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136 Cards in this Set
- Front
- Back
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DSM-V Major Depressive Disorder |
5 or more over 2 weeks Mood change (every day) Energy Sleep Interest Guilt Concentration Appetite Psychomotor Suicidality MFP |
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Melancholic Dperession |
Typical old lady picture: Worse in the morning. Loss of weight. Catatonic |
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Atypical Depression |
Typical teenager depressed picture: Eating lots, gaining weight, sleeping less, worse in afternoon. |
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Postpartum blues definition |
Transient mild depression following childbirth (affects 80% of mothers) lasts up to 10 days |
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Depression with a peripartum onset |
Mood disturbance onset within 4 weeks postpartum (can begin during pregnancy). Typically lasts 2-6 months, residual symptoms can last 1 year. |
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Definition of Persistent Depressive Disorder (Dysthymia) |
Depressed mood for most of the day, more days than not, for at least 2 years. During the two years never been without symptoms for 2 months 2 or more of the symptoms of MDD |
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Lifestyle factors |
SEERS Sleep Exercise Eating Healthily Relationships Stress - Hobbies |
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Warning when starting anti-depressants |
Take 14 days to be affective (but energy improved therefore increased suicidality). Trial of 6 weeks is required for an adequate trial of antidepressants. |
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When changing antidepressants |
Must have antidepressant free interval |
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SSRI options |
Citalopram - 20mg-40 mg taken morning Fluoxetine - under 21 Sertraline |
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SNRI's |
Venlafaxine Duloxetine Mirtazapine - weight gain |
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What drug is contraindicated with SSRI + SNRIs |
Tramadol |
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2nd line options for antidepressants |
Reversible MAO inhibitor Irreversible MAO inhibitor - cheese effect (hypertension, intracranial haemorrhage --> death) TCA - amitriptyline, clomipramine |
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TCA overdose presentation |
Anticholinergic effects Prolonged QRS Rhabdomyolysis Renal failure Metabolic acidosis |
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Presentation in Serotonin Syndrome |
Caused by Combination not overdose CAN Cognitive - Agitation, confusion Autonomic - hyperthermia, diaphoresis Neurological - hyperreflexia, tremor, |
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Mx Serotonin syndrome |
Cease medication Sedate - benzo Cyproheptadine |
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Presentation in NMS |
Antipsychotics - increased dosage FARM Fever Autonomic Changes Rigidity of Muscles Mental State Changes |
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Management of NMS |
Dantrolene - muscle relaxant Bromocriptine - dopamine agonist |
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DSM V for mania |
Abnormality for at least 1 week most of the day nearly every day/hospitalised GST PAID Grandiosity Sleep Talkative Pleasure/Pain Activity/Agitation Ideas (flight of) Distractibility MFP |
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DSM V hypomanic |
4 consecutive days/ never hospitalised |
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Management for MDD |
Admit? Bio - rule out organic, antidepressants, ECT Psycho - CBT, IPT, psychodynamic, supportive psychotherapy, mindfulness based Social - social worker referral, social skills support, optimise lifestyle |
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DSM V adjustment disorder |
Within 3 months of stressor, out of proportion to intensity of stressor, MFP, once stressor subsides does not persist for more than 6 months |
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Sodium valproate considerations + AE |
Narrow therapeutic window Can be used with lithium. Causes weight gain, liver, pancreas dysfunction |
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Depression vs grief |
G: loss/empty, waves, associated with reminders, can experience joy, wants to joint deceased MDD: depressed, persistent, no associated reminder, life's not worth living |
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Delusions vs overvalued idea |
Delusion held with absolute conviction, overvalued idea is not 100% firmly held. |
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Nihilistic delusions |
A belief that one is dead or a catastrophe will occur |
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Capgras syndrome |
