*** 5Th Year - Psychiatry Ese

Front 1

Important behavior patterns to note in patients?

Back 1

Social, cooperation, rapport, motor activity- posture, ambitendence (sign of catatonia), gestures, agitation, purposeless activvity

Front 2

What is sensorium? What is perception?

Back 2

Sum of an organism perception -total character of the unique & changing sensory environment perceived by the invdividual. Perception - process of acquiring, interpeting, selecting and organizing sensory information

Front 3

What is usually the order of formation of disorientation? Give 4 examples when disorientation can occur?

Back 3

Time-->Space-->Allopsychic-->Autopsychic
1. Impaired intelligence, 2.Korsakof syndrome (time, space), 3.Schizophrenia, 4.Organic causes (delerium, fever...)

Front 4

What is the definition of concentration?

Back 4

Concentration - selective responsiveness to one class of stimuli.

Front 5

Give 3 examples of assessing attention. also, define vigilance and tenacity. In which diseases do you see hypertenacity? Hypervigility?>

Back 5

1. Serial sevens, 2.Simple calculations, 3. days of week backwards.
Vigilance- ability to change attention.
Tenacity- ability to stay focused on one subject.
Hypertenacity- deperssion, hypervigility- mania

Front 6

What are the 3 characteristics of memory?

Back 6

1. Capacity, 2.Durability, 3.Accuracy

Front 7

Give 2 disorders of memory accuracy, 1 of durability, and 2 of capacity

Back 7

Accuracy- deja vu, jamais vu.
Durability- hypomnesia(defective)
Capacity- amnesia, hypermnesia

Front 8

Define mood, define affect

Back 8

Mood- sustained emotion subjectively experienced and reported by a patient and observed by others. Colors the patients perception of the world.
Affect- Emotional responsiveness, observed expression of emotions

Front 9

Give 3 mood examples, give 3 affect examples

Back 9

mood- labile, elevated, euphoric, depression
affect- full, flat, blunted, inappropriate

Front 10

How do you classify hallucinations?

Back 10

Complexity: elementary(light), complex(scenes).
Sensory modality(visual, tactile, coenestopathic)
Special features (organic, extracampine(outside of visualfield), hypnagogic)

Front 11

Define thinking

Back 11

Goal directed flow of ideas, symbols, started by a problem or task and leading to a real conclusion

Front 12

How do you assess thinking process?

Back 12

Ask patient to tell a story about what happened the last few days - assess SPEECH. Check for rate, pattern of thoughts, goal orientation.

Front 13

Name 7 disorders of thinking process

Back 13

1. Psychosis
2. Illogical thinking(conclusions are reached, however do not follow logic)
3. Blocking
4. Neologism
5. Incoherence
6.Circumstantiality
7.Echolalia
8. Tangentibilty

Front 14

What are the 2 most important disorders of content of thought

Back 14

Delusions, Obsessions.

Front 15

How do you assess severity of delusions?
Give 5 examples of delusions.
What is the less severe form of delusion?

Back 15

1.Persistence, 2.Complexity, 3.Extent to which subject acts upon the delusion. 4.extent of deviation of normal people.
Examples:
1.Persecutory
2. Sin/guilt
3.Somatic
4.Reference
5.Mind control
Less severe is called - overvalued ideas (these are not delusions but do dominated a person and may affect his life)

Front 16

Define obsessional thoughts

Back 16

recurrent thoughts, impulses, or images that enter one's mind despite his effort to exclude them.
Commonly involve thoughts of violence, contamination.

Front 17

How do you check for disturbances of intellectual functions?

