PACES psych

Question 1

depression counselling

Answer 1

• persistently low mood that impacts on day to day functioning
• very common, every year 1/4 suffer from MH problem
• address social needs
• explain role of psych therapy (CBT = talking therapy based on principle that thoughts, mood and behaviour are intertwined)
• role of medication (takes a number of weeks to work, can make feel worse first, F/U in 1 week, warn about side effects)
• advise about crisis resolution and home treatment team
• support: mind.co.uk, Samaritans

Question 2

BPAD counselling

Answer 2

• consider admission and section if risky
• explain is a condition where people experience extremes of emotion for variable lengths of time
• important to control
• both extremes can lead to making certain decisions and taking risks that you would otherwise regret
• medications available that help balance the chemicals in the brain
• advice about crisis resolution team and samaritans

Question 3

alcohol misuse counselling

Answer 3

• establish risks (driving, suicide, dependents)
• assess social issues (SAFEGUARDING)
• establish goals (elimination or moderation)
• symptoms of withdrawal worse in 48 hours, should pass after 3-7 days
• advise against stopping drinking abruptly
• referral to drugs and alcohol service
• assisted withdrawal uses benzodiazapines, psych treatment, relapse prevention and social support

Question 4

opiate withdrawal counselling

Answer 4

• explain worth getting tests done for blood-borne diseases, offer vaccinations
• features of withdrawal (restlessness, anxiety, sweating, diarrhoea, abdo cramps, N/V, palpitations)
• begin within 24 hours, peaks after 2-3 days, should be better by 1 week
• detox involved giving a subsititue that should lessen symptoms of withdrawal
• symptomatic treatment given to reduce nausea, diarrhoea
• psych therapies to prevent relapse and address underlying MH issues
• role of a key worker to support patient through detox
• support: narcotic anonymous, SMART recovery

Question 5

Benzo misuse counselling

Answer 5

• explain harmful effects of benzos (in long term can cause worsening of psych symptoms and cognitive impairment)
• can be reduced very gradually
• role of CBT to address underlying MH and provide help on sleep hygiene
• advice against driving if feeling drowsey

Question 6

main psych in Dementia

Answer 6

group cognitive stimulation

group reminiscence therapy

Question 7

drugs to avoid in forms of dementia

Answer 7

no Ach inhibitors in frontotemproral

no anti-psychotic in LBD

Question 8

panic disorder management ladder

Answer 8

1. recognition and diagnosis
2. treatment in primary care (self help)
3. review, consideration of alternative treatments (CBT + SSRI)
4. review and referral to specialist mental health services
5. care in specialist mental health services

Question 9

PTSD counselling

Answer 9

• condition that occurs after trauma
• characterised by flashbacks, hyperarousal, avoidance
• impact on patients life
• trauma focused CBT for 8-12 sessions: explores how trauma has affected belief systems and outlook
• medications e.g. sertraline and mirtazapine
• consider group therpay
• follow up

Question 10

SSCM, MANTRA

Answer 10

specialist supportive clinical management

Maudsley Anorexia Nervosa treatment for adults

Question 11

anorexia counselling

Answer 11

• explain characterised by morbid fear of fatness, reduced calorie intake and a low BMI
• risks of anorexia = osteoporosis, infertility and cardiac problems (arrythmias)
• psychological therapy options (CBT-ED, SSCM, MANTRA, family therapy)
• involves exploring through processes driving these behaviours
• set an eating plan and feasible weight gain targets
• medical therapy if depressed e.g. fluoxetine
• support: BEAT

Question 12

management of bulimia nervosa

Answer 12

1. referral for specialist care
2. BN-focused guided self help
3. if ineffective after 4 weeks = ED-focused CBT
4. trial of high dose fluoxetine

Question 13

postnatal depression counselling

Answer 13

• consider admission to mother and baby unit if severe
• involve HTT and health visitor
• likely due to hormonal changes
• occurs in 1/10 women
• address any concerns and provide support at home if needed
• explain psych treatment (CBT)
• medical treatment = sertraline which is safe in breastfeeding
• prognosis = most recover in moneth
• postnatal community mental health team will be involved

Question 14

puerperal psychosis counselling

Answer 14

• ADMIT
• explain that may be linked to hormonal changes causing chemical imbalances in brain
• treatment is anti-psychotics
• admission to mother and baby unit is needed to keep both safe
• recovery usually takes 6-12 weeks
• 30% risk of recurrence

Question 15

EUPD counselling

Answer 15

• explain is characterized by increased sensitivity to emotions
• likely to be linked to stressful life circumstances and experiences
• personality disorders are often underdiagnosed (10% have personality disorder)
• dialectical beahvioral therapy helps (helps you understand your thought processes and teaches you not to view things as black and white, teaches skills to cope with difficult emotions)
• use of therapeutic communities (meet other people with similar issues and support each other in recovering)
• crisis management: numbers for crisis team, community mental health nurse, out-of-hours social worker, Samaritans
• support: mind.co.uk

