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Psychiatry (P4) > Psychiatry (P4) > Flashcards

Psychiatry (P4) Flashcards

1
Q

Define an illusion.

A

Stimulus present but is misperceived.

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2
Q

Define an hallucination.

A

Stimulus is not present but there is a perception.

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3
Q

What are the terms for an hallucination just as you are going to sleep, and when waking up?

A

Hypnagogic (sleep)

Hypnopompic (waking)

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4
Q

What is a reflex hallucination?

A

When a stimulus in one sensory modality triggers a perception in another modality e.g. hear a sound and see a ghost.

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5
Q

What is an extracampine hallucination?

A

Perceiving something that is impossible e.g. hearing your deceased grandmother on mars.

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6
Q

What is the difference between an over-valued idea and a delusion?

A

Over-valued ideas are firmly held false beliefs but one can be reasoned out of them.

A delusion is a fixed false belief which one cannot be reasoned out of.

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7
Q

What is a Fregoli delusion?

A

Believing that various different people are the same person.

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8
Q

What is delusional perception?

A

When a perception triggers a delusional belief e.g. the traffic light signal was a sign from MI6.

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9
Q

Name three types of delusion/

A 
Nihilistic
Hypochondriacal
Grandiose
Fregoli
Guilt
Delusional perception
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10
Q

Name two kinds of thought disorder.

A

Insertion: external agent putting thoughts in my head.

Broadcast: People can hear my thoughts.

Echo: Hear their own thoughts said back to them.

Block: Train of thought/speech suddenly stops.

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11
Q

What is concrete thinking?

A

Rigid or literal thinking. Patients don’t grasp metaphor easily.

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12
Q

What is Knight’s move thinking (aka loosening of association)?

A

Where there is no link between what someone is saying.

(vs. Flight of ideas where you can still see the links).

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13
Q

What is circumstantiality?

A

When someone talks around a topic

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14
Q

What is perseveration?

A

When someone gives the same answer repeatedly to multiple questions.

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15
Q

In Schizophrenia what are Schneider’s 1st Rank symptoms?

A

[‘Have The Delusions Stopped’]

Hallucinations (typically auditory 3rd person)

Thought disorder e.g. insertion, broadcast etc.

Delusions e.g. delusional perception.

Somatic Passivity i.e. a sensation imposed by outside agent).

1+ for >1month = Dx

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16
Q

Give two examples of negative symptoms

A

Catatonic behaviour
Social withdrawal
Blunt affect
Apathy

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17
Q

Name a first generation antipsychotic. What receptors do they act on?

A

Haloperidol
Chlorpromazine

Block D2 receptors

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18
Q

What kind of side effects do 1st generation antipsychotics produce? Give 2 examples.

A

Extrapyramidal Side Effects

Akathisia (Restless legs)

Parkinsonism

Dystonia (twisting repeating movements)

Tardive Dyskinesia (jaw/face jerks).

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19
Q

What kind of patients should you avoid giving 1st generation antipsychotics to?

A

Patients with Parkinsons

Progressive Supranuclear Palsy

Lewy Body Dementia

CNS depression e.g. coma.

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20
Q

Name two 2nd generation antipsychotics. What receptors do they act on?

A 
Risperidone 
Clozapine
Olanzapine
Quetiapine
Aripiprazole

D2 + 5-HT2a

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21
Q

Give two side effects of 2nd generation antipsychotics

A

Weight gain [Olanzapine, Clozapine, Quetiapine].

Dyslipidemia [Olanzapine, Clozapine].

Hyperglycemia [Olanzapine, Clozapine]

Hyperprolactinemia [esp. Risperidone].

Agranulocytosis (reduction in granular leukocytes e.g. neutrophils). [esp. Clozapine]

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22
Q

Which antipsychotic is reserved for treatment resistant schizophrenia?

A

Clozapine

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23
Q

A patient presents with confusion, labile BP, hyperthermia, raised WCC and raised creatinine following treatment with antipsychotics. What is the most likely diagnosis? What is the treatment?

