1) Mental health problems are common, with 1 in 4 people experiencing a problem each year. Depression is one of the most common disorders.
2) The Mental Health Act and Mental Capacity Act govern the care, treatment, and detention of people with mental health problems in the UK. The Mental Health Act allows for the involuntary detention of individuals, while the Mental Capacity Act establishes a framework for making decisions for those deemed to lack capacity.
3) Evaluating mental capacity involves determining if an individual can understand, retain, weigh and communicate decisions about a specific matter. Mental state exams and assessments of suicide risk are important diagnostic tools in psychiatry. A variety of medications are used to treat mental health conditions.
The document outlines the key aspects of conversion disorder including its definition, history, epidemiology, etiology, clinical features, diagnostic criteria, differential diagnosis, investigations, course and prognosis, and management. Conversion disorder involves symptoms or deficits affecting voluntary motor or sensory functions that are judged to have a psychological cause rather than a medical condition. It has been described since ancient Egypt and was further explored by Freud. Conversion disorder is more common in females and usually onset in late childhood to early adulthood.
This document provides an introduction to the field of psychiatry. It begins with definitions of key terms like psychiatry, psychology, psychotherapy and psychoanalysis. It then discusses the history of psychiatry, from early views of mental disorders as supernatural to modern biological perspectives. Famous figures in the field like Sigmund Freud, Anna Freud, Jean Piaget are mentioned. The document outlines concepts in phenomenology like delusions, hallucinations and classification systems like ICD-10 and DSM-5. It describes various sub-specialties within psychiatry such as addiction, biological, child and adolescent psychiatry.
The document provides an overview of psychiatry and mental health topics. It defines mental health according to the WHO as a state of complete physical, mental, social and spiritual well-being. More than two-fifths of total disabilities worldwide are due to mental illnesses such as schizophrenia, depression, and substance abuse disorders. It discusses classification systems for psychiatric disorders, biological, psychological and social factors in mental illnesses, and specific conditions such as mood disorders, psychotic disorders, personality disorders, and more.
Mood disorders are a category of mental illnesses that involve serious changes in mood. There are several types of mood disorders including major depressive disorder, dysthymic disorder, bipolar I, bipolar II, and cyclothymic disorder. Mood disorders are among the most common mental illnesses and have a lifetime prevalence of 5-20%. Females are twice as likely as males to experience a mood disorder. The highest incidence rates occur between the ages of 20-40 years old. Mood disorders are a major cause of disability and suicide worldwide. Biological, psychological, and environmental factors all contribute to the development of mood disorders.
Clinical features and Management of SchizophreniaDr Kaushik Nandy
This document provides an overview of the clinical features and management of schizophrenia. It discusses the history and evolution of definitions and diagnostic criteria from Emil Kraepelin's original description of dementia praecox to the current DSM-5 and ICD-10 classifications. Key points include Bleuler's 4 As and Schneider's first-rank symptoms, differences between DSM-5 and ICD-10 criteria, assessment approaches, treatment options including pharmacological and non-pharmacological interventions, factors influencing medication selection, definitions of treatment response, and evaluating non-response.
The document discusses various classification systems for mental disorders, including the ICD-10 (International Classification of Diseases), DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), and an Indian classification system. It provides details on the main categories of disorders classified in the ICD-10, including organic mental disorders, substance-induced disorders, schizophrenia and other psychotic disorders, mood disorders, neurotic disorders, and more. It also lists some of the biological, psychosocial, and socio-cultural factors that can cause mental disorders.
- Affective disorders include persistent mood disorders like depression that cause socio-occupational dysfunction. Depression is the most common mental disorder.
- The document outlines depression and bipolar affective disorder, their diagnostic criteria, clinical features, management, and when to refer patients. Depression is a leading cause of disability and its early identification and treatment improves outcomes. Bipolar disorder involves episodes of mania or hypomania with or without depression.
Dissociative disorders are characterized by a disconnection from reality through dissociative symptoms like detachment from one's body or loss of memory. The three main types are dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder. Treatment involves psychotherapies like CBT and EMDR as well as medications which can help manage related conditions. While difficult to treat, dissociative disorders can be managed through therapy and coping strategies.
The document outlines the key aspects of conversion disorder including its definition, history, epidemiology, etiology, clinical features, diagnostic criteria, differential diagnosis, investigations, course and prognosis, and management. Conversion disorder involves symptoms or deficits affecting voluntary motor or sensory functions that are judged to have a psychological cause rather than a medical condition. It has been described since ancient Egypt and was further explored by Freud. Conversion disorder is more common in females and usually onset in late childhood to early adulthood.
This document provides an introduction to the field of psychiatry. It begins with definitions of key terms like psychiatry, psychology, psychotherapy and psychoanalysis. It then discusses the history of psychiatry, from early views of mental disorders as supernatural to modern biological perspectives. Famous figures in the field like Sigmund Freud, Anna Freud, Jean Piaget are mentioned. The document outlines concepts in phenomenology like delusions, hallucinations and classification systems like ICD-10 and DSM-5. It describes various sub-specialties within psychiatry such as addiction, biological, child and adolescent psychiatry.
The document provides an overview of psychiatry and mental health topics. It defines mental health according to the WHO as a state of complete physical, mental, social and spiritual well-being. More than two-fifths of total disabilities worldwide are due to mental illnesses such as schizophrenia, depression, and substance abuse disorders. It discusses classification systems for psychiatric disorders, biological, psychological and social factors in mental illnesses, and specific conditions such as mood disorders, psychotic disorders, personality disorders, and more.
Mood disorders are a category of mental illnesses that involve serious changes in mood. There are several types of mood disorders including major depressive disorder, dysthymic disorder, bipolar I, bipolar II, and cyclothymic disorder. Mood disorders are among the most common mental illnesses and have a lifetime prevalence of 5-20%. Females are twice as likely as males to experience a mood disorder. The highest incidence rates occur between the ages of 20-40 years old. Mood disorders are a major cause of disability and suicide worldwide. Biological, psychological, and environmental factors all contribute to the development of mood disorders.
Clinical features and Management of SchizophreniaDr Kaushik Nandy
This document provides an overview of the clinical features and management of schizophrenia. It discusses the history and evolution of definitions and diagnostic criteria from Emil Kraepelin's original description of dementia praecox to the current DSM-5 and ICD-10 classifications. Key points include Bleuler's 4 As and Schneider's first-rank symptoms, differences between DSM-5 and ICD-10 criteria, assessment approaches, treatment options including pharmacological and non-pharmacological interventions, factors influencing medication selection, definitions of treatment response, and evaluating non-response.
The document discusses various classification systems for mental disorders, including the ICD-10 (International Classification of Diseases), DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), and an Indian classification system. It provides details on the main categories of disorders classified in the ICD-10, including organic mental disorders, substance-induced disorders, schizophrenia and other psychotic disorders, mood disorders, neurotic disorders, and more. It also lists some of the biological, psychosocial, and socio-cultural factors that can cause mental disorders.
- Affective disorders include persistent mood disorders like depression that cause socio-occupational dysfunction. Depression is the most common mental disorder.
- The document outlines depression and bipolar affective disorder, their diagnostic criteria, clinical features, management, and when to refer patients. Depression is a leading cause of disability and its early identification and treatment improves outcomes. Bipolar disorder involves episodes of mania or hypomania with or without depression.
Dissociative disorders are characterized by a disconnection from reality through dissociative symptoms like detachment from one's body or loss of memory. The three main types are dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder. Treatment involves psychotherapies like CBT and EMDR as well as medications which can help manage related conditions. While difficult to treat, dissociative disorders can be managed through therapy and coping strategies.
This document provides an overview of psychosis (psychotic disorder). It defines psychosis as an abnormal condition of the mind involving a loss of contact with reality. Some key signs and symptoms include hallucinations, delusions, disorganized thinking, emotional changes, and personality changes. Psychosis can be caused by factors such as genetics, trauma, other psychiatric disorders, medical conditions, drugs, and medications. The main types of psychotic disorders discussed are schizophrenia, bipolar disorder, psychotic depression, and schizoaffective disorder. Diagnosis involves interviews and exams to evaluate symptoms, while treatment primarily uses antipsychotic medications along with psychotherapy.
This document provides an introduction to psychiatry, including definitions of key terms like mental illness, psychology, psychotherapy, and psychoanalysis. It discusses the etiology (causes) of mental illness, which can include biological factors like genetics and brain damage, as well as psychological and social factors like childhood experiences, relationships, and poverty. It also describes features of mental illness, classifications of mental disorders, and the roles of professionals on the mental health team.
Bipolar disorder is a chronic illness that causes major shifts in mood and energy, impairing various areas of life. While not curable, effective treatment exists to control symptoms and the course of the disorder. Treatment may include hospitalization if the person is a danger to self or others or unable to function. Pharmacotherapy focuses on acute symptom suppression, continuation treatment to prevent symptom return, and maintenance treatment to prevent recurrence. Treatment options include mood stabilizers, antipsychotics, antidepressants, anticonvulsants, and combination drugs. Prognosis depends on factors like episode duration, age of onset, and substance abuse history. Psychotherapy and support groups can also help manage the disorder.
information regarding psychopharmacology especially for nursing students and community. covers all group like anti psychotic, anti anxiety, antidepressants, mood stabilizing agents etc.
Trauma & Stressor Related Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
Adjustment disorder is a maladaptive reaction to an identifiable psychosocial stressor that occurs within 3 months of the stressor's onset and causes social or occupational impairment beyond what would be expected. It is a very common disorder, affecting about 10% of people in some studies. Adjustment disorder is diagnosed using the DSM-5 or ICD-10 and treated with psychotherapy, support groups, medication, or a combination. Developing strong social support networks and living a healthy lifestyle can help prevent adjustment disorder.
Mood disorders include conditions like depression and bipolar disorder. They are caused by biological factors like chemical imbalances, medical conditions, substance abuse, and genetics. Common symptoms include changes in mood, sleep, appetite, concentration, and energy levels. Mood disorders are classified based on symptoms and include types of depression like major depressive disorder and bipolar disorder. Diet and lifestyle factors can help manage mood disorders while early detection and treatment can reduce severity and improve quality of life.
Mood disorders:major depressive and bipolar disorderNandu Krishna J
a basic description about mood disorders mainly MDD and bipolar disorder. Can be made useful in presentations and theory exams. Subject was imbibed from different presentations and DSM IV manual. Thanks for viewing.
