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Neuroscience > Neuroscience Week 7: Psych Dx and Delirium > Flashcards

Neuroscience Week 7: Psych Dx and Delirium Flashcards

1
Q

What is psychiatry?

A

the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders

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2
Q

Psychiatrists vs psychologists

A
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3
Q

What is used to make a diagnosis in psychiatry

A
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4
Q

6 basic human emotions recognized by babies

A
  • happy
  • scared
  • anger
  • surprise
  • disgust
  • sadness
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5
Q

what makes a psychiatric disorder?

A

if they cause significant distress or impair function then they are considered a disorder

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6
Q

Question 1

A

D.

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7
Q

Whats the most important thing for a psychiatric evaluation?

A
  • history
  • mental status exam
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8
Q

BioPsychoSocial Formulation

A
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9
Q

Psychosis Definition

A
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10
Q

Psychosis positive symptoms

3 listed

A
  • delusions
  • hallucinations
  • disorganized speech
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11
Q

Psychosis negative symptoms

2 listed

A
  • diminished emotional expression
  • avolition
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12
Q

Perceptual disturbances examples

6 listed

A
  • Illusion
  • Hallucinations
  • derealization
  • depersonalization
  • Dissociation
  • Deja Vu
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13
Q

Illusion definition

A

Misperception of actual stimuli

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14
Q

Hallucinations definition

A

presence of a perception in the absence of stimuli

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15
Q

Derealization definition

A

feeling the world around you is not real

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16
Q

Depersonalization definition

A

thinking you are not real

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17
Q

Dissociation definition

A

feeling like you are not in your body or separate from body

(often seen in trauma where you dissociate from your body)

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18
Q

Deja Vu definition

A

feeling like you have already been or seen something

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19
Q

Question 2

A

B. Illusions

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20
Q

Thought disturbances examples

3 listed

A
  • Delusions
  • Obsession
  • Disorganization
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21
Q

Delusions definition and examples

A

(thoughts/beliefs)

A fixed, false belief (culturally inappropriate)

(Paranoid, grandiose, hyper-religious, erotomanic, somatic, of reference, of control)

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22
Q

Obsession definition

A

intrusive thought, image, or urge that is repetitive, unwanted, and in a moment of quiet reflection seen as ego-dystonic

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23
Q

Disorganization definition

A

starts as loosening of associations can progress to word salad in Schizophrenia

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24
Q

Question 3

A

B. Paranoid

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25
Q

Behavior disturbances examples

4 listed

A
  • Compulsion
  • self-injurious behavior
  • Suicidality
  • Acting out
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26
Q

Compulsion definition

A

behavior aimed at reducing obsession or anxiety in general, may be mental activity

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27
Q

Self-injurious behavior definition

A

behavior aimed at self-harm such as cutting, pinching, burning, scratching, often aimed at reducing anxiety or attempting to “feel”

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28
Q

Suicidality definition

A

behavior aimed at terminating one’s own life

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29
Q

What is mood

A

mood is a SUSTAINED predisposition to emotion

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30
Q

Mood is not _______

A
  • affect
  • smile then have a happy affect
  • if you actually feel happy you have a happy emotion
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31
Q

Mood disorders criteria

A

consist of prolonged episodes of disturbed, sustained mood causing distress or psychosocial dysfunction

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32
Q

Mood vs affect

A
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33
Q

The big 3 presentations in psychiatry

A
  • Depressed
  • Psychotic
  • Anxious
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34
Q

Differential Dx in psychiatry

A
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35
Q

Depressed presentation Psychiatric causes

5 listed

A
  • Major depression
  • Bipolar disorder
  • persistent depression
  • adjustment disorder
  • Bereavement
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36
Q

Depressed presentation questions to ask

A
  • feelings about self?
  • Negative triad
  • Mood-congruent psychosis?
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37
Q

Depressed presentation Non-Psychiatric causes

5 listed

A

think…

  • endocrine
  • infection
  • neoplasm
  • metabolic
  • meds/drugs
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38
Q

Medical causes of depressive presentation

A
  • degenerative changes (e.g. parkinsons, Huntingtons, MS)
  • cerebrovascular disease (stroke, MI, CHF)
  • endocrine (DM, hyper and hypothyroid, adrenal, and parathyroid)
  • autoimmune conditions (lupus)
  • viral or other infections (influenza, hepatitis, mononucleosis, HIV)
  • cancers (cancers of the pancreas)
  • chronic lung disease
  • vitamin deficiencies (vitamin B)
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39
Q

Degenerative neurological disease that can cause depressive presentation

A
  • Parkinsons
  • Huntingtons
  • MS
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40
Q

Cerebrovascular disease that can cause depressive presentation

A
  • Stroke
  • MI
  • CHF
41
Q

Endocrine issues that can cause depressive presentation

A
  • DM
  • hyper and hypothyroid
  • adrenal
  • parathyroid
42
Q

Autoimmune conditions that can cause depressive presentation

A

lupus

43
Q

Viral or other infections that can cause depressive presentation

A
  • influenza
  • hepatitis
  • mononucleosis
  • HIV
44
Q

Cancers that can cause depressive presentation

A

cancers of the pancreas

45
Q

Vitamin deficiencies that can cause depressive presentation

A

Vitamin B

46
Q

Substances that can cause depressive presentation: drugs of abuse

A

meth

alcohol/depressants

opioids

cannabis

47
Q

Substances that can cause depressive presentation: medications

4 listed

A
  • Steroid hormones
  • anticancer drugs
  • hepatitis treatment
  • melatonin
48
Q

