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
2
Q
Psychiatrists vs psychologists
A
3
Q
What is used to make a diagnosis in psychiatry
A
4
Q
6 basic human emotions recognized by babies
A
- happy
- scared
- anger
- surprise
- disgust
- sadness
5
Q
what makes a psychiatric disorder?
A
if they cause significant distress or impair function then they are considered a disorder
6
Q
Question 1
A
D.
7
Q
Whats the most important thing for a psychiatric evaluation?
A
- history
- mental status exam
8
Q
BioPsychoSocial Formulation
A
9
Q
Psychosis Definition
A
10
Q
Psychosis positive symptoms
3 listed
A
- delusions
- hallucinations
- disorganized speech
11
Q
Psychosis negative symptoms
2 listed
A
- diminished emotional expression
- avolition
12
Q
Perceptual disturbances examples
6 listed
A
- Illusion
- Hallucinations
- derealization
- depersonalization
- Dissociation
- Deja Vu
13
Q
Illusion definition
A
Misperception of actual stimuli
14
Q
Hallucinations definition
A
presence of a perception in the absence of stimuli
15
Q
Derealization definition
A
feeling the world around you is not real
16
Q
Depersonalization definition
A
thinking you are not real
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)
18
Q
Deja Vu definition
A
feeling like you have already been or seen something
19
Q
Question 2
A
B. Illusions
20
Q
Thought disturbances examples
3 listed
A
- Delusions
- Obsession
- Disorganization
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)
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
23
Q
Disorganization definition
A
starts as loosening of associations can progress to word salad in Schizophrenia
24
Q
Question 3
A
B. Paranoid
25
Behavior disturbances examples
4 listed
* Compulsion
* self-injurious behavior
* Suicidality
* Acting out
26
Compulsion definition
behavior aimed at reducing obsession or anxiety in general, may be mental activity
27
Self-injurious behavior definition
behavior aimed at self-harm such as cutting, pinching, burning, scratching, often aimed at reducing anxiety or attempting to "feel"
28
Suicidality definition
behavior aimed at terminating one's own life
29
What is mood
mood is a SUSTAINED predisposition to emotion
30
Mood is not \_\_\_\_\_\_\_
* affect
* smile then have a happy affect
* if you actually feel happy you have a happy emotion
31
Mood disorders criteria
consist of prolonged episodes of disturbed, sustained mood causing distress or psychosocial dysfunction
32
Mood vs affect
33
The big 3 presentations in psychiatry
* Depressed
* Psychotic
* Anxious
34
Differential Dx in psychiatry
35
Depressed presentation Psychiatric causes
5 listed
* Major depression
* Bipolar disorder
* persistent depression
* adjustment disorder
* Bereavement
36
Depressed presentation questions to ask
* feelings about self?
* Negative triad
* Mood-congruent psychosis?
37
Depressed presentation Non-Psychiatric causes
5 listed
think...
* endocrine
* infection
* neoplasm
* metabolic
* meds/drugs
38
Medical causes of depressive presentation
* 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)
39
Degenerative neurological disease that can cause depressive presentation
* Parkinsons
* Huntingtons
* MS
40
Cerebrovascular disease that can cause depressive presentation
* Stroke
* MI
* CHF
41
Endocrine issues that can cause depressive presentation
* DM
* hyper and hypothyroid
* adrenal
* parathyroid
42
Autoimmune conditions that can cause depressive presentation
lupus
43
Viral or other infections that can cause depressive presentation
* influenza
* hepatitis
* mononucleosis
* HIV
44
Cancers that can cause depressive presentation
cancers of the pancreas
45
Vitamin deficiencies that can cause depressive presentation
Vitamin B
46
Substances that can cause depressive presentation: drugs of abuse
meth
alcohol/depressants
opioids
cannabis
47
Substances that can cause depressive presentation: medications
4 listed
* Steroid hormones
* anticancer drugs
* hepatitis treatment
* melatonin
48
Anxious psychiatric causes
9 listed
**Anxiety Disorders**
* GAD
* Panic DO
* Phobia
* Social anxiety
* OCD
* ASD or PTSD
**Mood disorders**
* Psychotic disorder
* Adjustment disorder
* Bereavement
49
Anxious psychiatric causes
6 listed
GAD
Panic DO
Phobia
Social anxiety
OCD
ASD or PTSD
50
Mood disorders that can result in anxiety
3 listed
* Psychotic disorder
* adjustment disorder
* bereavement
51
Questions to ask for a suspected mood disorder
4 listed
* Chronicity?
