

These are strongly linked with GAD

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28
Q

Management of GAD

A

BIOPSYCHOSOCIAL

SSRI (sertraline)
Psychoeducatinal groups and CBT
Relaxation and mindfulness

Self help methods and support groups as well as exercise

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29
Q

Mx of anxiety disorders (agoraphobia, social phobia and specific phobia)

A

CBT
SSRI
Graduated exposure techniques (bit better each time)

Exposure therapy for specific

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30
Q

Features of panic disorder

A

Generally OK then episodes of panic (autonomic arousal)
Unpredictable (e.g. at an airport)
Feeling of not being able to breathe

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31
Q

Mx of panic disorder

A

SSRI are first line
Self help apps
CBT

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32
Q

How long should you keep taking SSRI after your mood has improved?

A

6 months, reduces rate of recurrence

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33
Q

Things associated with poor schizophrenia prognosis

A 
Gradual onset 
No clear trigger
Hx of social withdrawal 
Strong FH
Poor social support network 
Low socioeconomic status 
Low IQ
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34
Q

What key feature can help you determine between bullaemia and anorexia?

A

BMI is usually preserved in bullaemia

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35
Q

Personality change, brain autopsy shows TAU proteins, Dx?

A

Picks disease (fronto-temporal dementia)

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36
Q

Management of heroin/opiod withdrawal

A

Supportive measures only
Onset can be quick (6hours)
Peaks at 36-72hr

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37
Q

Anti-psychotic with reduced side effect profile

A

Aripiprazole

38
Q

First line Mx of autoimmune encephalitis

A

Methylprednisolone

39
Q

Mx of autoimmune encephalitis

A

Methylprednisolone
Rituximab
Plasma exchange

40
Q

First line Mx for post-partum depression

A

CBT

41
Q

Features of Alzheimers on CT

A

Widespread cortical atrophy

42
Q

Blood results in anorexia

A

Hypokalaemia
Low sex hormone levels (FSH, LH, oestrogen and testosterone)
Raised growth hormone and cortisol levels
Hypercholesterolaemia

43
Q

Symptoms of anorexia

A 
Low BMI
Hypotension
Bradycardia
Enlarged salivary glands
Lanugo hair (fine hair covering the skin)
Amennorhea
44
Q

Congenital RF for autism

A

Down’s syndrome

45
Q

What are delusional perceptions?

A

Pt sees something and makes an unreasonable leap

I saw the Queen on TV and I knew I was destined to save the world

46
Q

Side effects of SSRI

A

Sick
Sexual dysfunction
Serontonin dysfunction
Sodium disregulation

47
Q

RISK assessment components

A

HARMS
Hope for the future
Attempts at harming/suicide

Risk factors = unemployed, mental health disorders, male, depression

MSE
Support network

48
Q

Mx of suicidal patient

A

Consider admission and ensure they are safe
Psychiatric treatment
Risk assessment

49
Q

Management of patients with repeated suicide attempts

A

Crisis team
Detect and treat underlying disorders
Urgent hospitilisation
Building of support network

50
Q

Management of baby blues

A

Reassurance, support network, repeat appointment to check up on them (also make sure they attend their midwife appointment!)

51
Q

Management of post-partum depression

A

CBT

Consider admission

52
Q

Management of pueperal psychosis

A

Alert the post-natal mental health crisis team

Admission

53
Q

Management of dementia

A

BIOPSYCHOSOCIAL
Bio = donepezil or memantine (severe)
Psycho = memory clinic
Social = good support, adapting the home and home life

54
Q

DDx for dementia

A 
Alzheimers
Lewy Body 
Fronto-temporal 
Vascular dementia
Delirium 
Hypothyroidism 
SOL 
Depression 
CJD
55
Q

ADHD management

A

Family therapy

Methylphenidate and regular growth measurements as well as dietician involvement

56
Q

Features of ADHD

A

Inattentive
Lots of energy
Easily distractable
Impulsive (crossing roads without looking)

57
Q

Categories of ADHD

A

Inattention
Hyperactive
Mixed

58
Q

Features of anorexia

A 
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)
59
Q

Management of eating disorders

A

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

60
Q

Criteria to diagnose anorexia

A

FEED
Fear of weight gain
Endocrine disturbance Emaciated
Deliberate weight loss

61
Q

Ix for anorexia

A 
FBC (anaemia and leukopaenia)
U&E 
LFTs
Cortisol
GH 
Amylase (pancreatitis is a complication of AN)
62
Q