Delusion of doubles (someone's been replaced by an imposter) |
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Lycanthropy |
Delusion that the person is a werewolf or other animal |
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DSM V delusional disorder |
The presence of one or more delusion for 1 month or more AND NOT schizophrenic Functioning NOT impaired MP |
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Brief psychotic disorder |
schizophrenic symptoms, 1 day or more but less than 1 month MFP |
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Schizophreniform |
More than one months but less than 6 months |
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Schizophrenia DSM V |
2 or more of the following in aperiod of greater than 6 months Delusions Hallucinations Disorganised speech Grossly disorganised or catatonic behaviour Negative symptoms MFP |
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Tactile hallucination |
False perception of touch or surface sensation |
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Formication |
Crawling sensation on or under the skin |
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Schizoaffective disorder DSM V |
1- Uninterrupted period of illness during which there is a major mood episode concurrent with schizophrenia 2- 2 weeks of delusions or hallucinations alone during the course of the illness without mood
MFP |
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Differentials for psychiatry |
MOAPP Mood Organic Anxiety Psychotic PD Suicidality/Risk |
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EPSE's and Mx |
Acute dystonia - Benztropine Parkinsonism - Benztropine Akathisia - Diazepam or propanolol Tardive dyskinesia - Switch to clozapine |
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Switching between antipsychotics |
1-2 week crossover |
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Second generation/Atypical antipsychotics |
5-20mg Olanzapine - metabolic syndrome Quetiapine - sedation 2-8mg Risperidone - hyperprolactinaemia Sertindole - QT prolongation Paliperidone Aripiprazole |
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Management of a dangerous acutely psychotic patient who will not accept oral |
Midazolam IM |
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Clozapine councelling |
Good for negative symptoms and treatment resistant 200mg-600mg AE: agranulocytosis, myocarditis, matbolic syndrome - diabetes & weight gain Monitoring: FBEs weekly for a month then fortnightly. Before commencing needs FBE, Echo, BSL, cholesterol and weight
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Depot antipsychotics |
Risperidone consta Aripiprazole Paliperidone Olanzapine (still patent) Zuclopenthixol decanoate (WAS IN QUIZ!!!) |
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DSM V panic disorder |
recurrent unexpected panic attacks followed by 1 month or more of persistent concern about consequences of panic attack or maladaptive change in behvaiour MFP |
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Panic attack criteria DSM V |
4 out of STUDENTS FEAR the 3 C's Sweating Trembling Unsteadiness Depersonalisation Excessive Heart rate Nausea Tingling SOB Fear of dying, losing control, crazy 3 C's: Chest pain, chills choking |
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Agoraphobia DSM V |
Marked anxiety about 2 or more of the following' - using PT - open spaces - closed spaces - standing in crowd - leaving home alone
lasts for 6 months Can have panic disorder with agoraphobia |
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Generalised anxiety disorder DSM V |
Excessive anxiety and worry most days for at least 6 months in a number of settings. 3 or more of the following BESKIM Blank mind (concentration), Easily fatigued, Sleep disturbance, Keyed up, irritable, Muscle tension ASK: worry often, hard to control worry, what worries you |
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PTSD DSM V |
TRAUMA Traumatic event Reliving the trauma Avoiding associated stimuli Unable to function More than a month Arousal increased |
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Management anxiety disorders |
Bio - SSRIs/SNRIs (benzos in acute setting) Psycho - CBT, relaxation, Mindfulness based therapy, psychotherapy Social - sleep hygeine, diet, exercise, avoid caffine/ETOH, counselling, exposure therapy, IPT |
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ECT explanation |
Given 3x week 2-4 weeks usually stop other medication unless acutely unwell AE: headache, memory loss, muscle aches, small risk of death, anaesthesia C/I: recent MI, raised ICP, aneurysm, bleeding disorder, Pacemakers |
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Causes of Delirium |
Drugs Eyes&ears (sensation) Low oxygen (PE, AMI, stroke) Infection Retention Ictal state Under nutrition |
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Compare and contrast the different types of dementia |