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
This document provides an overview of electroconvulsive therapy (ECT). It discusses the history of ECT, including its development in the 1930s as a safer alternative to earlier convulsive therapies. The document defines ECT as the induction of a seizure through electricity to treat various mental health conditions. It outlines the indications for ECT, including severe depression, mania, and catatonia. The document also discusses contraindications, administration procedures, types of ECT (bilateral and unilateral), potential complications, and the roles of the treatment team.
Post traumatic stress disorder (PTSD) mamtabisht10
Post traumatic stress disorder (PTSD) is a stress related disorder (DSM5) is characterized by inability to adjust or recover after witnessing or experiencing a traumatic or life threatening event.
Mood disorders are characterized by episodes of depressed or manic mood. They are caused by biological, psychological, and social factors. Common types of mood disorders include major depressive disorder and dysthymic disorder, which involve emotional, cognitive, somatic, and behavioral symptoms. Treatment involves psychotherapy such as CBT, medication like SSRIs, or electroconvulsive therapy in severe cases. Mood disorders are highly prevalent and affect women more than men.
Mania is an abnormally elevated mood state characterized by inappropriate elation, irritability, insomnia, grandiose notions, increased speech and thoughts, and poor judgment. It is caused by biological and psychosocial factors and can be treated with mood stabilizers, antipsychotics, ECT, and psychotherapy. Nurses assess severity, monitor for injury/violence risks, address nutrition issues, and support social interaction for patients experiencing mania.
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
Depression is a state of low mood and loss of interest that affects thoughts, feelings, and physical health. It is characterized by feelings of sadness, anxiety, guilt, and fatigue. Depression is a common disorder that affects about 15% of the population. It has various causes such as genetic factors, neurotransmitter imbalances, life stressors, and lack of social support. Treatments include antidepressant medication, psychotherapy, and physical therapies like electroconvulsive therapy. Preventing depression involves managing stress, getting social support, and maintaining a healthy lifestyle.
Diagnosis and management of major depressive disorderNeurologyKota
This document provides information on major depressive disorder and dysthymic disorder, including their symptoms, classifications, prevalence, risk factors, pathophysiology, diagnostic criteria, sleep abnormalities seen in depression, and treatment options. It discusses antidepressant medications like TCAs, MAOIs, SSRIs, SNRIs, augmentation therapies, psychosocial therapies, and ECT in the treatment of depressive disorders.
Dysthymia, or persistent depressive disorder, is a chronic form of depression that lasts for at least two years in adults and one year in children. Common symptoms include feelings of negativity, low self-esteem, and changes in appetite and sleep patterns. Approximately 3-6% of Americans experience dysthymia at some point. Women and African Americans have higher rates than other groups. Causes may include genetic, biological, environmental, and psychological factors. Treatment options include yoga therapy, which can help regulate mood and reduce stress through gentle stretching, breathing, and meditation exercises.
The document provides an overview of mood disorders according to ICD-10 criteria and theories of depression and bipolar affective disorder. It describes the ICD-10 classification of affective disorders including depressive disorder, recurrent depressive disorder, and persistent mood disorder. It then covers biological, psychodynamic, behavioral, and cognitive behavioral theories of depression. For bipolar affective disorder, it discusses the social zeitgeber hypothesis, behavioral approach system dysregulation theory, and an integrated model.
This document summarizes a psychiatric assessment of a 45-year-old woman presenting with low mood and thoughts of self-harm. She has a history of depression and was feeling gradually lower in mood over 6 weeks after stopping her medication and losing her dog. On examination, she made little eye contact, was anxious, and reported a very low mood with thoughts of self-harm but no current suicidal ideation. The assessment formulates her presentation as a depressive episode.
This document provides instructions for performing various clinical skills assessments including: resuscitation, assessing peripheral pulses, measuring blood pressure, examining the cardiovascular and respiratory systems, performing an electrocardiogram, assessing peak flow, and using a vitalograph machine. Key steps are outlined for each skill, such as procedures for opening an airway, performing chest compressions, locating and feeling different pulse points, correctly applying a blood pressure cuff, examining heart sounds and murmurs, and interpreting vital sign readings.
This document provides an overview of psychosis (psychotic disorder). It defines psychosis as an abnormal condition of the mind involving a loss of contact with reality. Some key signs and symptoms include hallucinations, delusions, disorganized thinking, emotional changes, and personality changes. Psychosis can be caused by factors such as genetics, trauma, other psychiatric disorders, medical conditions, drugs, and medications. The main types of psychotic disorders discussed are schizophrenia, bipolar disorder, psychotic depression, and schizoaffective disorder. Diagnosis involves interviews and exams to evaluate symptoms, while treatment primarily uses antipsychotic medications along with psychotherapy.
This document provides an introduction to psychiatry, including definitions of key terms like mental illness, psychology, psychotherapy, and psychoanalysis. It discusses the etiology (causes) of mental illness, which can include biological factors like genetics and brain damage, as well as psychological and social factors like childhood experiences, relationships, and poverty. It also describes features of mental illness, classifications of mental disorders, and the roles of professionals on the mental health team.
Bipolar disorder is a chronic illness that causes major shifts in mood and energy, impairing various areas of life. While not curable, effective treatment exists to control symptoms and the course of the disorder. Treatment may include hospitalization if the person is a danger to self or others or unable to function. Pharmacotherapy focuses on acute symptom suppression, continuation treatment to prevent symptom return, and maintenance treatment to prevent recurrence. Treatment options include mood stabilizers, antipsychotics, antidepressants, anticonvulsants, and combination drugs. Prognosis depends on factors like episode duration, age of onset, and substance abuse history. Psychotherapy and support groups can also help manage the disorder.
information regarding psychopharmacology especially for nursing students and community. covers all group like anti psychotic, anti anxiety, antidepressants, mood stabilizing agents etc.
Trauma & Stressor Related Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
Adjustment disorder is a maladaptive reaction to an identifiable psychosocial stressor that occurs within 3 months of the stressor's onset and causes social or occupational impairment beyond what would be expected. It is a very common disorder, affecting about 10% of people in some studies. Adjustment disorder is diagnosed using the DSM-5 or ICD-10 and treated with psychotherapy, support groups, medication, or a combination. Developing strong social support networks and living a healthy lifestyle can help prevent adjustment disorder.
Mood disorders include conditions like depression and bipolar disorder. They are caused by biological factors like chemical imbalances, medical conditions, substance abuse, and genetics. Common symptoms include changes in mood, sleep, appetite, concentration, and energy levels. Mood disorders are classified based on symptoms and include types of depression like major depressive disorder and bipolar disorder. Diet and lifestyle factors can help manage mood disorders while early detection and treatment can reduce severity and improve quality of life.
Mood disorders:major depressive and bipolar disorderNandu Krishna J
a basic description about mood disorders mainly MDD and bipolar disorder. Can be made useful in presentations and theory exams. Subject was imbibed from different presentations and DSM IV manual. Thanks for viewing.
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
This document provides an overview of electroconvulsive therapy (ECT). It discusses the history of ECT, including its development in the 1930s as a safer alternative to earlier convulsive therapies. The document defines ECT as the induction of a seizure through electricity to treat various mental health conditions. It outlines the indications for ECT, including severe depression, mania, and catatonia. The document also discusses contraindications, administration procedures, types of ECT (bilateral and unilateral), potential complications, and the roles of the treatment team.
Post traumatic stress disorder (PTSD) mamtabisht10
Post traumatic stress disorder (PTSD) is a stress related disorder (DSM5) is characterized by inability to adjust or recover after witnessing or experiencing a traumatic or life threatening event.
Mood disorders are characterized by episodes of depressed or manic mood. They are caused by biological, psychological, and social factors. Common types of mood disorders include major depressive disorder and dysthymic disorder, which involve emotional, cognitive, somatic, and behavioral symptoms. Treatment involves psychotherapy such as CBT, medication like SSRIs, or electroconvulsive therapy in severe cases. Mood disorders are highly prevalent and affect women more than men.
Mania is an abnormally elevated mood state characterized by inappropriate elation, irritability, insomnia, grandiose notions, increased speech and thoughts, and poor judgment. It is caused by biological and psychosocial factors and can be treated with mood stabilizers, antipsychotics, ECT, and psychotherapy. Nurses assess severity, monitor for injury/violence risks, address nutrition issues, and support social interaction for patients experiencing mania.
Depression is the leading cause of disability world wide and is a major contributor to the overall global burden of diseases .At its worst depression can cause suicide .
There are effective psychological and pharmacological treatments for depression
Depression is a state of low mood and loss of interest that affects thoughts, feelings, and physical health. It is characterized by feelings of sadness, anxiety, guilt, and fatigue. Depression is a common disorder that affects about 15% of the population. It has various causes such as genetic factors, neurotransmitter imbalances, life stressors, and lack of social support. Treatments include antidepressant medication, psychotherapy, and physical therapies like electroconvulsive therapy. Preventing depression involves managing stress, getting social support, and maintaining a healthy lifestyle.
Diagnosis and management of major depressive disorderNeurologyKota
This document provides information on major depressive disorder and dysthymic disorder, including their symptoms, classifications, prevalence, risk factors, pathophysiology, diagnostic criteria, sleep abnormalities seen in depression, and treatment options. It discusses antidepressant medications like TCAs, MAOIs, SSRIs, SNRIs, augmentation therapies, psychosocial therapies, and ECT in the treatment of depressive disorders.
Dysthymia, or persistent depressive disorder, is a chronic form of depression that lasts for at least two years in adults and one year in children. Common symptoms include feelings of negativity, low self-esteem, and changes in appetite and sleep patterns. Approximately 3-6% of Americans experience dysthymia at some point. Women and African Americans have higher rates than other groups. Causes may include genetic, biological, environmental, and psychological factors. Treatment options include yoga therapy, which can help regulate mood and reduce stress through gentle stretching, breathing, and meditation exercises.
The document provides an overview of mood disorders according to ICD-10 criteria and theories of depression and bipolar affective disorder. It describes the ICD-10 classification of affective disorders including depressive disorder, recurrent depressive disorder, and persistent mood disorder. It then covers biological, psychodynamic, behavioral, and cognitive behavioral theories of depression. For bipolar affective disorder, it discusses the social zeitgeber hypothesis, behavioral approach system dysregulation theory, and an integrated model.
This document summarizes a psychiatric assessment of a 45-year-old woman presenting with low mood and thoughts of self-harm. She has a history of depression and was feeling gradually lower in mood over 6 weeks after stopping her medication and losing her dog. On examination, she made little eye contact, was anxious, and reported a very low mood with thoughts of self-harm but no current suicidal ideation. The assessment formulates her presentation as a depressive episode.