A

Neuroleptic Malignant Syndrome

Stop the antipsychotic
Supportive

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24
Q

What are the 4 Ps of the biopsychosocial model?

A

Predisposing
Precipitating
Perpetuating
Protective

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25
Q

What is Dysthmia? What is the treatment?

A

Sustained low mood for >2 years.

Treatment is an SSRI e.g. Fluoxetine + CBT.

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26
Q

What is Cyclothymia? What is the treatment?

A

Rapid (within hours/days) fluctuations between depression and HYPOmania.

Treatment: CBT + mood stabilisers e.g. Lithium or lamotrigine.

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27
Q

What is the difference between Bipolar I and II?

A

Bipolar I = Mania + Depressive episodes.

Bipolar II = Depression without mania (may have hypomania).

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28
Q

What is the difference between mania and hypomania?

A

Mania: Typically longer than a week and cannot function socially (50% become psychotic).

Hypomania: Shorter duration and can still function.

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29
Q

Define psychosis

A

When a person loses touch with reality e.g. hallucinations or delusions.

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30
Q

What is the treatment for mania?

A

Antipsychotic

Mood stabiliser e.g. carbamazepine or lithium

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31
Q

Can you take NSAIDs with Lithium?

A

Not advised. NSAIDs have been shown to reduce clearance of lithium which can potentiate its action.

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32
Q

Give an example of a Serotonin Noradrenaline Reuptake Inhibitor (SNRI)

A

Duloxetine

Venlafaxine

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33
Q

Give an example of a Tricyclic Antidepressant (TCA)

A

Amitriptyline

Nortriptyline

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34
Q

Name a monoamine oxidase inhibitor (MAOI)

A

Selegiline

(These are really only used as a last resort).

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35
Q

What kind of antidepressant is Mirtazapine?

A

Noradrenergic And Specific Serotonergic Antidepressant (NASSA)

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36
Q

Give two common side effects of antidepressants

A 
Low libido
Erectile Dysfunction
Anxiety
Dry mouth
Insomnia
Addiction
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37
Q

TCAs can produce anticholinergic side-effects (pro sympathetic). Name two of these effects.

A

[‘Can’t see, Can’t pee, Can’t spit, Can’t shit’]

Uveitis
Urinary retention
Dry mouth
Constipation

TCAs can also block alpha 1 adrenergic pathways and cause postural hypotension.

+block histamine pathways causing drowsiness.

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38
Q

Foods high in what amino acid can induce the “cheese effect” in patients talking SSRIs/MAOIs?

A

Tyramine

Strong cheese and cured meats.

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39
Q

A patient on SSRI switched to MAOI without stopping the SSRI and presents with confusion, hypertension, tremor, tachycardia, sweating and mydriasis (dilation). What is the likely diagnosis and treatment?

A

Serotonin Syndrome

Stop SSRI/MAOI

Cyproheptadine (5-HT2 antagonist).

Benzodiazepines.

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40
Q

Why are benzodiazepines such as diazepam (valium), lorazepam, and chlordiazepoxide not recommended for longer than 4 weeks?

A

Risk of addiction

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41
Q

What happens if you suddenly stop taking SSRIs?

A

Antidepressant Discontinuation Syndrome aka SSRI withdrawal.

Nausea, GI upset, Flu-like symptoms for up to 2 weeks.

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42
Q

What is a staggered overdose?

A

The cumulative effect of several overdoses over a short period of time which can be sufficient to kill the patient.

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43
Q

Name a mood stabiliser that is safe for pregnant women and one that is not safe

A

Safe: Carbamazepine or Lamotrigine.

Not Safe: Sodium Valproate (results in birth defects). Lithium can cause heart defects.

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44
Q

What does IAPT stand for?

What is it for?

A

Improving Access to Psychological Therapy

[Self referral service for depression and anxiety]

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45
Q

What support service is available for mental health issues affecting those between 4-18 years of age?

