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41 Cards in this Set
- Front
- Back
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First rank symptoms
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thought insertion, withdrawl, broadcasting
delusions of control (belief's that one's thoughts/actions are controlled by some external source) |
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Perceptions
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hallucinations
illusions depersonlization derealization |
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hallucination
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sensory perception in absence of external stim that is similar in quality to a true perception
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Delusions
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persecutory
delusions of reference Erotomania grandiose religious somatic |
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Persecutory delusions
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belief others trying to cause you harm
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Delusions of reference
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interpreting publically known events/celebrities as having direct reference to oneself
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Erotomania
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belief another is in love with you
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Religious delusions
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belief of receiving instructions/powers from higher being
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Somatic delusions
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belief one has a physical disorder/defect
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Cognition
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LOC
orientation memory intellectual functions - attention - concentration - calculation - abstraction (proverb interpretation) - language - communication |
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Insight
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ability to realize that has physical/mental illness and to understand its implications
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Judgement
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ability to understand relationships between facts and draw conclusions that determines one's actions
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Axis I
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DDx of DSM IV clinical disorders
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Axis II
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personality disorders
mental retardation |
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Axis III
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general medical conditions potentially relevant to understanding/managing mental disorder
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Axis IV
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psychological and environmental issues
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Axis V
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global asessment of functioning incorporating effects of Axes I-IV
61-70 - some mild symp, generally functioning well 31-40 - some impairment in reality testing/communication, impairment in several areas 21-30 - behaviour influenced by delusions/hallucinations or serious impairment in communication/judgement 11-20 - some danger of hurting self/others 1-10 - persistent danger of severely hurting self/others |
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DDx of psychosis
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"GASPP"
GMC Affective disorder Substance induced Primary psychotic disorder Personality disorder |
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Primary psychotic disorders
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schizophrenia
schizoaffective disorder delusional disorder brief psychotic disorder |
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Mood disorders in DDx of psychosis
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depression w psychotic features
bipolar (manic episode with psychotic features) schizophreniform |
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Personality disorders in DDx of psychosis
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schizotypal
schizoid borderline paranoid obsessive compulsive |
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Schizophrenia Dx criteria
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A. In 1m ≥2 of
delusions hallucinations disorganized speech grossly disorganized/catatonic behaviour negative symptoms 1 "A" symp if - delusions bizarre or hallucinations are running commentary/≥2 voices conversing w each other B. ≥1 area of dysfunction C. continuous signs of disturbance for ≥6m including ≥1m active symptoms |
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First rank psychotic symptoms
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"ABCD's"
Auditory hallucinations Broadcasting of thoughts Controlled thoughts Delusional perceptions |
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Subtypes of schizophrenia
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paranoid
catatonic disorganized undifferentiated residual |
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Rx of schizophrenia
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acute - antipsychotics +/- anticonvulsants, anxiolytics
manage S/E Ψsocial CBT ACT social skills, employment programs housing |
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Prognosis of schizophrenia
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⅓ imrpome
⅓ same ⅓ worse |
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Schizophreniform disorder criteria
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Criteria A, D, E of schizophrenia
- symptoms last 1-6m Px better than schizophrenia Rx similar to schizophrenia |
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Brief Psychotic disorder
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Dx - acute psychosis ≥1 +ve symptoms from 1d-1m with eventual return of premorbid level of fxn
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Non-bizarre delusions
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involve situations that could occure in real life (eg being followed, poisoned, loved at a distance)
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Negative Symptoms
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affective flattening
alogia avolition |
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Dx criteria for depression
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"MSIGECAPS"
≥5 symptoms in 2wks, representing ∆ from previous fxn, ≥1 of depressed mood or anhedonia depressed Mood ↑/↓ Sleep ↓ Interest ↓ Energy ↓ Concentration ↑/↓ Appetite Psychomotor agitation/retardation Suicidal ideation |
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Criteria for Mania
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"GST PAID"
≥1wk (or any duration if hospitalization necessary) off Elevated/Expansive/Irritable mood & ≥3 of (4 if mood only irritable) Grandiosity ↓ need for Sleep Talkative (pressure speech) Pleasurable activities w Painful consequences ↑ goal directed Activity/Psychomotor agitation flight of Ideas/racing thoughts Distractable |
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Depressive Disorders
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1. psychotic (with hallucinations/delusions - can be mood congruent)
2. chronic ≥2yrs 3. melancholic (Ψm retardation, EMA, mood worse in am, +++ guilt, ↓↓wt) 4. atypical (↑sleep, ↑wt, rejection hypersensitivity) 5. post-partum 6. seasonal |
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Dysthymic disorder
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depressed mood most of day, most days for ≥2yrs
≥2 of poor appetite/overeating ↓/↑ sleep ↓energy/fatigue ↓self-esteem poor concentration, or difficulty making decisions feelings of hopelessness No MDE during 1st 2 years of disturbance (1yr for kids or adolescents) |
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Postpartum "Blues"
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Normal emotional ∆'s of puerperium
50-80% mom's @2-4d post-partum, lasts ~48h (≤10d) transient period of mild depression, mood instability, anxiety, ↓concentration, ↑concern over own health and baby's |
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Post-Partum Depression
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Dx MDE, onset within 4wks post-partum
lasts 2-6m, residual symp ≤1yr must ask about suicidal/infanticidal ideation RF PHx mood disorder Ψsocial factors Rx no evidence meds superior to ΨRx in non-psychotic PPD established short term safety of SSRIs - long term unknown |
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Bipolar I vs II
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I - ≥1 manic/mixed episode
MDE not required for Dx II - ≥1 MDE, ≥1 hypomanic and NO past manic/mixed |
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Cyclothymia
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numerous pds of hypomania and depressive symptoms NOT meeting criteria for MDE
- No MDE, manic/mixed episodes |
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DDx of anxiety disorders
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Endocrine
- ↓/↑thyroid, pheo, hypoglycemia, hyperadrenalism, hyperPTH CVS - CHF, PE, arrhythmia, MVP Respiratory asthma, pneumonia, hyperventilation Metabolic Vit B12↓, porphyria Neuro neoplasm, vestibular dysfunction, encephalitis Substance induced |
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Medical w/u of anxiety
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Routine
P/E CBC Thyroid fxn lytes U/A +/- as indicated neuro consult, CXR, ECG, CT scan |
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Criteria for Panic disorder
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"STUDENTS FEAR the 3C's"
Sweating Trembling Unsteadiness, dizziness Depersonalization/ Derealization Excessive HR, palpitations Nausea Tingling SOB FEAR of dying, going crazy, losing control 3C's Chest pain Chills Choking |
