Ipc 6 (Minus Drugs)

Front 1

Case formulation (3 components)

Back 1

1) What is wrong

2) How it got that way

3) What can be done about it

Front 2

Case formulation vs diagnosis

Back 2

Case formulation includes the diagnosis and the integrated tx plan. May not always be a straightforward DSM diagnosis

Front 3

5 Categories for mental status exam

Back 3

1) General appearance, behavior, and attitude (GABA)

2) Mood & affect (M&A)

3) Thought process (TP) - how

4) Thought content (TC) - what

5) Sensorium and cognition (S&C)

Front 4

Indicators for psychiatric illness (5)

Back 4

1) Disheveled (schiz, depression)

2) Bizarre (mania, schiz)

3) Hygiene, makeup (looking at change, self esteem)

4) Flamboyant/seductive (mania, histrionic)

5) Appropriate for setting/weather

Front 5

Difference between mood and affect

Back 5

In theory, mood is subjective; affect, objective because it is what is observed by the clinician

Front 6

Thought process

Back 6

How the patient is thinking (speech patterns, goal directedness, organization)

Front 7

Affect descriptors (4)

Back 7

1) Range (full, constricted, flattened)

2) Intensity

3) Stability (vs. labile)

4) Appropriate and congruent with mood

Front 8

Examining suicidal/homicidal ideation (4 components)

Back 8

1) Passive deathwish vs. actively suicidal/homicidal

2) Do they have plans and means?

3) Have they written a note?

4) Appearance of imminent danger

Front 9

Types of hallucinations, typical associations (4)

Back 9

1) Auditory (psychiatric

2) Visual (medical/organic)

3) Olfactory/gustatory (usually organic)

4) Tactile ("bugs crawling," withdrawal)

Front 10

Examples of thought content (7)

Back 10

1) Suicidal/homicidal

2) Phobia

3) Preoccupation

4) Flashbacks

5) Illusions (misinterpretation of a stimulus that is actually there)

6) Hallucinations (no stimulus)

7) Delusions (fixed false belief)

Front 11

Sensorium and cognition is effectively the same as...

Back 11

... the Mini-Mental Status Exam

Front 12

Depressive disorders (DSM-V) (3)

Back 12

1) Dysthymic disorder

2) MDD

3) Depressive disorder NOS

Front 13

Bipolar disorders (DSM-V) (4)

Back 13

1) Cyclothymia

2) BD-I

3) BD-II

4) OSBRD (Other specified bipolar and related disorder)

Front 14

Bipolar I definition

Back 14

One or more manic or mixed episodes, usually accompanied by major depressive episodes (male = female)

Front 15

Bipolar II definition

Back 15

One or more major depressive episodes accompanied by at least one hypomanic episode (female > male)

Front 16

Cyclothymia definition

Back 16

At least 2 years of numerous periods or hypomanic and depressive symptoms

Front 17

Other specified bipolar and related disorder definition

Back 17

Bipolar features that do not meet criteria for any specific bipolar disorders

Front 18

Hypomanic episode definition (3)

Back 18

1) Period of persistent elevated, expansive, irritable mood (4 days)

2) Observable by others

3) Does not impair function, no psychotic features or hospitalization

Front 19

Manic episode mnemonic

Back 19

DIGFAST - need 3 (4 if only irritable)

Distractibility

Insomnia

Grandiosity

Flight of Ideas

Activity

Speech (pressured/subjective)

Thoughtlessness (spending/driving/sex)

Front 20

BD-I with psychotic features and additional treatment

Back 20

-- Delusions, hallucinations, grandiose &c.

-- Mood incongruency

Often needs antipsychotic medications

Front 21

Suicidality in BD vs. MDD

Back 21

Much more likely in BD (80% of patients exhibit significant suicidality)

Front 22

Untreated course of bipolar disorder

Back 22

Episodes occur more and more often. More common in BD-II because less likely to get treated initially (BD-I more severe).

Front 23

Usual sx in bipolar disorder (6)

Back 23

1) Depression

2) Mania/hyperactivity

3) Lack of sleep

4) Mood swings

5) Anger/irritability

6) Delusions/paranoia

Front 24

Predictors of suicide in bipolar disorder (5) and statistics fo suicide

Back 24

1) High impulsivity

2) Alcohol/substance abuse

3) Depression, mixed episodes

4) Hx of abuse in childhood

5) Exacerbation by incorrect tx

~50% attempt suicide, ~15% succeed

Front 25

Risk of using antidepressants in bipolar disorder

Back 25

Can cause the patient to go into a manic episode. Becomes a risk factor for suicide.