A

Child and Adolescent Mental Health Services [CAMHS]

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46
Q

Define delirium.

A

Acute confusional state

[Medical Emergency]

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47
Q

Name three things that can cause delirium

A

[PINCH ME]

Pain
Infection
Nutrition
Constipation
Hydration

Medical e.g. stroke/drugs
Environment

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48
Q

How do you treat delirium?

A

1st line: Verbal/non-verbal reorientation
2nd line: Low dose antipsychotic

NB: Benzos can make it worse! Only consider if patient is violent/uncontrollable.

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49
Q

What is paraphrenia?

A

Positive symptoms of schizophrenia (hallucination, thought disorder, delusions,, somatic passivity) without the negative. Mainly in older patients (>60yo).

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50
Q

How long can a person be detained under section 2 of the mental health act?

A

28 days maximum
[This cannot be renewed!]
[Sect 2 = ASSESSMENT]

NB: Treatment can still be administered under section 2.

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51
Q

What are the conditions that must be met for section 2 of the mental health act? (Who is required and what kind of patient?)

A

Patient must have a mental disorder which puts them or others at risk.

2 doctors (1 S12 approved). 
\+ Approved Mental Health Proffessional (AMHP).
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52
Q

How long can a patient be detained under section 3 of the mental health act?

A

6 months
[It can be renewed]

[Sect 3 = TREATMENT]

2 doctors (1 x S12 approved)
\+ AMHP
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53
Q

What is section 4 used for under the mental health act?

How long can a patient be detained under this?

A

Emergency assessment (out-patients). For max 72 hours (cant be renewed).

This is for a doctor to detain an outpatient while you wait for the criteria for Section 2 to be met.

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54
Q

What is the difference between Section 5(4) and 5(2) under the mental health act?

A

5(4) Nurses
6 hour detention for in patients.

5(2) Doctors
72 hour detention for in patients.

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55
Q

What is the difference between section 135 and 136 in the mental health act?

A

135 = Police detention from home. 24hrs. Requires a court order.

136 = Police detention from a public place. 24hrs.

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56
Q

What are the CAGE screening questions? Name another alcohol screening tool

A

Ever thought of Cutting down?

Ever get Angry when questioned about drinking?

Ever feel Guilty about your drinking?

Ever needed an Eye-opener in the morning?

AUDIT
MAST
JELLINEK
SADQ (severity)

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57
Q

What are the alcohol limits for blood and breath?

A 
Blood = 80mg/100ml
Breath = 35ug/100ml
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58
Q

How many units of alcohol are recommended per week?

A

Max 14 units per week

Spread over >3 days.

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59
Q

What is the technical definition of binge drinking?

A

> 8U in a single session (Men)

> 6U (Women)

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60
Q

How much is one unit of alcohol in ml and g?

A

10ml

8g

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61
Q

How do you calculate Units?

A

Units = [ABV% x Vol (ml)]

1000

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62
Q

Give two symptoms of alcohol withdrawal

A 
Tremor
Tachycardia
Hypotension
Confusion
Hallucination (typically visual/tactile).

NB: Formication = visual hallucination seeing insects crawling on you.

63
Q

What is the first line treatment for Delirium Tremens [medical emergency]?

A

Oral lorazepam

64
Q

What drugs are used to treat alcohol dependence?

A

Relapse prevention:

1) Acamprosate Calcium
2) Naltrexone Hydrochloride
3) Disulfiram

Reduce consumption in high risk individuals
1) Nalmefene

65
Q

What treatment should be given to all alcoholics to prevent encephalopathy?

A

Pabrinex

[Vitamin C + Thiamine B1]

66
Q

What are the signs of Wernicke’s and Korsakoff’s Encephalopathy?

A

Wernicke’s: [CAN]
Confusion
Ataxia
Nystagmus (ophthalmoplegia)

Korsakoff’s:
Amnesia (retro/anterograde)

67
Q

Name a service that supports alcoholics

A

Change Grow Live (CGL)

68
Q

What are the three Ps of personality disorders?

