Psy Flashcards
Nommer les 3 phases de la schizophrénie
Prémorbide: sx négatifs
Phase progressive: apparition sx positifs
Phase résiduelle: sx résiduels, pauvre fonctionnement social
DxD organique de la psychose
- métabolique
- Neurologique
- Endocrino
- MOF
- Maladies inflammatoires
Metabolic Disorders
•
Hypercalcemia
•
Hypercarbia
•
Hypoglycemia
•
Hyponatremia
•
Hypoxia
Inflammatory Disorders
•
Sarcoidosis
•
Systemic lupus erythematosus
•
Temporal (giant cell) arteritis
Organ Failure
•
Hepatic encephalopathy
•
Uremia
Neurologic Disorders
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Alzheimer’s disease
•
Cerebrovascular disease
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Encephalitis (including HIV infection)
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Encephalopathies
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Epilepsy
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Huntington’s disease
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Multiple sclerosis
•
Neoplasms
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Normal-pressure hydrocephalus
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Parkinson’s disease
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Pick’s disease
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Wilson’s disease
Endocrine Disorders
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Addison’s disease
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Cushing’s disease
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Panhypopituitarism
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Parathyroid disease
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Postpartum psychosis
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Recurrent menstrual psychosis
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Sydenham’s chorea
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Thyroid disease
Deficiency States
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Niacin
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Thiamine
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Vitamin B12 and folate
Nommer des éléments cliniques orientant vers un dx médical pour un patient avec sx psychotiques
Factors associated with primary medical conditions include new onset of symptoms, acute change in mental status, recent fluctuation in behavioral symptoms, onset in fifth decade of life or older, onset of symptoms after the patient has already been admitted to a medical care setting, and the presence of nonauditory hallucinations, lethargy, abnormal vital signs, and poor performance on cognitive function testing, particularly orientation to time, place, and person
Médicaments pouvant induire une psychose
Anxiolytiques: alprazolam, clonazepam, diazepam
Anticonvulsivants: phénytoine, phenobarbital
Antibiotiques: rifampin, izoniazide
Antidépresseurs: TCA
Cardiovasculaire: digitale, propranolol, procainamide, méthyldopa
Drogues d’abus
Autres: corticostéroides, métaux lourds, antihistaminiques
Critères dx schizophrénie
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
A.Delusions
B.Hallucinations
C.Disorganized speech (eg, frequent derailment or incoherence)
D.Grossly disorganized or catatonic behavior
E.Negative symptoms (ie, diminished emotional expression or avolition)
- Atteinte fonctionnement
- Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (ie, active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (eg, odd beliefs, unusual perceptual experiences).
- Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
- The disturbance is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition.
- If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
Trouble psychotique bref: inf 1 mois
Trouble schizophréniforme 1-6 mois
Critères dx ÉDM
Five or more of the following symptoms have been present almost every day during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms caused by a general medical condition.
1.
Depressed mood (can be irritable mood in children and adolescents)
2.
Loss of interest or pleasure in activities
3.
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite
4.
Insomnia or hypersomnia
5.
Psychomotor agitation or retardation
6.
Fatigue or loss of energy
7.
Feelings of worthlessness, or excessive or inappropriate guilt
8.
Diminished ability to think or concentrate, or indecisiveness
9.
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation, or a suicide plan or attempt
B.
Symptoms cause clinically significant distress or impairment in social, occupational, or other functioning.
C.
Symptoms are not caused by direct physiologic effects of a substance (eg, drug of abuse, medication) or a general medical condition (eg, hypothyroidism).
D.
Symptoms are not better explained by another mental health disorder.
E.
There has never been a manic or hypomanic episode.
Postpartum: dans les 4 sem suivant l’Accouchement
Définition trouble dépressif persistant
Specific criteria include the following: depressed mood most of the day, most days for at least 2 years; two or more of the following: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness; never more than 2 months of the 2 years without symptoms
Critères dx manie
DIGFAST
Distractibility
Increase talking
Grandiosity
Flight of ideas
Activity increased
Sleeplessness
Thoughtlessness (impulsivity, increased risk taking)
A.
Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy lasting at least 1 week (or any duration if hospitalization is necessary).
B.
During the period of mood disturbance and increased energy or activity, three or more of the following symptoms have persisted (four, if the mood is only irritable) and have been present to a significant degree:
1.
Inflated self-esteem or grandiosity
2.
Decreased need for sleep (eg, feels rested after only 3 hours of sleep)
3.
More talkative than usual or pressure to keep talking
4.
Flight of ideas or subjective experience that thoughts are racing
5.
Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli)
6.
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7.
Excessive involvement in pleasurable activities that have a high potential for painful consequences (eg, buying sprees, sexual indiscretions, foolish investments)
C.
Mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or social activities or to necessitate hospitalization to prevent harm to self or others, or psychotic features are present.
D.
Symptoms are not caused by direct physiologic effects of a substance (eg, drug of abuse, medication) or a general medical condition (eg, hyperthyroidism).
Critères dx attaques de panique
Abrupt surge of intense fear or discomfort that reaches a peak within minutes, in which four or more of the following occur:
Palpitations
Sweating
Trembling
Shortness of breath or feeling of being smothered
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy or light-headed
Chills or heat sensations
Paresthesias
Derealization or depersonalization
Fear of losing control or going “crazy”
Fear of dying
Critères dx PTSD
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.
