KC Psych Flashcards
*5 diagnostic criteria for schizophrenia
2 or more of the following for the majority of a month:
i. Hallucinations
ii. Delusions
iii. Disorganized speech
iv. Disorganized or catatonic behaviour
v. Negative symptoms
Continuous disturbance for at least six months
Social or occupational dysfunction
Not better explained by another psych disorder
Not better explained by a general medical disorder or intox
*What are FIVE elements that would suggest an organic cause of acute psychosis?
New onset of symptoms,
Acute change in mental status,
Recent fluctuation in behavioral symptoms, *islands of lucidity
Onset in fifth decade of life or older,
Onset of symptoms after the patient has already been admitted to a medical care setting,
Presence of nonauditory hallucinations,
Lethargy,
Abnormal vital signs,
Poor performance on cognitive function testing, particularly orientation to time, place, and person
*5 endocrine causes of psychosis
- Addison’s disease
- Cushing’s disease
- Panhypopituitarism
- Parathyroid disease
- Postpartum psychosis
- Recurrent menstrual psychosis
- Sydenham’s chorea
- Thyroid disease
*4 metabolic causes of psychosis
- Hyper-/hypo-calcemia
- Hypercarbia
- Hypoglycemia
- Hyponatremia
- Hypoxia
*Provide FOUR nutritional deficiencies that can cause acute psychosis
Niacin
Thiamin
Cobalamin
Folate
Or remember Vitamin B 1, 3, 9 and 12
*Provide FIVE infectious causes of acute psychosis
- HIV
- Syphilis
- Herpes simplex encephalitis
- Lyme disease
- TB
- Rabies
- EBV
- Leptospirosis
*3 psychiatric diagnoses that include delusions (question asked for axis IV)
o Schizophrenia
o Brief psychotic disorder
o Schizophreniform disorder
o Mood disorder with psychotic features
o Schizoaffective disorder
o Delusional disorder
*6 adverse effects of neuroleptics
o QT prolongation
o Neuroleptic malignant syndrome
o Dystonia
o Akathisia
o Tardive dyskinesia
o Drug-induced Parkinsonism
o Agranulocytosis, specifically with clozapine
o Weight gain
*What are 5 findings on INTERVIEW that would favour a psychiatric diagnosis
Insidious onset
Late teens – 20s
Family history of psychosis
Auditory hallucinations
Disorganized thought content, but oriented.
No fluctuation of LOC
Delusions
Erratic behaviour
Pressured speech or guarded affect
Normal vitals, normal glucose**
*2 treatments for acute dystonia
- Diphenhydramine 25 to 50 mg OR
- Benztropine 1 to 2 mg IV/IM/PO
*What bloodwork would you do to look for an organic cause of psychosis
CBC, lytes, Cr, extended lytes, tox screen, LFTs
What is schizophreniform disorder
Sx of schizophrenia but for 1-6mo
What is schizoaffective disorder
schizoaffective disorder - if symptoms consistent with schizophrenia persist for more than two weeks in the absence of a prominent mood episode
What is a brief psychotic disorder
Sx of schizophrenia but for <1mo
List 3 types of delusions
erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified
Other than psychiatric medications, list 5 medications that can induce psychosis
Antibiotics: isoniazid, rifampin
Cardiovascular drugs: captopril, dig, methyldopa, procainamide, propranolol
Antihistamines
Steroids
*What are 5 serious potential life threatening effects of these two medications (bupropion, citalopram)
- Higher rate of QT prolongation compared to other SSRIs
- Higher rate of seizures compared to other SSRIs
- SIADH
- Serotonin syndrome
- Decreased LOC
Bupropion inhibits reuptake of dopamine and norepinephrine - QRS prolongation
- QT prolongation
- Decreased LOC
- Delayed onset seizures with extended release formulation
*Bupropion is metabolized by CYP 450 enzymes in the liver. What are 6 classes of medications that inhibit the function of these enzymes.
