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163 Cards in this Set
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- 3rd side (hint)
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What is R & R ?
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Request (MH act 2000, s16A)- any adult, reasonable belief of mental illness, saw pt in 3/7
Recommendation (MH act 2000, s16(b) & 49(a)) - doctor or MH practioner, fulfill the criteria of s13 of the Act), saw in 3/7 |
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What is a JEO
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Justice examination order - from magistrate/Justice of Peace, lasts 1/52
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What is an EEO
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Emergency examination order
-Police/ambulance officer || psyciatrist -No more than 6/24 examination time |
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What is Wernick's classic triad
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Triad 10% only: (Can Alcoholism be Overcome, confused ataxis optometrists) Opthalmoplegia (LR6), Ataxia, Confusion
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Korsakoffs syndrome
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RACK
-Retrograde amnesioa -Anterograde amnesia -Confabulation -Kan't be bothered (loosing interest quickly) |
RACKorsakoff
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What is suboxone
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bupreorphine + naloxone
will produced withdrawal symptoms if injected by dependent person (but not if non-dependent). |
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What is norspan
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Buprenorphine = subutex
-Bioavailability ~50% -halft life 37hrs -partial agonist (receptors not-described in this card) |
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What is zyprexa
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Olanzapine
Antipsychotic drug |
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What is prozac
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Fluoxetine
SSRI |
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What is seroquel
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Quetiapine
short-acting atypical antipsychotic |
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What is clozapine
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Atypical antipsychotic, first of the atypicals
causes neutropenia 3%, fatal agranulocystosis 1% Action D2, D4, 5HT-2 Effective in treatment resistance cases |
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Acting out
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Behavioural response to unconscious drive, brings partial relief of inner tension. Releif attained by reacting to present situation as if it were the original situation which gave rise to the tension. Common in boarderlines
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Affect
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The subjective and immediate experience of emotion attached to ideas or mental representations of objects.
Described as: restricted, blunted, flattened, broad, labile, appropriate or inappropriate |
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Akathisia
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subjective motor restlessness, compelling need to be in constant movement; may be seen as extrapyramidal adverse effect of antipsychotic medication. May be mistaken for psychotic agitation
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alexthymia
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inability to describes ones mood
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ambivalence
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coexistance of two opposing impluses towards same thing/same time
schizophrenia, boarderline states, OCDs |
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anxiety
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feeling of apprehension caused by anticipation of danger, which may be internal or exteral
NOTE: contradicts definition by Dr on 25/09/2013 |
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Auditory hallucinations
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false perception of sound, usually voices, but also other noises such as music. MC hallucination
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Blocking
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Abrupt interuption in train of thinking before a thought or idea is finished; after a breif pause the person indicates no recall of what is being said or was going to be said (aka thought deprivation or increased thought latency.)
Common in anxiety, schizophrenia |
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catalepsy
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condition in which body position is maintained in the position placed
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Lepsy (stays) vs plexy (loss of tone, emotional)
Lepers stay, players loose tone |
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Cataplexy
Lepers stay, players loose tone |
tempory sudden loss of muscle tone, weakness and immobilisation, precipitated by emotional states, followed by sleep
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circumstantiality
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disturbance in the associative thought and speech processes in which a patient difresses into unnecessary details and inappropriate thoughts before communicating the central idea. Seen in: schizophrenia, obsessional disturbances, and certain cases of dementia
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Clang association
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association or speech directed by sound of a word rather than by its meaning; words have no logical connection; punning and rhyming may dominate the verbal behaviour. Seen more frequently in schizophrenia or mania
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Clouding of consciousness
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any disturbance of conciousness in which person is not fully aware, alert, orientated. Delirium, dementia, cognitive disorder
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compulsion
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pathalogical need to act on impluse, else anxiety, repeditive behaviour in response to an obsession or performed according to certain rules, with no true end in itself other than to prevent something from occuring in the future
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delusion
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false belief, based on incorrect inferences from reality, firmly held despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture to not share the belief
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delusion of reference
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false belief that behaviour of others refers to self, or events/objects/other people have unusual significance
compare: Ideas of reference |
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derailment
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gradual or sudden deviation in train of thought without blocking; sometimes synonymous with loosening of association
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derealisation
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sensation of changed reality/changes in ones surroundings
schizophrenia, panic attacks, dissociative disorders |
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denial
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dealing with emotional conflict stressor by reflusing as aspect of reality
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displacement
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deals with emotional conflict by transferring response to one object to another
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splitting
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compartmentalisation of affect states, - thus things seen in alternative states of good or bad.