Nommer 5 causes endocriniennes d’anxiété
hypoparathyroidism, hyperthyroidism and hypothyroidism, hypoglycemia, pheochromocytoma, and hyperadrenocorticism, diabète
Dfn trouble somatique
Conditions manifested by abnormal thoughts, feelings, and behaviors in response to distressing somatic symptoms causing impairment:
Somatic symptom disorder (SSD)
Illness anxiety disorder (formerly hypochondriasis)
Functional neurological symptom disorder (formerly conversion disorder)
Factitious disorder
Psychological factors affecting other medical conditions
Other specified somatic symptom and related disorders
Unspecified somatic symptom and related disorders
Critères dx trouble factice
1.
Falsification of psychological or physical signs or symptoms, or induction of disease or injury associated with identified deception.
2.
The individual presents to others as injured, ill, or impaired.
3.
The deceptive behavior is apparent even in the absence of external incentives.
4.
The behavior is not better explained by another mental disorder.
Nommer 4 caractéristiques de la simulation
1.
Medicolegal context of the presentation (eg, the patient was referred by his or her attorney)
2.
Marked discrepancy between the person’s claimed stress or disability and objective findings
3.
Poor cooperation during the diagnostic evaluation or poor compliance with previously prescribed treatment regimens
4.
The person exhibits or has a history of antisocial behavior
Nommer 20 facteurs de risque de suicide
FR additionnels de suicide chez l’adolescent
Sexual orientation (lesbian; gay; bisexual; unsure)
Sedentary activities (≥3 hours day TV or video games; sleep <8 hours per night)
Weight concerns (perceive self as overweight; prior fasting, diet pills, or vomiting/laxatives for weight control)
Sexual health (prior sexual intercourse; sex before age 13; four or more partners; sexually active; no use of condoms)
Exposure to violence (carried a weapon; in a physical fight, bullied electronically or in person; forced to have sex; hit by significant other; felt unsafe or threatened at school
Participation in Goth subculture
Évaluation suicide
Nommer des éléments d’un plan de sécurité pour idées suicidaires
Indications de dépistage toxico en cas de suspicion d’agression
Period of unconsciousness
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Period of loss of motor control
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Amnesia or confused state with suspicion of sexual assault
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Patient suspicion or belief that she or he was drugged prior to or during sexual assault
And
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Less than 72–96 hours since assault (depending on jurisdictional protocol)
Quelle est la substance utilisée pour augmenter la visualisation des lésions anogénitales?
Coloration bleu de toluidine
Nommer les traitements à donner post abus sexuel
Déterminer le besoin de prophylaxie post exposition pour le VIH après abus sexuel
Nommer 2 tests de dépistage de violence conjugale
HITS How often does your partner:
- Physically hurt you?
- Insult you or talk you down?
- Threaten or harm you?
- Scream or curse at you?
STaT Have you ever been in a relationship where your partner has:
- Slapped or pushed you?
- Thrown, broken, or punched things?
- Threatened you with violence?
Nommer 5 éléments pouvant orienter vers une personne victime de trafic d’humain
Delay in seeking medical care
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Stated age older than visual appearance
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Evidence of lack of care for previously identified or obviously existing medical conditions
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Discrepancy between stated history and clinical presentation or observed pattern of injury
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Scripted, memorized, or mechanically recited history
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A patient who is overly concerned with the time, contacting their “partner,” leaving the ED
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Subordinate, hypervigilant, or fearful demeanor
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Reluctance or inability to speak on one’s own behalf
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Companion who refuses to leave
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Lack of identification documents, or documents in possession of another party
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Accompanied by individual who answers questions for patient and attempts to control encounter, including insisting on providing interpretation (may be “grandmotherly” type)
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Has tattoos or other marks or insignias that may indicate a claim of “ownership” by another, unwilling or uncomfortable talking about the tattoo
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Evidence of any type of physical violence, including torture
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Frequent relocations
Nommer 5 questions simples pour évaluer le danger dans une relation abusive
1.
Has the physical violence increased in frequency or severity over the past 6 months?
2.
Has he ever used a weapon or threatened you with a weapon?
3.
Do you believe he is capable of killing you?
4.
Have you ever been beaten by him while you were pregnant?
5.
Is he violently and constantly jealous of you?
Nommer des trucs pour la désescalation verbale de la violence
1.
Respect personal space: Maintain a distance of two arm’s lengths and provide space for easy exit for either party.
2.
Do not be too provocative: Keep your hands relaxed, maintain a non-confrontational body posture, and do not stare at the patient.
3.
Establish verbal contact: The first person to contact the person should lead the effort.
4.
Use concise, simple language: Elaborate and technical terms are hard for an impaired person to understand.
5.
Identify feelings and desires: “What are you hoping for?”
6.
Listen closely to what the patient is saying: After listening, restate what the patient said to improve mutual understanding (eg, “Tell me if I have this right …”).
7.
Agree or agree to disagree: (a) Agree with clear specific truths; (b) agree in general (eg, “Yes, everyone should be treated with respect.”); (c) agree with minority situations (eg, “There are others who would feel like you.”).
8.
Lay down the law and set clear limits: Inform the patient that violence or abuse cannot be tolerated.
9.
Offer choices and optimism: Patients feel empowered if they have some choice in matters.
10.
Debrief the patient and staff: Be sure to include an opportunity for the patient and staff to speak.
Nommer des techniques d’entrevues utiles avec un pt difficile