There are many modulators of the cytochrome P450 system:
- Anti-depressants (e.g. bupropion)
- Anti-arrhythmics (e.g. amiodarone)
- Anti-hypertensives (e.g. amlodipine)
- Anti-biotics (e.g. trimethoprim-sulfamethoxazole)
- Anti-epileptics (e.g. valproic acid)
- Anti-fungals (e.g. fluconazole)
- Proton pump inhibitors (e.g. pantoprazole)
- Anti-TB (e.g. isoniazid)
- Anti-histamine (e.g. diphenhydramine)
*What is the mechanism of action of bupropion (list 2)
- norepi reuptake inhibition
- dopamine reuptake inhibition
*Other than suicidality, list 5 symptoms of depression
Sig E Caps
S leep amount increased or decreased
I nterest (anhedonia)
G uilt
E nergy level decreased
C oncentration decreased
A ppetite increased or decreased
P sychomotor activity increased or decreased
S uicidal ideation
*List 5 symptoms of acute mania
Dig Fast
D istractibility
I rritability
G randiosity
F light of ideas
A ctivity increased
S leeplessness
T houghtlessness (impulsivity, increased risk taking)
*What 2 neurotransmitters are commonly targeted by antidepressants?
- Serotonin
- Norepinephrine
(and dopamine)
List 5 medical conditions associated with depression
Endo: lytes, DM, thyroid/PTH, Cushing’s/Addison’s, pheo
Nutrient: anemia, folate/B12 deficiency, B1/2/6 deficiency
Neuro: subdural hematoma, stroke, Parkinson’s, dementia, NPH
D: HIV, hepB/C, HSV, syphilis, TB, Lyme, encephalitis
Malignancy: brain, heme, metastatic
Function-limiting disease: MI, CHF, ESRD, HIV, SLE/RA
What is the diagnostic criterial for depression
What is the diagnostic criteria for mania
What is the difference between Bipolar 1 and Bipolar 2
Bipolar I - at least one manic episode, usually 1 MDE
Bipolar II - no manic episode, at least 1 MDE + 1 hypomanic. “Milder” form of Bipolar I. Often missed
*What are the diagnostic criteria for PTSD
TRAUMA - traumatic event, re-experience the event, avoidance of stimuli, unable to function, more than a month, arousal increased
- Exposure to actual or threatened death, serious injury, or sexual violence.
- Presence of intrusion symptoms associated with the traumatic event.
- Persistent avoidance of stimuli associated with the traumatic event.
- Negative alterations in cognition and mood associated with the traumatic event.
- Marked alterations in arousal and reactivity associated with the event.
- Duration is greater than 1 month.
- Disturbance causes clinically significant distress or impairment.
- Disturbance is not attributable to the physiological effects of a substance or another medical condition.
*List 4 other anxiety disorders
Panic disorder
GAD
OCD
Phobias
*3 endo disorders that cause anxiety
Hypoparathyroidism,
Hyperthyroidism and hypothyroidism,
Hypoglycemia,
Pheochromocytoma,
Hyperadrenocorticism
List 5 medical conditions that may cause anxiety
Cardio (arrhythmia, CHF, PE, MI), resp (asthma, pneumonia, hyperventilation), endocrine (hyperthyroidism, pheochromocytoma, Cushing’s, hyperparathyroidism), neurologic (neoplasm), substance (caffeine, amphetamines, cocaine, withdrawal), mood disorders, personality disorders
List 4 predictors that anxiety may be due to an underlying medical issue
Box 102.1
- Onset of symptoms after 35 years old
- Lack of personal or family history of an anxiety disorder
- Lack of avoidance behaviour
- Absence of significant life events generating or exacerbating the anxiety symptoms
- Poor response to ant-anxiety agents
What is the definition of generalized anxiety disorder
Excessive worry for most of the time for >6 mo that is difficult to control with 3 of (restlessness, easily fatigued, difficulty concentration, irritability, muscle tension, sleep disturbances) causing significant stress or functional impairment
A patient comes in with recurrent pain and parasthesias despite an extensive normal workup. List 5 things on the differential
Psychiatric: somatoform disorder, functional neurological disorder, depression, anxiety, substance use
Medical: MS, porphyria, hyperparathyroidism, lupus, thyroid disease, Wilson disease, substance abuse disorder
Malingering
What is the difference between malingering and factitious disorder
Both are intention production of false or grossly exaggerated symptoms
In malingering the patient is motivated by some external reward ex. Financial compensation, avoiding work
In factitious disorder the patient is motivated by the desired to assume the ‘sick role’
*64-year old lady who drinks a lot, is not answering her phone, has COPD, husband died 6 months ago, and no family in town. Daughter comes to find her and brings her in.