Back 17

1. General info.
2. definition of ideas
3. sub/superordinate ideas (common to banana and orange)
4. symbolical thinking
5.reading/writing
6.Intelligence scales
7.Abstract/concrete thinking

Front 18

Name 6 clinical rating scales used in psychiatry

Back 18

1. Brief Psychiatric Rating Scale BPRS
2. Scale for the Assessment of Negative/Positive symptoms SAPS/SANS
3. Hamilton Rating scale for Depression HRSD
4. Beck Depression Inventory BDI
5. Yale-Brown Obsessive-Compulsive Scale YBOCS
6. Mini Mental State Exam MMSE
7. Global Assessment Scale GAS

Front 19

4 major elements of the BPRS, 4 characteristics of BDI

Back 19

BPRS: 1.Structured/unstructred interview+observation of behavior, 2. 16 items (somatic concern, anxiety, depressive mood...), 3.Rate of 1(normal) to 7, 4. Based on last 2-3 days.
BDI: 1. Symptom scale, 2.measures attitude and symptoms of odepression, 3. 21 items ff 0 to 3 (>30 severe depression), 4. <9 minimal depression

Front 20

MMSE- purpose, what does it assess, limitations, two important 'effects'

Back 20

Used to screen for cognitive impairment caused by dementia, widely used as a bedside tool in the elderly.
Assesses Memory, Orientation, Attention, Verbal, Nominal aphasia, Receptive aphasia, Alexia, Agraphia, Constructional Apraxia (MOAN CAR VAR).
Limitations- misleading in poor education/high education and in language/sensory difficulties or in depression. Note Ceiling effect and floor effect.

Front 21

ICD-10 classification

Back 21

F0 to F9:
Organic Substance Schizophrenia,
Mood Somatoform Physical,
Personality Retardation Development,
Early onset

Front 22

DSM-IV 5 axis

Back 22

Axis I - indicates the major syndromes
Axis II - disorders that arise relatively early in life&persist (mental retard, personality)
Axis III - medical conditions relevant to current illness
Axis IV - relevant psychosocial & environmental
Axis V - global assessment of level of functioning and psychological health of patient

Front 23

What is the classification of organic mental disorders

Back 23

Disorders with generalized cognitive impairment, with selective congnitive impairment (amnestic syndromes and hallucinosis), disorders resembling other major disorders (organic mood...), organic personality syndromes, substance induced, neurological etiology, environmental,metabolic,endocrine,infectious,AI etiologies

Front 24

5 characteristics of Delerium

Back 24

1. Distrubance of consciousness, impaired attnetion, change in cognition
2. Develops quickly over hours or days
3. Fluctates during the day
4. Common in medically ill and associated with higher mortality rate
5. Worse at night

Front 25

5 psychiatric symptom of delerium

Back 25

1. Disorientation
2. Overactive/underactive behaviour
3. slow thinking but with complex content
4. Labile mood
5. Memory disturbances

Front 26

Definition of Dementia

Back 26

Loss of intellectual abilities sufficiently severe to interefe with social/occupational functions. Cognitive impairment may include the 4 A's - Aphasia, Amnesia, Apraxia, Agnosia. Most are irreversible.

Front 27

What are the findings in early and late stages of dementia?

Back 27

Early- subtle personality changes, decreased intereste, labile/shallow emotions
Late- memory & cognitive impairment, mood/personality changes are exaggerated, loss of social skills, psychosis, impaired judgment. Eventually language impairment develops.

Front 28

Give 6 findings in a psychiatric evaluation of a dementic patient

Back 28

1. Memory loss
2. Impaired attention/concentration
3. Disorientation
4. Disorganized behavior
5. Speech distrubances
6. Illusions, Hallucinations

Front 29

DSM-IV classification of Dementias

Back 29

1. Dementia of the Alzheimer's Type (Early onset, Late onset, with/o delerium delusions depression, etc)
2.Vascular dementia (uncmplicated, with delerium, delusions etc)
3. Dementias due to Other General Medical Conditino (HIV, trauma, Parkinson, CJD..)
4. Substance-induced
5. Multiple etiologies
6. NOS

Front 30

Irreversible causes of dementia and clinical management.

