Psych incorrects Flashcards
antidepressants should be trialled for at least 4-6 weeks before considering effectiveness and switching to another/augumenting with another
psych can ask you what is diagnosis eg GAD
how to distinguish delusional disorder from paranoid personality disorder or other conditions
delusional = grandiose, erotomanic, jealous, somatic, persecutory. no psychotic symptoms like hallucination and disorganization
paranoid = distrust and suspicion of MANY people, not just directed at a single person
note* patients with alzheimers may develop psychosis including delusions of jealousy but this is in late stage of disease where other signs present
abnormal neurological exam -> can point to psychotic disorder due to other medical condition
how to differentiate dependent disorder from adjustment disorder
dependent disorder = submissive behaviour!! (eg getting a cat for gf when you are allergic), needs to be taken care of (eg gf used to prepare all meetings for), struggle to make decisions alone, fear of being alone. patients can often have anxiety/panic attacks or depression in context of relationship ending
Social anxiety disorder treatment?
performance only = beta blocker (preferred) OR benzodiazepines
SSRIs/SNRIs = if generalised anxiety or depression present
cause of tardive dyskinesia?
dopamine receptor upregulation and supersensitivity
in obsessive compulsive disorder, obsession with work for instance may make people neglect hobbies and social relationships
what are symptoms of gambling disorder?
triggers?
preoccupation with gambling, tendency to jeopardize relationships and work for gambling, relying on others when in debt
mood symptoms - irritability, feeling down
triggers for gambling - distressed, anxious, depressed
distinguish from bipolar manic epsiode as mania is episodic and unlikely to last greater than a year, increased energy, flight of ideas and pressured speech also seen in mania
Give an example of a depressive disorder due to another medical condition
Obstructive sleep apnoea -> can cause depressive symptoms like fatigue, difficulty concentrating, irritability, low mood.
excessive snoring, daytime sleepiness, male sex, BMI >35, HTN, age>50
cant diagnose MDD without excluding medical or substance use causes
what drug is used to treat depression in children?
fluuoxetine
how to differentiate language disorder from autism or specific learning disorder
specific learning disorder -> difficulties in reading, written expression or maths. requires testing. language disorders may be a precursor
in a language disorder patient will make multiple attempts to communicate unlike autism.
antidepressant of choice in patients with depression and comorbid neuropathic pain eg diabetic neuropathy?
SNRIs
Ropinirole and other dopamine agonists can induce impulse control disorders similar to manic symptoms
Lithium toxicity symptoms?
management?
altered mental status, siezures, fasciculations, tremor, GI (vomiting diarrhea)
hydration. Hemodialysis!! if severe
Sleep terror features?
management?
- occur in children aged 2-12. peak incidence 5
- occur EARLY on when falling asleep
- child inconsolable and cant be woken up
- NO MEMORY of event compared to nightmares
- reassurance
- low dose benzodiazepine only if frequent epsiodes with marked functional impairment
management for anxiety related nightmares?
CBT
investigation for restless leg syndrome?
serum ferritin levels
nocturnal enuresis managment?
imipramine or desmopressin
key way to distinguish adjustment disorder from MDD
- symptoms must be present for AT LEAST 2 weeks for MDD diagnosis and a certain number of symptoms must be present
- indentifiable stressor must be present in Adjustment disorder
when would you suspect phaechromocytoma rather than panic attack diagnosis?
how to differentiate from hyperthyroidsm and
- episodic headaches!! HTN!1
- palpitations diaphoresis
(anxiety and panic attacks can occur with phaeos)
palpitations in hyperthyroidism are not episodic. headaches are not seen. and other symptoms of hyperthyroidism eg weight loss, heat intolerance, diarrhea typically present
man with depression!!, gaining a lot of weight. central obesity. raised glucose.
next step in management?
urinary free cortisol
(or low dose dex test)
patient has cushings syndrome!!
changes in behaviour, dementia,
pmh htn and diabetes
most likely cause
frontotemporal dementia!!
not vascular because that would cause memory impairment + focal neurological deficits
patient presenting with muscle tension(headaches, shoulder neck and back pain), fatigue and insomnia. (core symptoms!)
worried about a few things.
next best step in management?
begin escitalopram (SSRI) and recommend CBT
premature ejaculation treatment?
SSRI
CJD cerebrospinal fluid findings?
high 14-3-3 protein titres
contrast to anti-hu antibodies seen in antihu encephalitis seen in small cell lung cancer
hoarding disorder treatment?
