Pysch Flashcards
how do you manage serotonin syndrome
Admit to hospital!
■ This patient has severe serotonin syndrome so REQUEST SENIOR HELP IMMEDIATELY
■ ABCDE- IV fluids, ECG, cooling measures
■ Bedside observations- monitor vitals using NEWS chart, ensuring that temp, BP and HR are recorded.
■ Cessation of tramadol and citalopram – request psych input to decide how to go about this to avoid
withdrawal effects
■ IV benzodiazepine and anti seratonergic drug like chlorpromazine or cyproheptadine
- See toxbase
Complications: DiC, rhabdomyolysis, renal failure
Yellow card, letter to GP/patient
what is the management of agranulocytosis?
Stop Clozapine, Sepsis 6 if necessary, treat infection
if present with Abx, granulocyte colony stimulating factor
(G-CSF) e.g. filgrastim to help body produce more WBCs.
Refer to specialist to decide on whether to continue
clozapine.
what should you always do in a psych medication hx?
risk assess the pt - harm to themselves or others
what are the organic causes of psychosis
temporal lobe epilepsy SOL limbic encephalitis B12 deficiency hyperthyroidism HIV infection
what are the primary mood dsorders that can cuase psychosis
depressive psychosis
manic episode with psychotic features
mixed affective state with psychosis
bipolar disorder
what are the brief/transient cuases of psychosis
schizophreniform disorder
substance induced psychosis
what are the enduring psychotic cuases if psychosis
schizophrenia
schizoaffective disorder
perisistent delusional disorder
unspecified non-organic psychosis
what other psychosis differentials should you consider
acute intoxication state
postpartum psychosis
non-pathological sx in context of developmental/environmental change
medication induced sx - steorids, mefloquine, dopamine agonists
post partum psychosis
what is the management of schizophrenia
Specialist - early intervention teams - allocated keyworker
psychiatrist
a MDT approach
consider
Community mental health team and info for the crisis team antipsychotic - risperidone etc plus counselling on the medication
Voluntary/compulsory hospital admission
psychological therapies - CBT and family intervnetions
Care programme approach - assessing health and social needs, creating care plan , appointing key worker and reviewing tx.
Social and occupational - suitable accommodation and options for employment
how would you describe schizophrenia
is a long term mental health problem affecting thinking, perception and affect
how many people suffer from scz
1 in 100 people
what is the management of NMS?
Physical health hospital!
Discontinue suspected agents, manage sedation with BDZ
Hx/Ex/Ix: raised WCC/CPK
Dantrolene (muscle relaxant), bromocriptine (dopamine agonist)
Complications: rhabdomyolysis, renal failure
Yellow card, letter to GP/patient
what is the management of deliurim
Identify and tx the cause
take a collateral hx
- General supportive management - gentle reorientation, calm and consistent care, ensure access to glasses, hearing aids walking sticks
- enable the patient to do anything they can for themselves
Environmental adaption - access to clock, control noise and lighting
Avoid unnecessary medication
MEdication review to check there are any drugs that can worsen sx
Haloperidol can be used.
- inform families carers of delirium
Info to those around the pt on how to manage the residual disorientation
follow-up is advisable
prevention of further episodes - avoiding drugs, assess any exarcerbating causes.
ix in deliruim
Vital signs (e.g. fever in infection, low SpO2 in pneumonia),e.g. GCS/AVPU, Evidence of head trauma, Sources of infection (e.g. suprapubic tenderness in urinary tract infection), Asterixis (e.g. uraemia/encephalopathy)
FBC (e.g. infection, anaemia, malignancy)
U&Es (e.g. hyponatraemia, hypernatraemia)
LFTs (e.g. liver failure with secondary encephalopathy)
Coagulation/INR (e.g. intracranial bleeding)
TFTs (e.g. hypothyroidism)
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics (e.g. B12/folate deficiency)
Glucose (e.g. hypoglycaemia/hyperglycaemia)
Blood cultures (e.g. sepsis)
Urinalysis:
UTI is a very common cause of delirium in the elderly.
A positive urine dipstick without clinical signs is NOT satisfactory to diagnose urinary tract infection as a cause of delirium.2, 3
Look for other evidence supporting the diagnosis (WCC↑/supra-pubic tenderness/dysuria/offensive urine/positive urine culture).
Imaging:
CT head: if there is concern about intracranial pathology (bleeding, ischaemic stroke, abscess)
Chest X-ray: may be performed if there is concern about lung pathology (e.g. pneumonia, pulmonary oedema)
what is the management of anorexia
Patient stable and no life-threateningly unwell, can be treated in the community. Make sure patient not clinically unwell/malnourished/dehyradted.
MDT!
Pateitn education and family education of condition.
Controlling any concurrent medical conditions
Psychoeducation- referral to specialist support services, family therapy, CAMHS, CBT (40 sessions over 40 weeks)
Medication review if req.
Regular CAMHS follow ups, written treatment plan- Weight gain to get periodss back. Make meal plans with adequate calories for weight restoration. Encourage fluid intake also. Target of increase in weight 1-2kg/week
Monitor bone health since this patient is amenorrheic
Consider referral to dietician
Monitor mood and suicidality
Can also offer hospital based care or residential treatment programmesà 24/7 care
There are also structured outpatient treatment programme
Consider SSRI is concurrenty depressed- Mirtazapine can increase appetite
NG feeding may be required if refusal or food and hospitalised. Beware of refeeding syndrome
Calorific prescriptions
vitamin supplements – inc calcium and vit d
Consider bisphosphonate further down the line