Back 30

Alzheimer's, Picks', Huntington's, Parkinson's , CJD, HSV, MS.
Management- Symptomatic Rx for anxiety, psychosis, depression (do not use tertiary TCAs, SSRIs are good), to improve cognitive symptoms give Tacrine (AchE inhibitor, 40mg/d -->140mg/d)

Front 31

Name 4 groups of treatable forms of dementia

Back 31

1. NPH
2. Infections (Syphilis, Cryptococcus, AIDS
3. Metabolic (thyroid, PTH, electrolytes, Hepatic encephalopathy, etc)
4. Nutritional (Thiamine, folate, niacin)
5. Mass effect, toxicity, seizures, demyalinating diseases)

Front 32

Define dependence, abuse, addiction

Back 32

Dependence- repeated use of drug or chemical with or without physical dependence. Physical dependence indicates an altered physiological state due to repeated administration of a drug - the cessation of which results in a specific syndrome.
Abuse - use of a drug in a manner that deviates from approved social/medical patterns.
Addiction - repeated and increased use of substance, the deprivation of which gives rise to symptoms of distress and an irresistible urge to use the agent again. This defenition is not in use anymore

Front 33

Criteria for substance dependence

Back 33

3 or more of the following, occurring during a 12 month period:
1. Tolerance
2. Withdrawl
3. Substance is taken in larger amounts or over a longer period than intended
4. Persistent desire or unsuccessful effort to cut down
5. a great deal of time is spent obtaining the substance or use it
6. Social, occupational activites are given up or reduced due to the substance use
7. substance is used despite knowledge of having a physical or psychological problem linked to the substance

Front 34

Criteria for substance abuse

Back 34

1 or more of the following during a 12 month period:
A -->
1. recurrent substance use resulting in failure to fulfill obligations at work, school, home
2. recurrent substance use in situations in which it is physicall hazardous
3. recurrent substance-related legal problems
4. continued use despite having persistent social or interpersonal problems caused by the substance
B --> symptoms have never met criteria for substance dependence

Front 35

Criteria for substance withdrawl

Back 35

A. development of substance specific syndrome due to cessation or reduction
B. the syndrome causes clinically significant distress or impairment
C. symptoms are not due to general medical condition or other mental disorder

Front 36

Name 5 alcohol related psychiatric problems

Back 36

Alcohol induced psychotic disorder with delusions/hallucinations
Alcohol induced mood diosrder
Alcohol induced anxiety
Korsakoff's syndrome
Alcohol induced dementia

Front 37

4 Alcohol withdrawal symptoms

Back 37

Minor withdrawal - the shakes:
12-18 to 7 days, tremor, n/v, HR/BP up
Alcoholic seizures - rum fits:
7h to 48h, bursts of one to 6 generalized seizures, precedes Delerium Tremens in 30%
Alcoholic hallucinosis:
vivid unpleasent auditory hallucinations, 48h to 1 week.
Alcoholic withdrawal delerium - Delerium Tremens:
delirium, fever, autonomic arousal, 2-3d to week. Supportive care.

Front 38

Schizophrenia criteria

Back 38

A. >2 of these for 1 month:
-Delusions/hallucinations/disorganized speech/catatonic behavior/negative symptoms. Note only one sx required if bizarre delusions or commentating audio hallucinations
B.For a significant portion of time since onset one or more areas of functioning (school, work..) are below level achieved prior to onset
C. Continous signs of disturbance >6 months
D. Schizoaffective and mood disorders are excluded
E. Substance abuse/general medical condition are excluded

Front 39

Positive sx of schizo

Back 39

1. Hallucinatoins
2. Delusions
3. Disorganized speech (inchoerence, derailment, tangentiality, neologism..)
4. Disorganized behavior - catatonic stupor, catatonic excitement, bizarre posture, echopraxia, negativism

Front 40

Negative sx of schizo

Back 40

Alogia, affective flattening, anhedonia, avolition, attention impairment

Front 41

other sx of schizo

Back 41

depression, lack of insight, physical-neurological (ocular, stereognosis, balance), sleep, sexual interest, constipation

Front 42

Criteria for paranoid type schizo

Back 42

A. Preoccupation with one or more delusions or frequent auditory hallucinations
B. None of the following is prominent: disorganized speech, catatonic behavior, flat/inappropriate affect