This document provides instructions for performing various clinical skills assessments including: resuscitation, assessing peripheral pulses, measuring blood pressure, examining the cardiovascular and respiratory systems, performing an electrocardiogram, assessing peak flow, and using a vitalograph machine. Key steps are outlined for each skill, such as procedures for opening an airway, performing chest compressions, locating and feeling different pulse points, correctly applying a blood pressure cuff, examining heart sounds and murmurs, and interpreting vital sign readings.
The Mental State Examination aims to assess a patient's current psychological symptoms and observable behavior during an interview. It objectively evaluates a patient's appearance, behavior, speech, mood, thoughts, perceptions, cognition, and insight. It also subjectively examines the patient's reported mood, thoughts, and perceptions. The exam provides information on factors like activity level, thought content and organization, sensory experiences, orientation, memory, and understanding of their condition. Challenging patients may be unresponsive, overactive, or confused, requiring modified approaches.
This document provides an overview of key concepts in psychiatry, including:
- Components of a mental status exam such as appearance, mood, thoughts, and perceptions.
- Common psychiatric conditions and syndromes such as delusions, hallucinations, dementia, and psychosis.
- Medications used to treat mental health conditions including lithium, antidepressants, antipsychotics, and mood stabilizers.
- Potential side effects of medications like weight gain, movement disorders, and increased prolactin levels.
The document defines technical psychiatric terms and describes approaches to assessment and treatment of mental illness.
Disorders in psychiatry are often described as syndromes, a constellation of signs and symptoms that together make up a recognizable condition. this ppt help in understanding basic sign and symptoms of psychiatry.
This document provides information on various anxiety disorders, including the symptoms, causes, and treatments. It discusses what constitutes normal and pathological anxiety, and defines different types of anxiety disorders like generalized anxiety disorder, panic disorder, phobias, PTSD, and OCD. For each disorder it outlines the key features including onset, prevalence between genders, associated symptoms, common comorbidities, and potential treatments like cognitive behavioral therapy and antidepressant medications.
Mark Baxter has provided case notes and video links about various medical ethics topics. The videos were too large to upload, so screenshots and YouTube links were included along with accompanying case notes that discuss the legal and ethical issues raised, relevant objectives, and references. The case notes cover topics like organ donation, medical research, conflicts of interest, confidentiality, and whistleblowing.
Alzheimer's disease is a degenerative brain disease that results in cognitive and behavioral impairment. It accounts for around 70% of dementia cases. The hallmarks of the disease are amyloid plaques and neurofibrillary tangles in the brain. Symptoms include memory loss, confusion, changes in personality and behavior, and problems with language and visual-spatial skills. Treatment focuses on acetylcholinesterase inhibitors and memantine to manage symptoms, as well as non-pharmacological approaches to improve quality of life. The disease is progressive and currently has no cure.
This document provides guidance for psychiatry assessments and evaluations. It outlines the key areas to cover in a psychiatric history including past medical history, medications, social history, substance use, and family history of mental illness. It describes how to conduct a mental status examination and lists common symptoms and management strategies for conditions like mania, depression, anxiety, psychosis, OCD, and more. It also reviews the sections of the Mental Health Act used to detain patients requiring inpatient treatment.
This document discusses anxiety and anxiety disorders. It defines anxiety as a generalized and pervasive fear that can be a normal physiological response to threats, but also become abnormal. There are two patterns of pathological anxiety: generalized anxiety that is continuous and not associated with external threats, and paroxysmal anxiety that involves discrete, intense episodes. Specific anxiety disorders discussed include generalized anxiety disorder, simple phobias, social phobia, agoraphobia, and panic disorder. The document provides details on the epidemiology, etiology, diagnostic criteria, and clinical features of each.
The document discusses the biological, psychological, and social complications that can arise from substance misuse. Biologically, substances can cause acute intoxication, chronic health effects, withdrawal symptoms, and interactions with pre-existing medical conditions. Psychologically, substances may lead to dependence and addiction as well as substance-induced disorders. Socially, substance misuse can result in failure to meet obligations, hazardous behaviors, legal problems, and interpersonal issues. The most common substances that are misused are alcohol, opiates, depressants, stimulants, hallucinogens, cannabis, and volatile substances. Clinically significant withdrawal symptoms typically occur with alcohol, opiates, nicotine, benzodiazepines, amphetamines
ADHD is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects approximately 1-7% of school-aged children worldwide, and is more prevalent in boys. While its exact causes are unknown, genetic and environmental factors like low birth weight, maternal substance use, and head injuries may play a role. ADHD is diagnosed when at least six symptoms of inattention and/or hyperactivity-impulsivity are present for over six months, causing impairment across multiple settings like school and home. Stimulant medications and behavioral therapies are effective treatment options, though symptoms often improve with age as the brain develops in late adolescence in many cases.
The immune system distinguishes self from non-self to protect the body from infection and tissue damage. It has both innate and adaptive responses. The innate system provides early defense through physical barriers, chemicals, and phagocytes. The adaptive system has lymphocytes that provide specific and long-lasting immunity through antibodies and memory. The immune system is organized with primary organs like the bone marrow and thymus that produce cells, and secondary organs like lymph nodes and spleen where immune responses occur.
This document is a student's 2012 PEP (Personal Educational Portfolio) titled "Designer Babies" that is 19 pages long. It contains an abstract, table of contents, and sections on the methods used to create designer babies (PGD and new methods like three-parent babies), the ethical arguments surrounding designer babies (parents' autonomy, nature vs nurture, child expectations, definitions of disease and disability), and a conclusion. The PEP was written by Jonathan Chernick for his supervisor Dr. Caroline Bowsher and discusses both the technical aspects and ethical debates involving genetic manipulation of embryos.
Antidepressants such as SSRIs, TCAs, and MAOIs work by increasing levels of serotonin, norepinephrine, or both in the brain. SSRIs are generally first-line treatment and safer in overdose than TCAs, but TCAs may be better for severe depression. Both classes of drugs can cause side effects like dry mouth, nausea, and sexual dysfunction. Antidepressants may take 10-20 days to work and should be continued for at least 6 months after symptoms improve to prevent relapse. Combining certain antidepressants can be dangerous due to increased serotonin levels.
This document provides guidance on effective communication skills when discussing difficult topics with patients or relatives. It outlines 5 key parts of a discussion: introduction, receiving, giving, agreement and planning, and confirming. For each part, it provides tips on body language, listening techniques, addressing concerns, establishing understanding, and confirming plans. The purpose is to have participants practice these skills in simulated scenarios covering childhood obesity, alcohol abuse, non-accidental injury, and breaking bad news, to assess their communication abilities.
Riley discusses her experience with anorexia nervosa, including how it began as a desire to be skinny like friends at age 10 and became an obsession, how she felt depressed and constantly worried about her appearance, and the physical symptoms like fainting that led to diagnosis. Her treatment included medical care for heart problems, nutritional counseling to gain weight healthily, and therapy to address the emotional factors and change her thought patterns.
This document summarizes various sensory and reflex systems in the human body. It describes different types of detectors for senses like touch, pain, temperature, and proprioception. It also discusses spinal reflexes like the stretch reflex and withdrawal reflex. The plantar reflex and pupillary light reflex are examined, outlining the neural pathways involved and clinical significance. In summary, it provides an overview of sensory systems, reflexes, and their importance in neurological examinations.
Three main approaches to learning and studying are identified: deep approach, surface apathetic approach, and strategic approach. The deep approach involves seeking meaning, relating ideas, and monitoring understanding, while the surface apathetic approach focuses on minimal effort and memorization. A strategic approach manages time and effort to achieve high grades. Factors like assessments, curriculum demands, teaching methods, and the overall learning environment can influence which approaches students adopt. Promoting deep and strategic approaches through measures like well-designed assessments and active learning teaching methods can optimize learning outcomes.
This document provides information on various mental health diagnoses including depression, schizophrenia, bipolar disorder, personality disorders, and substance abuse. It discusses the DSM-IV criteria and course of illness for each, as well as their effects on caregiving. Comorbidities and treatments including medications are also outlined. The long-term prognosis is generally good if the individual is compliant with medication and therapy, though relapse is common with substance abuse and personality disorders can be difficult to treat. Resources for support services in the Chicago area are provided.
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
This document provides information on bipolar disorder, including its symptoms, diagnosis, epidemiology, etiology, pathophysiology, clinical presentation, treatment goals, and treatment options. Bipolar disorder is a mood disorder characterized by one or more episodes of mania or hypomania often accompanied by one or more major depressive episodes. Correct diagnosis and early treatment are important to prevent complications and maximize treatment response. Treatment involves mood stabilizing medications like lithium, anticonvulsants, and atypical antipsychotics, as well as psychotherapy. The goals of treatment are to reduce symptoms, prevent recurrence, and improve quality of life.
Antidepressants are the second most prescribed medication in the US, with 15 million Americans affected by depression each year. Depression is treated through medications and therapy. Antidepressants work by adjusting neurotransmitter levels in the brain like serotonin, dopamine, and norepinephrine. Common classes include SSRIs, SNRIs, TCAs, and MAOIs. While effective, antidepressants can cause side effects like nausea, insomnia, sexual dysfunction, and increased suicide risk initially. Doctors closely monitor patients to improve treatment outcomes and safety.
This document discusses bipolar disorder, also known as manic depression. It is a mental illness characterized by periods of depression and mania. There are different types of bipolar disorder defined by the severity and frequency of mood episodes. While the causes are unclear, it is thought to involve imbalances in brain chemicals and may be influenced by genetic and environmental factors. Diagnosis involves evaluating mood symptoms and ruling out other potential causes. Treatment includes mood stabilizing medications, psychotherapy, and lifestyle management to control symptoms and minimize relapse.
This document discusses bipolar disorder, also known as manic depression. It is a mental illness characterized by periods of depression and mania. There are different types of bipolar disorder defined by the severity and frequency of mood episodes. While the cause is unknown, it is thought to involve imbalances in brain chemicals and may be influenced by genetic and environmental factors. Diagnosis involves evaluating mood symptoms and ruling out other potential causes. Treatment includes mood stabilizing medications, psychotherapy, and lifestyle management to control symptoms and minimize relapse.