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Sublimation
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channeling of emotional conflict/internal/external stressors to socially acceptable behaviour eg. contact sports
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undoing
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individual makes amends to negate (even if symbolically) for unacceptable thoughts, feelings or actions.
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formal thought disorder
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disturbance in FORM rather than CONTENT of thought eg.
loosened associations, neologisms, illogical constructs, thought process disordered -> psychotic assoc: schizophrenia |
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neologism
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new word whose derivation can’t be understood
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word-approximations
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head-shoe = hat
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reaction formation (K&S pocket)
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deals with emotional conflict/external/internal stresses by substituting behaviour/thoughts/feeling diametrically opposed to his/her own unacceptable thoughts/feelings.
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Illusion
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misperceptions of external stimuli
eg. appearance of bush as man at dusk more likely if consciousness reduced or anxious |
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Hallucinations
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percept experienced in the absence of external stimuli to the corresponding sense organ
CMP illusion- experienced from an external origin, can’t be terminated at will |
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hypnagogic || hyponopompic hallicinations
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hypnagogic hallucination
on going to sleep hyponopompic hallucination on waking |
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psychosis (oxford shorter psych)
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shizophrenic, some organic and affective disorders
“inability to distinguish between subjective experience and external reality as shown by the presence of delusions and hallucinations” note: term abandoned in ICD/DSM |
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SAD PERSONS
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popular mnemonic for suicide risk
Sex(male) Age (elderly/adolescent) Depression Previous suicide attempts Ethanol abuse Rational thinking lost Social supports lacking Organised plan for suicide No Spouse Sickness (physical) |
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Conditions of compentency
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RAIDED
R = Receive, retain, recall A = Adhere to decision I = Integrate information D = Decision making E = Evaluate with moral code D = Defend decision |
RAIDED
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The 8 key MDD features
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SIG+Energy+CAPSules
-Sleep disordered -Interest deficit -Guilt (worthlessness, hopelessness, regret) -Energy deficit -Concetration deficit -Appetite disorder -Psychomotor retardation/agitation -Suicidality MDD = 4 neuro veg + depressed mood || anhedonia for 2/52 http://www.aafp.org/afp/1998/1101/p1617.html |
SIG Energy CAPS
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Cardinal symptoms of manic episode
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-Distractability
-Indiscretion -Grandiosity -Flight of ideas -Activity increased -Sleep deficit -Talkaltiveness (pressured speech) manic episode = 3/7 + elevate/irritable mood |
DIG FAST
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Medical causes of psychotic episodes (LITFL)
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epilepsy, +/- thyroid, huntingtons, wilsons, porphyria, B12 deficiency, cerebral neoplasm, stroke, viral encephalitis, neurosyphilis, AIDS
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DSM-4-TR criteria for schizophrenia
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Delusions Herald Schizophrenias Bad News
Delusions Hallucinations (though echo, commentary, arguing) Speech disorganization Behaviour disorganisation Negative symptoms (flat affect, paucity of speech, avolition 'lack of drive') |
Delusions Herald Schizophrenias Bad News
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Major depressive episode
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- Time course: 2 weeks or more
- Need Persistent low mood or anhedonia. - How many? Need 5 or more of the following in total. Mnemonic: SADAFACES/sig e caps S - Sleep disturbance (increase or decrease) A - Anhedonia D - Depressed mood A - Appetite disturbance (increase or decrease) F - Fatigue or low energy levels A - Agitation (psychomotor) or psychomotor retardation C - Concentration (reduced ability) E - Esteem - Feelings of worthlessness / Excessive guilt S - Suicidal ideation |
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Dysthymia
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- Time course: 2 years or more
(in children / adolescents, only need 1 year or more) - How many? Depressed mood AND 2 or more Mnemonic: ACHEWS A - Appetite disturbance (more or less) C - Concentration poor / indecision H - Hopelessness, feelings of E - Energy low / fatigue W - Worthlessness = low self esteem S - Sleep disturbance (more or less) |
ACHEWS
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Manic episode
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- Time course: 1 week or more
- Need abnormally and persistently 1) elevated, 2) expansive or 3) irritable mood - How many? Need 3 or more (4 or more if irritable) Mnemonic: DIGFAST D - Distractability I - Indiscretion (excessive involvement in pleasurable activities that have a high potential for painful consequences - eg. buying sprees, sexual indiscretion, bad business investments) G - Grandiosity / inflated self-esteem F - Flight of ideas - thoughts racing A - Activity increase - more goal directed activity S - Sleep reduction - only need small amount of sleep T - Talkativeness - more talkative, or pressured speech |
DIG FAST
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Hypomanic episode vs manic episode
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Time: 4 vs 7 days
As per manic EXCEPT- -No marked impairment in social/occupational function -No psychotic features |
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Bipolar Disorder - what are the different types?