DDx for anorexia

A

Bulimia
Depression
OCD
Organic causes of weight loss

63
Q

Typical Hx of bulimia

A

Binge eating
Fear of fatness
Purging behaviour
Sense of compulsion to eat = cyclical

64
Q

Features of post-traumatic stress disorder

A

Intense, prolonged, delayed reaction following exposure to a traumatic event

Reliving the situation
Avoidance
Hyperarousal
Emotional numbing

65
Q

When must PTSD occur to be PTSD

A

Within 6mo of the traumatic event

66
Q

Cut off for normal berheavement response

A

6mo

67
Q

What is acute stress reaction?

A

Exposure to an exceptional event or stressor, response in the immediate aftermath = disorientation, excessive grief, hopelessness

68
Q

Management of acute stress reaction

A

Watchful waiting
Trauma focussed CBT
Short term drug treatment for things like sleep disturbance (e.g. zopiclone)
Risk assesment

69
Q

Features of OCD

A

Recurrent obsessional thoughts or compulsive acts

70
Q

What are obsessions? (in the context of OCD)

A

Unwanted, intrusive thoughts

Urges

71
Q

What are compulsions

A

Repetitive, sterotyped behaviours that the patient feels driven to perfrom to reduce the obsessive thoughts

72
Q

Key features of OCD thoughts/compulsions

A

Failure to resist
Originate in the patients mind
Repetitive and distressing
Carrying out is not pleasureable but reduces anxiety levels

73
Q

Example obsessive thought and corresponding compulsion

A

“I am covered in germs”

“I must clean my hands 10 times”

74
Q

Questionnaire for OCD

A

Yale Brown

75
Q

DDx for OCD

A

Anxiety disorders

Depressive disorder

76
Q

Mx of OCD

A 
CBT 
SSRI (fluoxetine and paroxetine)
Clomipramine can be added if severe
Psychoeducation
Self-help books
77
Q

What is psychosis?

CRUCIAL

A

Distortion of reality

Unsure what is real and what is not!

78
Q

What is a delusion?

A

Falsely held belief

Firmly held despite everything and background of patient

79
Q

What is a hallucination?

A

A perception in the absence of a stimulus

80
Q

What is a thought disorder?

A

An impairment in the ability to form thoughts logically

81
Q

RF for schizophrenia

A 
Black and other ethnic minorities
Urban upbringing 
Family history
Substance misuse 
Smoking cannabis
82
Q

How long do you have to have Sx of psychosis for it to be Schizophrenia?

A

> 1mo

83
Q

What are some features of schizophrenia?

A

Delusional perception
Third person auditory hallucinations
Thought interferanec (broadcast, insertion, withdrawal)
Passivity phenomenen

84
Q

Great question to ask if worried about Schizophrenia?

A

Do you ever struggle to determine whats real and what is not?

85
Q

Negative symptoms of schizophrenia

A

Anhedonia
Attention deficits
Alogia (poverty of speech)

86
Q

Characteristics of hebephrenic schizophrenia

A

Child-like state

87
Q

Characteristics of simple schizophrenia

A

Just the negative symptoms

88
Q

How do you diagnose someone with schizophrenia often?

A

Palpable ‘loss of person’
Can be terrifying for the patient!
They dont know what is real and can have hallucinations aswell, scary

89
Q

Ix for schizophrenia

A

Check for organic cause = anaemia and thyroid aswell as delirium
Toxicology screen
ECG because need to check before using anti-psychotics

90
Q

Mx of schizophrenia

A 
RISK assessment 
Admit the patient 
Antipsychotics
Support groups 
Catatonic schizophrenia -> ECT 
CBT (reduces residual symptoms)
Art therapy (reduce negative symptoms)
91
Q

Last line medication after trying 2 different antipsychotics?

A

Clozapine

92
Q

Categories of personality disorders

A 
ABC
Mad Bad Sad (MBS)
Schizoid and Schizotypal
Borderline
Avoidant and dependent

Week 2 paces cases (3 decks)

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