Here are some key points I would focus on in discussing this case:
- Ensure safety first by removing any dangerous items and closely monitoring for risk of self-harm or violence
- Explain the diagnosis in simple terms and emphasize it is a biological brain disorder, not the client's fault
- Discuss treatment plan including medications, importance of compliance, and managing side effects
- Provide education on triggers, warning signs of mood changes, healthy coping strategies
- Refer to support groups to help client and family understand the illness and not feel alone
- Screen for substance use as common with bipolar disorder and address as a treatment priority
- Set limits on any manipulative behaviors while also validating the client's experience with empathy
- Develop
This document discusses mania and its treatment. It begins with an overview of theories of mania's causes and descriptions of its signs and symptoms. It then describes the three stages of mania - hypomania, acute mania, and delirious mania - and the associated mood, cognition, behavior, and impairments at each stage. Nursing priorities for patients with mania are discussed, including safety, meeting physiological needs, and managing behavior. Lithium is then discussed as an antimanic mood stabilizer, including its dosing, therapeutic levels, nursing diagnoses, and risks of toxicity.
-Definition of mental health
-Definition of mental illness
-When do you need to see a psychiatrist?
-Causes of mental illness
-Consequences of mental illness
-Treatment team
-Medications used in mental illness
-Myths and facts about mental illness (misconceptions)
The document discusses various substances of abuse including definitions of substance abuse, intoxication, withdrawal, tolerance, polysubstance abuse, and dependence. It also discusses specific substances like alcohol, opioids, cocaine, amphetamines, cannabis, hallucinogens, inhalants, and nicotine. For each substance, signs and symptoms of intoxication and withdrawal are described as well as appropriate emergency treatment approaches.
This document provides information on various types of mental disorders including neurotic disorders, mood disorders, schizophrenia, chemical abuse, eating disorders, phobias, mental retardation, and obsessive compulsive disorder. It discusses the definition, types, causes, symptoms, and treatments of neurotic disorders and mood disorders such as depression and bipolar disorder. It also discusses what mental illness is, how it is diagnosed, what forms it can take, and emphasizes that recovery is possible.
Here are my responses to the case vignettes:
Case 1:
Q1: Diagnosis - Bipolar I disorder, current episode manic
Q2: Management - Conduct a thorough assessment. Start treatment with mood stabilizer (lithium or valproate) plus atypical antipsychotic. Consider hospitalization given severity of symptoms. Provide psychoeducation to family.
Case 2:
Q1: Diagnosis - Bipolar I disorder, current episode depressed
Q2: Management - Conduct assessment. Start antidepressant under cover of mood stabilizer due to risk of switching. Consider ECT given severity. Provide psychoeducation and support to family.
Case 3:
Q1:
Depression and anxiety are common in people with epilepsy, occurring in up to 43% of patients. Untreated depression and anxiety can negatively impact quality of life and make achieving seizure control more difficult. Both psychological and biological factors may contribute to increased rates of mood disorders in people with epilepsy. Treatment options include therapy, lifestyle changes, and antidepressant medications, with SSRIs being a first-line pharmacological approach. Integrated treatment of both mood symptoms and epilepsy management is important.
The document discusses signs and symptoms of depression, diagnostic criteria for depression according to ICD-10, causes of depression, types of depression including major depression, dysthymia, and bipolar disorder, the relationship between depression and suicide, antidepressant medications including classes such as MAO inhibitors, SSRIs, and tricyclic antidepressants, and their mechanisms of action and common side effects. It provides information on assessing and diagnosing depression according to standardized criteria and treating depression through pharmacological interventions.
Obsessive compulsive disorder(OCD)
Characterized by obsessional thoughts and compulsive rituals.
Secondary to both depressive illness and Gilles de la Tourette syndrome.
OCD is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry; by repetitive behaviours aimed at reducing the associated anxiety; or by a combination of such obsessions and compulsions
This document provides an overview of obsessive compulsive disorder (OCD), including its definition, symptoms, causes, diagnosis and treatment. OCD is characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) performed to reduce associated anxiety. It has been linked to imbalances in serotonin and dopamine levels in the brain. Treatment involves cognitive behavioral therapy and medication, primarily selective serotonin reuptake inhibitors. The goals of treatment are to reduce symptoms and restore optimal functioning.
This document summarizes key points about dealing with difficult behaviors in dementia patients. It discusses common behavioral problems seen in dementia, such as agitation, aggression, and resistance. Factors that can trigger behaviors are reviewed, like unmet needs, medical issues, and psychiatric conditions. Non-pharmacological approaches are emphasized, like enhancing communication, controlling stimulation, and addressing the patient's environment and needs. Medications should usually only be used as a last resort. The document provides an overview of assessing behaviors and implementing strategic non-drug interventions.
The document summarizes information about bipolar disorder from an interview with a bipolar patient. Bipolar disorder involves mood swings between depression and mania. During manic episodes, people feel very energetic and distracted, while depression brings feelings of sadness, worthlessness and thoughts of suicide. Treatments include mood stabilizing medications, antidepressants, antipsychotics, therapy and lifestyle changes. Research is ongoing to better understand the genetic and brain factors involved in bipolar disorder and develop more effective treatments.
This document discusses depression and its prevalence in India and neurological clinics. It provides criteria for diagnosing a major depressive episode according to DSM-5 and notes challenges in diagnosis for neurologists. Signs, symptoms, and treatment approaches for depression are also outlined. The document concludes by discussing depression associated with specific neurological disorders like Parkinson's disease.
1. Brown-Séquard syndrome was first described in 1850 based on observations of machete injuries in sugar cane farmers, with key features being ipsilateral motor paralysis and mixed sensory loss below the level of the spinal cord lesion.
2. Understanding the anatomy of ascending and descending spinal tracts is important for explaining the clinical features of Brown-Séquard syndrome and other spinal cord injuries.
3. Injuries can disrupt motor or sensory tracts differently, causing varying neurological deficits depending on whether the lesion involves upper or lower motor neurons.
The document discusses several inflammatory arthropathies known as spondylarthropathies. They are commonly associated with the HLA B27 gene and involve entheses, synovium, and the spine. Major types include ankylosing spondylitis, psoriatic arthropathy, reactive arthritis, and enteropathic arthritis. They often present with enthesitis, uveitis, and spondylitis and are treated with NSAIDs, DMARDs, anti-TNF drugs, or surgery depending on the specific condition and symptoms.
Lung cancer is classified into two main types - non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). NSCLC makes up about 80% of cases and can be further divided into squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. SCLC accounts for 10-15% of lung cancers and grows more quickly. The main symptoms are cough, chest pain, and coughing up blood. Risk factors include smoking, asbestos exposure, and radiation exposure. Diagnosis involves tests such as sputum analysis, biopsies, CT scans, and PET scans to determine the cancer type and stage. Treatment options depend on the cancer type and stage but may include surgery, chemotherapy
Eczema herpeticum is a potentially life-threatening herpes infection that occurs when herpes simplex virus infects disrupted skin in patients with pre-existing skin conditions like eczema or atopic dermatitis. It presents with clusters of vesicles and punched-out erosions that spread and become hemorrhagic and crusted. Diagnosis involves identifying characteristic lesions along with fever and pain, and can be confirmed with tests like Tzanck smear, viral culture, or antibody testing. Aggressive treatment with IV acyclovir is required to prevent complications like herpes keratitis, which can lead to blindness. Early recognition and effective antiviral therapy are important given the potential severity of eczema her
The vagus nerve connects organs in the neck and below to the brainstem. It has both sensory and motor functions and helps control the heart rate, digestion, and other involuntary processes. Stimulation of the vagus nerve has been shown to reduce seizures, experimental pain, and inflammation, and may help treat conditions like epilepsy, obesity, and heart disease. Damage to the vagus nerve or its connections in the brainstem can impact swallowing, heart rate variability, and level of consciousness.
Poor water and sanitation are responsible for a huge global burden of disease, with contaminated water alone contributing to about 2.4 million preventable deaths per year, mainly in children. While progress has been made in increasing access to safe water and improved sanitation, current rates of progress will not meet the Millennium Development Goal targets. Water and sanitation remain a low priority on international development agendas despite their importance for health and achieving the MDGs. Coordinated efforts are still needed to address this critical issue.
This document discusses medical student electives in developing countries. It notes potential benefits like exposure to rare diseases and personal growth, but also flags ethical issues. Electives could exploit local health systems and raise false expectations. They may perpetuate neo-colonial practices by benefiting students and health systems in wealthy countries more than local populations. The document also examines how non-governmental organizations can undermine public health systems and calls for electives to minimize harm, respect local needs, and establish long-term exchange programs to provide mutual benefit.
This document provides an overview of global health by defining key terms, outlining major players and organizations, and summarizing the history and evolution of the field from 1945 to the present day. It describes how global health has shifted from a focus on infectious disease control to addressing social determinants of health and health issues that transcend national borders. Major milestones discussed include the founding of the UN and WHO, the Alma-Ata Declaration, structural adjustment policies, the Millennium Declaration and MDGs, debt relief campaigns, and the establishment of the Global Fund. The summary highlights the ongoing tension between disease-specific and comprehensive primary healthcare approaches.
The document discusses how international organizations like the WTO and treaties it has established like TRIPS and GATS impact healthcare. The WTO aims to liberalize trade and its dispute process enforces agreements. TRIPS established intellectual property standards that require drug patenting, raising prices. Some countries like Brazil and South Africa have issued compulsory licenses to produce cheaper generics, facing opposition from pharmaceutical companies but helping improve access to treatment.
Global health examines influences on health across borders, including issues like globalization, poverty, and human rights. It draws from multiple disciplines. Globalization refers to reducing barriers between countries, leading to increased trade, investment, and communication. This has effects like economic growth but also rising inequalities. Agreements like TRIPS have increased pharmaceutical patent protection globally, raising concerns about access to medicines, especially in developing countries. Networks of both commercial and civil society actors have been important in debates over balancing intellectual property with public health.
Migration of health care workers has both positive and negative effects on health. It reduces the availability of health services in source countries while increasing access in destination countries. This unequal distribution of health workers is driven by push factors like low pay and poor working conditions in source countries and pull factors like higher wages in destination countries. As a result, source countries experience worse health outcomes due to lack of health workers, while destination countries receive an indirect subsidy through the receipt and employment of trained medical professionals from poorer nations. Proposed policy responses aim to strengthen health systems in source countries, implement ethical recruitment practices, and foster partnerships between nations to promote more equitable health worker distribution.
Global institutions play major roles in health financing and policy. The key players discussed are the World Health Organization (WHO), World Bank, International Monetary Fund (IMF), and World Trade Organization (WTO). The WHO is the UN agency for health, working with 192 member states. The World Bank aims to reduce poverty through loans and policy advice to developing countries. The IMF promotes international monetary cooperation and provides temporary financial assistance. The WTO, formed in 1995, ensures trade flows freely through treaties and enforcement mechanisms, which some criticize can undermine public health systems.
