Intro to Psychiatry (Tobia) - 10/10/16

Question 1

Mood Disorders (2x2 table)

Answer 1

Question 2

Major Depressive Disorder (MDD)

How long do major depressive episodes usually last?

How are episodes characterized?

What is the treatment?

Answer 2

How long do major depressive episodes usually last?

• 6-12 months

How are episodes characterized?

• At least 5 of the 9 symptoms for 2 or more weeks
  
  • Depressed mood
  • SIG E CAPS
    
    • Sleep disorder (increased or decreased)
    • Interest (decreased - anhedonia)
    • Guilt (worthlessness, hopelessness, regret)
    • Energy (decreased)
    • Concentration (decreased)
    • Appetite/weight changes
    • Psychomotor retardation or agitation
    • Suicidal ideations

What is the treatment?

• First line: CBT and SSRIs
• Additional: SNRIs, mirtazapine, bupropion
• Electroconvulsive therapy (ECT) in select patients

Question 3

DIG FAST

Answer 3

Screening for mania (BAD 1 vs BAD 2)

Present at least 4 or 5 of the symptoms

Duration: > 7 days (mania), < 7 days (hypomania)

• *D** = Distractibility and easy frustration
• *I** = Irresponsibility and erratic uninhibited behavior
• *G** = Grandiosity
• *F** = Flight of ideas
• *A** = Activity increased w/ weight loss and increased libido
• *S** = Sleep decreased
• *T** = Talkativeness

Question 4

When do you perform the psychiatric evaluation?

Answer 4

• When patient’s cc is psychiatric in nature
• Change name of routine H&P to “Psychiatric Evaluation”
  
  • Create new heading of “Past Psychiatric History”
  • Include after PMH
• If cc is not psych-related (i.e. chest pain), include psychiatric history with PMH heading

Question 5

How does mental illness impact biopsychosocial functioning?

Answer 5

I. Mental Illness - 1. Patient presents with symptoms of a mental disorder

II. Bio - 3. Psychiatric eval focuses on impact on interpersonal, social functioning

III. Psycho

IV. Social

V. Functioning - 2. Psychiatric evaluation focuses on impact on interpersonal, social functioning

Question 6

Formulation: the goal of gathering info (H&P, psych eval) is to formulate most likely diagnosis

Factors contributing to mental illness

Answer 6

Question 7

Freud’s model of the psyche

Answer 7

• Personality = unconsciously driven
• We are anxious animals (equal and opposite)
  
  • Id (pleasure principle) vs. Super Ego (reality principle)
  • Ego = moderator

Question 8

Jung’s model of the psyche

Answer 8

• Personality = unconsciously driven
• We are one animal
• Collective unconscious (archetypes)
• Shadow (Id)
• Self (Ego)
• Animus/Anima

No superego*

Question 9

What is a personality disorder?

Answer 9

When deficits in 2 or more of the 4 domains → impairement in social, occupation, or interpersonal functioning