Lecture 07 - Psychiatry

Question 1

What is a psychiatric disorder

Answer 1

a constellation of symptoms that causes impairment in function and/or daily living that is not attributed to other causes

Question 2

How do you make a psychiatric diagnosis

Answer 2

rule out organic causes, rule out substances, review symptoms as described in the DSM 5

Question 3

What are lab tests used for in psychiatry

Answer 3

primarily to rule out medical causes that can mimic a psychiatric condition, monitor side effects of drugs and therapeutic monitoring of drugs

Question 4

What are typical investigations in psychiatry

Answer 4

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

Question 5

How to diagnose major depressive disorder

Answer 5

five or more symptoms lasting for 2 or more weeks in duration with exclusion of medical causes and substances

Question 6

What are the symptoms of major depressive disorder

Answer 6

depressed mood, loss of interest, weight loss, insomnia/hypersomnia, psychomotor agitation/retardation, loss of energy, guilt/worthlessness, decreased concentration, recurrent thoughts of death

Question 7

What is the biological hypothesis for the cause of depression

Answer 7

monoamine hypothesis (too low serotonin)

Question 8

What is the treatment for major depresseive disorder

Answer 8

SSRIS (selective serotonin reuptake inhibitors)

tricyclic antidepressants (need therapeutic monitoring)

Question 9

How do you diagnose schizophrenia

Answer 9

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

Question 10

What are the symptoms of schizophrenia

Answer 10

delusions, hallucinations, disorganized speech, disorganized of catatonic behaviour, negative symptoms

Question 11

What is the suspected cause of schizophrenia

Answer 11

excess dopamine in subcortical areas and deficient dopamine in cortical areas

Question 12

What is the treatment for schizophrenia

Answer 12

first generation drugs (can cause movement side effects and elevated prolactin)

second generation drugs (can cause metabolic side effects)

Question 13

What is the monitoring for schizophrenia medications

Answer 13

new patients: glucose, HBA1C, lytes, BUN, CR, lipids (to monitor for metabolic side effects)

Question 14

What is the monitoring for clozapine

Answer 14

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

Question 15

Why must we monitor clozapine

Answer 15

risk of agranulocytosis

Question 16

How do we diagnose dipolar disorder

Answer 16

Mania
exclusions of medical causes and substances

Question 17

What are the requirements for manni

Answer 17

any hospitalization or one week or more of:
decreased sleep, increased activity, rapid speech, impulsivity, racing thoughts

Question 18

What is the treatment for bipolar disorder

Answer 18

lithium or divalproex sodium

Question 19

What is the monitoring required for lithium

Answer 19

lithium level (therapeutic window), ECG, creatinine

Question 20

What is the monitoring required for divalproex sodium

Answer 20

therapeutic window for anticonvulsant response, serum levels to monitor compliance, liver function tests, CBC and diff

Question 21

What defines a substance use disorder

Answer 21

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

Question 22

What type of monitoring is done for substance abuse

Answer 22

urine tox screen, pulmonary function tests, liver function tests

Question 23

What are considered psychiatric emergencies

Answer 23

overdose, overdose from suicide attempt, acute psychosis