Haemochromatosis is an autosomal recessive condition characterized by excessive iron accumulation in the body. It affects around 0.5% of Caucasians and usually presents in the 40s-50s with a triad of pigmentation, diabetes mellitus, and hepatomegaly. Diagnosis involves blood tests showing elevated serum iron, transferrin saturation over 50%, and elevated serum ferritin. Liver biopsy can confirm iron deposition and damage. Treatment aims to reduce iron stores through weekly venesection of 1 unit of blood for 6-12 months followed by maintenance venesection.
Ascites is an abnormal collection of fluid in the peritoneal cavity, commonly caused by portal hypertension due to cirrhosis. It results from sodium and water retention triggered by vasodilation and activation of the renin-angiotensin system, as well as increased hydrostatic pressure and transudation of fluid from the liver and spleen into the peritoneal cavity. Hypoalbuminemia due to decreased liver function also contributes by reducing plasma oncotic pressure. Spironolactone is used as treatment as it is an aldosterone antagonist. Management involves dietary sodium restriction, diuretics, stopping alcohol, monitoring for complications, and procedures such as paracentesis or shunts.
The liver has two lobes, separated by veins, and is divided into sections supplied by individual blood vessels. Blood flows through hepatic arteries and portal veins into sinusoids, where waste is filtered by Kupffer cells in the space of Disse before draining into hepatic veins. The liver performs many functions including synthesizing proteins, metabolizing carbohydrates and lipids, and detoxifying hormones and drugs. Liver function can be assessed through blood tests of enzymes and proteins.
Gout is caused by deposition of uric acid crystals in the joints, which leads to acute inflammation. It typically presents as sudden severe pain, swelling and redness in one joint, most commonly the big toe. Diagnosis is made based on symptoms and identification of crystals in joint fluid under polarized microscopy. Treatment involves medications to reduce symptoms during acute attacks as well as long-term drugs like allopurinol or probenecid to lower uric acid levels and prevent future episodes. Without treatment, gout can progress to a chronic stage with multiple joint involvement and growth of tophi deposits in the tissues.
Review of orthopaedic services: Prepared for the Auditor General for Scotland...meducationdotnet
1. Orthopaedics is a large specialty that treats musculoskeletal conditions through surgery, medication, and rehabilitation. It accounts for a significant portion of NHS spending and activity in Scotland.
2. Waiting times for orthopaedic services have reduced in recent years through changes to service delivery and additional funded activity. However, further improvements to meet 18-week referral targets will be challenging to sustain.
3. There is variation in orthopaedic efficiency across Scotland that is not fully explained by resources or procedures. The report finds opportunities to use existing resources more efficiently through measures like increasing day surgery and reducing hospital length of stay.
This document discusses the use of muscle relaxants in anesthesia and the potential role of sugammadex as a reversal agent. It provides background on why muscle relaxants are used, types of muscle relaxants, and current problems with reversal agents. It then summarizes research on sugammadex, which appears to be a more effective reversal agent than anticholinesterases, allowing faster recovery from neuromuscular blockade. Sugammadex may allow safer use of muscle relaxants and replace agents like suxamethonium, but economic factors will also influence its adoption.
This document contains a series of slides related to ophthalmology. It tests the reader's knowledge on topics like visual acuity measurements, refractive errors, eye abnormalities, causes of vision loss, and eye examination techniques. The slides include images showing conditions like cataracts, glaucoma, retinal detachments, and more. Key details are provided about diagnoses, symptoms, investigations, and treatments.
1) Keloid and hypertrophic scars differ in that keloids grow beyond the boundaries of the original wound while hypertrophic scars remain within the boundaries and eventually regress.
2) Second degree burns extend into the deeper dermal layers and can cause blistering and moderate pain due to damage of some nerve endings, while third degree burns reach the subcutaneous fat and cause minimal pain as most nerve endings have been destroyed.
3) Venous ulcers on the legs indicate severe venous insufficiency and are the most common type of leg ulcer, affecting around 80% of cases. They are associated with signs of venous stasis such as hemosiderin deposition, telangiectasia,
2. Background Info on Mental Health
1 in 4 people experience some kind of MH problem in 1 year
Mixed anxiety & depression is the most common MH disorder in Britain
Women are more likely to have been treated for a MH problem than men
10% children have a mental health problem
Depression affects 1 in 5 older people
The UK has one of the highest self-harm rates in Europe (400/100000 population)
9/10 prisoners have a mental disorder
4. Human Rights Act
‘Everyone has the right to liberty and security of the person.’
‘No-one shall be subjected to torture or to inhuman or degrading
treatment or punishment.’
‘Everyone has the right to respect for his private and family life, his
home, and his correspondence.’
5. Mental Capacity Act
Assume capacity unless established that he/she doesn’t
Do not treat as unable to make a decision unless all practicable steps to do help
have been taken without success
Do not treat as unable to make a decision just because it is unwise
Any act or decision made under the MCA for or on behalf of someone who lacks
capacity must be done in his/her best interests
Before anything is done, you must consider whether the purpose can be
achieved in a way that is less restrictive of a persons right’s and freedom’s
6. Assessing Capacity
MUST have a diagnosis that may impair functioning
Need to assessed as to whether they can make a decision on a SPECIFIC matter
◦ Understand the information
◦ Retain the information
◦ Use and weigh the information to make a choice
◦ Communicate the decision
7. Mental Health Act
1983 Act of UK Parliament, revised in 2007
Covers reception, care and treatment of mentally disordered persons
Also covers detention of people (AKA sectioning)
8. People Defined in the Act
Approved Mental Health Professional
Section 12 Approved Doctors
Approved Clinicians
Responsible Clinicians
13. Assessing Suicide Risk
Male Gender
Age
Unemployed
Concurrent mental disorder
Treatment and care received after a
previous suicide attempt
Alcohol and drug abuse
Physically disabling or painful illness
Low socio-economic status
Previous psychiatric treatment
Professions
Low social support/living alone
Significant Life events
Institutionalisation
Bullying
14. PATHOS scoring
Have you had PROBLEMS for longer than 1 month?
Were you ALONE in the house when you attempted suicide?
Did you plan the suicide for more than THREE hours?
Are you feeling HOPELESS about the future and that things will not get much better?
Were you feeling SAD for most of the time before the attempt?
16. SSRIs
INDICATION: Moderate-severe depression. MAY be effective in bulimia nervosa.
EXAMPLES: Citalopram, Fluoxetine, Sertraline
MECHANISM: Increase 5-HT neurotransmission by blocking 5-HT reuptake
SIDE-EFFECTS: GI, side effects, agitation, sexual dysfunction
SPECIAL INSTRUCTIONS: Dyscontinuation syndrome if sertraline/citalopram stopped suddenly.
Fluoxetine has longer half-life therefore safer.
17. SNRIs
INDICATION: Major depression
EXAMPLES: Venlafaxine
MECHANISM: Increase noradrenaline & serotonin availability by blocking re-uptake
SIDE-EFFECTS: loss of appetite, weight and sleep. Sexual dysfunction.
SPECIAL INSTRUCTIONS: More dangerous in overdose than SSRIs
18. TCAs
INDICATION: Depression with anxiety and/or agitation
EXAMPLES: Amitriptyline, clomipramine, dothiepi
MECHANISM: Increase 5-HT, NA and DA availability by non-elective blockade of mono-amine
reuptake
SIDE-EFFECTS: dry mouth, constipation, sedation. Cardiotoxic in overdose
SPECIAL INSTRUCTIONS: Treat overdose with activated charcoal
19. MAOIs
INDICATION: Depression resistant to SSRIs/TCAs
EXAMPLES: Moclobemide, Isocarboxazid, Phenelzine
MECHANISM: block the monoamine oxidase enzymes responsible for intracellular metabolism of
monoamine neurotransmitters
SIDE-EFFECTS: serotonin syndrome!! Hypertensive crisis due to interaction with
sympathomimetic amines.
SPECIAL INSTRUCTIONS: when starting MAOIs ensure SSRIs/TCAs have been stopped for 2 weeks
20. Anxiolytics
INDICATION: Short-term treatment of severe, disabling anxiety/
EXAMPLES: Benzodiazapines, beta blockers, buspirone, SSRIs
MECHANISM: Increase the effect of GABA. Benzodiazapines increase GABAergic activity. Beta
blockers act on sympathetic nervous system and busprione is a 5-HT agonist.
SIDE-EFFECTS: Dependence, withdrawal, daytime sedation
SPECIAL INSTRUCTIONS: Decrease slowly and make sure only on them short term. Don’t drink on
them (increased sedative effect)
21. Hypnotics
INDICATION: Short-term treatment of insomnia causing significant distress/disability
EXAMPLES: Benzodiazapines, zopiclone, barbituates (but not really), antihistamines
MECHANISM: Increase effect of GABA
SIDE-EFFECTS: Dependence & tolerance. Withdrawal, daytime sedation,
SPECIAL INSTRUCTIONS: Same as anxiolytics
22. Lithium
INDICATION: Bipolar disorder
MECHANISM: Unclear.
SIDE-EFFECTS: Nausea, thirst, polyuria, hypothyroidism, tremor, ataxia and teratogenicity.
Toxicity – dysrhythmias, renal impairment, convulsions.
SPECIAL INSTRUCTIONS: Titrate dose to achieve plasma conc of 06-1.0mmol/L. Narrow
therapeutic range. Treat toxicity with fluid resuscitation, haemodialysis. Do not withdraw
abruptly.
23. Typical Antipsychotics
INDICATION: Acute treatment of psychotic states, schizophrenia & chronic psychoses
EXAMPLES: Chlorpromazine, promazine, prochlorperazine, haloperidol
MECHANISM: Dopamine receptor antagonists. Primarily affect D2 receptors.
SIDE-EFFECTS: Sedation, extra-pyramidal side effects of parkinsonism, dry mouth, drowsiness,
postural hypotension, weight gain, photosensitivity. NEUROLEPTIC MALIGNANT SYNDROME =
hyperthermia, loss of consciousness and autonomic dysfunction.
Chlorpromazine associated with raised prolactin & galactorrhoea
SPECIAL INSTRUCTIONS: Do NOT give haloperidol in parkinsons. Contraindicated in
cardiovascular disease, epilepsy, coma patients, bone marrow disorders.
24. Atypical Antipsychotics
INDICATION: Psychoses as in typical. Behavioural challenges in Alzheimer’s, controlling tics in
tourettes.
EXAMPLES: Clozapine, olanzapine, quetiapine, risperidone
MECHANISM: Affect D3 and D4 receptors.
SIDE-EFFECTS: Increased appetite and weight gain. Metabolic syndrome. Clozapine causes
agranulocytosis.
