Psychiatry Flashcards
“<span>List 7 physical exam findings consistent with a diagnosis of anorexia nervosa/ bulimia?</span>”
“Hypotension<br></br>Orthostatic hypotension<br></br>Bradycardia<br></br>Hypothermia<br></br>Clinical signs of dehydration<br></br>Dry skin<br></br>Thin hair<br></br>Hair loss<br></br>Lanugo hair<br></br>Calloused dorsum of hand (Russell’s sign)<br></br>Dental erosions<br></br>Parotid gland enlargement<br></br>Peripheral edema<br></br>Short stature<br></br>Cachexia<br></br>BMI <17.5 or <85% of the expected weight in children”
“<span>What are 3 life-threatening complications of anorexia?</span>”
Cardiac arrhythmias<br></br>Cardiomyopathies/ CHF<br></br>Electrolyte abnormalities (hyponatremia, hypokalemia, hypochloremia)<br></br>Renal failure/ Rhabdomyolysis<br></br>Hepatic failure<br></br>GI Bleeding/ Hemolysis<br></br>Suicide
“<span>What are 3 other features of anorexia (not listed in Question 3) that are indications for admission?</span>”
Weight <75% of healthy weight<br></br>Abnormal vital signs<br></br>ECG changes: Prolonged QTc, AV block, ST depression, T wave inversion<br></br>Persistent decline in oral intake or weight despite maximal outpatient treatment<br></br>Comorbid psychiatric illness<br></br>Request for voluntary admission
“<span>What are 3 general management goals in patients admitted for anorexia nervosa?</span>”
Rehydration<br></br>Correct electrolyte abnormalities<br></br>Gradual refeeding<br></br>Cognitive behavioural therapy<br></br>Address any co-morbid depression, anxiety, suicidality
<div>Agitated Patient DDx:</div>
“<div><b><u><span>Organic:</span><span></span></u></b></div> <div><b>Intoxication/Substance abuse</b></div> <div>o Esp. etoh, sympathomimetics, hallucinogens, marijuana</div> <div>o Drug/etoh withdrawal</div><div><br></br></div> <div><b>Endocrinopathies</b></div> <div>o Thyroid disease</div><div><br></br></div> <div><b>Metabolic derangements</b></div> <div>o Hypo or hyperglycemia, electrolyte abnormalities, uremia, hepatic failure, hypoxia</div><div><br></br></div> <div><b>Infectious</b></div> <div>o Sepsis, delirium, encephalitis</div><div><br></br></div> <div><b>Autoimmune</b></div> <div>o SLE, anti-NMDA receptor encephalitis </div><div><br></br></div> <div><b>Chromosomal (peds)</b></div> <div>o PKU, Fragile X</div><div><br></br></div> <div><b>Neurologic</b></div> <div>o ICH, epilepsy, malignancy </div> <div></div> <div><b><u><span>Psychiatric</span></u></b>:</div> <div>· Schizophrenic</div> <div>· Manic</div> <div>· Delusional/ paranoid thinking</div> <div>· Depression</div> <div>· Personality disorders</div>”
<p>List 4 findings on Hx/PE consistent with an <em>organic </em>etiology of agitation</p>
<ul> <li>Abnormal vital signs</li> <li>Signs of head trauma</li> <li>Focal neurologic weakness/ deficits</li> <li>Specific toxidrome: anticholinergic, sympathomimetic</li> <li>Altered level of consciousness</li> <li>Disorientation</li> <li>Sudden onset of symptoms</li> <li>Visual hallucinations</li> <li>New symptoms after age 40</li> <li>New medications</li> </ul>
<ul> <li>You want to keep the patient and your team safe while caring for this patient</li> <li>What are two potential strategies you could employ in this case?</li> </ul>
<p>–Non-pharmacologic (verbal de-escalation)</p>
<p>–Pharmacologic (PO vs IM)</p>
What is Delirium?
Impaired orientation<div>ALOC</div><div>Inattention</div><div>Sensory misperception</div>
What is dementia?
Impaired cognitive functioning over chronic time course of months or years
When can a patient be admitted against will for medical (not psychiatric) reasons?
