Psychiatric diagnosis and management Flashcards
What are some common psychiatric emergencies?
Alcohol withdrawal
Acute Anxiety
Depression
Grief and bereavement
Hallucinations
High fever
Insomnia
Lithium toxicity
Why fasting blood glucose or A1C is an important lab to order for patients with psychiatric conditions?
Patients prescribed 2nd generation antipsychotics such as olanzepine (Zyprexa) and quetiapine (Seroquel) may be at greater risk for development of DM
What is PHQ-9 and have many questions are in this questionnaire? Specifically what is question 9 about?
Patient health questionnaire with 9 questions to screen, diagnose and measure severity of depression.
Question 9 is about thoughts that you would be better off dead or of hurting yourself in some way
If your patient’s scores of PHQ-9 are 0-4 , what level of depression is this pt in and what your interventions?
None-minimal, and no interventions are needed
If your patient’s score between 5-9 what level of depression is this pt in and your interventions as provider?
This pt has mild level of depression and as provider we need watchful waiting and we will repeat PHQ-9 at follow up
Your patient completed PHQ-9 and his scores fall between 10-14…. what level of depression and what are your interventions?
Moderate, think of treatment plan, consider counseling, follow-up and/or pharmacotherapy
You patient’s scores are between 15-19…. what level and what interventions?
Moderately severe, active treatment with pharmacotherapy and/or psychotherapy
Your patient scores 20-27 what level and what interventions?
Severe. Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management
What three areas does serotonin affect?
Mood
hunger
sleep
SIGECAPS is a mneumonic for diagnostic criteria for Major Depressive Disorder…. what does this abbreviation stand for?
S—-sleep changes , trouble falling asleep or staying asleep or sleeping too much
I—- little interest or pleasure in doing things
G—–guilt, feeling bad about yourself, or that you are a failure or have let yourself or family down
E—- little energy, feeling tired or having little energy
C—-decreased concentration, trouble concentrating on things, such as reading the newspaper or watching television
A— appetite changes, poor appetite or overeating
P—–psychomotor changes,, moving or speaking so slowly that other people could have noticed or the opposite being so fidgety
S— suicidal ideation
In SIGE CAPS what G and P stand for?
G—- guilt
P– psychomotor changes
In SIGE CAPS what S and E stands for?
E— decreased energy
S at the beginning for sleep changes
S at the end for suicidal ideation
Which SSRI has a high risk for QTC prolongation?
A. Citalopram (celexa)
B. Escitalopram (Lexapro)
A. Citalopram (celexa) (rememeber by QTC has C and celexa citalopram has C)
So you can switch pt to escitalopram (Lexapro)
What is the difference between Bipolar I and bipolar II disorder?
Bipolar II disorder differs in that patients experience no mania but have at least one episode of hypomania and major depression
Characteristics of Bipolar I disorder include manic episodes
What is the difference between hypomanic and manic episode?
Hypomanic episode does not cause markedly impaired social functioning, markedly impaired functioning at work
