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52 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Features Associated with Organic Cause Psychosis
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1. Abnormal Vital signs
2. Diorientation with Clouded consciouness 3. Abnormal mental status examination 4. Recent Memory loss 5. Age >40 without prior psych hx 6. Focal Neurological signs 7. Visual hallucinations 8. Psychomotor retardation |
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Mental status in the ED
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Behaviour
Affect Orientation Language Memory Thought Content Pereceptual abnormalities Judgement |
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Medical Evaluation in ED
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1. Document behavioural changes throughout hx
2. Identify medical symptoms 3. Determine medical comorbities 4. Obtain medication and drug hx 5. Perform PE 6. Perform Neuro Exam |
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Lab Testing
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No evidence for routine lab or image testing.
As indicated by Hx and PE |
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Potential violence indicators
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Hostile Behaviour
Verbal Aggressiveness Statements about violent intent |
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Suicide Risk
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SAD PERSONS
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Sex
Age Depression Previous Attempt Ethanol Use Rational Thinking Loss Social support Lacking Organized Plan No Spouse Sickness |
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Asseement and Management of Suicide Pts
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Establish Rapport
Assess intent Determine access to means of suicide If no evidence of mental disorder offer a safety plan, including help-seeking and problem-solving strategies If interpersonal or family issue, allow catharsis and offer problem-solving strategies; consider psychosocial referral If a mental disorder is present arrange refferral ensure safety plan is in place before discharge and arrange follow-up |
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High risk for suicide in adults or adolescents
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Males
Separated, divorced or widowed Family hx of chaos or suicide Recently unemployed Recent Conflict or loss of relationship Disciplinary trouble at school Weak or no suicide taboo Illness or substance use Any Psych issues Frequent intense suicidal ideation Previous Attempts Plan Lethal method Guilt Unambiguous or continuing wish to die Lacks insight Poor Rapport Unsupportive family or friends Socially Isolated |
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Guidelines for d/c of pts with suicidal ideation or behaviour
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Not imminently Suicidal
Medically Stable Agrees to return if intent returns Sober, not demented or delirious Lethal means of self harm have been removed Tx of underlying psychiatric d/o has been arranged precipitants have been addressed Convinced that pt and family will follow through Caregivers and social supports are in agreement |
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Axial Psych Assesment
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Axis I Mental Disorders
Axis II Personality d/o and mental retardation Axis III General medical conditions Axis IV Psychosocial and environmental problems Axis V Globabl assessment of function |
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Dementia
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Pervasive disturbance of cognitive functioning in several areas, including memory, abstract thinking, judgment, personality and other higher cortical functions such as language
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Delirium
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clouding of consciousness, a reduction in awareness of the external environment (difficulty sustaining attention) varying degrees of alertness ranging from drowsiness to stupor and sensory misperception.
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Amnestic D/O's
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Unable to learn new information or to recall information that is already learned
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Schizophrenia (Positive Symptoms)
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hallucinations, delusions, disorganized speech and behaviour, catatonia.
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Schizophrenia (Negative Symptoms)
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blunted affect, emotional withdrawal, lack of spontaneity, anhedonia, attentional impairment
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Old antipsychotics
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Attack Positive symptoms
EPS |
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Newer Antipsychotics
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Atack +/- symptoms
Metabolic disorders |
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Schizophreniform
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less than 6 months
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Brief Psychotic D/O
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less than 4 weeks
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Major Depression
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Persistant sad or depressed mood or pervasive loss of interest in usual activities lasting at least 2 weeks.
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Screening pneumonic for depression
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Interest
Sleep Appetite Depressed mood Concentration Activity Guilt Energy Suicide |
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Mania
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Elative or Irritable mood
Emotional Lability Poor Judgement |
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bipolar d/o
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Full mania vs hypomania
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Dysthymic
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Chronic and less severe depression. 2 years, and no evidence of psychosis
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Panic disorder
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Sudden Surge of anxiety and dread, with autonomic signs: palpitations, tachycardia, SOB, Chest tightness, dizziness, sweating and tremulousness
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Generalized Anxiety D/O
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Persistant worry, tension or free floating anxiety lasting at least 6 months
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Phobic D/O's
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recognized excessive anxiety symptoms when anticipating or when exposed to a specific situation. Avoidance of the situation that interfere's with person's life.
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PTSD
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anxiety reaction to severe psychosocial stressor, usually life-threatening. Repetitive and intrusive memories of the event, nightmares, emotional numbing, survivor guilt, and different degrees of depression and anxiety. Substance abuse is a complication.
