Confusion Bloods
• FBC
• Bone profile
• U&Es
• Glucose
• LFTs
• Blood culture
• Coagulation/INR
• Urine culture
• TFTs
PSYCHIATRY
, ACUTE STRESS DISORDER PTSD
• Occurs WITHIN first 4 weeks after a traumatic event • Occurs AFTER the first 4 weeks after a traumatic event
Clinical Features Clinical Features
• Intrusive thoughts - flashbacks, nightmares • Re-experiencing - flashbacks, nightmares, repetitive
• Dissociation - time slowing, ‘being in a daze’ • Avoidance
• Negative mood • Hyperarousal
• Avoidance • Emotional numbing
• Arousal - hypervigilance, sleep disturbance
Management
Management • CBT
• CBT = 1st line • Eye-movement desensitisation and reprocessing (EMDR)
• Benzodiazepines - used for acute symptoms -> • Venlafaxine or SSRI (risperidone) - severe cases
agitation, sleep disturbance
S
disorders result in
Anxiety can
calcaemia due to allalosis-
hypo
.
to albumin
induced calium binding
Can numbness in the
cause
tingling or
hands feet
,
or around mouth .
, GENERAL ANXIETY DISORDER PANIC DISORDER
4
Always
↳
rule outaphysical
Hyperthyroidism
+
NICE Step-wise Approach
NICE Step-wise Approach
• Educate about GAD + active monitoring • Recognition and diagnosis
• Low intensity psychological interventions • Treatment in primary care
• High intensity psychological interventions • Review and consideration of alternative treatments
• High specialist input • Review and referral to specialists
• Care in specialist mental health services
Management e up if
2 weeks check > 30
• 1ST LINE = setraline >
- I for
week 30
• Symptoms have to be present for at least a month
• 2ND LINE = alternative SSRI or SNRI • More common in females
- SNRI = duloxetine, velafaxine • 2 peaks are 15-24 and 45-53
• 3RD LINE = pregabalin
• Weekly follow-up for first month Management
• CBT or drug treatment
• 1ST LINE = SSRI
• If contraindicated or no response after 12 months
- imipramine or clomipramine
• FBC
• Bone profile
• U&Es
• Glucose
• LFTs
• Blood culture
• Coagulation/INR
• Urine culture
• TFTs
PSYCHIATRY
, ACUTE STRESS DISORDER PTSD
• Occurs WITHIN first 4 weeks after a traumatic event • Occurs AFTER the first 4 weeks after a traumatic event
Clinical Features Clinical Features
• Intrusive thoughts - flashbacks, nightmares • Re-experiencing - flashbacks, nightmares, repetitive
• Dissociation - time slowing, ‘being in a daze’ • Avoidance
• Negative mood • Hyperarousal
• Avoidance • Emotional numbing
• Arousal - hypervigilance, sleep disturbance
Management
Management • CBT
• CBT = 1st line • Eye-movement desensitisation and reprocessing (EMDR)
• Benzodiazepines - used for acute symptoms -> • Venlafaxine or SSRI (risperidone) - severe cases
agitation, sleep disturbance
S
disorders result in
Anxiety can
calcaemia due to allalosis-
hypo
.
to albumin
induced calium binding
Can numbness in the
cause
tingling or
hands feet
,
or around mouth .
, GENERAL ANXIETY DISORDER PANIC DISORDER
4
Always
↳
rule outaphysical
Hyperthyroidism
+
NICE Step-wise Approach
NICE Step-wise Approach
• Educate about GAD + active monitoring • Recognition and diagnosis
• Low intensity psychological interventions • Treatment in primary care
• High intensity psychological interventions • Review and consideration of alternative treatments
• High specialist input • Review and referral to specialists
• Care in specialist mental health services
Management e up if
2 weeks check > 30
• 1ST LINE = setraline >
- I for
week 30
• Symptoms have to be present for at least a month
• 2ND LINE = alternative SSRI or SNRI • More common in females
- SNRI = duloxetine, velafaxine • 2 peaks are 15-24 and 45-53
• 3RD LINE = pregabalin
• Weekly follow-up for first month Management
• CBT or drug treatment
• 1ST LINE = SSRI
• If contraindicated or no response after 12 months
- imipramine or clomipramine