Lack of capacity to make decisions about their medical care<div>Requires SDM consent (with capacity)</div>
<p>What are some subtle, atypical, or hidden presentations of suicidality?</p>
<p>–“Accidental” medication errors</p>
<p>–Self-neglect (incl reduced intake, self-care)</p>
<p>–Unexplained accidents or injuries</p>
<p>If a patient was assessed to have low suicide risk, what components of a discharge plan should be included?</p>
<p>–Safe location and time for discharge</p>
<ul> <li>ie. not intoxicated, not overnight, responsible person to observe patient, etc</li> </ul>
<p>–Specific plan for subsequent follow up</p>
<ul> <li>Counselling, GP follow up, psychiatrist referral.</li> </ul>
<p>–Initial pharmacologic management, when appropriate, with patient education</p>
<p>–Contingency plans if acute crisis arises</p>
<ul> <li>Crisis line, mobile crisis unit</li> </ul>
<p>Return to ED advice</p>
Agitated/agressive child ddx:
Conduct disorder<div>ODD</div><div>Developmental delay</div><div>Autism spectrum</div><div>ADHD</div>
Schizotypal personality disorder
social and relationship discomforts,<div>decrease in close relationships, and</div><div>magical thinking (eccentric)</div>
Features of sexual trafficking
<ul> <li>Females of reproductive age</li> <li>Have tattoo that is unwilling to discuss</li> <li>travelling with an older companion who insists on answering questions or Being present at all times</li> <li>Recurrent drug use</li> <li>Extensive knowledge of sexual practice</li> </ul>
Which is a finding most concerning for risk of suicide?
Anhedonia (feeling of hopelessness)
Personality disorders:
“<div class=""> <div class=""> <div class=""> <div><span><strong>A. Antisocial personality disorder</strong></span></div> </div> <div class=""> <div class=""> <div class=""> <div class=""> <p>Antisocial personality disorder is characterized by pervasive disregard for the rights of others and failure to conform to social/legal norms, often highlighted by a history of crime/legal problems/aggressive behavior.</p> </div> </div> </div> </div> <div class=""><span><strong>B. Borderline personality disorder</strong></span></div> </div> </div> <div class=""> <div class=""> <div class=""> <div class=""> <div class=""> <div class=""> <p>This patient likely has borderline personality disorder, characterized by unstable relationships, self image issues, labile affect, poor impulse control, and polarizing interactions with others.</p> </div> </div> </div> </div> </div> </div> <div class=""> <div><span><strong>C. Histrionic personality disorder</strong></span></div> <div class=""> <div class=""> <div class=""> <div class=""> <div class=""> <p>Histrionic personality disorder is characterized by a pattern of excessive emotions and attention-seeking behavior, characterized by inappropriately seductive behavior and excessive need for approval (e.g. dramatic, flirtatious, overly enthusiastic).</p> </div> </div> </div> </div> </div> </div> <div class=""> <div><span><strong>D. Narcissistic personality disorder</strong></span></div> <div class=""> <div class=""> <div class=""> <div class=""> <div class=""> <p>Narcissistic personality disorder is characterized by an excessive preoccupation with personal adequacy, power, prestige and vanity.</p> </div> </div> </div> </div> </div> </div>”
Malingering is most strongly linked with which personality disorder?
Antisocial
Features of cocaine withdrawal:
Severe depression<div>Suicidal ideation</div><div>Increase REM sleep</div><div>Increase risk of myocardial ischemia within 1st week</div>
SAD PERSONS
Sex: male<div>Age: Elderly</div><div>Depression</div><div>Previous attempt</div><div>Etoh</div><div>Rational thinking loss</div><div>Social support lacking</div><div>Organized plan</div><div>No spouse</div><div>Sickness</div>
“<span>What are 5 high risk populations for completed suicide?</span>”
-Elderly<br></br>-Male<br></br>-Post-partum<br></br>-Substance abuse<br></br>-Schizophrenia/underlying mental health disorder<br></br>-Aboriginal/Northern populations<br></br>-LGBTQ
