Psychiatry Flashcards
What are Signs?
Objective findings elicited by clinician.
What are symptoms?
Subjective experiences reported by the patient.
What is described as a combination of signs and symptoms?
Syndrome
What is the major psychotic disorder?
Schizophrenia
What are examples of mood disorders?
Depression and Bipolar Disorder
What is Affect?
It is an observed expression of emotion
Fill in the blanks. “ In a warm affect , expressed emotion is _____ while in a ______ expressed emotion is reduced.
Warm affect - expressed emotion is appropriate
Blunted affect - expressed emotion is reduced.
A normal mood can be described as?
Euthymic
An elated mood can be described as ?
Mania
What is perception?
This is a process by which sensory stimuli brought to awareness.
What are examples of disorders of perception?
Hallucination
Illusion
What is the most common form of Hallucination in Schizophrenia?
Auditory ( hearing voices)
True or False? A hypnogogic hallucination occurs when one is awakening while a hypnopompic hallucination occurs while sleeping.
FALSE!!! Hypnogogic - sleeping
‘ I go to sleep’
Hypnopompic - awake
‘I wake up PrOMPtly ‘
What is an illusion?
Misperception of stimulus
What are subdivisions of disorders of thought?
Thought form
Thought content- Delusions
What are examples of disorders of thought form?
*Neologism- new words
*Word salad: Incoherent mixture of words
*Loosening of association: Ideas shift from one subject to another
What is Delusion?
Fixed, False Belief, inappropriate to socio-cultural background.
ex: Rojay lol
A belief that you one has more power, wealth, smarts, or other grand traits than is true is an example of what delusion.
Delusion of Grandeur
A belief that a partner is being unfaithful to another is a example of what delusion?
Delusion of Jealousy
Fill in the blanks.” ______ is the belief that un-related occurrences in the external world have a special significance for the person who is being diagnosed.”
A delusion of reference
True or False? A Somatic delusion, occurs when the individual believes something is wrong with part or all of their body.
TRUE!!
What are examples of psychotic disorders?
Halllucinations
Delusions
Disorder in Thought form
Fill in the Blanks . In depression , your mood is _____ while in _____ your mood is elevated.”
Depression - mood is depressed
Bipolar disorder - mood is elated
In order for one to be diagnosed with major depression , what is the criteria?
Patient must present with 5 symptoms in 2 weeks
What are the symptoms of Major Depression?
S- Sleep—insomnia or hypersomnia
I- Interest—loss of interest in pleasurable activities (anhedonia)
G- Guilt—feelings of guilt or worthlessness
E- Energy—fatigue or loss of energy
C- Concentration—diminished ability to concentrate or focus
A- Appetite—increase or decrease in appetite or weight
P - Psychomotor retardation or agitation
S- Suicidality or thoughts of self-harm (active or passive)
“sig e caps”
What is Patient depressive disorder( Dysthmia)?
Dysthymia can be thought of as a milder form of depression that is more chronic (lasting at least 2 years, or 1 year in children and adolescents).
What are examples of Anxiety Disorders?
P- Phobias
P- Panic disorder
P- PTSD
O- OCD
G- Generalised Anxiety Disorder
In OCD ( Obsessive - Compulsive disorders) , What are Obsessions and what are compulsions?
Obsessions -recurrent thoughts that cause distress to the patient.
Compulsions- Compulsions are compensatory actions that the patient does to relieve the anxiety caused by the obsessions
What are symptoms experienced by PTSD patients?
*Trauma Exposure: (disaster, MVA, rape etc) Witness it, Experience it, Told about it
* Re-experience trauma- (recollections, flashbacks, nightmares, bad dreams)
* Avoidance (thoughts, people, places, things)
* Memory activated
* Arousal increased: (Hypervigilance,emotional outburst, sleep disturbances, exaggerated startle response)
What is the time period to be diagnosed with PTSD?
Patients must have symptoms for at least one month .
*If shorter they are diagnosed with Acute Stress Disorder (ASD)
Delirium, Demtentia and Amnestic Disorders are examples of what kind of disorders?
Neuroognitive disorders
What is Delirium?
This is a disorder which causes changes in consciousness ,changes in cognition ( memory, orientation, language) perceptual disturbance,acute onset, fluctuating course
True or False? Dementia is Irreversible while Delirium is reversible.