Front 43

Criteria for disorganized type schizo

Back 43

A. All are prominent: disorganized speech, disorganized behavior, flat/inapproriate affect
B. Criteria for catatonic type not met

Front 44

Criteria for catatonic type schizo

Back 44

At least 2:
1. Motoric immobility such as catalepsy or stupor
2. Excessive purposeless motor activity
3. Extreme negativism or mutism
4.Peculiarities of voluntary movements (bizarre posture, stereotyped movements)
5. Echolalia / echopraxia

Front 45

Criteria for residual type schizo

Back 45

A. Absence of delusions, hallucinations, disorganized, etc
B. Presence of negative symptoms or two or more symptoms listed in Criteria A for schizo present in an attenuated form

Front 46

Criteria for Delusional disorders

Back 46

A. Nonbizarre delusions involving situations that occur in real life, >1month
B. Criterion A of schizo has not been met
C. Functioning is not markedly imparied and behavior not odd or bizarre
D. If mood episodes have occured their duration is brief relative to the delusion
E. Exclusion of substance or GMC

Front 47

Classification of delusional disorders

Back 47

1. Persecutory type
2. erotomanic type - De Clerambault syndrome - another person is inlove with the patient
3. grandiose type
4. jealous type
5. somatic type (believes he has cancer)
6. unspecified
7. mixed

Front 48

classification, subtypes of mood disorders

Back 48

Depressive disorders --> Major depression, single. Major depression, recurrent. Dysthymic. Depression NOS
Bipolar --> bipolar disorder, manic. Bipolar disorder, depressed. Bipoloar mixed. Cyclothymic disorder. Bipolar NOS.
Note bipolar can be even only mania (Bipolar I).
The disorders can be further subcategorized as primary/secondary.
also note Hypomania.

Front 49

Criteria for major depressive episode

Back 49

A. >5 of these for the same 2 week period and a change from previous functioning. 1 or 2 are mandatory.
1.Depressed mood most of the day nearly every day
2. Markedly diminshed intereset of pleasure in all or almost all activites nearly every day
3. Significant weight loss/gain or decrease/increased appetite
4. insomnia/hypersomnia nearly every day
5. psychomotor agitation or retardation
6.fatigue/loss of energy
7. worthlessness/guilt
8. diminished ability to think, concentrate
9. recurrent thoughts of death, suicuide
B. sx do not meet criteria for mixed episode
C. clinically significant distress of impairment in functioning
D. not due to direct substance abuse or GMC
E. not due to bereavement, persist >2 months or seriously affect functioning.
Criteria A: MSIGECAPS
Mood Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicide

Front 50

Criteria for Manic episode

Back 50

A. distinct period of abnormally & persistent elevated, expansive, irritable mood lasting >1 week or any other duration if hospitalized
B. >=3 of these symptoms have significantly been present: 1. inflated self-esteem or grandiosity, 2. decreased sleep, 3.more talkative, 4.flight of ideas, 5.distractability, 6.increase in goal-directed activity of psychomotor agitation, 7.excessive involvement in pleasurable activites that have high potential for painful consequences
C. Symptoms do not meet criteria for mixed episode
D. disturbance is severe enough to cause marked impairment in functioning or necessitates hospitalization or shows psychotic features
E. not due to substance abuse or GMC
Note criterion B requires at least 4 if mood only irritable

Front 51

Criteria for Panic disorder without agoraphobia

Back 51

A. Both 1+2:
1. recurrent unexpected panic attack- period of intense fear and discomfort with >=4 of these sx developing abruptly and peaking within 10 minutes:
Sweating, Trembling, Unsteadiness, Depersonalization, Deralization, Excessive heart rate, Nausea, Tingling, Shortness of breath, Fear(dying, going crazy), 3 C's- chills, choking, chest pain
2.at least one attack has been followed by 1 month of one or more of: persistent concern about having further attacks, worry about implications of attack, significant change in behavior relating to attacks