Anxious psychiatric causes

9 listed

A

Anxiety Disorders

  • GAD
  • Panic DO
  • Phobia
  • Social anxiety
  • OCD
  • ASD or PTSD

Mood disorders

  • Psychotic disorder
  • Adjustment disorder
  • Bereavement
49
Q

Anxious psychiatric causes

6 listed

A

GAD

Panic DO

Phobia

Social anxiety

OCD

ASD or PTSD

50
Q

Mood disorders that can result in anxiety

3 listed

A
  • Psychotic disorder
  • adjustment disorder
  • bereavement
51
Q

Questions to ask for a suspected mood disorder

4 listed

A
  • Chronicity?
  • Stressor?
  • Trauma?
  • Drug/medication side effect?
52
Q

Substance-induced anxiety disorder

A
53
Q

Most common medical disorders causing anxiety symptoms

A
  • endocrine
  • cardiovascular
  • respiratory
  • metabolic
  • neurological
54
Q

Endocrine conditions that can cause anxiety syndromes

A
  • thyroid
  • DM
  • Pheochromocytoma
  • Cushing’s
55
Q

Cardiovascular conditions that can cause anxiety syndromes

3 listed

A
  • CHF
  • PE
  • Arrhythmia
56
Q

Metabolic conditions that can cause anxiety syndromes

2 listed

A
  • B12 deficiency
  • Porphyria
57
Q

Respiratory conditions that can cause anxiety syndromes

3 listed

A
  • COPD
  • Pneumonia
  • Asthma
58
Q

Neurological conditions that can cause anxiety syndromes

A
  • neoplasia
  • vestibular
  • encephalitis
59
Q

Psychotic

A
  • psychotic disorders
  • mood disorders
60
Q

Psychotic disorders

4 listed

A
  • brief psychosis
  • schizophreniform
  • schizophrenia
  • Schizoaffective disorder
61
Q

Mood disorders that can cause psychosis questions

A

Bizarre?

acuity vs chronicity?

Does past tend to repeat itself?

mood congruence?

visual hallucinations: medical?

Somatic hallucinations: “formication” is substance induced?

62
Q

Mood conguence

A

do the presentations go along with the mood of the person

63
Q

visual hallucinations makes you think?

A

Medical causes

64
Q

Somatic hallucinations makes you think?

A

drug induced causes

65
Q

Confusion psychiatric presentations

A
66
Q

Anyone over 50 with new psychiatric presentation consider?

A

medical causes until proven otherwise and RETEST

67
Q

Confusion affect presentations

A

agitated or depressed presentation

68
Q

always check ______ in all inpatients

A

cognition

69
Q

In elderly for confusion check?

A

urine, consider drugs, bowel status, hydration, infections

70
Q

DSM-5 criteria for delirium

5 listed

A
71
Q

Delirium symptoms

6 listed

A
72
Q

Delirium prevalence

A
73
Q

Delirium DDx

A
74
Q

Risk factors for delirium

5 listed

A

↑ DA, ↓ACh

  • Age/dementia
  • Infection/surgery
  • Drugs
  • Nutrition
  • Hypoxia
75
Q

Common medical causes of delirium

3 listed

A
  • Viral encephalopathy
  • Seizure disorder
  • Lupus cerebritis
  • Hepatic (metabolic) encephalopathy
  • Wernicke-Korsakoff
76
Q

Viral encephalopathy causes of delirium

2 listed

A
  • Herpes
  • HIV: causes rapid and acute confusion, hallucinations, may cause seizures
77
Q

Seizure disorder causes of delirium

A
  • various perceptual distrubances
  • hallucinations
  • comorbid depression is common
78
Q

Lupus cerebritis causes of delirium

3 listed

A
  • Mania
  • psychosis
  • hyper-religiousity
79
Q

Hepatic (metabolic) encephalopathy causes of delirium

A
  • confusion
  • ascites
  • asterixis
  • suggestibility
  • dermatologic signs
  • hepatorenal syndrome
80
Q

Wernicke-Korsakoff causes of delirium

A
  • Acute Wernicke triad confusion, lateral recuts palsy and ataxia
  • Chronic Korsakoff anterograde amnesia (repleted with thiamine)
  • Confabulation
81
Q

Delirium work-up

A
82
Q

Delirium vs Dementia

A
83
Q

Delirium onset

A

Acute

84
Q

Delirium Course

A

fluctuating

85
Q

Delirium duration

A

hours to weeks

86
Q

Delirium attention

A

fluctuates

87
Q

Delirium perception

A

hallucinations

88
Q

Delirium sleep/wake

A

reversed

89
Q

Dementia onset

A

insidious

90
Q

Dementia course

A

steady decline

91
Q

Dementia duration

A

months/years

92
Q

Dementia attention

A

normal

93
Q

Dementia perception

A

delusions

94
Q

Dementia sleep/wake

A

fragmented

95
Q

Dementia with behavioral disturbances

A
96
Q

Treatment of dementia with behavioral disturbances

A
97
Q

Beers Criteria

A
  • best not to add medicines to a brain that is already confused
  • certain medications can cause or exacerbate delusions or delirium
98
Q

Beers criteria psychotropics

A

DONT GIVE to people over 65

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