Differentials psychiatry / MSE Flashcards
List some differentials for a patient presenting with mood fluctuations (+/- delusions or hallucinations)
- Schizoaffective disorder (mood symptoms with hallucinations or delusions)
- Cyclothymic disorder (subclinical fluctuations in mood)
- Unstable personality disorder
- Generalized anxiety disorder
- Major depressive disorder
- Substance-induced
List some primary neurodegenerative disorders (underlying pathology)
Dementia:
- Alzheimer’s disease
- Frontotemporal dementia
- Lewy Body dementia
- Vascular dementia
Other:
- Huntington’s disease
- Parkinson’s disease
- Progressive supranuclear palsy (PSP)
- Multiple system atrophy
- Corticobasal degeneration
List some infections which can cause reduced cognition (potentially reversible)
- Sepsis
- Meningitis / encephalitis
- Neurosyphilis
List some metabolic issues which can cause reduced cognition (potentially reversible)
- Electrolyte derangement (sodium)
- Glucose derangement
- B1 deficiency (thiamine) i.e. Wernicke-Korsakoff’s
- B12 deficiency (cobalamin)
- Folate deficiency
- Hepatic/uraemic encephalopathy
Suggest some important questions to ask when a patient presents with elated mood
- Any episodes of low mood
- Energy levels (increased)
- Sleep (decreased)
- Concentration (decreased)
- Libido (increased)
- Delusions/overvalued ideas e.g. persecutory, grandeur
- Hallucinations
- Work
- Relationships / new partners
Suggest some important questions to ask when a patient presents with psychosis
- Hallucinations (auditory, visual, somatic)
- Delusions (persecution, reference, grandeur)
- Though disorders (withdrawal, insertion, broadcast)
- Passivity phenomenon
KEY: ever taken any steps to protect yourself?
Suggest some important questions to ask when a patient presents with low mood
Core symptoms:
1. Low mood ‘what’s your mood like’ ‘is your mood particularly worse during certain times of the day?’
2. Low energy
3. Anhedonia (lack of pleasure)
Biological symptoms:
- Sleep (clarify time, what they struggle with, quality of sleep)
- Appetite (increased / decreased)
- Weight (increased / decreased)
Psychological symptoms:
- Concentration (poor) ‘able to concentrate on activities e.g. watching TV?’
- Memory / brain processing (slow down)
- Feelings about future ‘how do you see things unfolding in the future?’
- Feelings of hopelessness
- Feelings of guilt
- Psychomotor retardation ‘Has anyone around you mentioned that you seem low or restless?’
- Loss of libido ‘when people feel down, sometimes their sexual drive also goes down, has this happened to you?’
KEY: thoughts of self-harm
KEY: thoughts of death or suicide
KEY: thoughts of harming others
Suggest some important questions to ask when a patient presents with anxiety
- Define trigger for worries
- Avoidance
- Sleep
- Appetite
- Weight loss
Specific symptoms of anxiety:
- Palpitations
- Chest tightness
- Breathlessness
- Sweating
- Dizziness
- Dry mouth
- N&V
- Paraesthesia
Screen for other subtypes / comorbid conditions:
- OCD
- PTSD
- Panic disorder
- Social anxiety
- Agoraphobia
- Depression
Suggest some important questions to ask when a patient presents with suspected eating disorder / weight loss
General:
- Relationship with weight (current weight / change over time)
- Eating behaviours
- Adaptive behaviours (exercise, binging, purging
- ICE-i
Physical symptoms:
- Temperature regulation
- Fainting
- Concentration problems
- Absence of periods
- Hair loss or new finer hair growth on body
- Dry skin
- Change to bowel habits
- GORD
- Abdominal pain
Screen for psychological symptoms:
- Low mood
- Self harm
- Suicide
- Anxiety / panic attacks
- Obsessive or compulsive thoughts
General social:
- Particular triggers / worsening when
- Occupation
- Smoking / alcohol / illicit drugs
What specific questions should you ask for patients presenting with self-harm
- Detail surrounding what happened (what was done, what was used / how much, where did they get it from, planned or spontaneous)
- What triggered event?
- What was going through mind at the time?
- Feel like self-harm was going to end their life?
- What happened after event? How did they feel? Would they do it again?
- First episode or previous episodes?
- Taken any drugs or alcohol at that time?
- Patient’s current mood
KEY: would they do it again
KEY: assess for suicidal ideation
What specific questions should you ask for patients presenting after suicide attempt
- Detail of what happened (when, how it was done)
- Planned or spontaneous?
- Made any preparations e.g. will / suicide note
- Take any precautions against being discovered?
- How did you come to the attention of the medical team?
- How did you feel when help arrived?
- How do you feel about it now?
KEY: would they do it again?
Outline some differential diagnoses for schizophrenia
- Schizoaffective disorder
- Depression with psychosis
- Organic psychosis (often presence of neurological symptoms or changes to mental status) e.g. brain injuries
- Substance-induced psychotic disorder
- Metabolic disorders e.g. hyperthyroidism or hyperparathyroidism
- Depression
- Dementia
- Autoimmune encephalitis
List some differentials for narcissistic personality disorder
- Mania (delusions of grandeur / grandiosity)
- Anxiety
- Depression
List some differential diagnoses for borderline personality disorder
- Schizophrenia
- Mania
- Depression
- Anxiety
List some differentials for mood disorders (which are depressive, bipolar or persistent)
- Normal mood fluctuations
- Adjustment disorders e.g. stress related
- Dementia and other organic brain pathology
- Personality disorder
- Anxiety disorder
List some differential diagnoses for anxiety
Medical:
- Anaemia
- Hyperthyroidism
- Hypoglycaemia
- Phaeochromocytoma
- Cushing’s disease
Substance related:
- Substance withdrawal
- Intoxication e.g. alcohol, cannabis, caffeine
- Medication side effects e.g. beta-blockers
- Depression
- Dementia (anxiety causes forgetfulness)
- Schizophrenia (or other psychotic conditions)
State different types of formal thought disorder (whether thoughts are disordered, from MSE)
- Loosening of associations
- Flight of ideas
- Circumstantiality
- Tangential
- Neologisms
State some different types of content of thoughts (from MSE)
- Delusions e.g. persecutory, grandiose, nihilistic etc.
- Overvalued ideas
- Obsessions
- Phobias
State some different types of hallucinations
Auditory:
- 2nd person auditory
- 3rd person auditory
- Running commentary
Visual
Tactile / gustatory / olfactory
State some important questions to ask in a risk assessment of someone presenting with self-harm / suicide
Triggers
- What led up to it?
- Pre-existing mental health issues / chronic physical issues
- Psychotic symptoms?
Preparation
- Advanced planning
- Final acts
Circumstances
- Act itself
- Precautions to prevent discovery
- Alone?
- Taken with alcohol / other substances?
- What did they think would happen?
- What did they want to happen?
After act
- Seek help?
- Regret or failure
- Support network?