A

Persistent
Pervasive
Problematic

69
Q

Name a personality disorder in Cluster A, B and C

A

A:
Paranoid
Schizoid
Schizotypal

B:
EUPD
Narcissistic
Histrionic
Antisocial

C:
Avoidant
Dependent
Obsessive Compulsive PD

70
Q

What are the four diagnostic criteria for PTSD?

A

1) Exposure to stressful event
2) Persistent remembering e.g. flashbacks
3) Avoidance association
4) Either memory loss or hypersensitivity e.g. startle response (hyperarousal).

[All must occur in the 6 months following the stress/trauma]

71
Q

What treatment is available for PTSD?

A

Eye Movement Desensitisation Reprocessing (EMDR)

Trauma focussed CBT

Antidepressants

72
Q

What is the difference between PTSD and Adjustment disorder?

A

Adjustment disorder is a dysregulated response to minor stressors (no single big event).

73
Q

What are the three diagnositc criteria for Anorexia Nervosa?

A

1) Body weight >15% below expected.
2) Weight loss self-induced e.g. dieting, purging, exercise.
3) Weight is an over-valued idea (body image distortion).

All three must be present

74
Q

Give three signs of anorexia nervosa

A 
Lanugo hair
Calloused knuckles
Enamel erosion
Prolonged QT
Hypokalaemia
75
Q

How do you calculate BMI?

A

Weight (kg) / height (m) squared

76
Q

What are the categories for BMI?

A 
Underweight: <18.5
Normal: 18.5-25
Overweight: 25-30
Obese: 30-35
Morbid obesity: 35+
77
Q

Which is more common Bulimia Nervosa or Anorexia Nervosa?

A

Bulimia Nervosa

78
Q

What is binge eating?

A

Eating more than normal within a 2 hour period.

79
Q

What are the three diagnostic criteria for Bulimia Nervosa?

A

1) Bingeing
2) Self induced weight loss (vomiting, starvation, exercise)
3) Morbid fear of being fat.

80
Q

What is the key difference between Anorexia and Bulimia?

A

Anorexia = underweight

Bulimia are often normal/overweight.

81
Q

What is the treatment for Bulimia?

A

Nutritional counselling
Psychotherapy/CBT
SSRI

NB: Mirtazapine (NASSA) is useful as it can cause weight gain.

82
Q

What is the SCOFF questionnaire?

A

1) Ever make yourself Sick because of eating too much?
2) Do you worry you have lost Control of your eating?
3) Have you recently lost more than One stone (last 3 months).
4) Do you think you are Fat when others don’t?
5) Does Food dominate your life?

83
Q

What scoring tool is used to assess patients for malnutrition?

A

Malnutrition Universal Screening Tool [MUST]

1) BMI
2) % Weight loss (3-6 months)
3) Acute disease

Scores:
0 = low risk
1 = moderate risk (monitor)
2+ = high risk (ref dietician)

84
Q

What are the three categories of deficit for ADHD? (Provide one example for each category).

A

Hyperactivity: fidgets, talks a lot, can’t play quietly.

Impulsivity: Interrupts, can’t take turns, speaks without thinking.

Inattention: Loses things, can’t focus, lacks structure.

85
Q

What are the diagnostic criteria for ADHD?

A

6 signs of (Hyperactivity + Impulsivity)
OR
6 signs of inattentiveness.

Signs must be present before the age of 12 and must last for >6 months.

86
Q

What is the treatment for ADHD?

A

Methylphenidate (Ritalin)
Or Amphetamines.

NB: Must be over 5 years old to take this.

87
Q

What investigations can be done to determine a diagnosis of ADHD?

A

Clinical interview (parents/teachers).

Clinical History

Quantitative Behavioural Test [QB Test].

88
Q

What are the diagnostic criteria for autism?

A

Difficulties with social interaction

Difficulties with social communication

Strereotyped behaviours / resistance to change.