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Type I Bipolar disorder - manic episode with/without other types of mood episodes (ie. can have Bipolar Disorder - Single episode manic)
Type II Bipolar disorder - Recurrent major depressive episodes with hypomanic episodes |
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Side effects of SSRIs
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Royal College Psych:
SSRI Weeks -Anxiety, nausea, indigestion (take with food), sexual (libido, anorgasmia, ejaculatory disturbance. -most get fews and resolve after a few weeks rare -difficulty urinating, confusion, increasing forgetfulness, ?suicidal thoughts Note: -Withdrawal symptoms (GIT/flu/anxiety/nightmares) -Risk of serotonin syndrome |
Royal College Psych:
SSRI Weeks -Anxiety, nausea, indigestion (take with food), sexual (libido, anorgasmia, ejaculatory disturbance. -most get fews and resolve after a few weeks rare -difficulty urinating, confusion, increasing forgetfulness, ?suicidal thoughts Note: -Withdrawal symptoms (GIT/flu/anxiety/nightmares) -Risk of serotonin syndrome |
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Generalised Anxiety Disorder
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Mnemonic: Macbeth Frets Constantly Regarding Illicit Sins
M - Muscle tension C - Concentration difficult / mind going blank F - Fatigued easily R - Restlessness (feeling keyed up / on edge) I - Irritability S - Sleep decrease (difficulty falling / staying asleep / restless sleep) |
Macbeth Frets Constantly Regarding Illicit Sins
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Borderline Personality Disorder
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Mnemonic: I DESPAIRR
I - Identity disturbance - unstable sense of self D - Disordered affect - reactive mood, lasts a few hours E - Emptiess, chronic feelings of emptiness S - Self-harm / suicidality - recurrent threats, gestures etc) P - Paranoid ideation or severe dissociative symptoms A - Abandonment, fear / frantic efforts to avoid I - Impulsivity in at least 2 areas that are potentially self-damaging (ie drugs, reckless driving, binge eating) R - Relationships unstable and intense - ie. splitting... R - Rage, inappropriate, difficulty controlling anger |
I DESAPAIRR
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Suicide risk stratification: TRAAPPED SILO SAFE/FAST mnemonic
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TRAAPPED
Trigger Rational thinking loss Age (15-24, > 65; more leathal, less warning) Previous attempts Previous psychiatric care Excessive EtOH/other drugs Depression, hopelessness Sickness Ideation (SI) ; 78% of psych inpatients who completed gave NO warning Lack of Social Supports Organized or serious plan (more detail, more risk) Social Support Awareness (insight/coping) Future Orientated Engaged in therapeutic process Future/Awareness/Social/Therapeutic alliance |
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Altered perceptions vs false perceptions
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eg. sensory distorsions/illusions vs hallucinations/pseudo-hallucinations
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Primary vs secondary delusion
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secondary eg. can be understood in light of another disorder eg. MDD and delusions of poverty
primary - directly arising from pathological process |
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Confusion Assessment Method - 4 Features
OF-AID |
-Acute onset and fluctuating course
-Inattention -Disorganised thinking -Altered LOC |
OF-AID
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Conditions associated with Wernicke's encephalopathy
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-Chronic alcoholism
-Anorexia nervosa/dieting -Hyperemesis of pregnancy -Prolonged IV feeding without supplementation -prolonged fasting or starvation, esp with refeeding -Gastrointestinal surgery -Systemic malignancy -Transplantation -Haemodialysis/PD -AIDS |
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Path of Wernickes encephalopathy
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B1/Thiamine required for energy metabolism - higher requirement in high metabolic demand, high glucose.