* Stressor?
* Trauma?
* Drug/medication side effect?
52
Substance-induced anxiety disorder
53
Most common medical disorders causing anxiety symptoms
* endocrine
* cardiovascular
* respiratory
* metabolic
* neurological
54
Endocrine conditions that can cause anxiety syndromes
* thyroid
* DM
* Pheochromocytoma
* Cushing's
55
Cardiovascular conditions that can cause anxiety syndromes
3 listed
* CHF
* PE
* Arrhythmia
56
Metabolic conditions that can cause anxiety syndromes
2 listed
* B12 deficiency
* Porphyria
57
Respiratory conditions that can cause anxiety syndromes
3 listed
* COPD
* Pneumonia
* Asthma
58
Neurological conditions that can cause anxiety syndromes
* neoplasia
* vestibular
* encephalitis
59
Psychotic
* psychotic disorders
* mood disorders
60
Psychotic disorders
4 listed
* brief psychosis
* schizophreniform
* schizophrenia
* Schizoaffective disorder
61
Mood disorders that can cause psychosis questions
Bizarre?
acuity vs chronicity?
Does past tend to repeat itself?
mood congruence?
visual hallucinations: medical?
Somatic hallucinations: "formication" is substance induced?
62
Mood conguence
do the presentations go along with the mood of the person
63
visual hallucinations makes you think?
Medical causes
64
Somatic hallucinations makes you think?
drug induced causes
65
Confusion psychiatric presentations
66
Anyone over 50 with new psychiatric presentation consider?
medical causes until proven otherwise and RETEST
67
Confusion affect presentations
agitated or depressed presentation
68
always check ______ in all inpatients
cognition
69
In elderly for confusion check?
urine, consider drugs, bowel status, hydration, infections
70
DSM-5 criteria for delirium
5 listed
71
Delirium symptoms
6 listed
72
Delirium prevalence
73
Delirium DDx
74
Risk factors for delirium
5 listed
↑ DA, ↓ACh
* Age/dementia
* Infection/surgery
* Drugs
* Nutrition
* Hypoxia
75
Common medical causes of delirium
3 listed
* Viral encephalopathy
* Seizure disorder
* Lupus cerebritis
* Hepatic (metabolic) encephalopathy
* Wernicke-Korsakoff
76
Viral encephalopathy causes of delirium
2 listed
* Herpes
* HIV: causes rapid and acute confusion, hallucinations, may cause seizures
77
Seizure disorder causes of delirium
* various perceptual distrubances
* hallucinations
* comorbid depression is common
78
Lupus cerebritis causes of delirium
3 listed
* Mania
* psychosis
* hyper-religiousity
79
Hepatic (metabolic) encephalopathy causes of delirium
* confusion
* ascites
* asterixis
* suggestibility
* dermatologic signs
* hepatorenal syndrome
80
Wernicke-Korsakoff causes of delirium
* Acute Wernicke triad confusion, lateral recuts palsy and ataxia
* Chronic Korsakoff anterograde amnesia (repleted with thiamine)
* Confabulation
81
Delirium work-up
82
Delirium vs Dementia
83
Delirium onset
Acute
84
Delirium Course
fluctuating
85
Delirium duration
hours to weeks
86
Delirium attention
fluctuates
87
Delirium perception
hallucinations
88
Delirium sleep/wake
reversed
89
Dementia onset
insidious
90
Dementia course
steady decline
91
Dementia duration
months/years
92
Dementia attention
normal
93
Dementia perception
delusions
94
Dementia sleep/wake
fragmented
95
Dementia with behavioral disturbances
96
Treatment of dementia with behavioral disturbances
97
Beers Criteria
* best not to add medicines to a brain that is already confused
* certain medications can cause or exacerbate delusions or delirium
98
Beers criteria psychotropics
DONT GIVE to people over 65
