Pysch Flashcards

Question

management of alcohol withdrawal

Answer 1

BDZ: most effective for alcohol withdrawal seizures, rapidly reducing regime prevents BDZ dependence. Chlordiazepoxide for OPD use, diazepam for inpatient Antipsychotics: PRN haloperidol 5-10mg PO if BDZ does not manage hallucinations Vitamins: IV thiamine, Pabrinex

Answer 2

Chlordiazepoxide is used in OPD because of long half life, lower abuse potential Diazepam works faster and used in patient because allows for dose titration

Answer 3

Pt with clinical symptoms of withdrawal, Hx of alcohol withdrawal symptoms Or Hx of drink >10 units/day for past 10 days, BAC=0, no withdrawal symptoms

Answer 4

OPD - if uncomplicated, if worried about compliance can see pt daily and breathanalyse before dispensing drug Inpt - Complicated withdrawal with seizures, confusiong, suicide risk, Wernicke-korsaff, lack of stable home environment

Answer 5

Give verbal and written advice inform GP Give pt contact for emergencies Decide on explicit follow up after detox

Answer 6

Disulfiram - irreversible acetyladehyde dehydrogenase inhibition, causes ahngover if drinking. prescribed once abstinence is achieved, loading dose of 800mg then reduce over 5 days to 100-200mg/day Acamprosate - to prevent craving for alcohol. Enhance GABA transmisison. Give 333mg/tds or 666mg/tds depending on weight. Start after abstinence

Answer 7

* 14 units/week. Check pt understanding of what is a unit * Should be at least two non-drinking days a week * Amounts should be spread over several days, not drunk at one sitting * Weekly limits. Don't ‘save up’ units from one week to use in another week * Some situations where the safe amount is zero, e.g. pregnancy, driving * Do not drink alone, avoid company of heavy drinkers * Don’t buy rounds * Alternative soft drinks and alcohol. Drink with meal * Rehearse what to say when declining offer of drink * Plan alternative non-drinking activities

Answer 8

• One unit is 8g of alcohol • Number of units = volume in L x % alcohol • Pint of beer is 2 units, can of strong lager 9% is 4 units, pint of cider is 2.5 units, 125ml glass of unit is 1.5 units, 25ml shot of gin/vodka/rum is 1 unit

Answer 9

40% die prematurely (15% by suicide) 30% have lifelong alcohol related problems 30% favourable outcome

Answer 10

For AN and BN (eating disorder) • Used in primary care but low sensitivity, score of 2+ yes indicates more detailed history is needed Do you make yourself sick because you feel uncomfortably full? Do you worry you have lost control over how much you eat? Have you recently lost more than one stone (6kg) in a 3 month period? Do you believe yourself to be fat when others say you are too thin? Would you say that food dominates your life?

Answer 11

• BMI <17.5 (or weight 15% less than expected) • Deliberate weight loss – extraordinary lengths to lose weight, laxative abuse, vomiting or excessive exercise. Use of appetite suppressants, thyroxine, diuretics and stimulants o Common history of exercising before onset • Distorted body image – preoccupation with body shape and dread of weight gain. Overvalued ideas that they are fat, this thought persists above all • Endocrine dysfunction – amenorrhoea in women and impotence in man, decreased libido. AN before puberty can lead to delay of menarche and breast development

Answer 12

Hypotension (systolic <70mmHg), cardiomyopathy (heart is a muscle, muscle breakdown in starvation), significant bradycardia (30-40bpm) ``` ECG changes • Sinus bradycardia • ST segment elevation • T wave flattening • Low voltage • Right axis deviation • All of which predisposes to arrhythmias ``` Echo/cardiomyopathy • Decreased heart size • Decreased left ventricular mass • Mitral valve prolapse without significant mitral regurgitation

Answer 13

Hypokalaemia (from vomiting), hyponatraemia (water-loading), hypoglycaemia, hypothermia (very common because they have lost all their brown fat and they tend to take cold showers which apparently burn calories), altered thyroid function, hypercortisolaemia, amenorrhoea (diagnostic criteria), delay in puberty, arrested growth, osteoporosis  fractures MOA of osteoporosis • Due to low levels of progesterone and decrease IGF-1 levels Anaemia, leukopenia, thrombocytopenia  pancytopenia due to bone marrow hypoplasia  increased infections and challenging to tell if they are suffering from sepsis – albumin drops and CRP rises but normal/low WBC