-unclear how brain lesion caused ?neuronal injury in high metabolic demand in alcoholics - inadequate intake/reduced GI absorption/decreased hepatic storage, impaired utilization lesions 3rd/4th ventricles, mammilary bodies |
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Most reliable Lab test for thiamine levels
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Erythrocyte thiamine thrans-ketolase (EKTA)
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Substance abuse
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Tempted With Cognac
Tolerance | Withdrawal | Loss of Control |
Tempted with Cognac
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CAGE
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Felt should CUT down
Anybody ANNOYED with comments Felt GUILTY about drinking EYE OPENER to get rid of a hangover |
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Psychiatric review of symptoms - headings
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Depressed Patients Sound Anxious So Claim Psychiatrists
Depression/mood -MDD, BPAD, Dysthymia, SAD, Adjustment Psychotic disorders -Schizophrenia, schizoaffective, Delusional Substance abuse disorders -EtOH/other Anxious disorders -Panic disorder, agoraphobia, GAD, OCD, PTSD Somatoform disorders -Somatisation disorders, eating disorders Cognitive Disorders -Dementia, delirium, mental retardation, ADHD Personality disorders -PDs |
Depressed Patients Sound Anxious So Claim Psychiatrists
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GAD
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WATCHERS - 6 months - 3/6 (with worry & anxiety)
W - Worry A - Anxiety T - Tension in muscles C - Concentration difficulty H - Hyperarousal (irritability) E - Energy loss (fatigue) R - Restlessness S - Sleep disturbance |
WATCHERS
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OCD
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Washing and Straightening Make Clean Houses
Washing Straghtening Mental rituals Checking Hoarding |
Washing and Straightening Make Clean Houses
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PTSD
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T - Traumatic event occurred caused intense helplessness, fear, and horror
R - Reexperiences trauma (intrusive thoughts, nightmares, flashbacks, or images). A - Avoidance and emotional numbing emerge (detachment from others; flattening of affect; loss of interest; lack of motivation) U - Unable to function (significant impairment in social, occupational, and interpersonal functioning) M - Month > 1 A - Arousal (startle reaction, poor concentration, irritable mood, insomnia, and hypervigilance) |
TRAUMA
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Anorexia Nervosa (DSM-IV)
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Weight Fear Bothers Anorexics - 4/4
Weight - Weight <85% of ideal Fear - Fear of fat Bothers - Body image distortion Anorexics - Amenorrhea ICD-10 -15% below expected or BMI < 17.5 -self-induced avoidance, purging, excessive exercise, appetite suppressants, diuretics -body image distortions - overvalued idea, intrusive -endocrine disorder - sexual disinterest, amenorrhoea -if prepubertal delayed growth. |
Weight Fear Bothers Anorexics
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Bulimia Nervosa
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Bulimics OverConsume Pastries - 4/4
Bulimics - Bingeing Over - Out of Control feeling when eating Consume - Concern with body shape Pastries - Purging |
Bulimics OverConsume Pastries - 4/4
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Somatisation disorder
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4 pain - Four pain symptoms
convert - Conversion symptom (neurological) 2 stomachs - Two GIT Symptoms 1 sex - One sexual symptom |
4 pain: convert 2 stomachs to 1 sex
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Delirium assessment (FRAT boys get delirious)
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Medical cause
F - Fluctuating course (over course of day) R - Recent onset (days to weeks) A - Attention impairment T - Thinking impairment (memory deficit, disorientation, language disturbance or perceptional abnormalities) |
Fluctuating
Recent onset Attention impaired Thinking impaired |
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First line SSRIs for MDD (eTG)
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Citalopram
Escitalopram Fluoxetine Fluvixamine Paroextine Sertraline |
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Cotard delusion
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The Cotard delusion, Cotard's syndrome, or Walking Corpse Syndrome[1] is a rare mental disorder in which people hold a delusional belief that they are dead (either figuratively or literally), do not exist, are putrefying, or have lost their blood or internal organs. In rare instances, it can include delusions of immortality.[2] (WIKI DEF)
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How do neuroleptics cause hyperprolactinaemia, outcomes
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D2-dopamine receptor antagonism in the pituitary gland
Gynaecomastia Galactorrhoea Menstrual irregularities Impotence Weight gain |
at-a-glance
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How do neuroleptics cause EPSPs
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D2 antagonism at basal ganglia -
4 hrs - Dystonia 4 days akinesia 4 weeks - akathesia 4 months Tardive dyskinesia |
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Incidence of NMS, fatality rate
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1%, 15%
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Suggested monitoring for those on atypical antipsychotics
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ECG
Fasting blood glucose FBC BP U&Es LFTs Weight/BMI Waist/Hip |
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Extra monitoring for clozapine
