SAQ Psych

Question 1

Safety

Answer 1

SADPERSONS and PAMSCANS

Sex, age, depression/hopelessness, previous attempts, ethanol/substance abuse, rational thinking loss, social/cultural support, organised plan, no friends, stated future plan

Psychosis, anxiety, mood, suicide, concentration, ahendonia, nutrition, suicide

Question 2

PAMSCANS

Answer 2

Psychosis, anxiety, mood, suicide, concentration, ahendonia, nutrition, suicide

Question 3

Depression

Immediate Management:

Answer 3

Immediate management. Admit. No beds at the moment. We can use the psch room in ED in the short term. If suitable, consider the SSU or a medical bed if safe. Psych danger to herself and/or others? Push for acute CATT asses. Start planning for care of child. ? Paeds asses.

Pharmacology: If agitated consider acute bendzo. – Need to find alternative feeding for baby ?Express some milk first then benzos. Short term management of agitation, sleep difficulties and anhedonia with these. View to use of fluoxetine in the medium long term. Start sooner rather than wait.
Medically FBC, toxicology, thyroid, LFTs, rule out medical causes.

Psychological: Push for acute asses. Get her fed and to sleep. Reassure about baby and immediate future. Organise appropriate family and cultural supports. ?Financial worries.
Medium term. Diet. Exercise. Sleep guidance. Finincial asses ?support. Education. Wider issues/other stressors.

Family: Reassure husband. Discover family situation in terms of Whanau beliefs/systems. Investigate family Hx of pych problems. Care plan for Rangi. Check social support networks. Education/information for appropriate family members (Husband).

Cultural: What are the families cultural beliefs? Are they the same as patients? Are the “hallucinations” culturally based? What are the cultural needs of the patient and family? Is there a place here for Maori liason or Maori Mental health teams?

Question 4

Panic Attack DDx

Answer 4

Psych GAD
Performance Anxiety Disorder
Somatiform Disorder
Bipolar disorder

                    Medical     Heart Disease
                                Reflux
                                Thyroiditis
                                Substance abuse
                                Menieres

Question 5

Positive symptoms:

Answer 5

• Auditory Hallucinations
• Delusions – Ideas of reference, Delusions of paranoia; mind reading & control
  (passivity) thought insertion/broadcasting
• Disordered thought (flight of ideas, loosening of associations)
• Disorganised behaviour (catatonia)

Question 6

Negative symptoms:

Answer 6

• Poverty of thought
• Affect blunting
• Apathy
• Alogia
• Social withdrawal

Question 7

Alleviation of psychosis and distress

Answer 7

· Consider some sedatives eg Benzodiazepines, possibly regular Lorazepam
· Consider help with sleep eg PRN Zopiclone
· Consider anti-psychotics eg Risperidone/Olanzapine
· Consider treating for depression if symptoms present eg SSRIs