Answer 14

albumin drops and CRP rises but normal/low WBC

Answer 15

1st line = structured eating plan with oral nutrition by dietician accompanied by psychological and biological treatments • Realistic weight gain of 0.5-1kg/week BIOLOGICAL 1. Potassium repletion from purging/laxative abuse 2. Mg repletion if hypoK refractory to oral K, Ca repletion, Na repletion 3. Pt with hypoglycaemia – give milk over glucagon as it increases BM more slowly 4. Pharmacological: fluoxetine (especially if obsessional ideas about food or pt with depression) but only when AN pts have normalised electrolyte and heart rate. SSRIs can cause long-QT

Answer 16

* Physical complications – cardiac, severe electrolyte imbalance * Extremely rapid weight loss or BMI<13.5 * High suicide risk

Answer 17

* Severely underweight <14BMI * Rapid weight loss – more dramatic methods used, no compensation * Binge purge subtypes – hypoK, hypoNa * Exercise – increases strain on the heart * Alcohol problems * Medical comorbidities/pregnancy * Early stages of refeeding

Answer 18

Repeated episodes of binge eating with compensatory behaviors e.g. purging. Body weight may be normal – BMI>17.5.

Answer 19

Incidence 1-1.5% of women with mid-adolescent onset Presentation later than for anorexia nervosa (late teens or twenties) Pt with AN can progress to BN

Answer 20

Diagnostic criteria – ICD-10: 1. Persistent preoccupation with eating and irresistible craving for food. Binging. 2. Attempts to counteract “fattening” effects of food by one of: self-induced vomiting, purgative abuse, alternation periods of starvation, drugs to suppress appetite, thyroid preparations or diuretics. Diabetics may neglect insulin treatment 3. Psychopathology consists of morbid dread of fatness; patient sets sharply defined weight threshold (well below premorbid weight or healthy weight). Often but not always Hx of anorexia nervosa (months to years previously)

Answer 21

Most are managed in the community. 1st line = CBT + nutritional and meal support (dietician) +/- SSRI and other psychological therapies. 2nd line = SSRI alone Admission only if suicidal, DM, physical symptoms e.g. LOC, syncope, seizures, pregnant

Answer 22

BN generally good - almost all recover except those with sig issues of low self-esteem, PD AN rule of 1/3. 1/3 recover, 1/3 partial 1/3 chronic

Answer 23

Learning disability is a developmental condition characterised by global impairment of intelligence (IQ<70) and significant difficulties in socially adaptive functioning. Both must be present before age <18 years. It is NOT A DIAGNOSIS – it merely describes a constellation of symptoms for which the aetiology may or may not be known e.g. Down’s syndrome

Answer 24

* Mild: IQ50-69 Mental age 9-12 years old * Moderate: IQ34-49 Mental age 6-9 years old * Severe: IQ20-34 Mental age <6 years * Profound: IQ<20

Answer 25

2.5% of population has mild LD 0.4% moderate LD <0.1% for both severe and profound combined

Answer 26

Impairment = any loss or abnormality of psychological, physiological, or anatomical structure or function Disability = restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being Handicap= disadvantage for a given individual, resulting from impairment or disability that limits or prevents the fulfilment of a role that is normal to that individual

Answer 27

Specific cause of LD can be identified in 80% of severe and 50% of mild LD. Modern classification of aetiological factors are based on timing of the causative event: ``` Antenatal * Genetics (see later) * During pregnancy • Alcohol: FAS • Drugs • Medication • Smoking • Infection e.g. rubella ``` Perinatal * Neonatal hypoxia/sepsis * Birth trauma * Hypoglycaemia * Prematurity Postnatal * Social deprivation * Malnutrition * Lead * Infections e.g. meningitis * Head injury Mild disability often no aetiology can be found