summary Flashcards
psychiatric history
confientiality
demographics
PC - impact, timing
past pychiatric history
past medical history
family history
medications and allergies
personal history - education, relationships, childhood
forensic history
drug and ETOH
social history - housing, supports
systems review and risk assesssment
MSE
sytems review
depression - mood, apetite, sleep
mania - impulsivity, flight of ideas, lack of sleep
anxiety - worry, panic attacks
psychosis - delusions, thought content
ED - laxatives, frequent weighing
PTSD - trauma, flashbacks, nightmares
OCD - obsessions, comppulsions, checking
organic causes - endocrine, neurological
risk assessment
- thought, plan and inent for suicide
- risk to others eg. dependants
- unintentional risk eg. medical compromise due to ED, neglect due to amotivation, risk to reputation due to disinhibition
mental state examination
A ppearance and behaviour
S peech - rate, tone, fluency
E motions - mood and affect and congruence
P erception - hallucination, derealisation
T hought - form, content
I nsiight
Cognition
RISK
management
disposition - if the patient is at risk and not amenable to voluntary admission
biological - organic screen
psychological - psychoeducation, CBT, medication
social - SW, ALO, support groups, employment
organic screen
bedide - BSL, urine drug screen
laboritory - FBC, UEC, CMP, LFT, ESR, ANA, prolactin, TFT, vit B12/folate, Fe studies, hepatitis serology, sypphilis serology, HIV serology, coppper and ceruloplasmin (wilson’ss disease), vit D
consider imaging - MRI/CT
baby blues vs. perinatal depression
baby blues is up to 2-4 weeks post delivery and is milder and more transient
PND is longer, can occur prriorr to delivery
clinical presentation of postnatal depression
sadness, loss of interest
brain fog
peersisant worry - checking on baby, not leaving baby with other people, worry they dont love the baby enough
somatic symptoms - nausea, vomiting, palpitations
misuse of ETOH
edinburgh postnatal depression scale
completed at 12 weeks and at 28-30 weeks
mental health should also be assessed at the six week check
managment of post natal depression
risk assessment
disposition - consider need for admission to mother and baby unit
general management - build trust, validate, psychoeducation, empower
specific management - psychotherapy first line for mild/moderate, SSRI for severe (sertraline). address risk factors, consider support groups
follow up
safety net - ED, lifeline
HEEADSSS assessment
*confidentiality
Home
Education and employment
Eating and exercise
Activities
Drugs
Sexuality
Suicide
Safety
the two Es
education and employment
eating and exercise
the three Ss
sexuality
suicide
safety
how to ask about HEEADSSS
Home - relationship with family, do you feel safe
Educataion - school or working, performance, friends, plans
Eating - stress about body, recent changes to exercise
Activties - hobbies
drugs - alcohol, vaping
sexuality and gender - preamble, normalcy, gender identitity, relationships
suicidality - self harm, thought about taking your own life
safety - anything making them feel uncomfortable or treatened
serotonin syndrome
think like MDMA, aantidepressants
1. neuromuscular hyperactivity - clonus, hyperreflexia, hhypertonia, tremour, seizure
2. autonomic stimulatiion - hyperthermia, diarrhoeaa
3. agitation