TRUE!!
What are characteristics of Dementia?
M - Memory impairment
A- Aphasia (language disturbance)
A-Apraxia (inability to carry out motor activity despite intact motor function)
A- Agnosia (failure to recognize objects despite intact sensory function)
E- Executive function impaired (SOAP)
” Dementia patients MAAAE have these symptoms’
True or False? They psychiatric history is best performed with multiple informants and must be approached with a high level of sensitivity.
TRUE!!
What does demographics of the psychiatric patient include?
Patient’s name
Age
Address
Marital status
Religion
Occupation
Circumstances of referral
When listening to the presenting complaint, who is information taken from?
The patient and informant
What does the History of the Presenting complaint include?
*Duration, Frequency, Intensity
*Precipitating and relieving factors
*Review of symptoms of likely diagnoses (as suggested by PC): psychosis, depression, anxiety, etc
True or False? When taking the family history of the psychiatric patient, the occupations/achievements of siblings as compared to those of patient.
TRUE!!
What are different aspects of the Personal History of the psychiatric patient?
Antenatal and perinatal history
Developmental history
Childhood illness, separation
School history: academics, social, behavioural
Occupational history: achievement, stability
Trauma history
Forensic history
What are different aspects of the Past medical/surgical History of the psychiatric patient?
Relationship to current illness
Head trauma /head injury
Seizures
Recent infections/sexual
Endocrine illnesses
Chronic illnesses/ meds for chronic illnesses
Vitamin deficiencies
What is the Mental Status Examination?
The MSE examines mental and emotional functioning, it is a combination of Observation (Inspection) and Interview.
What are factors that can affect the patient’s MSE?
*Cultural background
*Educational level
*Religious beliefs
*Type and severity of mental illness, e.g. he/ she may be too psychotic, depressed, angry, drowsy, … to fully participate
What are the different components of the MSE?
I - Insight ( level at which patient realises smn wrong)
M- Mood ( depressed,elated, angry)
P- Perception(hallucination, illusions)
A- Appearance( grooming,appropriateness)
A- Attitude ( retardation, mannerism, eye contact)
A- Affect (blunted ,labile, sus)
C- Cognition ( orientation, memory, general knowledge)
T- Thought form( tangentiality, loose association)
T- Thought content( delusional, suicidal,obsessions)
S- Speech ( rate, rhythm ,pitch)
Judicious- Judgment
” Impaaactts of the MSE should be judicious”
What would be the appearance of a Manic patient versus a psychotic patient?
Manic- bright colours, heavy makeup
Psychotic- poor grooming
What is Tangentality?
One idea leads to another to which there is some connection, but the patient never concludes his/ her original point.
What is Circumstantiality?
The patient considers many related (but unnecessary) ideas before returning to the main point.
What is Loose of association?
No connection between words/ sentences/ phrases.
What are some Organic causes of Psychiatric symptoms?
Thyroid disease- Depression
Auto immune (SLE)- psychosis, mood disorder
VitaminB12 deficiency- Dementia & delirium
STDs- anxiety , anger
How long does a patient have to experience specific symptoms in order for them to be diagnosed with Schizophrenia?
More than 6 months
How long does a patient have to experience specific symptoms in order for them to be diagnosed with Generalised anxiety disorder ( GAD)?
At least 6 months
How is the approach to managing the psychiatric patient described as?
Holistic Approach
What is the main approach model used in management of the psychiatric patient?
Biopsychosocial approach
What does the psychological treatment of the psychiatric patient entail?
Supportive therapies
Psychotherapies
Psychoanalysis
What does the social treatment of the psychiatric patient entail?
Community Care
Rehabilitation
What is the purpose of Antipsychotics ?
These drugs are noted to reduce delusions , hallucinations and to have a sedating/calming effect.
What are the two types of antipsychotics?
Typical and Atypical
What are examples of Typical Antipsychotics?
Please -Phenothiazines (Chlorpromazine)
Buy - Butyrophenones (Haloperidol)
Some -Substituted benzamides (Amilsulpride)
Typical- Thioxanthines (Clopixol)
Drugs- Diphenylbutylpiperidines (Pimozide)
What are examples of Atypical Antipsychotics?