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ECG, Troponin I, echo
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Progression of antipsychotic induced cardiac arrhythmias
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QT interval prolongation -> cardiac arrhythmia and torsade de pointes -> ventricular fibrillation
Risk proportional to QTc |
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Risk factors for anti psychotic induced fatal arrhythmia
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Major risk factors
- Structural heart disease (IHD, HF, LVH) - Congenital long QTc syndromes - FHx sudden death - Prior QTc prolongation or Torsade de Pointes -Electrolytes (hypoK+, HypoMg2+, HypoCa2+), kidney failure, HF, female gender |
http://www.watag.org.au/wapdc/docs/antipsychotic_guidelines_aug06.pdf
eTG |
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Why should sedation not be used for patients with ? raised ICP
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Hypercarbia -> increased ICP
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Recommendations for tranquilisation in psych setting
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Benzos > antipsychotics
Oral route if possible monitor vitals DO NOT USE DIAZ IM - unpredictable DO NOT USE chlorpromazine -> hypotension/abscess/sudden death Beware the oldies Beware of pregnancy |
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First line oral treatment of acute psychosis
Just DO it |
Diazepam 5-20mg,
possible add ons: -Their current meds -olanzapine 5-10mg, |
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First line IM treatment of acute psychosis
Putting the M in IM |
midaz 2.5-10IM per 20/60
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Treatment of acute mania
eTG |
Evidence for antipsychotics, in particular Olanzapine(1), risperidone(1).
ROmania Olanzapine - 5, 10, 30 OD -Caution using in conjunction with Benzos, LBD, CNS depressants, Long QT, anticholinergic effects, blood dyscrasia Often Li/Na Valproate used in conjunction |
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Treatment of alcohol withdrawal
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Diazepam 20mg q2hr up to 60mg
Thiamine 300mg IV/IM 3/7, then oral 300mg Delirium ? -haloperidol 0.5-2mg |
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Main presenting features of opioid overdose (eTG)
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CNS - CNS depression
Cardiovascular - dextroproproxyphene QRS widening, methadone QT prolongation/torsades GIT - Nausea, vomiting Respiratory effects - aspiration pneumo, noncardiogenic pulmonary oedema |
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Features of SNRI overdose
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delayed onset seizures, hypotension, arrhythmias, hyperthermia, severe serotonin toxicity
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Triad of serotonin syndrome (Don't use NAC -)
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Neuromuscular excitation
-hyperreflexia, clonus, ocular clonus, myoclonus, shivering, tremor, hypertonia, rigidity Autonomic effects -hyperthermia, diaphoresis, flushing, mydriasis, tachycardia Central Nervous System -agiation, anxiety, confusion |
neuromuscular, autonomic, CNS
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DDx serotonin syndrome
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Serotonin toxicity
Anticholinergic delirium CNS infection Malignant hyperthermia Neuroleptic malignant syndrome Non convulsive seizures Sympathomimetic toxicity |
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Brief psychotic disorder (eTG)
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Less than 2/52, hallucinations, delusions, though disorder predominate.
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Schizophreniform (eTG)
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Features of schizophrenia, but < 6/12
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Delusional disorder (eTG)
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presenting middle/late adult life - delusions (grandiose, persecutory, erotomania, somatic). Hallucinations may be present, but not predominate
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Schizoaffective
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Mood symptoms + schizophrenia
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Depot antipsychotic formulations
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Flupenthixol, Fluphenazine, haloperidol, paliperidone, risperidone, zuclopenthixol,
2nd line - olanzapine monitor q30/60 for 3/24 |
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First psychotic episode - first line tx
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Amisulpride
aripiprazole olanzapine paliperidone qeutiapine risperidone ziprasidone |
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First psychotic episode - first line tx
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Amisulpride
aripiprazole olanzapine paliperidone qeutiapine risperidone ziprasidone |
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What is BPSD (eTG)
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Behavioural and Psychological Symptoms of Dementia - usually transient, often respond to simple measures eg. removing an aggravating factor
eg. Aggression, agitation, screaming, anxiety, depression, psychosis, repetitive vocalisation, sleep disturbance, shadowing, sundowning, wandering, non-specific eg. hoarding |
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Frequency of BPSD in dementia (eTG)
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80%
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MC early symptom of dementia (eTG)
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impaired ability to learn and remember new information.