Question 16

depression history

Answer 16

ask all core symptoms
biological symptoms
cognitive symptoms
forensic history

Question 17

depression investigation important details

Answer 17

PHQ9
physical exam
blood (FBC, TFT, Ca)

Question 18

depression management

Answer 18

• CBT + SSRI
  4-6 weeks to work, 2 week follow up, SEs (nausea, appetite change, anxiety)
• advice: sleep hygiene, exercise, self-help, IAPT

Question 19

somatisation DDx

Answer 19

• delusional disorder

- adjustment disorder

Question 20

important thing to check in psych history

Answer 20

insight

Question 21

Lewy body dementia management

Answer 21

• patient adaptions with OT (reality orientation, environmental modifications)
• social support
• optimise physical health
• pysch therapies e.g. reminiscence
• Parksinons symptoms can treat with Parkinsons drugs but make hallcuinations worse
• Ach inhibitors

Question 22

DLB on CT

Answer 22

mild atrophy

Question 23

if child psych history

Answer 23

some aspects of paeds history

Question 24

counsellin in anorexia

Answer 24

• condition characterised by restriction of energy intake
• leads to low body weight, intense fear of gaining weight and disturbance in way individual perceives body
• can lead to physical health problems so we would like to treat her to help her achieve healthy weight
• anorexia focused family therapy = show how you can support your daughter

Question 25

schizophrenia counsel

Answer 25

- voices you have been hearing and feeling are due to imbalance in chemicals in your brain - when these chemicals are unbalanced, can cause you to see and hear things that other people don't - we can give you medications to help balance these chemicals and make symptoms go away

Question 26

what to check in psychosis?

Answer 26

are taking steroids

Question 27

main important management in delirium

Answer 27

admit as it fluctauates

Question 28

important question to assess insight

Answer 28

"are the thoughts your own"

Question 29

counsel in OCD

Answer 29

it is a condition where you have recurrent intrusive thoughts to do something and it can really affect your life this can be managed by CBT (explain CBT)

Question 30

what to do when start SSRI?

Answer 30

1 week F/U

Question 31

important lifestyle question in anxiety?

Answer 31

caffeine intake

Question 32

what is agoraphobia?

Answer 32

fear of being unable to easily escape to safe place

Question 33

counsel about trauma-focused CBT

Answer 33

trauma can shatter previous belief systems these beliefs can be examined and tested doesn't require patient to vividly recall trauma helps patient understand link between current feelings and trauma

Question 34

counsel about PTSD

Answer 34

condition that occurs when someone has gone through major traumatic event characterised by episodes where you may feel anxious and on high alert can affect your behaviour and cause you to avoid things that trigger these memories

Question 35

important question to ask in child with fever/unwell

Answer 35

are they tugging at their ear

Question 36

investigations in febrile seizure

Answer 36

FBC, ESR, CRP for sign of infection U&E for electrolyte imbalance GLUCOSE exclude hypoglycaemia

Question 37

management of seizure

Answer 37

``` ABCDE approach give oxygen, gain IV access check blood glucose give buccal midazolam IV lorazepam phenytoin infection ```

Question 38

assess what in a manic patient

Answer 38

capacity

Question 39

Pysch and social management of BPAD

Answer 39

Psychological (CBT – identify relapse indicators, relapse prevention strategies), Social (family support, aiding return to work, deal with financial issues resulting from overspending)

Question 40

mania counselling

Answer 40

o We believe you’re experiencing something called mania – this is when a chemical change in your brain can lead to a very increased mood o This may not sound like a bad thing and I know you’ve told us that you feel great right now, but it can actually be very damaging in the long run o It can lead you to make risky decisions that you wouldn’t otherwise make and this can cause you serious harm (financial, physical, emotional) o We would like to keep you in the hospital to give you some treatment that can normalise the chemicals in your brain and help you think clearer o When you’re feeling back to normal, we can also discuss how we can help you get back to regular work and perhaps discuss any financial issues that you may have

Question 41

if patient presented in depressive phase of BPAD

Answer 41

Antidepressant (e.g. SSRI) with an atypical antipsychotic (e.g. aripiprazole, quetiapine) to prevent triggering mania 1st line = quietapine/olanzapine/fluoxetine + olanzapine/lamotrigine

Question 42

what drug does clozapine interact with?

Answer 42

lithium

Question 43

PHQ 9 score meanings

Answer 43

0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.

Question 44

medically unexplained symptoms

Answer 44

conversion disorder chronic fatigue fibromyalgia