SPECIAL INSTRUCTIONS: Clozapine = last resort, monitor FBC on all atypical antipsychotics.
25. Cognitive Enhancers
INDICATION: Treatment of cognitive symptoms in Alzheimer’s disease.
EXAMPLES: Donepizil, galantamine, rivastigmine, memantine
MECHANISM: Acetylcholinesterase inhibitors.
SIDE-EFFECTS: Nausea, vomiting, diarrhoea, headache, insomnia, dizziness.
SPECIAL INSTRUCTIONS: Do NOT prescribe in asthmatics or COPD. Nor in patients with a history
of gastric/duodenal ulcers.
26. CNS stimulants
INDICATION: Narcolepsy and ADHD.
EXAMPLES: Methylphenidate (Ritalin), atomoxetine, dexamfetamine
MECHANISM: Increase availability of monoamines by stimulating release into synapse and/or
blocking reuptake
SIDE-EFFECTS: Insomnia, restlessness, tremors, anxiety, anorexia, dependence, psychosis.
Growth retardation in children.
SPECIAL INSTRUCTIONS: Do not prescribe in patients with cardiovascular disease or in
pregnancy/breastfeeding women.
28. Dementia
Describes the symptoms that occur when the brain is affected
◦ Memory loss
◦ Confusion & mood changes
◦ Problems with speech & understanding
NOT a natural part of growing old.
Various types. ALL are progressive.
29. Alzheimer’s
A woman attends surgery with her 72-year old mother. She reports that her mother
has recently been misplacing everyday things such as keys and has missed a few bill
payments and she demands you test her memory. Her mother feels there isn’t a
problem at that her daughter is exaggerating everything that has happened, she
then begins to tell you about the builder who knocked on her door two weeks ago
saying she needed her kitchen renovated under new council laws.
30. Vascular
An 81-year old male presents with his wife to the GP. He had a stroke 8 months ago
and, despite recovering reasonably well, he has found his memory just isn’t the same
as it used to be and he sometimes struggles to understand what people are saying.
Four months later he has another stroke. This time his wife brings him in post-
recovery saying she has noticed he drastically worsened. He is now unable to
remember what he has said, constantly repeating himself, and is often very agitated
due to struggling to communicate and understand what is being said.
31. Dementia with Lewy Bodies
A 65-year old male presents to the surgery informing you he thinks he has a memory
problem. It started about 6 months, he has noticed he has been increasingly
forgetful misplacing objects, and the other day he couldn’t recognise his wife. This is
very distressing for him and he is scared about what will happen. Observing him you
notice a resting tremor in his right hand and that the movements are quite slow. He
informs you the tremor has been going on for about 2 months.
Two years later he is being assessed by a psychiatrist and reports that he often see’s
people that aren’t there and hears dogs barking that his wife can’t hear.
36. Other considerations
In-patient care
◦ Psychiatric inpatient admission if severely disturbed
◦ If in for medical reasons ALWAYS liaise and assess impact on
dementia
Palliation
38. Substance Abuse Histories
How long?
How much? How strong?
What time in the day/week?
Has it interfered with daily life?
Do you need more to create the same effect?
Do you get withdrawal symptoms?
If so, are these relieved by having more of the substance?
39. Alcohol Use
A 32-year old woman comes to you feeling depressed and complaining of work,
housing and financial stresses. She admits she is struggling to cope and her children
are being very difficult to handle at the moment.
When you question about how she is coping she reluctantly tells you she has started
drinking a bit more than usual, but it’s just because of the stress and it isn’t causing
her any problems. Her boss has caught her drunk after lunch once though.
40. Quick Scores for Alcohol Use
CAGE
Have you ever felt you needed to CUT down on your drinking?
Have people ANNOYED you by criticising your drinking?
Have you ever felt GUILTY about drinking?
Have you ever felt you needed a drink first thing in the morning (EYE-OPENER) to steady your
nerves or get rid of a hangover?
FAST Test
1:- MEN: How often do you have EIGHT or more drinks on one occasion?
WOMEN: How often do you have SIX or more drinks on one occasion?
NEVER LESS THAN MONTHLY MONTHLY WEEKLY DAILY
2:- How often during the last year have you been unable to remember what happened the
night before because you had been drinking?
NEVER LESS THAN MONTHLY MONTHLY WEEKLY DAILY
3:- How often during the last year have you failed to do what was normally expected of you
because of drinking?
NEVER LESS THAN MONTHLY MONTHLY WEEKLY DAILY
4:- In the last year has a relative, or friend, or a doctor or other health worker been
concerned about your drinking or suggested you cut down?
No YES, ON ONE OCCASION YES, ON MORE THAN ONE OCCASION
42. Assessment
Bombard the patients with questionnaires
◦ Severity of Alcohol Dependence Questionnaire
◦ Alcohol Problems Questionnaire
Motivational intervention
◦ Identify drinking problem
◦ Resolve ambivalence and encourage positive change
◦ Be persuasive rather than confrontational
Refer Children and
Young People
Triage Adults
Assess co-morbidities,
patterns of use and
other problems
INTERVENE
43. Assessment
Advice to Adults re safe alcohol consumption
◦ Potential harm
◦ Barriers to change
◦ Practical strategies to reduce alcohol consumption
◦ Create a set of goals
Brief interventions for young adults and adults
◦ Motivational interviewing
Refer to specialist services ONLY IF NEEDED
◦ Show signs of moderate or severe alcohol dependence
◦ Failed to benefit from structured brief interventions
◦ Show signs of alcohol-related impairment
47. Prevention IS Better…
School programmes to educate children
Increasing the cost of alcohol
Limiting the licences on places selling alcohol
Encouraging companies to place warnings on the alcohol containers
48. Opioids Use
How to recognise…
◦ Physical signs :- miosis, needle marks, respiratory depression, increased sphincter tone, hypovolaemia
◦ Request specific opioids
◦ Unresponsive to the medication, always insisting they need a higher dose
◦ Malingering
◦ Failure to do what is expected of them
49. Treating Intoxication
A – clear if needed
B – provide ventilation if needed
C – IV fluids
OBSERVATIONS
IV Naloxone
50. Mechanism of Tolerance & Withdrawal
Internalisation of Mu and Delta opioid receptors
Down regulation of secondary messengers such as cAMP
Therefore need larger amount of opioid to create same effect
Withdrawal occurs when endogenous opioid cannot activate the remaining receptors
52. Treating Withdrawal
INFORMATION
CREATE A PLAN WITH GOALS
OFFER SUPPORT TO FAMILIES AND CARERS
METHADONE OR BUPRENORPHINE = FIRST LINE
LOFEXIDINE = OPTION FOR SHORT-TERM DETOXIFICATION
DETOXIFICATION LASTS 4 WEEKS IF INPATIENT
◦ 12 WEEKS IF IN COMMUNITY
54. Cannabinoids
Recognised using CAGE for dependence
May have: -
◦ Miosis
◦ Loss of balance
◦ Impaired cognitive functioning
◦ Loss of sensory perceptions
57. Epidemiology
Onset
◦ Between 17 & 30 in men
◦ 20 and 40 in women
Lifetime risk between 0.7 and 0.9%
Increased prevalence in urban areas and lower social classes
58. Schneider’s First Rank Symptoms
Auditory hallucinations
Thought withdrawal, insertion and interruption
Thought broadcasting
Somatic hallucinations
Delusional perceptions
Feelings/actions experienced as if made or influenced by external agents
60. Paranoid Schizophrenia
An 24-year old male comes into GP. He has been feeling especially stressed since a
van parked outside his house has started watching him. He claims it is because they
know about his mission. Half-way through the consultation he becomes incredibly
aggressive towards you claiming you’re colluding with them and storms out.
61. Hebephrenic Schizophrenia
A 39-year old female is bought to the GP by her concerned husband. Both of them
lost their jobs a year ago and had to move into council housing. He says recently
she’s changed drastically, sometimes talking about one thing then going off on a
tangent and he struggles to keep up. She’s also started rhyming her words a lot and
on other occasions it’s very hard to get anything out of her. They were also at a
funeral the other day and she just began laughing uncontrollably and wouldn’t stop.
62. Catatonic Schizophrenia
A psychiatrist attends a home visit to see a patient that has been referred to him.
Upon arrival at the property he is met by a mother who shows him her son. He is
standing at the window on one leg, with the other slightly flexed and one finger
pointing upwards. She tells you he will wake up at 8.30 in the morning and maintain
this position for the entire day. If ever he does talk it’s intelligible words that make
no sense.
66. Delusional Disorder
Patient expresses idea with unusual persistence/force
Idea is exerting influence on patients life
Quality of secretiveness/suspicion
Humorless and sensitive about the belief
No matter how unlikely patient believes it fully and completely
Any contradiction to the idea is met with force
Belief is out of keeping with patients cultural and social background
Others who observe the behaviour believe it to be abnormal
67. Delusional Disorder
Stable disorder characterised by delusions that are clung to
Chronic illness
Delusions are logical and have internal consistency
Delusions do not interfere with logic unless related to the delusion
69. Schizoaffective disorder
Mixture of Schizophrenia & Mood Disorders
Bipolar Type or Depressive Type
Treat symptoms of mood disorders and of schizophrenia
71. Manic Episodes
“An episode where mood is higher than the person’s situation warrants and may vary from
relaxed high spirits to barely controllable exuberance, accompanied by hyperactivity, a
compulsion to speak, a reduced sleep requirement, difficulty sustaining attention and, often,
increased distractability”
PSYCHOLOGICAL
• Pressured speech
• Flight of ideas
• Grandiose delusions
• Expanded self-esteem
• Preoccupying thoughts
• Over-indulgence in behaviours with high risk
PHYSICAL
• Sweating
• Pacing
• Weight loss
72. Bipolar Affective Disorder
A 23-year old man walks into your practice. He stands out wearing brightly coloured
clothing and wearing shorts and flip-flops despite the snow. He talks incredibly
quickly and you struggle to keep up with him, but understand a few words about
‘living on mars’ and ‘communicating with the Gods for his mission.’ When you try to
get him to slow down he gets irritable telling you there’s no time and that he is of
vital importance to all their plans.