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Most common causes of dementia and frequency (eTG)
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-Alzheimers disease 50%
-Vascular 20% -Parkinsons & DLB 10% -Primary frontal demenitas 10% -Alcohol related 5% -AIDS |
6 items
Als Violent Plan Fran Alcohol Aids |
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Features of alzheimers disease (eTG)
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Insidious onset of forgetfulness -> profound impairment with dysphasia, dyspraxia, personality change
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Features of frontal dementia (eTG)
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Early: personality change and alteration in behaviour
Social disinhibition, work finding difficulty -> nonfluent dysphasia. Often apathetic and withdrawn later |
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Features of dementia with lewy bodies (eTG)
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2 of - visual hallucinations, spontaneous motor parkinsonism, fluctuations in mental state. Dementia in parkinsons will appear similarly
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2 Hallucinations, parkinsonism, fluctuations
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Features of vascular dementia (eTG)
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Sudden onset, focal neuro with CV disease. often present with mixed alzheimers/vascular picture
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DDx for patients presenting with a reaction to stress/trauma (Crashcourse)
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-Adjustment disorder
-Acute stress reaction -Post traumatic disorder -normal bereavement reaction -Dissociation disorder -Exacerbation or ppt of other disorders (mood, anxiety, psychotic disorders) |
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maximum length of 'normal bereavement reaction' in DSM-IV-TR
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2/12
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What law relates anxiety to performance
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Yerkes-Dodson Law
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Difference between 'fear' and 'anxiety' (crashcourse)
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Fear - response to threat that is external/known/definate
Anxiety - response to threat unknown/internal/vague |
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Classification of anxiety symptoms
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generalised vs paroxysmal
situational vs non-situational Reaction to stress vs not secondary to other disorders (psychosis, depression) secondary to drugs |
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Classify the anxiety disorders
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Non-situational
-panic -GAD Phobic -social -specific Reaction to stress -ASR -PTSD -Adjustment OCD Secondary to psychotic condition Secondary to GMC Secondary to drugs |
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The Big Fiver personality traits
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OCEAN
Openness to experience Conscientiousness Extraversion Agreeableness Neuroticism |
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Define transference reaction
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unconcious emotional reaction of patients to physicians - based on previous child-parent relationships
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Positive transference
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patient regards physician highly, without having done anything.
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Negative transference
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unjustified resentment/anger of patient toward physician
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Countertransference
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Physicians idiosyncratic reaction to patient - physicians may feel guilty when unable to help/remind them of a relative/friend
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Evaluation of Appearance
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Posture
Grooming Appearance for age Clothing |
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Evaluation of behaviour
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mannerisms: abnormal facial expressions
Psychomotor agitation/retardation" does she seem 'slowed down' Tics ? Eye contact ? |
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Evaluation of patients attitude to examiner
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Reliable
Cooperative Seductive Hostile Defensive |
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What is Hakim's triad ?
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Triad of Normal Pressure Hydrocephalus
-Gait instability -Urinary incontinence -Dementia (Demented urine gates) |
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Negative symptoms of schizophrenia
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Anhedonia
Anergia Avolition Affective flattening Lack of spontaneity |
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symptoms of anticholinergic delirium
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dilated pupils, hot/dry/flushed skin, tachycardia
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Pharm - risperidone/Risperidal/Consta
