Diagnosis Flashcards
- ↑ Mood Change
- Restlessness
- Difficulty Sleeping
- Unsteadiness
- Sweating
- GI Symptoms → pain, cramping, diarrhoea, vomiting
- Paraesthesia
Discontinuation Symptoms of SSRIs
How can depression be classified?
-
Mild
- 2 weeks
- 2/3 core symptoms
- 2 of other symptoms (none of an intense degree)
- doesn’t affect work/social functioning
-
Moderate
- 2 weeks
- 2/3 core symptoms
- 3/4 other symptoms
- considerable difficulty continuing with normal work/social functioning
-
Severe
- 2 weeks (if particularly severe symptoms can make early diagnosis)
- all 3 core symptoms affected
- 4+ other symptoms of severe intensity
- severe distress and/or agitation
- can experience psychotic symptoms with severe depressive episodes
Which tools can be used to assess depression?
-
HAD (Hospital Anxiety and Depression) Scale
* 14 questions (7 anxiety, 7 depression) - PHQ-9 (Patient Health Questionnaire)
- ‘over the last 2 weeks, how often have you been bothered by any of the following problems?’
- 9 items scored from 0-3
- 5-9 = mild (depression)
- 10-14 = moderate (depression)
- 15-19 = moderately severe (depression)
- 20-27 = severe (depression)
Which one of the following is not a recognised feature of anorexia nervosa?
- Raised cortisol levels
- Low FSH
- Raised growth hormone levels
- Hyperkalaemia
- Impaired glucose tolerance
Hyperkalaemia
Anorexia Features
- Most things low
-
G’s and C’s raised
- growth hormone
- glucose
- salivary glands
- cortisol
- cholesterol
- carotinaemia (yellow pigmentation of skin)
A 56-year-old lady and her husband present to you in hospital. The husband describes how he is growing increasingly concerned as his wife seems to be becoming more and more forgetful. She has lost her keys a number times and often forgets where she has been during the day and what activities she has been doing. She also agrees that she has been more forgetful recently and is worried she is developing dementia, since her grandmother also suffered from it. She is a diabetic who also suffers from hypertension and agitated depression. She has recently been taking medication for a urinary tract infection also. A list of her medication is shown below. Which of the following medications is most likely to be causing her memory problems?
Lorazepam
Lorazepam belongs to the benzodiazepine class of drugs
One of the side effects of this drug is that this can cause anterograde amnesia
- where memory recall and the creation of new memories is significantly impaired
Lorazepam is also used in anaesthesia
A 44-year-old man attends his GP surgery. He explains that his long term partner died last month. When he woke up this morning he thought he was lying next to her. He claims he heard her voice saying his name. Although he realizes this is not possible it has caused him significant distress. He is worried that he may be ‘going mad.’ He has no other psychiatric history of note.
What is the most likely diagnosis?
Pseudohallucinations
- Sometimes seen in the grieving process
- Experienced in the mind, not the external environment
- The patient has insight due to the fact he realizes that the voice and feeling came from his own mind - this separates the incident from a true hallucination, a symptom which would be seen in more serious psychiatric conditions
A 23-year-old man presents do his GP complaining of worsening headaches for the past few months. They are generalized and present most of the day. He also complains that he is more forgetful, forgetting appointments and telephone numbers. He attends with his partner who complains he has been more irritable in the past few months. He currently takes no medications and has no past medical history of note. He plays rugby for his local team but denies any major bumps to the head. He concedes that he has had a few rough matches this season.
What is the most likely diagnosis?
Post-Concussion Syndrome
- Post concussive syndrome symptoms last more than three months after the initial injury
- They are often non specific neurological symptoms
- The initial injury is often trivial and can be overlooked by patients
-
Typical Features →
- headache
- fatigue
- anxiety/depression
- dizziness
A 35-year-old woman, who is accompanied by her husband, presents to her GP exhibiting strange behaviour. Her husband reports that the changes have mostly taken place over the last week and that he has never witnessed this behaviour before. He describes often waking to find her walking around the house and talking to people who don’t appear to be there. During the consultation, the patient seems distracted and occasionally smiles and waves at the wall behind you. There is no personal or family history of psychiatric illness. The patient does not appear to be distressed and politely asks if she can leave as she believes the appointment is a waste of time.
The patient usually takes loratadine 10mg once daily for hay-fever, salbutamol and beclometasone inhalers for asthma, and has recently started a combined oral contraceptive pill for contraception. She is also taking a course of prednisolone tablets following a recent exacerbation of her asthma.
Which of her medications is most likely to be the cause of her symptoms?
Prednisolone
Sudden onset psychosis following course of corticosteroids – consider steroid-induced psychosis
Steroid-induced psychosis is a recognised side effect of corticosteroid use. In this scenario, both her beclometasone inhaler and prednisolone are corticosteroids, however prednisolone would certainly be a higher dose than beclometasone and would therefore be the most likely cause of her symptoms.
