Lecture 07 - Psychiatry Flashcards
What is a psychiatric disorder
a constellation of symptoms that causes impairment in function and/or daily living that is not attributed to other causes
How do you make a psychiatric diagnosis
rule out organic causes, rule out substances, review symptoms as described in the DSM 5
What are lab tests used for in psychiatry
primarily to rule out medical causes that can mimic a psychiatric condition, monitor side effects of drugs and therapeutic monitoring of drugs
What are typical investigations in psychiatry
imaging (had CT, chest xray)
bloodwork (TSH, lytes, glucose, creatinine, BUN, preg test)
toxicology (urine, blood ethanol, ASA, acetaminophen, lithium)
ECG
EEG
pulmonary function tests
How to diagnose major depressive disorder
five or more symptoms lasting for 2 or more weeks in duration with exclusion of medical causes and substances
What are the symptoms of major depressive disorder
depressed mood, loss of interest, weight loss, insomnia/hypersomnia, psychomotor agitation/retardation, loss of energy, guilt/worthlessness, decreased concentration, recurrent thoughts of death
What is the biological hypothesis for the cause of depression
monoamine hypothesis (too low serotonin)
What is the treatment for major depresseive disorder
SSRIS (selective serotonin reuptake inhibitors)
tricyclic antidepressants (need therapeutic monitoring)
How do you diagnose schizophrenia
two or more symptoms, impairment in multiple areas, acute symptoms for 1 month, continuous symptoms for 6 months and exclusion of medical causes and substances
What are the symptoms of schizophrenia
delusions, hallucinations, disorganized speech, disorganized of catatonic behaviour, negative symptoms
What is the suspected cause of schizophrenia
excess dopamine in subcortical areas and deficient dopamine in cortical areas
What is the treatment for schizophrenia
first generation drugs (can cause movement side effects and elevated prolactin)
second generation drugs (can cause metabolic side effects)
What is the monitoring for schizophrenia medications
new patients: glucose, HBA1C, lytes, BUN, CR, lipids (to monitor for metabolic side effects)
What is the monitoring for clozapine
CBC weekly for first 6 months
every 2 weeks for next 6 months
monthly for duration
troponin, CRP in first month
regular metabolic monitoring as with other drugs
Why must we monitor clozapine
risk of agranulocytosis
How do we diagnose dipolar disorder
Mania
exclusions of medical causes and substances
What are the requirements for manni
any hospitalization or one week or more of:
decreased sleep, increased activity, rapid speech, impulsivity, racing thoughts
What is the treatment for bipolar disorder
lithium or divalproex sodium
What is the monitoring required for lithium
lithium level (therapeutic window), ECG, creatinine
What is the monitoring required for divalproex sodium
therapeutic window for anticonvulsant response, serum levels to monitor compliance, liver function tests, CBC and diff
What defines a substance use disorder
two or more of the following in a 12 month period:
greater amount/time used, inability to fulfill roles, inability to cut down, activities given up, time to use/obtain/recover, craving, hazardous use, use despite psychosocial problems, use despite physical/psychological problems, tolerance, withdrawl
What type of monitoring is done for substance abuse
urine tox screen, pulmonary function tests, liver function tests
What are considered psychiatric emergencies
overdose, overdose from suicide attempt, acute psychosis