73. Bipolar Affective Disorder
Occurrence of at least one manic episode
◦ If hypomanic episode (without full manic episode) occurs then bipolar II disorder
Major social complications
◦ Marital
◦ Financial
◦ Social
Medical complications
◦ Increased mortality
◦ Substance abuse tends to occur concomitantly
75. Treatment
ACUTE MANIA DISCUSSED LATER
Mood stabilisers
◦ Lithium
◦ Semisodium valproate
Second-line
◦ Add carbamazepine or lamotrigine
76. Lithium Treatment
Before starting treatment
◦ TFTs
◦ Renal function
◦ ECG
◦ Avoid if in first trimester/advocate reliable contraception in women of child-bearing age
Check levels 12 hours after latest dose
◦ Therapeutic range = 0.7-1.0 mmol/L if dose is taken once daily
◦ Twice daily dose = 0.4-0.8 mmol/L at 12 hours
When starting check 1 week after commencing and 1 week after every dose change
Monitor monthly in first 6 months then every 3 months if lithium levels are stable and adherence is
good
Check TFTs & U&Es every 6 months
77. Lithium Toxicity
Occurs at levels above 1.4mmol/L
Symptoms
◦ Diarrhoea
◦ Vomiting
◦ Ataxia
◦ Nystagmus
◦ Dysarthria
Management
◦ Isotonic saline fluids
◦ Haemodialysis if renal failure
o Confusion
o Epileptic Seizures
o Hypereflexia
o Hypertonia
o AV Heart Block
78. Depression
A 33-year old woman comes to see her GP. It takes her a while to start talking, but
she reports symptoms of insomnia and early morning waking. She denies feeling of
low mood, but on further probing she has lost interest in her gardening and does feel
tired a lot of the time. She has been losing weight steadily over the past few months,
and has struggled to get the energy for her job.
79. Persistent sadness or low mood
Loss of interests or pleasure
Fatigue or low energy
+/-
◦ Disturbed sleep
◦ Poor concentration or indecisiveness
◦ Low self-confidence
◦ Poor or increased appetite
◦ Suicidal thoughts or acts
◦ Agitation or slowing of movements
◦ Guilt or self blame
80. Management
Refer if there is psychosis, a risk of suicide or a history of bipolar
Mild – moderate depression
◦ Watchful waiting
◦ Exercise
◦ Self Help
◦ Psychological therapies
Moderate depression
◦ SSRIs
◦ CBT
Consider need for ECT in severe depression
82. Specific Phobias
Irrational fear
Provokes physical response
Usually purely behavioural conditioned response
Treat with:-
◦ Counselling
◦ Psychotherapy
◦ CBT
◦ Desensitisation
◦ Medication
83. Panic Disorder
Characterised by panic attacks
◦ Sudden, overwhelming, discrete episodes of anxiety
◦ Patients think they might die, collapse or lose control
◦ Psychosomatic symptoms
◦ Palpitations Sweating Trembling Shortness of breath Choking Chest pain Nausea Dizziness
Derealisation/Depersonalisation Fear of losing control Fear of dying Paraesthesias Chills
Hot Flushes
Initial attacks sudden, later associated with environments
85. Management of Anxiety Disorders
SSRIs = first line along with CBT
Increase dose
Tricyclics second-line
Hypnotics third-line
If still no response reconsider diagnosis
86. Post-Traumatic Stress Disorder
Direct response to extreme stress or life-threatening event
Characteristics
◦ Recurrent reliving of the traumatic experience
◦ Nightmares/flashbacks
◦ Phobic avoidance of stimuli associated with trauma
◦ Persistent arousal
◦ Hypervigilance & abnormal startle response
Offer trauma focussed CBT
Eye movement desensitisation & reprocessing
Drugs are NOT first-line
87. Obsessive Compulsive Disorder
Recurrent obsessions &/OR compulsions
Unpleasant, intrusive repetitive thought
Recognised to be the patients own
Cause a degree of anxiety to patient
Treat same as other anxieties
88. Conversion Disorders
Typically involves loss of motor or sensory function
Symptoms aren’t consciously feigned or for material gain
Patients may be indifferent to symptoms (La Belle Indifference)
89. Somatisation Disorders
Multiple physical SYMPTOMS present for at least 2 years
Multiple investigations but patient refuses to accept reassurances or test results
93. Anorexia Nervosa
Behavioural disturbance leading to marked weight loss or lack of weight gain
BMI <17.5
A morbid fear of fatness
An endocrine disorder
◦ Amenorrhoea
◦ Loss of sexual interest
May employ drastic means for weight control
◦ Laxative abuse
◦ Excessive exercise
◦ Self-induced vomiting
95. Bulimia Nervosa
Recurrent episodes of binge eating with loss of control
Extreme compensation (purging)
◦ Self-induced vomiting
◦ Laxative abuse
Morbid fear of fatness
96. Managing Eating Disorders
Anorexia
◦ Motivational interviewing
◦ CBT
◦ Family therapies
◦ DO NOT USE MEDICATION
Bulimia
◦ CBT
◦ Interpersonal therapy
◦ SSRIs
97. Postnatal Mental Health
'Baby-blues' Postnatal depression Puerperal psychosis
Seen in around 60-70% of women
Typically seen 3-7 days following birth
and is more common in primips
Mothers are characteristically anxious,
tearful and irritable
Affects around 10% of women
Most cases start within a month and
typically peaks at 3 months
Features are similar to depression seen
in other circumstances
Affects approximately 0.2% of women
Onset usually within the first 2-3 weeks
following birth
Features include severe swings in mood
(similar to bipolar disorder) and
disordered perception (e.g. auditory
hallucinations)
Reassurance and support, the health
visitor has a key role
As with the baby blues reassurance and
support are important
Cognitive behavioural therapy may be
beneficial. Certain SSRIs such as
sertraline and paroxetine may be used if
symptoms are severe - whilst they are
secreted in breast milk it is not thought
to be harmful to the infant
Admission to hospital is usually required
There is around a 20% risk of recurrence
following future pregnancies
101. Antisocial Personality Disorder
Disregard for the rights of others
Begins in childhood/adolescence and continues into adulthood
History of legal problems
Poor moral sense/conscience
102. Emotinally Unstable Personality Disorder
Variability and depth of moods
Affects interpersonal relationships
Impulsive behaviour
Unstable self-image and relationships
Feelings of abandonment
104. Acute Psychosis
Characterised by the presence of delusions, hallucinations, thought disorder and affective
disorder
May occur secondary to organic brain disorders, substance abuse, as an acute psychotic episode
or part of a chronic mental health issue
Assessment
◦ Evidence of Organic Brain Disorder
◦ Presence of Substance Abuse
◦ Risk of Self-Harm/Harm to Others
◦ Physical complications such as self-neglect
May need Rapid Tranquilisation
Consider oral antipsychotics or IM depo injection
105. Severe Depression
1. Organic cause?
2. Mini mental state exam
3. Psychosis?
4. Psychomotor retardation
5. History of bipolar?
6. Medical complications of neglect/self-harm?
7. Physical complications
8. SUICIDE RISK/RISK OF HARM TO OTHERS
ADMIT UNDER
MHA IF NECESSARY
CONSIDER NURSING
REQUIREMENT
TREAT
PHARMACOLOGICALLY
ECT FIRST-LINE
106. Management of Suicidal Behaviour
1. Is there evidence of a psychiatric disorder?
2. Is there evidence of medical
consequences?
3. Has there been a previous suicide attempt?
4. Is there evidence of a social crisis?
5. What social and financial support is
available?
6. Is there on-going suicidal intent?
7. Does the patient intend to harm others?
1. To what extent was the act planned?
2. Were there final acts (e.g. note/will)?
3. How dangerous was the act of self harm?
4. How dangerous was it perceived by the
patient?
5. Were any precautions to avoid discovery
taken?
6. Did the patient seek help?
SYMPATHY
TREAT PHYSICAL
CONSEQUENCES
TREAT PSYCHIATRIC
CONDITIONS
IDENTIFY
PRECIPITATING
FACTORS
CONSTANT
REVIEW &
REASSESSMENT
108. Acute Mania
Pure Mania Rapid CyclingMixed
Lithium OR atypical
OR semisodium
valproate
Semisodium
Valproate
Olanzapine OR
semisodium
valproate
Add Benzodiazapine Add Benzodiazapine
Add Lithium/
Carbamazapine
Add Atypical Add Atypical Add Atypical
ASSESS RESPONSE
109. Severe Anorexia Nervosa
Severe defined as:-
◦ Bradycardic/hypotensive
◦ Glucose <4mmol/L
◦ Electrolyte imbalance – HYPOKALAEMIA
◦ WCC <2
◦ Hypothermia
◦ Dehydration
◦ Muscle weakness
◦ Hepatic, renal or CVS impairment
◦ BMI <13
110. Severe Anorexia Nervosa
Multidisciplinary Approach Required
◦ Refer to local psychiatric services
◦ Refer to eating disorder service
◦ Refer to local endocrinologist/gastroenterologist for medical evaluation
◦ Refer to a dietician
Motivational interviewing
Physical monitoring
Nutritional therapy with psychological support
MONITOR FOR RE-FEEDING SYNDROME
Treat any depression
111. Rapid Tranquilisation
RISKS vs BENEFITS
CAUTIONS
CONSULTATIONS & PATIENT CHOICE
MEDICATION
Over-sedation & airway problems
CVS & Respiratory Collapse
Interaction with prescribed/illicit medications
Damage to therapeutic relationship
Underlying physical/psychological disorders
Congenital prolonged QT syndrome
Hypo/hyperthermia
Stress
Physical exertion
Advanced Directive if possible
ORAL
IM
IV
Lorazepam/antipsychotics
Lorazepam+-Haloperidol
Benzodiazapines/Haloperidol
112. Acute Violence
MAINTAIN YOUR SAFETY
DO NOT BE ALONE WITH THE PATIENT
USE PERSONAL ALARMS
SUMMON THE POLICE IF NECESSARY
CONSIDER ESCAPE ROUTES
IDENTIFY POTENTIAL WEAPONS
IDENTIFY PARTICULARLY AT RISK INDIVIDUALS
ATTEMPT TO TALK TO PATIENT & CALM THEM
MAINTAIN DISTANCE
GIVE SIMPLE SHORT POSITIVE INSTRUCTIONS
ASK THE PATIENT WHAT THEY WANT AND MEET NEEDS IF POSSIBLE
DEPERSONALISE THE SITUATION
GAIN CONSENT FOR TREATMENT
AIM TO TRANSFER PATIENT TO A SAFE PLACE
TREAT APPROPRIATELY
CONSIDER RAPID TRANQUILISATION
SUGGESTED USE IM OLANZAPINE OR LORAZEPAM
MONITOR VITAL SIGNS
CONSIDER DIAGNOSIS POST-EVENT
CONTINUE TO MONITOR PATIENT
CONSTANT RISK ASSESSMENTS
REVIEW THE INCIDENT AND PROCEDURES TAKEN
ENSURE ADEQUATE COUNSELLING AND SUPERVISION OF INDIVIDUALS INVOLVED
113. Delirium
Disordered thinking
Euphoric, fearful, depressed or angry
Language impaired
Illusions/delusions/hallucinations
Reversal of sleep-awake cycle
Inattention
Unaware/disorientated
Memory deficits
115. Tests in Delirium
FBC – INFECTION, ANAEMIA
U&Es – ELECTROLYTE IMBALANCES
LFTs – LIVER FAILURE, ALCOHOL WITHDRAWAL
Blood Glucose - HYPOGLYCAEMIA
ABG - HYPOXIA
Sepsis Screen - INFECTION
ECG – CARDIAC CHANGES
Lumbar Puncture – CNS INFECTION, CSF PRESSURE
CT/MRI – BLEEDING, MASSES
Malaria Films – IF SUSPICIOUS OF MALARIA AS SOURCE OF INFECTION
EEG – POST-ICTAL
116. Management of Delirium
TREAT UNDERLYING CAUSE AS APPROPRIATE
Reduce distress, prevent accidents, encourage family to stay with patient
Nurse in a moderately lit, quiet room
Same staff in attendance
Do not use physical restraints, try not to cathetrise
Augment self-care, discourage passive dependency & napping
3M’s of delirium. Music, Massage, Muscle relaxation
Minimise medication
Editor's Notes
Article 5 & 3 & 8 need to be considered with mental health
Article 5 = right to liberty. Strict rules on detention. MUST be done in authorised institution, assessment done by objective independent expert, disorder must be severe.