Alzheimers (60%) - Aphasia, apraxia, agnosia, executive function Vascular - stepwise Lewy body - parkinsonism, visual hallucinations, fluctuating cognition Frontotemporal- disinhibition, memory sparing, decreased social awareness |
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Management of alzheimers |
Optimise physical and mental health Challenging behaviour, alagesic, antidepressants Cholinesterase inhibitor donepezil (MMSE <12) - cholinergic |
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Reversible causes of dementia |
Intoxication or withdrawal (wernicke'korsakoff) Medication Hypothyroidism NPH (AID) Chronic subdural haematoma Pseudodementia |
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Pseudodementia vs. dementia |
PD - acute onset, emphasis failures, 'don't know' D - insidious onset, delights in accomplishments, sundowning common, guesses answers |
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Pharmacotherapy for ADHD |
Methylphenidate (ritalin) dexamphetamine SSRI |
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Management for ADHD |
Bio - Methylphenidate (ritalin) dexamphetamine Psycho - social skills training, family therapy, anger control Social - parental Mx & education, positive reinforcement, classroom intervention |
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ODD vs conduct disorder |
ODD - gets angry lots CD - Violates others |
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Autism assessment |
ADOS, hearing and visual, neurological evaluation (exclude epilepsy) karyotyping, FBC/dietary assessment, Denver II, |
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Management Autism |
Early intervention Multidisciplinary - school, psychologist, OT, physio, Speech therapy, paediatrician, psychiatrist Family education Pharmacotherapy - SSRI |
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Substance Abuse vs dependence |
Abuse: Not fulfilling obligation, causing danger to themselves or others, legal problems, interferes with function Dependence: Tolerance, in larger than intended amounts, recurrent attempts to cut down, replacing other activities |
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Mx Alcohol dependence |
Bio - Naltrexone (reduce craving), disulfiram (makes uncomfortable - can be dangerous), acamprosate (can cause impotence), thiamine Psycho - motivational interviewing, behvaiour modification Social - supportive services e.g. halfway houses, AA, detox centres |
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Delirium tremens |
stage 4 of alcohol withdrawal.3-5 days after last drink Confusion, delusions, hallucinations, agitation, tremor, autonomic hyperactivity Benzo's!! |
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Mx alcohol withdrawal |
Diazepam, thiamine |
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Wernicke-Korsakoff syndrome |
Wernicke's encephalopathy - nystagmus, ophthalmoplegia, ataxia, confusion Korsakoff's syndrome - chronic, 20% are reversible. Anterograde amnesia
THIAMINE!!!! |
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Opiate overdose management |
DRABC - naloxone |
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Long term management opiate withdrawal |
methadone once daily at clinic. CBT, counselling, social support |
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BMI ranges |
under 18.5 - underweight 18.5-25 - normal 25-30 - overweight 30+ - obese |
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Anorexia complications |
Hypochloraemic hypokalaemic alkalosis Amenorrhea osteoporosis Dry skin/brittle hair Postural hypotension Vitamin deficiency Bradycardia/arrhythmia (hypokalaemia)
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Difference between bulimia and anorexia |
Bulimia - can't control their eating, binge and then regret - maintain insight Normal BMI usually More likely to self harm/ substance abuse Worse prognosis in bulimia
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Cluster A personality disorders |
Schizoid - doesn't like others, loner, withdrawn, aloof, cold Schizotypal - wants relationships but hasn't got social skills. Also has magical thinking Paranoid - suspicious |
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Cluster B personality disorders |
Histrionic - dramatic, centre of attention, egocentric, vain, shallow Antisocial - Unlawful, lies, steals, delinquent, criminal Narcissistic - Grandiosity, self importance, entitled Borderline - instability in mood, unstable identity, intense anger, empty |
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Cluster C personality disorders |
Avoidant - Hypersensitive to potential rejection or shame, social withdrawal, needs affection Dependent - Doormat, passive, needs to be taken care of Obsessive compulsive - perfectionist, indecisive, preoccupation with order and control, egosyntonic
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Psychotherapy for borderline PD |
