Psych Review Notes 3

Question 1

What is the MC method of suicide for both sexes?

-2nd most common for men, women?

Answer 1

Firearms

Men-hanging, Women-drug OD

Question 2

What country has highest suicide rate?

Answer 2

Lithuania. Japan is #2.

Question 3

What are 10 risk factors for suicide?

Answer 3

1. Males
2. > 65 y/o or adolescents
3. Whites
4. Prior Attempt (repeat is usually w/in 2 yrs)
5. Divorced
6. Family hx
7. Hx of childhood abuse
8. Mental illness (50% of suicides d/t MDD, also think bipolar, then schizo)
9. Substance Abuse
10. Co-Morbid medical conditions

Question 4

What are 3 protective factors for suicide?

Answer 4

1. Social support
2. Religious inclination
3. Parents w/ children

Question 5

Which sex completes more suicides? Which sex attempts more?

Answer 5

Completes 3x more=men

Attempt 4x more=women

Question 6

Of the anxiety disorders, which one carries the highest risk of suicide

Answer 6

Panic Disorder

Question 7

Of the personality disorders, which one carries the highest risk of suicide?

Answer 7

Borderline PD

Question 8

What is the SAD PERSONS scale for assessing risk of suicide?

Answer 8

S=sex (1 if male)
A=age (1 if <19 or >65)
D=depression (1 if yes)

P=previous attempt (1 if yes)
E=EtOH (1 if yes)
R=rational thinking (1 if psychotic)
S=social support (1 if lacking)
O=organized plan (1 for plan)
N=No spouse (1 if divorced, widowed, separated)
S=sickness (1 if cancer, epilepsy, MS, GI illnesses)

*OVER 5 strongly consider hospitalization

Question 9

What is the DSM Criteria for a Manic Episode?

Answer 9

Abnormally and persistently Elevated, Expansive or irritable mood, lasting at least 1 week and including 3/7 DIGFAST sxx (or 4/7 if irritable mood):
D-Distractibility
I-Insomnia (a decreased need for sleep)
G-Grandiosity (or inflated self-esteem)
F-Flight of Ideas (or racing thoughts)
A-Activity/agitation
S-Speech is pressured (uninterruptible, rapid talking)
T-Thoughtlessness (risky behavior-sexual, financial…)

Note: 75% of manic patients have psychotic sxs
*A manic episode is a psychiatric emergency that may warrant admission

Question 10

How is hypomania different from mania?

Answer 10

Hypomania—no marked impairment in functioning, does not require hospitalization, no psychotic features.
Use same criterion as above with 4 days of symptoms.
-hypomania goes with BPAD II
-any manic episode (see above, lasts at least 7d is BPAD I)
-any psychotic features=BPAD I or need hospitalization=BPAD I

Question 11

What are some medical reasons for a manic episode?

Answer 11

Metabolic (hyperthyroid), Neurologic (seizures), Tumor, HIV, Syphilis, Steroid Use (Prednisone!), or TCA antidepressants
Methamphetamines and cocaine can cause manic symptoms

Question 12

Do more women or men get bipolar and how old are they?
Marital status?
Depression or Mania first?

Answer 12

Women=Men, onset from childhood-50 years, average age=19y
More common in singles and divorced people
Most common presentation of BPAD is depressive episode
-note presentation data is different
-in BPAD I, men usually present w/initial episode of mania

Question 13

What labs should be ordered in w/u of Bipolar pt?

Answer 13

CMP and CBC, LFT’s, Urine Drug, TSH, B12, RPR, HIV

Question 14

What is the criteria for cyclothymic disorder?

Answer 14

2 years of symptoms with periods of hypomanic symptoms, depressive symptoms with no more than 2 months of time symptom-free.
-pts may not have MDD, manic or mixed episodes

Question 15

What is a non-pharmacologic treatment for BPAD?

Answer 15

ECT (electroconvulsive therapy)

Question 16

What is the procedure for ECT?

Answer 16

Early morning after 8-12 h fast, pts get atropine or another anticholinergic as well as anesthetics before procedure. Stimulus electrodes are placed bitemporally, pts get brief pulse stimuli.

Question 17

What are the side effects during the ECT procedure?

Answer 17

Increased Intracranial Pressure
Bradycardia which advances to Tachycardia (can be arrhythmogenic)
-absolute CI is increased ICP
-relative CI are=recent MI, large aneurysms, tumors
s/e after=memory loss, HA, confusion

Question 18

Which of the dementias is the most common?

Answer 18

Alzheimer’s

Question 19

Which dementia has a stepwise history of progression and a hx of CVD?

Answer 19

Vascular

Question 20

Which dementia is associated with visual hallucinations and responds
Poorly to levodopa and may worsen with antipsychotics?

Answer 20

Lewy Body

Question 21

Which dementia is associated with younger patients (usually under 75y)
Who have a major personality change with prominent early behavior changes?

Answer 21

Frontotemporal

Question 22

Describe the natural history of Alzheimer’s disease.

Answer 22

More common in women, Age most key risk factor
Slow progressive loss of cognitive function
Early onset is <65 years
Lots of memory problems, later loss of ADL’s
Attention is okay, they will guess for you

Question 23

Describe the natural history of Vascular dementia.

Answer 23

2nd MC after Alzheimer’s, onset may be sudden though
Pts have difficulty w/in 3 months of CVA
Pts have HTN, HL, DM as risk factors
Hx of triggering CV event, stepwise progression
Early difficulty with gait, may have +neuro deficits on exam, neuroimaging w/ infarcts or white matter lesions

Question 24

Describe natural history of Lewy Body dementia.

Answer 24

More parkinsonian type symptoms
Visual hallucinations
Difficulty with attention, cannot cooperate
Neuroleptics may cause mortality, high rate of EPS s/fx
*note PD pts have tremor & motor sx first, not cognitive

Question 25

Describe natural history of frontotemporal dementia.

Answer 25

Pts generally are <65 years (younger)
Pts have behavioral issues (lying, stealing, telling dirty jokes, poor hygiene)
Pts no localized neurologic issue
Memory is generally OK in early course