[Should be present from childhood, must limit everyday function, must not be explainable by intellectual disability].

89
Q

Describe three signs of autism spectrum disorder?

A 
Not smiling by 9 months
Not sharing by 3-4 years
Repetitive movements/sounds
Obsessive interests
Avoidance of eye contact
No words by 16 months
90
Q

What is the difference between Asperger’s and Autism?

A

Both are on the autism spectrum disorder (ASD).

However, Asperger’s is high functioning with no speech delay during development.

Asperger’s are normal/above average intellenge but tend to be obsessive/narrowly focussed and don’t grasp the nurances of language/communication such as humour, irony or listening to others. Their tone/speech pattern tends to be atypical i.e. monotone, broken, higher pitch.

91
Q

Define dementia

A

Progressive global decline in cognitive function

92
Q

What are the hallmark pathological changes in the brain with Alzheimer’s disease?

A

Beta amyloid plaques
Neurofibrillary Tau tangles
Atrophy (hipocampus)

93
Q

Name three clinical investigations would you do in a patient with Alzheimer’s

A

FBC, U&E, ESR, Calcium, HbA1c, LFT, Thyroid, Serum B12 [+HIV, CXR, ECG if indicated]

MRI or CT to rule out other causes.

94
Q

What are the four domains of the mental capacity assessment?

A

Understand
Retain
Weight up
Communicate

95
Q

Name three cognitive assessment tools

A 
Mini Mental State Exam
MOCA
Mini Cog
GPCOG
Memory Impairment Screener (MIS)
10 point cognitive screen (10CS)
6 item cognitive impairment test (6-CIT)
Test your memory (TYM)
ACE-III
Abreviated Mental Test (AMT)
96
Q

What is an IMCA?

A

An Independent Mental Capacity Advocate. They support those patients without capacity who are under Deprivation of Liberty (DoLs) to ensure they are being detained appropriately.

97
Q

Where do you commonly see atrophy of the brain in Alzheimer’s patients?

A

Temporal lobe atrophy

Esp. hippocampus

98
Q

What is the typical early presentation specific to Alzheimer’s?

A

Visuospatial deficits - tend to get lost easily.

Loss of episodic memory - forget recent events, repeat the same questions

Cognitive impairment - struggle to learn new things.

99
Q

What is the typical early presentation of vascular dementia?

A

Step-wise progressive loss

  • Attention
  • Personality change
  • Focal deficit e.g. paralysis
100
Q

What is the typical presentaiton of Fronto-Temporal Dementia aka Pick’s disease?

A

Personality change e.g. social or sexual disinhibition.

They may be otherwise congitively normal.

101
Q

What is the typical presentation of Lewy Body or Parkinson’s dementia? What is the difference between them?

A

Falls, delusions, hallucinations. Acute sensitivity to antipsychotics.

Parkinson’s = Motor then dementia

Lewy Body = Dementia then motor.

102
Q

Define mild cognitive impairment (MCI). What proportion go on to develop dementia?

A

Decline in cognitive function which does not affect daily activities.

50% go on to develop dementia

103
Q

What is sundowning? How can it be managed?

A

An associated phenomenon of dementia where the symptoms get worse at night. Believed to be related to circadian rhythm dysregulation.

  • Boost natural light in day
  • Provide structure
  • Avoid caffeine/alcohol late in the day
104
Q

Name two reversible causes of dementia

A 
Hypothyroidism
Delirium
Tumours
Depression
Vit B/Folate deficiency
Neurosyphilis
105
Q

What four main drugs are used to treat dementia? Which types of dementia are they effective in?

A

Acetylcholinesterase inhibitors

  • Donepezil
  • Rivastigmine
  • Galantamine

NMDA receptor antagonist
- Memantine

Lewy Body, Alzheimer’s. Parkinson’s [LAP] respond.

106
Q

What are the three cardinal symptoms of depression?