Article 3 = compulsory medical treatment can be degrading. Treatment MUST be therapeutic and in best interest
Article 8 = includes physical and psychological integrity. Again must be justified to be broken.
Section 2 = assessment order (28 days). Cannot be renewed. Instituted by 2 doctors and an AMHP, one must be section 12 approved.
Section 3 = treatment order (6 months) and can be renewed. Must be clear about diagnosis and proposed treatment plan.
Section 4 = emergency order (72 hours). Implemented by one doctor and an AMHP. Can be converted into section 2 once another doctor reviews.
Section 5 = holding powers (2) = doctors (72 hours), (4) = nurses (6 hours)
Section 135 = magistrate order. Allows police detention in private property
Section 136 = police detention in public
Appearance = very specific!! Height weight, manner of dressing, grooming. Do they look their age, belong to a subculture, personal hygiene. Signs of depression & neglect/mania
Attitude = rapport. Approach to the interview process and interactions.
Behaviour = level of activity and arousal. Observations of eye contact and gait. Tremor/choreiform/athetoid movements. Akathisia, psychomotor agitation/hyperactivity.
Mood = subjective state described by patient
Affect = objective apparent emotion portrayed by individual.
Speech = Pressured/poverty of speech. Rhythm, intonation, pitch, phonation, articulation
Thought process = quantity, tempo and logic of thought. Flight of ideas, perseveration, formal though disorder.
Thought content = delusions, overvalued ideas, obsessions, phobias & preoccupations.
Perception = SENSORY EXPERIENCE. hallucinations, (sensory perception in the absence of external stimuli). Pseudohallucination (sensory perception in the presence of external stimuli) or illusion
Cognition = alertness, orientation, attention, memory, visuospatial functioning, language
Insight = ideas, concerns, expectations
More features = greater significance of suicidal intent
Pathology:- accumulation of neurofibrillary tangles (due to pairing of tau proteins) and beta-amyloid plaques. Develop in hippocampus and cerebral cortex.
Risk factors include:- advancing age, family history, APOE 4 enotype, obesity, insulin resistance, dyslipidaemia, hypertension, inflammatory markers, down syndrome, traumatic brain injury
4 stages.
Preclinical:- may begin in 5th decade of life. NFTs and BA plaques begin to accumulate.
Mild Alzheimer’s disease = memory loss, confusion about familiar places, taking longer to accomplish normal, daily tasts, trouble handling money and paying bills, compromised judgement, loss of spontaneity, increased anxiety.
Moderate = increased of the above. AND short attention span, problems recognising friends and family, difficulty organising thoughts and thinking logically, inability to learn new things, restlessness & agitation, repetitive statements, hallucinations, loss of impulse control.
Severe = no recognition of family or loved ones and can’t communicate. Weiht loss, seizures, skin infections, groaning, moning or grunting, increased sleeping, lack of bladder/bowel control
Stepwise
If symptom onset within 1 year DwLB. If outside of 1 year then Parkinsons with Dementia.
Only perform mid-stream urine test, CXR, ECG if indicated by clinical presentation.
Do NOT examine CSF. Do not test for syphilis or HIV unless there are risk factors.
Cognitive assessment =
MMSE <28/30 = Dementia
6-Item Cognitive Impairment Test = score greater than 7 = memory problems
GP Assessment of Cognition = <5 = cognitively impaired. 5-8 = equivocal and >8 = intact cognition
7-minute screen
Addenbrooke’s Cognitive Examination revised
Educate the patient on the disease course and management options. Advise them to inform family, and advise them of sources of support and options. Promote independence – try and give them as much support as needed to stay in familiar locations
Cognition - Alzheimer drugs = anti-cholinesterase inhibitors (donepezil, galantamine, rivastigmine) in moderate disease, memantine in severe disease. Group cognition stimulation.
Depression – treat as depression
Behaviour – non-pharmacological = aromatherapy, animal-assisted therapy, massage, music/dance therapy. Pharmacological = antipsychotics/anti-cholinesterase inhibitors
FAST – if answer to Q1 is never, not misusing alcohol. If answer to Q1 is weekly, misusing alcohol. If Q1 is monthly or less than monthly ask Qs 2, 3 and 4. Score for hazardous drinking = 3 or more.
Alcohol Use Disorders Identification Test
SADQ for severity of dependence
APQ for the nature and extent of problems arising from alcohol misuse
Assess BIOPSYCHOSOCIAL – mental and physical health problems, relatonships and functioning, cognitive needs, education, abuse history, risk to self and others, readiness to change
Assess alcohol consumption (need to score 20 or more on AUDIT OR drink 15 units of alcohol per day). Assess likelihood of drinking as an outpatient and not complying.
Community-based programme 2-4 meetings per week + drug regimen, and psychosocial support. CONSIDER IF:- drink between 15-30 units per day, score less than 30 on the SADQ, are NOT on benzodiazapines
Inpatient & resident withdrawal:- consider if above the thresholds above OR have a history of epilepsy or have previousl experienced delirium tremens OR have significant psychiatric/physical co-morbidities
If 10-17 year olds base withdrawal plan on adult recommendations. Promote abstinence and prevent relapse offering CBT, family therapies (functional or brief strategic family therapy).
DRUGS:- use a benzodiazepine as the preferred medication,
Acamprosate = GABA receptor agonist, reduces glutamate surge in withdrawal and neuroprotective.
Naltrexone antagonises opioid receptors. Helps in withdrawal because endogenous opioids have augmented effects in the presence of alcohol.
Disulfiram inhibits acetaldehyde dehydrogenase, creating unpleasant reactions when alcohol is consumed.
Acute alcohol withdrawal = give thiamine to protect from Wernicke’s. Decide whether to admit or not based on:- suicide risk and risk of DT. Assess appropriately.
THIAMINE FOR WERNICKE’S ENCEPHALOPATHYKorsakoff = supported independent living if mildly impaired. 24 hour care if severe cognitive impairment
Alcoholic hepatitis = corticosteroids/liver transplant
Alcoholic pancreatitis = offer analgesia, pancreatic enzymes, refer to specialist, surgery
Naloxone = opiate antagonist without euphoric effects.
Gain informed consent, talking about physical and psychological aspects of withdrawal. Non-pharmacological interventions, continued support. Risk of overdose due to decreased tolerance.
ADVICE on a balanced diet, adequate hydration, sleeping well, physical exercise
Lofexidine is an alpha-2 receptor agonist. Alleviates symptoms but does not provide replacement.
- Ultra rapid and rapid detox start with naloxone treatment and sedation.
Genetics – MZ concordance = 50%
Development – influenza in 2nd trimester may increase risk
Brain abnormalities – Ventricular enlargement & reduced brain size
Overactivity of dopamine in the mesolimbic pathway
Life events – stress occurs more frequently in the month before the first psychotic episode and may precede illness
Expressed emotion – family/carers becoming over-involved, critical or hostile
Delusions of persecution, reference, exalted birth, special mission or jealousy.
Hallucinatory voices that threaten or give commands. Or Auditory hallucinations without verbal form (whistling, humming/laughing)
Olfactory/gustatory hallucinations.
Negative symptoms may be present but the above features dominate the clinical picture.
Also known as disorganised schizophrenia.
Formal thought disorder is most common presentation, alongside flattening or inappropriate emotions/effects.
Delusions and hallucinations not prominent.
No difference in typical or atypical for antipsychotics
Offer CBT to ALL schizophrenics
Offer family intervention
Arts therapy for negative symptoms
Need at least one of top 3 persistent for two weeks.
If <4 symptoms, not depressed. 4 symptoms = mild. 5-6 = moderate, >6 = severe
Antidepressants/beta blockers
If psychological intervention not working, consider mirtazapine/paroxetine and amitriptyline/phenelzine
Hypnotics for sleep disturbance
Little evidence for medication in AN. Also people with AN often have prolonged QT and many psychiatric medications prolong QT further putting them at risk of Torsades des Pointes and Sudden Death
Paroxetine recommended because of low milk:plasma ratio
Fluoxetine is best avoided due to long half life
Risperidone if glucose intolerance, weight gain or sedation are an issue. Olanzapine if extra-pyramidal side effects are an issue
IM depot injection if non-compliant
Consider Venlafaxine due to quick onset of action
Beware Antidepressants in bipolar, may precipitate mania
And treatment of psychomotor retardation may enhance suicide risk (allows patient to carry out plans)
6 – discussing suicide does NOT increase risk.
Factors indicating suicidal intent in 2nd box
Only prescribe drugs that are safe in overdose & limit access to tablets
Re-feeding syndrome:- individual who has had negligible nutrition for 2 days is at risk. Occurs within 4 days. Develop fluid & electroly disorders. Fluid retention/CCF. Cardiac arrhythmias, delirium, seizures, hypophosphataemia or acute bowel obstruction can occur.
Consider psychotic context (use antipsychotics/haloperidol in psychosis otherwise do not use)
IM olanzapine is another alternative
DO NOT USE HALOPERIDOL IN PARKINSONS DISEASE