Psychiatry Flashcards
First psychiatric examination
Most important aspects:
chief complaints/symptoms,
their course over time,
immediately dangerous behavior?
What does involuntary commitment mean in psychiatry?
If the patient displays signs of immediately dangerous behavior; that is, due to their mental health condition, the patient poses immediate and direct danger to harm the health, well-being, social or financial situation of themselves or others
Who has the right to refer a patient to a psychiatric ward? What should be contained in a referral?
From the referring physician. Apart from the personal and insurance data of the patient, the referral must include the chief complaints, the most relevant symptoms, the most likely diagnosis, a brief history of illness and past treatments, and a statement on the presence or absence of directly-endangering behavior.
Psychiatric Status
provides a detailed, comprehensive description of the most relevant psychological functions, behavioral responses and psychopathological symptoms organized in structured manner, that records both the pathological symptoms and the physiologic functions/behaviors.
Consciousness-related functions (Figure 2.3.1.):
the awareness of self and the environment
- consciousness alertness (vigility) és quality (integrity)
- orientation (time, space, self, others)
- attention alertness (vigility) and ability to sustain focus (tenacity)
Perceptual functions (Figure 2.3.2.):
Ability to detect and recognize stimuli:
- perception formal (quantity, quality) and content by sensory modality
Cognitive functions (Figure 2.3.3.):
Ability to process, integrate/associate, learn and forget the perceived stimuli
- thought formal/procedural (speed, structure) and thought content disorder
- concept formation abstract thinking
- memory: encode, store, retrieve
- intellect: global cognitive ability
Emotional (affective) functions (Figure 2.3.4.):
An archaic, non-analytic information processing, reflects a subjective involvement and disposition
mood: the long-lasting emotional tone with no specific object
- self-feeling: the emotional tone of perceiving oneself, no object
- emotional reactions: object oriented reaction reflecting one’s involvement
- impulse-control: strength of affect control
- anxiety: vegetative, subjective, behavioral signs
Volatile or response functions (Figure 2.3.5):
Ability to initiate or respond actions
- psychomotorium: planned motor activity,
- volatile functions: motivation, activity, instinct-driven behavior
- communication: verbal, non-verbal
- complex behavior: social activity, value orientation, personality functions, attitude towards the examiner
Risk factors:
Symptoms that correlate with immediately dangerous behavior or efficacy of treatment
- suicidal behavior: ideation, intention, past attempts
- violent behavior, verbal, physical hostility, previous actions
- insight of illness: adequate, partial
- critical sense/judgement: intact, diminished
- reality-testing: ability to distinguish the objective/real contents from the subjective/fantasy elements or distortion
what three things are included in a psychiatric case report?
Internal/physical examination
Neurological examination
Psychiatric examination
The most important steps of the emergency psychiatric care:
- Psychiatric, internal and neurological examination, and (if necessary) laboratory tests, imaging techniques and consultation with other professionals as well.
- Immediate treatment (reduction or elimination) of the psychiatric emergency (symptom).
- Deciding if the patient needs further care?
- Deciding if the patient’s behavior is dangerous to himself or others?
Pharmacological interventions in emergency psychiatry.
In psychiatric emergency, antipsychotics and anxiolytics (high-potential benzodiazepines) are the most frequently administered drugs.
Most common indications of antipsychotics in emergency psychiatry:
- aggression or hostility
- agitation or psychomotor retardation,
- acute psychotic symptoms (e.g. hallucination, delusion).
Most common indications of anxiolytics in emergency psychiatry:
- severe anxiety due to panic attack, psychosis or substance use),
- insomnia or hypervigilance,
- agitation or psychomotor retardation,
- agression or hostility,
- withdrawal symptoms (e.g. alcohol, benzodiazepine).
Indications of parenteral administration of medication (intramuscular or intravenous injection or infusion following the instructions of the label):
- lack of cooperation,
- dangerous behaviour,
- urgent need of action of medication (particularly iv. benzo)
The most important psychiatric disorders with psychotic features are as follows:
schizophrenia, schizoaffective disorder, bipolar disorder (depressive or manic phase) with psychotic features, severe depression with psychotic features, delusive (paranoid) disorder, drug-induced psychosis.
symptoms of schizophrenia
fragmented thinking and perception, inadequate/flattened affect; most frequent psychopathological symptoms are: disturbed perception (comment hallucinations, imperative hallucinations), (heterothymic) delusions (persecutory, inventory, erotomania, delusional jealousy, delusion of control, nihilistic delusions, somatic delusions), incoherent speech, disorganized thinking, cognitive disturbance, negative symptoms
delirium symptoms
- delirium: disturbance of consciousness which develops over a short period of time (reduced clarity of awareness of the environment), with associated changes in attention, cognition (memory loss, disorientation), perception (hallucinations); its course is fluctuating over the day; the sleep-wake cycle and emotional reactions can be involved as well
sychotic symptoms can not only develop in case of psychiatric disorders, as a general rule, their differential diagnosis should always include the consideration of (at least) the following general medical conditions:
- CNS disorders: tumours, epilepsy, meningitis, encephalitis, multiple sclerosis, autoimmune disorders (e.g.: antiNMDA-receptor encephalitis)
- Endocrine disorders: hypo- or hyperthyreosis, Addison’s disease, Cushing’s disease, hypo- or hyperparathyreoidism
- Metabolic changes: renal failure, hypo/hyperglycaemia, haemochromatosis, Wilson’s disease,
- Haematologic conditions: leukemia
- Infectious diseases: HIV, syphilis, neuroborreliosis
- Toxic effects: drugs, medications (dopamin antiparkinson-agents, steroids)
5 effects of benzodiazepines
anxiolytic
sedative
antiepileptic
amnestic
muscle relaxant
drugs NOT indicated of anxiety
barbiturates
antihistamines
antiepileptic drugs
antipsychotics
what to combine antidepressants with in the beginning and why?
BZ because it decreases side effects especially suicide