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OCD
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Intrusive thoughts or images that cannot be eliminated from the mind. images of graphic violence, contamination or perverse sexual behaviour that the patient would not carry out but obsessively fantasize about. engage in compulsive behaviours or rituals to control the obsessive thoughts
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Conversion Disorders
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Loss of function of neurological system with no organic cause. More common in culturally and psychologically unsophisticated persons. Caution diagnosing in ED
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Somatization D/O
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wide variety of complaints and a long complicated histories with no apparent medical condition. Caution diagnosing in ED, but past Hx of can be helpful
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Hypochondriasis
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Preoccupation with fears of serious illness, fears that persist despite appropriatte medical evaluation and reassurance
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Pain disorder
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When only c/o is pain with no etiology
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Dissociative D/O
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Sudden alteration in the normal integration of identity and consciousness.
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Factitious D/O
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physical or Psychological symptoms that are exhibited in order to assume the sick role.
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Malingering
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Invention or exaggerating of physical or psychological symptoms for external gain
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Anorexia Nervosa
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Refusal to maintain normal body weight with intense fear of gaining wt
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Bulimia Nervosa
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Binge eating, sense of loss of control over eating and inappropriate compensatory behaviours
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Sleep disorders
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Insomnia, hypersomnia, circadian rhythm sleep disorder, narcolepsy
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Personality disorder
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Lifelong pattern of behaviour that causes significant impairment in social and occupational functioning
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Personality Disorders
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Paranoid
Schizoid Schizotypal Antisocial Borderline Histrionic Narcissitic Avoidant Dependent OCPD |
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Rapid Tranquilization
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Ativan 2mg IM/IV
Haldol 5mg IM/IV (unless concerns of QT prolongation) Atypicals Antipsychotics (not in Dementia, or concerns of QT prolongation) |
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Antipsychotic Side Effects
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Acute Dystonia
Akathisia Parkinsonism Anticholinergic effects Cardiovascular effects NMS |
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Warnings with Atypicals
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Clozapine - Agranulocytosis
Zirprasidone - QT Prolongation and sudden death Aripiprazole - NMS, CVAE Olanzipine - CVAE |
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Benzo overdose
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Flumazenil - limited use, can't be used for withdrawal.
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Mood Stabilizer Side Effects
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Carbamazepine - agranulocytosis
Lamotrigine -Stevens-Johnson Syndrome Lithium - Narrow Therapeutic Window |
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Complications of restrictive eating behaviours
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Cachexia
Growth Retardation Osteopenia Amenorrhea Cardiac Complications Bone marrow Suppression Impaired Cell-mediated immunity Neurological complications Euthyroid sick syndrome Derm GI metabolic |
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Complications of Purging behaviours
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Dental Erosions and caries
Palatial Abrasions Parotid/submandibular hypertrophy knuckle abrasions or callouses facial petechiae pharyngitis/esophagitis Mallory Weiss Tears Esophogeal/gastric ruptures intestinal atony Pancreatitis Dehydration Electrolyte disturbances Vomiting- Meta Alkalosis, hypokalemia, hypochloremia Laxatives - Meta Acidosis, hypok,Ca, Mg, Ph Diuretics - Meta Alkalosis, hypoNa, K, Cl Ipecac Cardiomyopathy Compulsive exercise complications |
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Society for adolescent Medicine guidelines for hospitalization
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Severe Malnutrition
Dehydration Electrolyte Disturbance Cardiac Dysrhythmia Physiological instability (HR <50, BP <80/50, ortho hypo, hypothermia) Arrested Growth or develp failure of Outpt tx Acute food refusal Uncontrollable binging or purging Acute Meical Condition of malnutrition Acute Psychiatric emergency Comorbid diag |
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Panic Attack Symptoms
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Palpitations, Sweating, SOB, smothering, Trembling, feeling of choking, CP or discomfort, N or abdo distress, presyncope, paresthesia, chills or hot flashes
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Ddx of Panic Disorder
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CVS - Angina, MI, MVP, CHF, Arrythmia's
Pulm- Hyperventilation, Asthma, PE Endocrine - Hyperthyroidism, hypoglycemia, hyponatremia, pheochromocytoma, carcinoid syndrome, cushing syndrome Neurologic - Migraine H/A, Meniere disease, complex partial sz, TIA Drug induced - Caffeine, cocaine, sympathomimetics, theophylline, thyroid preparations, SSRI's, Cannabis, Corticosteroids, Beta Agonists, Triptans, Nicotine, Yohimbine, Hallucinogens, anticholinergics Drug withdrawal - Alcohol, Barbituates, benzo's, opiates, beta antagonists Psychiatric- Post-traumatic stress disorder, Depressive d/o, anxiety d/o Psychosocial d/o - Partner violence sexual abuse or assault, other situational stressors |
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Alcohol withdrawal symptoms
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Hand Tremors, H/A, loss of appetite, N/V, Diaphoresis, insomnia, tachycardia, htn, fever, psychomotor aggitation, craving, anxiety, seizures, hallucinations, delirium
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