Sike 2

Question 1

tic disorder/tourette’s

Answer 1

1. most cases reassurance and education
   + bio psycho social (reassure that a lot of children grow out of it)
2. if severe then refer to specialist developmental clinic
   bio- antipsychotics eg haloperidol, risperidone
   psycho: CBT Habit reversal
   social: school, manage comorbidities eg do they have comorbid ADHD, OCD etc

Question 2

schizophrenia pathways involved in:
positive symptoms
negative symptoms
extrapyramidal symptoms
prolactinaemia

Answer 2

positive = mesolimbic
negative = mesoCORTICAL
nigrostriatal = extrapyramidal
tubuloinfudibular pathway = prolactinaemia

Question 3

schizophrenia diagnosis criteria (rachel mentioned to screen for these in hx)

Answer 3

Paces need to ask these questions:
hallucinations 
delusions  
passivity (do you feel like someone else is controlling you)
thought disorder 

Negative symptoms:
poor volition (socially isolated/wont leave bedroom, withdrawn)
poor cognition
blunted affect

these symptoms need to be present for >1 month for diagnosis

Question 4

define delusions

Answer 4

delusions (fixed, false, unshakeable belief that is out of context of a persons cultral, religious and social norms)

Question 5

anorexia criteria to screen for in history

Answer 5

BMI<18.5 OR rapid weight loss in short period of time

• Restriction of energy intake relative to requirements
• fear of weight gain
• Body image disturbance (undue influence of body weight or shape on self evaluation/denial of the seriousness of the current body weight)

Question 6

BUlimia nervosa criteria to screen for in hx

Answer 6

• over eating episodes (large quantity + lack of control)
• innapropriate compensatory mechanisms
• body image disturbance
• occur at least once a week for 3 weeks

Question 7

Questions to ask for eating disorders screen in paces

Answer 7

In PACES ask about: 
Change in weight
Talk through food in a  day
Fear of gaining weight
How feel when look in mirror
Compensatory behaviours
Physical symptoms 
Comorbid MH conditions (v common in eating disorders)
SHx,  stressors and protective factors

Some Physical symptoms of EDs to ask
• Increased sensitivity to cold
•  Dizziness and syncope
Constipation
• Amenorrhoea (in females not taking an oral contraceptive)

Question 8

social history protective factors tro ask

Answer 8

family/partner/job/school anything they enjoy that keeps them going. this guides management

Question 9

Risk Assessment

Answer 9

Risk to self:

• do you self harm
• have you previously been suicidal
• plans/wills

Risk to others:

what you are telling us (the voices/delusions etc) sounds horrible/scary. do you ever need to harm anyone/do anything to protect yourself? eg carrying a weapon

eg for severe depression:
sometimes people in your situation feel really scared and feel the need to harm others or carry a weapon around to protect themselves, has this ever happened to you