Management of delirium?
- Assess patient in a safe environment with someone else
- Treat any underlying causes
- Re-orient to environment
- Can give haloperidol -> benzos if risk to self or others
Management of Alzheimer’s?
- Refer to memory clinic.
- Acetylcholinesterase inhibitors like donepezil
- Review in 6 months
Mx of Lewy Body?
Biological
- Acetylcholinesterase inhibitors (rivastigmine)
- Optimise physical health
- Don’t give antipsychotics or anti-parkinsons medication as both dangerous
What do you see on autopsy in Pick’s disease?
Knife blade atrophy + tau proteins in the substantia nigra
General Mx of dementia?
- MDT
- Refer to memory clinic
- For alzheimers and lewy body can give Acholinesterase inhibitors
- Reminiscence/validation/cognitive stimulation/behavioural therapies
- Alarms for wanderers/clocks/carers and consider LPA and ADs
- Tell DVLA
Where is there loss in huntington’s?
Basal ganglia, in particular caudate nucleus and thalamus
Also loss in frontal regions
Mx of psychosis
first decide where to treat
If first time and patient or others at risk, admit. Once discharged, taken care of by community psych nurse + is given a key worker
If in the community, can instead deal with the early intervention and psychosis team or crises resolution and home treatment team
Then decide on bio treatment First gen -> extrapyramidal (haloperidol) Second gen -> try for 6-8 weeks Doesn't work -> give clozapine BDZ/ECT can be used
Psych
Psychoeducation
CBT
Family therapy
Social
Rehab into community
Care programme approach
DVLA for 3 months after resolution
What can you give in depression if SSRIs dont work?
Mirtazapine
ECT if life threatening -> requires full informed consent
When do you do a care programme approach?
When there is a disorder affecting insight:
e.g. psychosis, severe depression and mania
What is the general treatment for PD?
Dynamic and group psychotherapy
For borderline PD, dialectical behavioural therapy
Mx of alcohol misuse?
First thing is give drink diary to note how much of a problem it really is and see in a week
After that, they probably drink a lot, so need intervention. Give them motivational interviewing to encourage them to carry out treatment.
Then give CBT, this will also help if they are depressed or anxious.
Now as they’re stopping, make sure to give pabrinex (3 days IV) and reducing regimen of chlordiazepoxide to stop delirium tremens.
After they’ve stopped, give them either disulfiram or ACAMPROSATE (stops craving for alcohol) as prevention.
To support this whole process, “social” interventions like the 12 step AA programme could be joined
What is damaged in Wenicke’s?
Mammillary body
Maintenance therapy in opiate abuse?
Methadone and buprenorphine
What stupid shit random scale do you use for depressed mums to see if there is baby blue?
The Edinburgh depression scale
Which drug should you have ECGs for? And why?
Pimozidine, and because it causes prolonged QT syndrome.