A

Anhedonia
Anenergia
Low mood

(early morning waking, suicidal ideation, tearful, loss of libido, low self esteem etc)

[more than 2 weeks]

107
Q

How is Generalised Anxiety Disorder (GAD) diagnosed?

A

> 6 months of chronic, excessive worry that is disproportionate to their experience/environment.

108
Q

What screening tool is used to assess anxiety?

A

GAD-7

HADS

109
Q

Name a screening tool for depression

A

Patient Health Questionnaire-9 [PHQ9]

Beck Depression Inventory [BDI]

Hospital Anxiety & Depression Score [HADS]

ICD-10 Depression Inventory

110
Q

Give two differential diagnoses for generalised anxiety disorder

A 
Hyperthyroidism
Phaeochromocytoma
PTSD
Adjustment disorder
Panic disorder
Social phobia
Cardiac arrhythmias
111
Q

What is the difference between OCD and OC personality disorder?

A

OCD is typically less disruptive to life/personal relationships as it involves a specific recurring behaviour e.g. hand washing.

However, OCPD is generalised perfectionism which does impair life/relationships.

112
Q

What is the difference between an obsession and a compulsion?

A

Obsession is a recurring, intrusive thought or idea.

Compulsion is a recurring actions/behaviours.

113
Q

What is the treatment for OCD?

A

CBT

SSRIs

114
Q

What is the treatment for anxiety?

A

CBT

SSRIs

115
Q

Are SSRIs safe in pregnancy?

A

Not advised during the first trimester as increase the chance of birth defects (especially heart defects).

116
Q

What is clanging?

A

Rhyming words e.g. “I heard a bell, tell, sell, well, spell…”

117
Q

What are made acts/feelings/drives?

A

The belief that acts, feelings or drives are caused by an external agent.

118
Q

What is a neologism?

A

Forming new words

119
Q

What is the difference between a mood and affect?

A

Mood is an individual’s subjective emotional state.

Affect is the objective expression of emotion.

120
Q

What is the difference between blunt and flat affect?

A 
Blunt = significantly reduced
Flat = no emotional expression
121
Q

What is incongruity of affect?

A

Mismatch between reported mood and displayed affect.

122
Q

What is conversion?

A

Where psychological trauma results in physical symptoms e.g. loss of vision or motor function.

123
Q

What is Belle Indiference?

A

Psychological conversion which the patient doesn’t recognise as a problem e.g. loss of function of left arm is normal to them.

124
Q

What is derealisation?

A

Belief that the world is not real (external disconnect)

125
Q

What is depersonalisation?

A

An internal disconnect between mind and body.

126
Q

What is Charles Bonnet Syndrome?

A

Visual hallucination (shapes, patterns, colours) in patients with visual impairment.

127
Q

What is erotomania?

A

The delusion that someone is in love with them.

128
Q

What is an elementary hallucination?

A

A simple, unstructured sound e.g. buzzing, whistling.

129
Q

How long do SSRIs take to work?

A

4-6 weeks

130
Q

Give three risk factors for suicide

A 
Male
Young
Substance abuse
FHx
Recent antidepressants
Prior attempts
Physical illness
Access to means
Severe depression
Lack of social relationships
131
Q

True or false Wernicke’s encephalopathy is reversible?

A

True

[Korsakoff’s is not]

132
Q

What is another name for an Advanced Statement? Is it legally binding?

A

A living will
Sets out preferences of care.
Not legally binding.

133
Q

What are the two types of lasting power of attorney? Where are they registered?

A

Health & Welfare
Property & Finance

Registered at the Office of the public guardian (OPG).

134
Q

What is the CIWA score used for?

A

Clinical Institute Withdrawal Assessment for Alcohol

To assess whether treatment is needed for alcohol withdrawal.

135
Q

When would you use Lorazepam vs [Diazepam or chlordiazepoxide] in patients with alcohol withdrawl?

A

Lorazepam is indicated if the liver is impaired.

If the liver is fine you can give diazepam or chlordiazepoxide.