Front 26

Basic pathophys for bipolar disorder

Back 26

Dysregulation between excitatory and inhibitory neurotransmitters (excessive vs. deficient NE, DA)

Front 27

Treatment of acute mania in bipolar disorder (2 steps)

Back 27

1) Initiate mood stabilizer (lithium, valproic acid, carbamazepine)

2) Adjunctive tx: benzodiazepine vs. antipsychotic (the latter if psychosis)

Front 28

Basis of cognitive behavioral therapy

Back 28

Based on idea that thoughts cause our feelings and behavior, not external factors

Front 29

Types of psychotherapy (3)

Back 29

1) Cognitive-behavioral therapy

2) Dialectical behavior therapy

3) Acceptance and commitment therapy

Front 30

Commonalities among psychotherapies (4)

Back 30

1) Strong therapeutic alliance

2) Opportunity for catharsis

3) Practicing new behaviors

4) Patient's positive expectation for help

Front 31

BATHE (how to interview patients with psychotherapeutic techniques)

Back 31

Background

Affect

Trouble (what troubles you most?)

Handling

Empathy

Front 32

Uses for ACT (Acceptance and commitment therapy)

Back 32

Uses mindfulness as a way to handle pain without avoiding it.

Front 33

Use for DBT (dialectical behavior therapy)

Back 33

Developed for borderline personality disorder, but generally good for emotion dysregulation

Front 34

Positive BATHE

Back 34

Best thing that happened today

Affect: How'd that make you feel?

Thankfulness

Happen (how to make good things happen more frequently)

Empathy/Empowerment

Front 35

Current model for depression risk

Back 35

"Diathesis-stress model" - genetic + psych (past & present) + social (current stressors)

Front 36

Approximate % of US with MDD, median age of onset

Back 36

6.7%

Age: 32

Front 37

Family Hx risk factors for depression (4)

Back 37

1) Depression

2) Bipolar disorder

3) Alcohol abuse

4) Other psychiatric illness

Front 38

Diagnostic criteria for major depressive disorder (9)

Back 38

5+ for 2+ weeks:

1) Depressed mood

2) Loss of interest/pleasure

3) Appetite/weight change

4) Sleep disturbance

5) Psychomotor disturbance

6) Fatigue/low energy

7) Feelings of worthlessness/inappropriate guilt

8) Impaired ability to think or concentrate

9) Recurrent thoughts of death or suicide

Front 39

3 most common primary care presenting symptoms for depression

Back 39

Fatigue

Pain

Sleep disturbance

Front 40

Common concomitant conditions with depression (5)

Back 40

1) Cancer

2) Diabetes

3) Postpartum

4) Post-stroke

5) Post-myocardial infarction

Front 41

High risk demographics for suicide (8)

Back 41

1) Male

2) White

3) Older

4) Living alone/unmarried/separated

5) Unemployed

6) Family hx

7) Recent loss

8) Poor health status or pain

Front 42

Patient Hx risk factors for depression (3)

Back 42

1) Gender

2) Periods of significant depression in the past

3) Previous episodes of other psychiatric disorder(s)

Front 43

Brief intervention steps for substance abuse (5 steps)

Back 43

1) Raise the subject

2) Provide feedback

3) Offer advice

4) Enhance motivation

5) Negotiate a plan

Front 44

Four "A's" of schizophrenia

Back 44

Autism

Ambivalence

Associations

Affect

Front 45

DSM V definition of schizophrenia (Criterion A)

Back 45

2+ of the following for at least 1 month. At least one must be 1-3:

1) Delusions

2) Hallucinations

3) Disorganized speech

4) Grossly disorganized or catatonic behavior

5) Negative symptoms

Front 46

DSM V definition of schizophrenia (additional components)

Back 46

B) Social & occupational dysfunction

C) Signs of active psychosis for 1+ months persisting for 6+ months

D) SAD and mood disorder excluded

E) Substances and medical excluded

F) Not PDD (autism) alone

Front 47

Schizoaffective disorder criteria (4)

Back 47

A) Uninterrupted period of illness with a major mood episode concurrent with Criterion A of schizophrenia

B) Delusions or hallucination sx for 2+ wks w/o major mood episode

C) Sx that meet criteria for major mood disorder for the majority of illness

D) Not attributable to substance or medical condition

Front 48

Criteria for delusional disorder (5)