DBT |
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When to use psychodynamic psychotherapy |
Past events predispose to current problem. Deal with that past event, clarify emotions, rarely confront |
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When to use interpersonal therapy |
Role transition (loss of loved one, new mother) role disputes (work of relationship issues) |
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When to use family therapy |
Any disorder where multiple members of the family are indicated/ causing the tension Eating disorders are a big one |
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Risk assessment components |
MYREASON Medication non-compliance Young or dependent harm Reputation Exploitation Absconding Suicide/self harm Oh dollaazz Neglect |
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SSRI adverse effects |
SHINAS -Sexual dysfunction -Headache -Insomnia -Nausea & diarrhoea -Anxiety and restlessness -Serious: suicide and SS |
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Define malingering |
Intentional production of false physical or psychological symptoms motivated by an external reward - avoiding work, financial compensation |
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Define Factitious Disorder |
Feigning psychological or physical symptoms in order to assume the sick role where external incentives are absent |
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Somatic Symptom Disorder |
One or more somatic symptom with excessive thoughts, feelings or behaviours related to the symptom that are - disproportionate, cause anxiety, time and energy devoted. 6 months MFP |
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Illness anxiety disorder |
Preoccupation with having or acquiring a serious illness - no symptoms, anxiety about health 6 months + MFP (Previously hypochondriasis) |
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Conversion disorder |
Functional neurological symptom disorder Symptoms of altered voluntary motor or sensory function Do not make sense and neurological assessment cannot find anything |
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Autochthonous delusion |
'Out of nowhere' realises something bizarre, doesn't understand why they didn't realise before. |
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Clang associations |
Playing with words, stringing together words that sound similar with different meanings or rhyme |
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Stereotypy |
Repeated complex series of movements 'habit'. Waving hand then brushing tie |
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Tic |
Repetitive uncontrolled short action, e.g cough |
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Pharmacotherapy for Generalised anxiety disorder |
1. SSRI 2. Venlafaxine/duloxetine |
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When to use supportive therapy |
listen & clarifying emotions
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Management in psych always! |
Psychoeducation Psych first aid - exercise, diet, drug, community program Psychotherapy Pharmacotherapy ECT |
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Pt is depressed and needs to gain weight and eat and sleep. What drug |
Mirtazapine |
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Symptoms of lithium overdose |
Diarrhoea, N/V CNS - hyperreflexic, tremor, confusion Cardiac - QT prolongation |
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Criteria for involuntary treatment |
1. Person must appear mentally ill 2. Person must require immediate treatment 3. Involuntary treatment is necessary 4. Refused consent or unable to consent 5. Cannot be undergone in a less restrictive manner
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Questions to ask for Antisocial Personality Disorder |
Have you been in trouble with the police? Would you be described as honest? Do you plan ahead? Irritable or aggressive? Longest in relationship/job? Remorse? How long? |
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Question to ask for paranoid personality disorder? |
Others exploiting or harming? Trust others? Grudges? Spouse cheating? Hidden negative meanings in events? |
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Question to ask for schizoid personality disorder? |
Friends? Alone or in group? (alone) Sexual partners? Activities you enjoy? Opinions of others important to you? |
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Questions to ask for schizotypal personality disorder? |
Do you see things other people don't see? Things are referring to you? Odd/eccentric? Social anxiety? Friends? |
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Questions to ask for histrionic personality disorder? |
Do you need to be the centre of attention? Sexually seductive? Easily influenced? Concerned with physical appearance?