a. List 5 risk factors for suicide in this patient
o Age groups: Adolescence, older age
o Gender: Male
o Ethnicity: White, American Indian, or Alaskan Native
•
o Mental disorders (including mood disorders, schizophrenia, borderline personality disorder, anxiety disorders, post-traumatic stress disorder)
o Alcohol or substance abuse
o Prior suicide attempt
o History of trauma or abuse
o Chronic pain or major physical illness Terminal illness
o Hopelessness
•
o Job or financial loss
o Access to lethal means (eg, guns)
•
o Lack of social support
o Inadequate access to care for mental health or substance abuse
o Certain cultural and religious beliefs
*List 3 criteria required for involuntary admission
- Active intent to harm self
- Active intent to harm other
- Inability to care for self
- Lacking capacity*
*Memory aide: CURVES:
Choose and communicate,
understand, reason, values, emergency, surrogate
*Organic causes of depression (2 each) endocrine, neoplastic, neurologic
neoplastic: brain tumor, pancreatitic carcinoma, abdominal carcinomatosis
endocrine: hypothyroidism, DM, cushing’s, addisons
neurologic: parkinson’s, CVA, MS
*List 10 RF for suicide
• Demographic
o Age groups: Adolescence, older age
o Gender: Male
o Ethnicity: White, American Indian, or Alaskan Native
• Biopsychosocial
o Mental disorders (including mood disorders, schizophrenia, borderline personality disorder, anxiety disorders, post-traumatic stress disorder)
o Alcohol or substance abuse
o Prior suicide attempt
o History of trauma or abuse
o Chronic pain or major physical illness Terminal illness
o Hopelessness
• Environmental
o Job or financial loss
o Access to lethal means (eg, guns)
• Sociocultural
o Lack of social support
o Inadequate access to care for mental health or substance abuse
o Certain cultural and religious beliefs
*3 vital sign changes in anorexia
Hypothermia
Hypotension
Bradycardia
*6 metabolic lab findings in anorexia
Hyponatremia,
Hypokalemia,
Hypomagnesemia,
Hypophosphatemia
*5 physical exam findings in anorexia
Xerosis (dry, scaly skin), lanugo-like body hair, acne, hyperpigmentation, seborrheic dermatitis, acrocyanosis, petechiae, livedo reticulitis, pretibial edema, Russel sign (callus over the knuckles of the dominant hand), stomatitis, dental erosions
*What valve abnormality is most common in anorexia
Mitral valve prolapse
*5 behaviours associated with / diagnostic of anorexia
- Intense fear of gaining weight
- Persistent behaviour that prevents weight gain, despite being underweight
- Distorted perception of body weight and shape
- Undue influence of weight and shape on self-worth
- Denial of medical seriousness of one’s low body weight
- Engaged in weight loss through dieting or fasting
- Excessive exercise
- Episodic binge eating and purging (Note: If regular, suggestive of bulimia nervosa)
*In eating disorders, list 2 findings from each of: CVS, heme, endocrine, metabolic/electrolytes, skin
i) Cardiovascular: Bradycardia, hypotension, decreased ventricular function, pericardial effusion, mitral valve prolapse, myocardial fibrosis
ii) Hematological: Anemia, leukopenia, thrombocytopenia
iii) Endocrine/metabolic: Amenorrhea, estradiol deficiency, infertility, osteopenia, hypercortisolemia
iv) Electrolytes: Hyponatremia, hypokalemia, hypomagnesemia, hypophosphatemia
v) Skin: Xerosis (dry, scaly skin), lanugo-like body hair, acne, hyperpigmentation, seborrheic dermatitis, acrocyanosis, petechiae, livedo reitcularis
List 2 ECG findings that can be seen in severe eating disorders
Prolonged Qtc, bradycardia, dysrhythmias
What is refeeding syndrome? List 2 lab abnormalities and 2 physical findings
Life-threatening metabolic response involve fluid and electrolyte shifts in response to refeeding (endogenous insulin release after given food) in severely malnourished individuals.
Labs: Hypophosphatemia, hypokalemia
Sx: CHF, peripheral edema, rhabdomyolysis, seizures, hemolysis, respiratory insufficiency (due to diaphragm weakness)
What is the definition of anorexia nervosa
Restriction of energy intake relative to requirements leading to significantly low body weight PLUS intense fear of gaining weight PLUS change in perception of how one’s body weight is experienced, often with lack of seriousness of low body weight
What is the definition of bulimia
Recurrent episodes of binge eating (larger than what most individuals would eat, with a sense of loss of control) with inappropriate compensatory behaviour (self-induced vomiting, laxatives, diuretics, excessive exercise)