Back 48

A) 1+ delusions of 1+ months (can be bizarre)

B) Criterion A for schizophrenia not met

C) Functioning not greatly impaired or behavior odd or bizarre

D) Brief manic or depressive episodes

E) Not due to substance or medical condition

Front 49

DSM V criteria for personality disorders

Back 49

Enduring pattern of inner experience & behavior that deviates markedly from the expectations for the individual's culture. Manifested in 2+ areas:

1) Cognition (ways of perceiving self, other people, events)

2) Affectivity (range, intensity, appropriateness of emotional response)

3) Interpersonal functioning

4) Impulse control

Have to be pervasive, inflexible, maladaptive, early onset, egosyntonic.

Front 50

Cluster A personality disorders

Back 50

Paranoid

Schizoid

Schizotypal

Front 51

Cluster B personality disorders

Back 51

Antisocial

Borderline

Histrionic

Narcissistic

Front 52

Cluster C personality disorders

Back 52

Dependent

Avoidant

Obsessive compulsive

Front 53

General areas of development affected by autism spectrum disorders (2)

Back 53

1) Social communication and interaction

2) Restrictive repetitive patterns of behavior, interests, or activities

Front 54

Specific social interaction deficits in autism (3)

Back 54

1) Social-emotional reciprocity

2) Nonverbal communicative behaviors used for social interaction

3) Developing, maintaining, and understanding relationships

Front 55

DDx of Autism (4)

Back 55

1) Hearing loss/congenital deafness

2) Childhood onset schizophrenia (very very rare)

3) Mixed receptive/expressive language disorder

4) Psychosocial deprivation

Front 56

Oppositional defiant disorder vs. conduct disorder

Back 56

Oppositional is aimed at authority figures and tends to be less higher level aggression; conduct disorder violates other people's rights generally

Front 57

DDx of conduct disorder (4)

Back 57

1) Oppositional defiant disorder

2) ADHD

3) Bipolar disorder

4) Depression

Front 58

DDx of oppositional defiant disorder (3)

Back 58

1) Normal oppositional behavior (typically younger)

2) Conduct disorder

3) Mood disorder

Front 59

Dx of Tourette's

Back 59

1) Both multiple motor and 1+ vocal tics have been present at some time during illness

2) Can wax/wane in frequency but persist for 1+ yrs

3) Onset before 18 yrs

Front 60

Selective mutism clinical features (5)

Back 60

1) 1+ month (not first month of school)

2) Not attributable to a lack of knowledge of spoken language

3) Child speaks in some social situations but not others

4) May communicate with hand gestures

5) Different from normal shyness

Front 61

DDx for social anxiety disorder (3)

Back 61

1) PTSD

2) OCD

3) Panic disorder

Front 62

Diagnostic criteria for PTSD in children (over 6 yo) (5)

Back 62

1)Exposure to actual or threatened death, serious injury, or sexual violence

2) Intrusion sx: memories/dreams/flashbacks, repetitive play with themes of trauma

3) Persistent avoidance of stimuli associated with trauma

4) Negative alterations in cognition & mood

5) Altered arousal and reactivity

Front 63

Clinical aspects of dementia (which is not, itself, a diagnosis)

Back 63

-- It's an acquired deficit in:

• Memory and

• Other mental fxns

-- It's not acute.

-- It impairs functioning (if no impairment of fxn, then it's mild cognitive impairment, not dementia).

Front 64

Where the brain fails in AD and major cognitive deficits (4)

Back 64

It's largely posterior (listen to the lecture again; Shenker slide 27)

1) Retrieval

2) Language

3) Object recognition

4) Visiospatial processing

Front 65

Questions about spirituality: FICA

Back 65

Faith (do you consider yourself spiritual?)

Influence (Importance of beliefs in life, illness?)

Community (Part of spiritual community?)

Addressing spiritual concerns (Journal, referral?)

Front 66

Medical mimics of psychiatric illness (3)

Back 66

1) Hypoglycemia

2) Hyper- or hypothyroidism

3) CNS trauma, bleed (such as chronic SDH)

Front 67

Clinical profile of delirium (7)

Back 67

1) Acute onset and reversible

2) Impaired cognition and attention

3) Flucuating over days

4) Impaired judgment

5) Hallucinations

6) Mental confusion, incoherent thoughts

7) Restlessness

Front 68

RULE of MI

Back 68

Resist the Righting Reflex

Understand the patient's motivations

Listen with empathy

Empower the patient