136
Q

What is the treatment for acute dystonia e.g. resulting from Extra Pyramidal Side effects of antipsychotics, antidepressants or metoclopramide?

A

Procyclidine IM

137
Q

Give two signs of acute dystonic reaction?

A

Mout open
Dysarthria
Upward eye gaze
Neck spasms

[Tends to occur in younger men & cocaine users who are on antipsychotics, antidepressants or metoclopramide]

138
Q

What medications are used to rapidly tranquilise a psychotic or aggressive patient who cannot be calmed?

A

Lorazepam (IM)

or

Haloperidol + Promethazine (IM)

139
Q

Give three side effects of 2nd generation antipsychotics

A
  • Metabolic disorder: weight gain, hyperlipidemia, DM
  • Agranulocytosis (neutropenia) [Clozapine]
  • Hyperprolactinaemia + Gynaecomastia [Risperidone]
  • QT prolongation
  • Sexual dysfunction
  • Constipation [Clozapine]
  • Hypersalivation [Clozapine]

Clozapine needs frequent monitoring!

140
Q

What is the difference in presentation between neuroleptic malignant syndrome and Serotonergic syndrome?

A

Both exhibit:

  • Autonomic instability
  • Fever
  • Altered mental state e.g. confusion
NMS = Neuromuscular HYPOactivity (hypotonia, rigidity)
SS = Neuromuscular HYPERactivity (twitching, brisk reflexes etc.)
141
Q

Can Section 5 of the mental health act be used in A&E?

A

No. Section 5 [5(4) and 5(2)] Can only be used for in patients. Patient’s in A&E have not been admitted.

Section 2/3 or 4 would be more appropriate.

142
Q

Give 2 extrapyramidal side effects of antipsychotics

A

Acute dystonia [
Akathisia [Switch to 2nd gen]
Parkinsonism (without tremor) [Switch to 2nd gen]
Tardive dyskinesia [No treatment]

143
Q

What receptor do most 1st generation antipsychotics work on?

A

D2 receptors

144
Q

True or false, Creatine Kinase and WCC are elevated in neuroleptic malignant syndrome and Serotonin syndrome?

A

True. CK is particularly high in NMS. This can result in renal failure! WCC is raised in both.

145
Q

Give two common side effects of Lithium

A 
Nausea
Metallic taste in mouth 
Dry mouth 
Tremor (mild)
Thirst 
Diarrhoea

[Lithium has a narrow therapeutic index so it becomes toxic very easily]

146
Q

True or false, Lithium is safe during pregnancy

A

False. It can cause foetal abnormalities.

147
Q

Give two signs of Lithium toxicity. What should a patient be advised to avoid toxicity?

A 
Nausea
Polyuria
Tremor
Twitching
Incontinence
Drowsiness
Avoid dehydration (e.g. travel/sport)
Avoid rapid drop in sodium (diet)
Caution with diuretics
148
Q

True or false, a woman of childbearing age who is sexually active and wishes to take sodium valproate must be on contraceptives?

A

True.

149
Q

What mood stabiliser is safe in pregnancy?

A

Lamotrigine is a safe option

[Sodium valproate and Lithium are not safe!]

150
Q

How long can a patient be detained under a section 5(4) and 5(2)?

A

5(4) - 6 hours

5(2) - 72 hours

151
Q

What rights does a patient have under the Mental Health Act?

A
  • Told why they have been detained
  • Allowed legal advice
  • Ask police/hospital to inform someone where they are
  • To get treatment for their mental health condition
152
Q

Can any treatment be given without consent to a patient who is under the mental health act?

A

No. Only treatment can be given to a patient to treat their mental health condition. With eating disorders, this may include food and drink.

If you want to give other treatment without their consent this needs to be under the Mental Capacity Act i.e. they must lack capacity.

153
Q

What is waxy flexibility?

A

When you move a person they adopt the new position.

It is a sign of catatonia

154
Q

What is negativism?

A

When a person does the opposite of what is asked of them

Psychiatry (P4) (1 decks)

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