Random Psych Conditions and things Flashcards
Somatoform Disorders
Physical illness symptoms occur due to poor mental health, without evidence of neurological abnormalities.
Examples of somatoform disorders
Somatisation disorder/Bruquet's syndrome. Hypochondriacal disorder Body dysmorphia disorder Somatofrom autonomic dysfunction Persistent somatoform pain disorder
Somatisation disorder/Bruquet’s syndrome symptoms
GI upset - nausea, vomiting, food intolerance, constipation, stomach pain.
Endocrine - low libido, irregular menses, erectile dysfunction.
Urinary - dysuria, frequency, incontinence
Neuro - paraestoesia, difficulty swallowing, loss of balance
Diagnosing Somatisation disorder
2 years of unexplained symptoms
Refusal to accept reassurance form healthcare professionals of no physical cause of symptoms.
Degree of functioning impairment form symptoms or behaviour due to symptoms.
Must have numerous symptoms symptoms for each system not just an isolated one or two.
Baby blues
Postnatal blues occur in 50% of new mothers. Occur in first 10 days of birth and are self-limiting. Irritable, tearful, mild depression, anxious.
Postnatal depression
Occurs within 3 months of birth and can let between 2-6months.
Symptoms = anxious about baby, guilt, inadequacy, reduced affection for baby, infanticidal thoughts, obsessional, intrusive thoughts about baby, low mood, loss of enjoyment, suicidal ideation, low energy.
Management = primary care, psychological therapy, specialist advice on antidepressant drug treatment.
Tourette’s
vocal or motor tic.
onset around 18yrs
Rx = risperidone
Conversion disorder
Loss of motor or sensory function.
Hypochondrial disorder
Persistent belief that there is an underlying serious disease
Somatisation
Multiple physical symptoms which continue despite negative tests results and reassurance to patient.
Munchausen’s syndrome
Intentional production of symptoms
Malingering
Simulation or exaggeration of symptoms for personal gain.
Main therapy for borderline personality disorder
DBT - dialectical behavioural therapy.
Puerperal psychosis treatment
ECT
Good psychotherapy for borderline personality disorder
Dialectical behaviour therapy
Mentalisation based therapy
Features of borderline personality disorder
Fear of abandonment Feeling empty Self-harm and suicidal behaviour Impulsivity Bouts of anger and intense emotions Inability to sustain relationships
5 key principles to address every patient under mental health act
- Treated as having capacity unless proven otherwise.
- Supported in making own decisions including availability of information in different formats (written, visual, auditory etc).
- Have right to make an unwise decision.
- Anything done for someone who lacks capacity must be done in their best interest.
- Anything done for someone who lacks capacity must be the least restrictive option available.
Section 2 of Mental Health Act
Detention in hospital for assessment of the patient’s mental health and potential treatment.
Lasts 28 days
Section 3 of Mental Health Act
Detention in hospital for treatment necessary for health of patient or protection of others.
Lasts 6 months
Section 5(2) of Mental Health Act
Doctor’s holding power of a patient for assessment under MHA. Lasts 72 hours.
Section 5(4) of MHA
Nurses holding power.
Lasts 6 hours.
Section 136 of MHA
Police power to remove a patient from a public place to a place of safety for mental health assessment.
Section 135 of MHA
Police power to enter private home and remove patient to place of safety for mental health assessment.
Name 5 classes of a antidepressants
Selective serotonin re-uptake inhibitor (sertraline)
Non-selective serotonin re-uptake inhibitor (venlafaxine)
Monoamine oxidase inhibitors (moclobemide)
Tricyclic antidepressants (amitriptyline)
Mirtazepine
Side effects of SSRI
Nausea and vomiting Sexual dysfunction Make anxiety and suicidal ideation worse initially Weight gain Sleep disorder SEROTONIN SYNDROME DISCONTINUATION SYNDROME
What to tell a patient starting an SSRI
- don’t use St John’s wart.
- suicide and anxiety may be worse initially.
- warn of other side effects e.g sleep or sexual dysfunction.
- will continue drug for a while even when you are feeling better.
Monoamine oxidase inhibitor side effects
e.g Moclobemide. Constipation Hypotension Sleep disorder Nausea
HYPERTENSIVE CRISIS with tyramine rich food.
Tyramine food = mature cheese, salami, pickled herring, Marmite®.
Side effects of tricyclic antidepressants
e.g. Amitriptyline.
Long QT interval - palpitations
Dizzyness, sleep disorder
Anticholinergic syndrome symptoms = dry mouth, flushed, urinary retention.
What is anticholinergic syndrome and what drugs cause it
“red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, full as a flask” = flushed, dry mouth, mydriasis, altered mental state, fever and urinary retention.
TCA, anti-psychotics e.g. Haloperidol, Olanzapine, anti-convulsants e.g. Carbamazepine.
Side effects of mirtapezine
Sedative!! (good for old people before bed 😴)
Weight gain
Sleep disorder
Serotonin syndrome S+S and Mx
Mental state = agitation, pressure of speech.
Autonomic instability =tachycardia, diarrhoea, shivering, dry eyes.
Neruomusclar abnormalities = tremor, cloys, hyperreflexia
RX = hydrate, ensure body temp is not too hot/cooloing, benzodiazepines, cyproheptadine.
What must be satisfied for detention under MHA
Presence of a mental disorder
In-patient treatment is appropriate, available and necessary.
Treatment is necessary for health and safety of the patient.
Definition of gender dysphoria
Distress due to a person’s biological sex and associated gender roles (assigned at birth) and that which the person’s senses as their own identity or gender.
not all gender non-conforming people experience dysphoria.
Cisgender
Identify with sex signed at birth
Management of gender dysphora
- Gender identity clinic
- Endocrine investigations
- Psycho-social assessment of occupational, social and family circumstances. Advice on medical and legal consequences.
- SALT therapy.
- Psychotherapies e.g. CBT.
- Endocrine treatment.
- Trans-male = facial hair removal, genital reconstruction/testicular prosthesis, mastectomy. etc etc
- Trans-female = orchidectomy, vaginoplasty,
Questions to assess suicide risk
Do you ever think about suicide?
Have you made any plans for ending your life?
Do you have the means for doing this available to you?
What has kept you from acting on these thoughts?
Risk factors for suicide
Previous attempts Male Single / living alone Substance or alcohol misuse Recent initiation of SSRI therapy
De Clerambault’s delusion
Famous person is in love with the patient
Cotard’s syndrome
some part of the patient’s body is dead.