Can - Clozapine(Clozaril)
Queen- Quetiapine (Seroquel)
Zendaya- Zisprasidone (Geodon)
Order- Olanzapine (Zyprexa)
Atypical -Aripripazole (Abilify)
Rx- Risperidone (Risperdol)
What is the action of mechanisms for Typical antipsychotics?
They may block serotonin, dopamine, adrenergic, histaminergic and cholinergic receptors ( increase cAMP).
True or False? Atypical antipsychotics block serotonin receptors while some block dopamine receptors ONLY in the limbic system.
TRUE!!!
What are examples of Antidepressant drugs?
*Selective Serotonin Reuptake inhibitor( SSRI)
*Selective Serotonin and Noradrenaline reuptake inhibitor (SNRI)
*Atypical Antidepressants
*St.John’s Worts( Hypericum)
*Tricyclics
*Monoamine Oxidase Inhibitors
*New reversible MAOI eg: moclobemide
*Noradrenaline selective reuptake inhibitor (NaSSA ) ex reboxetine
What are examples of Selective Serotonin Reuptake Inhibitors?
Fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram, citalopram.
What is the mechanism of action for SSRI’s?
They block the reuptake of Serotonin
What are examples of Selectively Serotonin - Norepinephrine Reuptake Inhibitors?
Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran, milnacipran.
What is the mechanism of action for SNRI?
They inhibit reuptake of Serotonin and NE
What are examples of Tricyclics ( TCA)?
Amitriptyline, nortriptyline, imipramine, desipramine, domipramine, doxepin, amoxapine.
What is the mechanism of action for TCA’s?
They block reuptake of norepinephrine and serotonin into the presynaptic neuron
What are examples of MAO’s?
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor).
(MAO Takes Pride In Shanghai).
What is the mechanism of action of MAO’s
They inhibit monoamine oxidase thus causing an increase in the levels of serotonin, dopamine and NE
What are examples of Atypical antidepressants?
Trazadone, Nefazadone & Bupropion
What is the mode of administration for antidepressants?
Orally
What type of drugs are used in the treatment of of bipolar disorder and aggression?
Mood stabilisers
What is the most common mood stabilizer?
Lithium
What is the mechanism of action for mood stabilisers?
They involve the sodium and potassium and GABA inhibitory systems.
What is the most important class of Tranquillisers?
Benzodiazepines, eg:alprazolam
What makes up the team within community care for a psychiatric patient?
Psychiatric nurse, Psychiatric aides, Psyhciatrist
What are examples of Anxiety disorders?
Panic Disorder
Phobias
Generalised Anxiety disorder
OCD
PTSD
What is Agoraphobia?
Fear of being in an open or overcrowded space/ leaving one’s home
What are the characteristics of delirium?
A-Acute – onset
F- Fluctuation – course
A- Attention – decreased concentration
C- Consciousness – decreased level
T- Thoughts - disorganized
“It is A FACT that you’re delirious”
What are neurocognitive disorders?
Delirium
Dementia
True or False? Dementia is classified to it’s aetiology.
TRUE!!
What type of Dementia can be associated with diabetes mellitus , hypertension and cerebrovascular accidents (CVA)?
Vascular Type
What are the etiologic factors of Alzheimer’s Disease?
Amyloid plagues & tau proteins in the brain
What type of Dementia has spontaneous features of Parkinson’s disease?
Lewy- Body dementia
True or False? HIV infection is associated with Dementia.
TRUE!!
Bovine Spongiform Encephalopathy (BSE) aka mad cow disease is a form of what disease that causes dementia?
Prion disease
What is the name of the brain disorder due to thiamine deficiency which causes neurocognitive disorders contributing to dementia?
Wernicke-Korsakoff Encephalopathy
What are symptoms of Dementia?
Memory Impairment (short -term first)
Aphasic speech - ( Language disturbances)
Apraxia - inability to carry out motor activity despite intact motor function.
Agnosia- Failure to recognise objects despite intact sensory function.
Impairment in executive Functioning ( Sequencing, organising, abstracting and planning)
What is a major neurocognitive disorder?
Amnestic disorder
True or False? Valporic Acid is a mood stabiliser
TRUE