CBT
how to differentiate schizoid vs avoidant personality disorder?
when avoidant - you prefer to be alone due to fear of criticism and rejection “who would want to be friends with someone ugly and stupid like me anyway”
distinguish between bulimia and binge eating disorder
both have binge eating
bulimia only -> compensatory behaviours to prevent weight gain = laxatives, fasting, exercise, vomiting, diuretics, diet pills
SSRI plays a role in treatment of both
no binge eating in anorexia and in anorexia, you can vomit etc but your weight is low unlike bulimia
NMS is different from malignant hyperthermia. the latter is caused by anaesthetic use
differentiate acute stress disorder and ptsd.
treatment for acute stress disorder
PTSD =>1 month symptoms
treatment for both = CBT (Trauma focused)
patient with sleep difficulties,
stopped spending time with friends, discontinued hobbies (anhedonia)
feeling tired (fatigue)
weight gain
missed deadlines, mistakes at work (impaired concentration)
increasingly anxious and restless (psychomotor agitation)
next best step in management?
Escitalopram and CBT for depression
SIG-E-CAPS
Sleep, interest, guilt, energy, concentration, appetite, psychomotor changes, suicidality
SSRIs and what else are the first line treatment for GAD?
SNRIs eg Venlafaxine
in dementia with lewy bodies, what are the possible side effects from treatment with antipsychotics
worsening confusion
parkinsonism
autonomic dysfunction -> eg postural htn
psychotic! man
temp 38
ataxia
NYSTAGMUS (Clinches diagnosis!)
muscle rigidity
history of substance abuse
most likely diagnosis?
how to manage?
Phencyclidine intoxication (PCP)
lorazepam! (benzodiazepines)
to distinguish a person with major depression with psychotic features from schizophrenia, in MD there will be lots of depressive features like sleep and appetite
when assessing suicidal risk, keep to open questions, ask what prompted to feel scared
most likely physical finding in patient taking phenelzine (MAOI) experiencing headaches, after eating heavy sauces and wines?
hypertension
(hypertensive crises = key side effect)
how do you diagnose pesistent depressive disorder (dysthmia)
depressed/low mood for at least 2 years:
plus at least two depressive symptoms eg:
- low self esteem - believing you are unattractive - patient was not avoidant because she still tried to have a relationship
- fatigue
- concentration
- feelings of hopelessness
- etc
how do you manage pyschosis in parkinsons disease?
ps reduction of PD medications failed
specific antispychotics - quietapine!!! clozapine!!, Pimavanserin!! - low dopamine receptor antagonism
postpartum woman with fatigue + unsteady gait + assymmetric lower extremity weakness + hyperreflexia (UMN sign). what is the next step in managment?
obtain MRI of brain and spinal cord
Multiple sclerosis can often present or worsen in post partum period
patient with schizophrenia, on antipsychotics. inner restlessness (pacing, inability to sit still so walking all around neighbourhood), agitation(seen in severe cases)
management options?
reducing dosage
switch to antipsychotic with less of this eps
or add on Propanolol!!!! (or less commonly a benzodiazepine or benztropine)
agitation, restless behaviour, irritability, insomnia, and signs of psychosis in a 16 year old who has been staying up studying for exams. history of adhd. family history of BAD
next best step in management?
lorazepam!! (benzodiazepine)
patient misused adhd stimulants
psychosis, mood changes/ anxiety. when you suspect acute intermittent porphyria as the cause, what other symptoms would you expect?
abdominal pain acute onset
sensory and motor neuropathies
how would you manage a child that has a specific phobia about when it rains and thunderstorms?
read stories that depict storms to the patient - exposure therapy (a type of CBT) is first line
hallucinations can occur in both parkinsons disease and dementia w lewy bodies. in PD, typically minor hallucinations (eg presence/passage) but can be major if on dopaminergic therapy.
thus how do you distinguish both conditions?
in PD, dementia is late onset >1 year after symptoms
in DWLB <1 year
delirum tremens does not present until 48 hours after the last drink and is marked by htn, hyperthermia and tachychardia.
so if alcoholic has hallucinations that resolve by 48 hours, what is the most likely diagnosis?
alcoholic hallucinosis
psychotic symptoms, paranoid delusions(plotting your murder), hallucinations including tactile hallucinations, multiple sores on body due to skin picking!!!!!, tooth decay, decreased need for sleep.
all point to what diagnosis?
methamphetamine use disorder
management of acute agitation?
benzodiazepine
or antisphycotic eg haloperidol
depression, worsened junk food cravings (binge eating symptom) and hypokalemia and hypochloremia on bloods. which antidepressant is contraindicated?
buproprion -> signs of eating disorder including electrolytes hintig to vomiting
buproprion contraindicated in patients with bulimia, anorexia and epilepsy as it lowers siezure threshold!
what to say to someone with a motivation of 2/5 to stop drinking?
what makes your rating a 2 rather than a 0
evoke their reasons for change