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Atypical antipsychotic
Ind: Schizophrenia PO start: 0.5-1 Therapy: 2mg nocte Max: 6mg SE: orthostatic hypotension, inc prolactin |
*Toms notes
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Pharm -
Olanzapine |
Atypical antipsychotic
Ind: schizophrenia PO start: 5mg Therapy: 10mg Max: 60mg SE: sedation, rapid weight gain |
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Pharm-
Clozapine |
Atypical antipsychotic
Ind: treatment resistant schizophrenia start:12.5->25->50 therapy:200-600 Max: 900 SEs: agranulocytosis |
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Pharm-
Haloperidol |
Typical antipsychotic
Ind: second-line schizophrenia start: 1.5 therapy: 2-10 max: 10 QTc prolongation, EPSPs, increased prolactin |
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Pharm-
Chlorpromazine |
Typical antipsychotic
Ind: 2nd line treatment start: 200mg therapy: 200-800 max: 800mg SE; sedation, anticholinergic, EPSPs, orthostatic hypo, weight gain, metabolic, increased prolactin |
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Pharm:
Mirtazapine |
Ind: Depression 2nd line PTSD
Start: 15-30 therapy: 30-45 max: 60 |
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Pharm:
Venlafaxine |
Ind: depression, anxiety
start: 75mg therapy: 75-225 Max: 375 SE: nil noted |
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Pharm:
(Li)2CO3 |
Ind: Mania
start: 750-1000 therapy: 1000-2000 Max: 0.9-1.4 -> toxic |
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Pharm:
Na Valproate |
Ind: Mania
start: 200-400 therapy: 1000-2000 max: 3000 |
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Pharm:
Midazolam |
Ind: acute behavioural emergencies, agitation in delirium
Start: IMI/SC 2.5-5 therapy: 5/10mg Max: 20 IMI / 10 SC |
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Pharm:
Lorazepam |
Ind: Acute behaviour - Medium acting
Start: 1-2mg Max: 10mg |
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Pharm:
Diazepam |
Ind: alcohol withdrawal, anxiety, agitation, parasomnias, acute behaviour
start: 1-20mg therapy: +20mg q2 Max: 100mg |
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Pharm:
Benzotropine |
Ind: EPSEs
1-2mg bd |
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PTSD diagnosis - eTG
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3 Clusters, more than 1 month
Re-experiencing (nightmares, flashbacks) Hyperarousal (irritability, sleep disturbance) Avoidance and numbing (deliberate attempts, loss of interest in activity, restricted emotional responses) |
Re-experiencing
Hyperarousal Avoidance/numbing Avoiding Hyper experiencing |
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Mature defense mechanisms (SASH)
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Suppression
Altruism Sublimation Humor |
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Neurotic defenses DD RRR
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Denial
Displacement Repression Reaction formation Rationalisation |
DD RRR
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Immature defenses PAP ds
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Passive aggression
Acting out Dissociation Projection Splitting (idealisation/devaluation) |
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Psychotic defenses Denial & distorsion
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Denial of external reality
Distortion of external reality |
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What is ARCHARSE ?
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Arse of an Arch.
therapeutic Alliance Risk Assessment Clarify diagnosis Hospitalisation yes/no Acute management Referrals (ie allied health) Services (Ie. everything else) Extended management |
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NMS symptoms
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FALTER
Fever Autonomic Instability Leukocytosis Tremor Elevated enzymes (ie CK) Rigidity of muscle |
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How effective are antidepressants in treating Moderate to severe depression
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after 3/12, about 50% will be much improved (vs 30% placebo)
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What is CBT ?
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Address the cognitive and emotional process that maintain psychopathology.
Includes a wide array of interventions including -goal setting -Cognitive-behavioural assessment -Self monitoring -Cognitive restructuring -Problem solving -Hehavioural activation/activity scheduling -relapse prevention Exposure therapy |
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Longterm outcomes of treatment of AN
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50% - normal weight, eating, menses
1/3 intermediate ~20% remainder poor suidice risk = 1.5 * MDD mortality 12 * normal Often become EDNOS |
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Guidelines for inpatient admission of AN
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Medical: bradycardia (40) BP < 90/60, low K+, temp ?incomplete?
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SE of SSRI/SNRI by VOPP
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Agitation/anxiety
headache Nausea Dirrhoea Sleep disturbance Sexual Weight gain Extra-pyramidal |
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DDx MDD (BestPractice)
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situation adjustment reaction with depressed mood (adjustment disorder?)
