• Alcohol Withdrawal → use decreasing dose of long-acting benzodiazepine (chlordiazepoxide or diazepam). Symptoms (tremor, sweating, anxiety, tachycardia) after 6-12 hours, seizures after 36 hours, delirium tremens after 72 hours.
• Depression → if PHQ-9 score is >15, indicates ‘more severe’ depression. Combination of CBT and antidepressant is recommended.
• Depression vs Dementia → sleep disturbance, stress triggers and normal MMSE score with global memory loss suggests depression rather than dementia.
• OCD → manage with exposure and response prevention as first line. Technique within CBT to expose individual to trigger of their obsessive thoughts/behaviours without permitting the ensuing compulsion, allowing the anxiety/urge to diminish over time. Alternatives include SSRI or clompiramine.
• Electroconvulsive Therapy → may be used in patients with severe depression refractory to medication. Side effects include headache, nausea, memory impairment, memory loss, cardiac arrhythmia.
• OCD vs Psychosis → lack of insight (ie. believing if they don’t perform the acts something bad will happen) indicates psychosis over OCD. In OCD patients normally have good insight, and understand if they don’t perform the acts their obsessive thoughts would not come true, but they still get the urge to perform them to put their mind at ease.
• PTSD → if CBT or EMDR (eye movement desensitization and reprocessing) therapy are unsuccessful, first-line drug treatments are an SSRI or venlafaxine (SNRI). Symptoms must be present for at least 1 month for diagnosis.
• Anorexia in Children/Adolescents → family therapy is first-line treatment.
• Hypomania (vs Mania) → lasts for <7 days, does not impair social functioning, no psychotic symptoms.
• Anorexia → most things low - potassium, FSH, LH, oestrogen, testosterone, T3. G’s and C’s are raised - growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia.
• Conversion Disorder → psychological stress is unconciously manifested as physical, neurological symptoms.
  • Somatisation Disorder → multiple bodily complaints lasting months to years and persistent anxiety about their symptoms.
• Acute Mania/Hypomania in Patient on Antidepressant → stop antidepressant and start antipsychotic therapy (haloperidol, olanzapine, quetiapine, risperidone).
• Pseudohallucination → patient has insight and knows what they are seeing/hearing isn’t real.
• Cotard Syndrome → characterised by a person believing they are dead or non-existent. Seen in patients with schizophrenia or severe depression.
• Charles-Bonnet Syndrome → persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. Occurs with background of visual impairment (most commonly due to age-related macular degeneration).
• Suicide → risk factors include male sex, history of deliberate self-harm, alcohol or drug misuse, history of mental illness, history of chronic disease, advancing age, unemployment or social isolation, being unmarried or divorced.

Psych Drugs

• MAO Inhibitors (atypical depression) → have anticholinergic effects. Hypertensive reaction may occur with tyramine containing foods (cheese, marmite, broad beans).
  • Don’t give with SSRI due to risk of serotonin syndrome (mental status changes, hyperthermia, sweating, hyperreflexia, rigidity).
• Clozapine (atypical antipsychotic for treatment-resistant schizophrenia) → causes seizures, constipation, agranulocytosis, and myocarditis (SCAM).
  • Need FBC monitoring due to risk of agranulocytosis/neutropenia.
  • If doses are missed for >48 hours, the dose will need to be restarted again slowly.