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Intro into Psychiatry (Rotation A) Macky Padilla EdMedSoc 18:00 - 22 August 2022Psychiatry in Year 5 ONLY REPRESENTATIVE FOR OUR YEAR (CURRENT YEAR 6s) • No OSCEs/CCS Stations related to Psychiatry • SAQs not typically geared towards Psychiatry • Good number of SBA questions were on PsychiatryMental State Examination Appearance ASEPTIC External Appearance Appearance • Suitable clothing for time, weather and place? • Are they neat, tidy and well-presented or messy and Speech unkempt? Emotion Behaviour Perception • Are they agitated? Are they distracted? Thoughts • Are they threatening? Are they cooperative? Insights • Do they make eye contact? CognitionMental State Examination Speech ASEPTIC • Tone Appearance • Pace • Pressure of Speech Speech • Poverty of Speech Emotion • Intonation Perception Thoughts Insights CognitionMental State Examination ASEPTIC • How are they feeling at the moment? Appearance • How has their mood been in the past week? Speech Emotion Perception Thoughts Insights CognitionMental State Examination ASEPTIC • Can they see anything that you or others cannot see? Appearance • Can they hear anything that you or others cannot hear? Speech Emotion Perception Thoughts Insights CognitionMental State Examination Thoughts ASEPTIC Appearance • Are they comprehensible? • What are they thinking at the moment? Speech • Flight of ideas Emotion • Do they believe that their thoughts are not their own? Perception • Thought removalon Thoughts • Thought broadcasting Insights • Thought block CognitionMental State Examination Insight ASEPTIC • Do they have insight into their condition? Appearance • Do they understand the severity of their condition? •functioning?erstand how their condition affects their daily Speech • Do they understand if they require treatment? Emotion Perception Thoughts Insights CognitionMental State Examination ASEPTIC Cognition • Are they orientated to time and place? Appearance • Are they able to recall things short-term and long-term? Speech • Can they concentrate? Emotion • Can do MMSE, MoCA or Mini-ACE Perception Thoughts Insights CognitionBipolar DisorderLithium Lithium Levels • Lithium levels should taken 12-Hours post- dose • Weekly measurements until established • Once established 3-monthly measurements Lithium Toxicity Precipitated by dehydration Coarse Tremor Hyperreflexia Acute Confusion PolyuriaSchizophrenia Positive Symptoms Negative Symptoms Psychotic Symptoms Symptoms of Deficit • Audio Hallucinations • Anhedonia • Visual Hallucinations • Flat Effect • Delusional Thinking • Disorganised Thinking • AgitationAntipsychotics Typical / First Generation Atypical / Second Generation D2 Receptor Blocker 5-HT, D4 and Weak D2 Receptor Haloperidol, Chlorpromazine Blocker Clozapine, Risperidone, Olanzapine D2 Receptor Blocker Typical / First Generation Antipsychotics Haloperidol, Chlorpromazine Mesocortical Dysfunction associated with cognitive impairments and negative affect Blockade can induce secondary negative and cognitive symptoms Mesolimbic Antipsychotic action Nigrostriatal Associated with extrapyrimaidal symptoms Tuberoinfundibular Prolactin release 5-HT, D4 and Weak D2 Receptor Blocker Antipsychotics Atypical / Second Generation Clozapine, Risperidone, Olanzapine Reduced risk of Extra-Pyramidal Symptoms Warnings Weak antagonism of D2 Receptors • Increased risk of stroke • Increased risk of venous thromboembolism Clozapine Side Effects • Agranulocytosis • Reduced Seizure ThresholdPersonality DisordersPersonality Disorders Cluster A Suspicious Paranoid Personality Disorder Read threats and danger in everyday situations, difficulty relaxing, difficulty trusting Schizoid Personality Disorder Prefer to be alone, difficulty in forming relationships, cold towards other Schizotypal Personality Disorder Feel that you are ‘odd’ and cannot relate to others, difficulty in forming relationshipsPersonality Disorders Cluster B Emotional and Impulsive Antisocial Personality Disorder Put oneself in risky situations, behave dangerously or illegally, aggressive behaviour, problems with empathy Histrionic Personality Disorder Uncomfortable not being the centre of attention, constantly seek approval from others, reputation for being dramatic and overemotional Narcissistic Personality Disorder Fragile self-esteem, resent other people’s success, seen as selfish Emotionally Unstable Personality Disorder quickly, no strong sense of selftions that changePersonality Disorders Cluster C Anxious Avoidant Personality Disorder Expect disapproval and criticism, worry about being ridiculed, fear rejection Obsessive-Compulsive Personality Disorder High standards for oneself and others, anxious if not perfect, worry about making mistakes, do not have insight Dependent Personality Disorder Feel needy and weak, allow/require others to make decisions in your life, low self- confidence, avoid being aloneAlcohol Excess Wernicke’s Encephalopathy Thiamine Deficiency • Nystagmus • Ophthalmoplegia Tx: Thiamine Replacement • Ataxia Korsakoff’s Syndrome • Amnesia • ConfabulationAlcohol Excess WernickLEs EThiamine Deficiency • OVEthalmopTx: Thiamine Replacement • Ataxia • AmnRSiaEs Syndrome •IREnfabulationAlcohol Withdrawal 6 Hours Tremor, Sweating, Tachycardia, Anxiety 36 Hours Peak incidence of seizures 48-72 Hours Delirium Tremens: Coarse Tremor, Confusion, Delusions, Auditory, Visual Hallucinations, Fever Tachycardia Treatment: Chlordiazepoxide or diazepamAlcohol Misuse Recommendation of no more than 14 units per week At least spread over 3 days in a week Treatment • Alcoholics Anonymous, CBT and Counselling • Disulfiram • AcamprosateAcute Dystonic Reaction Associated with antipsychotic use • Nigrostriatal dopamine D2 receptor blockade • Excess striatal cholinergic outputSerotonin Syndrome vs Neuroleptic Malignant SyndromeDetention • Section 2 – Assessment (Up to 28 Days) • Section 3 – Treatment (Up to 6 Months – can be extended) • Section 4 – Urgent assessment from Community (Up to 72 Hours) • Section 5(2) – Urgent detention by a Doctor (Up to 72 Hours) • Section 5(4) – Urgent detention by a Qualified Nurse (Up to 6 Hours) • Section 135 – Police removal from Home • Section 136 – Police removal from Public PlaceFeedback bit.ly/3AAEKth Slides available after completing feedback!