Bipolar disorder Premenstrual dysphoric disorder Grief reaction inappropriate guilt, persistant thoughts of death, morbid preoccupation after 4-6/12 assess for depression Dementia cognitive/psych/personality MMSE, TSH, B12 Anxiety disorders co-morbid GAD/specific anxiety disorder Alcohol abuse CAGE Anorexia nervosa Dx Hypothyroidism TSH Medicines glucocorticoids, interferon, levodopa, propranolol, OCP Cushings obesity, derm, adrenal androgen excess 24hr free cortisol B12 deficiency serum vitamin B12 |
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Bipolar disorder (BEST PRACTICE)
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Mood disorder due to GMC
eg. stroke, thyroid, MS Substance induced mood disorder UDS, withdrawal may take 4/52 Major depressive disorder Dysthymic disorder 2 symptoms for 2 years Cyclothymia 2 years with hypomanics Psychotic disorders schizophrenia, schizoaffective, delusional disorder personality disorder Obsessive-compulsive ADHD |
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Post-natal depression ddx (Bestpractice)
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Psych dx
Minor mood disorder transient libility no worthlessness/hopelessness/suicidality postnatal psychosis v. high risk if BPAD, puerperal psychosis BPAD Postnatal symptoms unrelated to depression sleep/weight change Med dx thyroid dysfunction anaemia organic brain dysfunction exogenous toxins/hormones |
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GAD ddx(Bestpractice)
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Psych DDx
Panic disorder social phobia Obsessive complusive Post traumatic stress somatoform depression Substance or drug induced anxiety disorder CNS - depressant withdrawal Anorexia nervosa Situational anxiety (non-pathological) Adjustment disorder medical DDx Cardiac disease (angina) pulmonary conditions (asthma, COPD) Infection (TB, viral) Peptic ulcer disease (if GIT symptoms) Crohn’s disease (if GIT symptoms) IBS (dx of exclusion) |
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Personality disorder ddx (BestPractice)
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Psych ddx
Mood disorder psychotic disorder anxiety disorder substance-related disorder personality change due to GMC (head trauma, endocrine) Sub-threashold personality traits (not rigid/maladaptive/stable/linked to impairment) |
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Psychotic disorders ddx (Bestpractice)
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Psych ddx
Schizophrenia delusional disorder MDD with psychotic features Dementia with psychosis Bipolar with psychosis Malingering/factitious Medical ddx Recent substance use (UDS) Seizure disorder EEG/MRI/CT Organic psychosis CO poisoning Heavy metal (mercury) Medicine induced psychosis Syphilis quaternery serum & CSF: VDRL, RPR, Trep pallidum, other Sarcoidosis serum ACE increased, MRI/CT/CXR Lung Ca MRI/CT for ets, CXR/CT Thyrotoxicosis TSH Head trauma MRI/CT |
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Anorexia nervosa ddx (Bestpractice)
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Psych ddx
Bulimia nervosa depression Med dx hyperthyroidism Type 1 DM Crohns disease Ulcerative colitis OCD (important as medication is effective) Cancer HIV infection |
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Bulimia nervosa ddx (BestPractice)
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Psych ddx
Eating disorder not otherwise specified affecting normal function, not BN/AN Anorexia nervosa - binge-eating purgingin subtype note: pathological fear of gain leading to LOSS BMI/body fat lower -> hypothermia, bradycardia, anaemia Binge-eating disorder obese Kleine-levin syndrome MDD in up to 50% Anxiety/substance/personality disorders Med ddx Hyperemesis gravidarum |
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Dementia ddx (Bestpractice)
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ddx
Mild cognitive impairment delirium depression Alzheimers demenia Vascular dementia Lewy body dementia Uncommon- amnestic syndromes Aphasia Frontotemporal dementia Parkinsons disease Huntingtons disease Brain tumours Cushings syndrome hypopituitarism thyroid wilsons B12 TBI TB syphilus SLE sjogrens sarcoid Medications Toxins Normal pressure hydrocephalus CJD |
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DDx Delirium
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Common -
Dementia Pain Stroke/cerebrovascular accident and transient ischaemic attack Myocardial infarction Acute systemic infection Hypoglycaemia Hyperglycaemia Hypoxia Hypercarbia Acute urinary obstruction Medication- or illicit drug-related Alcoholic ketoacidosis Hepatic encephalopathy Renal failure Inc Na+, Dec Na+ Inc Ca2+ Meningitis/encephalitis Brain tumour Post-ictal state Dehydration (volume depletion) Constipation |
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Sub classification of delirium
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1. - hyperactive; agitation hallucinations, inappropriate behaviour
2. - hypoactive; lethargy, reduced motor activity, incoherent speech, lack of interest 2. - Mixed delirium |
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Key Dx features of Fronto-temporal dementia (Bestpractice)
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Coasening of personality/habbits
Loss of language fluency Development of memory impairment Progressive self-neglect |
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Memory BREW
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Dx dementia -
memory impairment + Behaviour disorganised Recognition Impaired Executive function impaired Word problem |
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Fatal complications of refeeding syndrome
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The 5Cs
-Arrhythmia -Confusion -Coma -Convulsion -Cardiac failure *wiki |
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