Psychiatry Flashcards
Suicide Risk Screen
Mental State
* Active disease
* Hopelessness
* Psychosis
Suicide attempts
* Continuous thoughts
* Plan
* Intent
* Means
* Motivation
* Opportunity
* Note/organising personal affairs
Substance abuse
Supports
Loss
* Recent major rel breakdown
* New diagnosis of major illness
Suicide Risk Factors
Sex
Age
Ddepression
Previous attempt
Ethanol abuse
Rational thinking loss
Social supports lacking
Organised plan
No spouse
Sickness - chronic, debilitating, severe
Aggression risk tool
- Previous Hx of aggression
- Alert on chart
- Vioence or agitation last 72 hrs
- Intoxicated
- Homicidal
- Weapon use previously
*
Risk of absconding
- Police escort
- Handcuffed
- Family / Carer coercion
- PMHx of abscondingAlert
- Verbalising intent to leave
- Lack of insight into illness
- Non-compliance with meds
MSE
Appreance/Behaviour
* Clothing / Cleanliness
* Eye contact / facial expressions
* Reaction to interviewer
Mood/Affect
* As above + motivation / energy / sleep
Speech
* Rate / volume /tone
Thought process
* form, fluency, organisation
* Circumstanitality, distractible, flight of ideas, tangentiality, clanging, neologisms, blocking
Thought content
* Delusions / suicidal /homicidal / hopeless /guilty
Perception
* Hallucinations
Cognition
* Consciousness / orientation / memory / attention
Insight/judgement
Organic vs Psychiatric
Age > 40yrs
Acute onset
AbN vital signs
CNS
- Drowsy, confused
- Memory impairment, confabulation, perseveration
- Fluctuating course
- Disorganised - delusions
- Hallucinations - NOT auditory
Physcial exam - abN - incontinence, opthalmoplegia (Wernickes)
Social - social stressors or substance abuse
Psych - No previous psych history
PMHx - recent illnes, surgery
FHx - metabolic disease or hereditary neuro disorder
Ix
Bloods
Urine
CXR
CT head
Urine Drug sceen
HIV/ Syphillis screen in high risk patients
Anorexia Nervosa
Diagnosis
1. BMI < 17.5 or 15% below expected
2. Fear of gaining wt
3. Self induced wt loss
4. Control over weight gain
a. Self- induced vomiting
b. Laxative use
c. XS exercise
5. Distorted body image
6. Assocaited endocrine disorders - amenorrhoea
Presentation
Skin - dry birrtle ahir, lanugo hair, dry skin,
CVS - OH, palpitations
GI - cachexia, constipation, dental erosions/ gastritis (bulaemia)
GU - amenorrhoea
CNS - dizziness, cinfusion
MSK - cachexia, msucle wasting, diminshed DTR, knickle callsuses
Metabolic
- Hypothermia
- hypoglcaemia
- Electrolytes - low K, Na, PO4, Mg
- High lipids
- O’porosis
ECG - look for bradycardia, hypokalaemia (prolonged PR, widespread, TWI, U waves, long QT interval)
Admission criteria
Temp < 36.0
BMI < 15 kg/m2
Unable to eat independently
CVS
- Tachcardia
- BP < 90/60 adults and 80/40 for adolescents
- OH > 20mmHg drop
Metabolic
- Electrolyte disturbance K<3.0, Na <130, PO4 <0.5
- Ketotic
- Dehydration
- Refeeding syndrome
Psych
- failure of OP treatmetn
- Co-existing psychiatric disease
Psychosis
Definition
A distortion or loss of contact with reality, without any clouding of consciousness
Classifications
* Brief psychotic disorder > 1d but < 1mo - DRUGS
* Schizophreniform - 1-6mo
* Schiophrenia > 6mo (60% psychoses)
* Shizoaffective disorder
a. >2/52 psychossi sx , no mood sx
b. psychosis + mood distubrance meting crtieria for schizophrenia
* BPAD
* Delusional disorder
* Post-partum
* Organic illness
Schizophrenia
Positive symptoms
1. Delusions
2. Hallucinations
3. Disorganised speech
4. Grossly diroganised or catatonic behaviour
Negative Symptoms
1. Avolition - unable to initiate goal directed bahaviour
2. Affect blunted
3. Alogia
4. Poor self care
5. Social withdrawal
6. Reduced spech output
7. Impaired cognitive function - impaired planing, mental flexibility, memory and insight
Risk Factors - adolescence, genetics, drug abuse, schizoid premorbid personality
Prognostic - younger age of onset, gradual onset, schizoid premorbid personality, no precipitating event
Delirium Differentials
DIMES
Drug
Infection
Metabolic
Environmental
Structural (CVA/SAH)