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Questions to ask Borderline personality disorder? |
Impulsive? Anger? Suicide/self harm? Stable sense of self/labile mood? Scared of being abandoned? Feel empty? |
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Questions to ask narsissistic personality disorder |
Important? Dream of unlimited success? Jealous? What kind of people do you surround yourself with? |
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Questions to ask avoidant personality disorder |
Avoid activities with interpersonal contact? Restraint within intimate relationship |
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Things you need to know about OCD |
Obsessions: intrusive and unwanted + attempts to ignore thoughts Compulsions: Feels driven to perform + aiming to reduce anxiety - time consuming |
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Explaining CBT to a patient |
Talking therapy Focuses on here and now Recognition that conscious thoughts rather than deeper feelings - look at things differently Usually one-to-one Occurs once-a-week for 8-12 session Patient will get homework |
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Lithium counselling |
Mechanism unknown - but very effective Pre test - ECG, renal function, TFT Regular blood monitoring - lithium levels, TFT, creatinine, urinalysis, ECG Once a day at night AE - initial: Metalic taste, tremor, N/V, polyuria/polydipsia AE - long: Renal problems (Diabetes insipidus), weight gain, Thyroid, acne, teratogenic (+breast feeding) Acute toxicity: DIARRHOEA, N/V, Coma, seizures, ataxia Usually lifelong, at least a year
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severity of Alzheimer's |
Severe: 0-11 Moderate: 11-18 Mild: 19-24
If well educated move them up a severity rating |
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Person who is on an antidepressant becomes confused on a really hot day. What drug causes this? |
SSRI's - hyponatraemia |
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Cause of left sided hemispatial neglect |
Right parietal lobe lesion (non dominant) |
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Temporal lobe lesion causes |
Memory and language |
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Frontal lobe lesion causes |
Executive functioning |
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Restricted vs blunted vs flat affect |
Restricted - mildy reduced Blunted - very reduced (schizophrenia) Flat - nothing |
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Delusion vs overvalued idea vs obsession |
Delusion: fixed, false belief that usually cannot be swayed (illogical reason for it) Overvalued idea: Not held with as much conviction - they question it! (they don't make up illogical reasons) Obsession: recurrent intrusive thoughts that patient recognises as irrational and may find distressing or try to resist |
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Flight of ideas vs loosening of association |
FOI: Abnormal connection between statements (no meaningful connection, rhyme or pun) LOA: There is no association
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Tangentiality vs circumstantiality |
Tangentiality: Speaker never gets to the points, always speaks of irrelevant things Circumstantiality: Indirect and delayed reaching the point, lots of parenthetical remarks |
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Schizoid PD vs Schizotypal PD |
Schizoid: Detachment from scoial relationships, restricted range of expression of emotions. Loner Schizotypal: Uncomfortable in social situations but wants to be involved. Fantasy thinking. Crazy |
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Poor memory + walking problems + confused + fluctuating + visual/auditory hallucinations |
Dementia with Lewy bodies |
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Renee, aged 66 became upset about 6 months ago as someone was stealing from her. Usually these were small inexpensive but last week the pearl necklace belonging to her mother went missing. In the absence of signs of forced entry, she was obliged to conclude that her daughter had used her key to take it (and presumably the other things as well). |
Alzheimers disease with psychosis |
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Patient on clozapine stable for 6 months. He has a monthly FBE which is normal, what investigation? |
Echo |
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What investigation do you do for alzheimers |
MRI brain |
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Man with visual hallucinations 3 days after being admitted for surgical treatment of injuries sustained in MVA. What drug caused the side effects? |
Diazepam |
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Chronic pain + maximum dose of analgesia + tried all antidepressants + getting worse Mx? |
Supportive therapy |
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Therapy used when dealing with a current manifestation of a previous deep psychological trauma i.e. struggles with authority figures, hated parents when younger |
Insight orientated |
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Man + delusion that dying of cancer + thinks he deserves it. Diagnosis? |
MDD with psychotic features |
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Man in hospital following a fall + initially well but now confused + fluctuating cognition + ants over flaw + Problems with short term recall. Diagnosis? |
Delirium tremens visual hallucinations common |
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Old lady acutely confused investigation? |
UTI - urine microscopy and culture |
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After partial response to treatment patient became very agitated with excessive persipiration after dose was increased |
SSRI (causes anxiety and sweating) |
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Levels of depression and management? |
5/9 - mild - CBT 7/9 - moderate - SSRI/SNRI 9/9 severe - Admission SSRI ECT |
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Someone refuses to eat because so depressed. Mx? |
ECT |
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Man very stressed at work. Needs something to tide him over the next few weeks. |
Oxazepam |
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Patient presents with delusion what do you need to ask |
Why do you think that? What would you say if I disagreed with you? |
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MMSE findings in OSCE what they mean |
NOT diagnostic - screening test. Say you'd refer to specialist but MMSE is "consistent with dementia" Above 26 is normal but take into account tertiary education |
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Acute delirium management |
Haloperidol |
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Dose of citalopram |
20-40mg |
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Dose of fluoxetine |
20-80mg |
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Dose of Risperidone |
1-5mg |
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Dose of clozapine |
200-600mcg |
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Dose lithium |
125-500mg |
