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AMC Pediatrics > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Screening Qs for major Depression?

A

@MSIGE CAPS ( 5 of these including mood & anhedonia)

M- mood

S- sleep

I - interest

G- guilt

E- energy

C- concentration

A- appetite

P- psychomotor

S- suicide

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2
Q

Diagnosis criteria for BAD?

A

Should be more than 3 criteria such as:

  • Grandiosity
  • Lack of sleep
  • Excessive talking
  • Flight of ideas
  • Distractibility
  • Increased level of pleasurable activity ( sexuality/ goal-oriented activity)

Screening Qs: Have you ever had an episode in which you feel extremely happy and energetic?

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3
Q

DDx for patient coming with acute mania?

A
  • BAD
  • Schizophrenia
  • Schizoaffective disorder
  • Drug-induced psychiatric illness
  • Delusional disorder
  • Personality disorder
  • OCD
  • Organic disorder
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3
Q

How do you explain mania?

A

you have more energy, need less sleep, engage in risky activities such spending a lot of money, and exploring sexual activity.

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4
Q

What are the questions you need to ask in Grief cases?

A
  • Do you have intense yearning or longing for your mother?
  • Are you always preoccupied with thoughts & memories of your mother?
  • Are you avoiding reminders of your mother?
  • How is this affecting your life? Do you feel that life is worthless without her?
  • Are you feeling lonely, numb?
  • Are you finding it difficult to carry on with your life after your mothers death?
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5
Q

DDx for major depression with psychotic symptoms?

A
  • Schizoaffective disorders
  • Bipolar disorder
  • Unipolar major depression
  • Schizophrenia
  • Drug induced psychotic disorder
  • PTSD
  • Adjustment disorder
  • Organic cause
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6
Q

DDx for patient coming with grief after a loved one passing?

A
  • Grief disorder / prolonged grief disorder
  • Major depression
  • PTSD( bereavement related PTSD)
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7
Q

How do you explain adjustment disorder?

A

It is an emotional and behavioral response/reaction to a stressful events .

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8
Q

19 year old girl/boy who has been referred to you by the dentist due to concerns regarding her dental caries. She has a history of binge eating and induces vomiting after eating. DDx?

A
  • Binge eating disorder
  • Obsessive compulsive disorder
  • Body dysmorphic disorder
  • Major depression
  • Schizophrenia
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9
Q

DSM 5 Qs for Mania?

A

DIGFAST:

Distractibility: Easily distracted.
Irresponsibility: Impulsive and reckless behavior.
Grandiosity: Exaggerated self-esteem or belief in abilities.
Flight of ideas: Rapid, disjointed thoughts.
Activity increase: Increased activity or agitation.
Sleep deficit: Decreased need for sleep.
Talkativeness: Rapid speech and verbosity.

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10
Q

Screening Qs for dependence personality disorder?

A

DECIDEAR

D - Dependence: Excessive need for others to take care of them.

E - Excessive Fear: Fear of being left alone or abandoned.

C - Can’t Decide: Difficulty making decisions on their own.

I - Insecurity: Low self-esteem and constant need for validation.

D - Deference: Submissive and compliant in relationships.

E - Avoid Responsibility: Avoids responsibility and prefers subordinate roles.

A - Abuse Tolerance: Tolerates mistreatment to avoid being alone.

R - Reliance on One: Overly dependent on one specific person.

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11
Q

What’s Dysthymia?

A
  • It’s persistent depressive disorder: > 2 yrs
  • Symptoms same as MDD
  • No episodes of mania during the period
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12
Q

State PTSD DDx?

A
  • Acute stress disorder (<1 month )
  • Adjustment disorder
  • Panic disorder
  • GAD
  • MDD
  • Concussion syndrome
  • Schizophrenia
  • OCD
  • Drug intake
  • Thyroid
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13
Q

DSM criteria for PTSD?

A

📌DSM-5 Criteria: Need 4

BAD STRESS:

  • Bad memories: Repeated, distressing memories of the trauma.
  • Avoidance: Avoiding reminders of the trauma.
  • Disturbed mood: Negative changes in mood or beliefs.
  • Stress reactions: Easily startled, on edge, or irritable. Anger outbursts
  • Trauma reminder: Physical or emotional reactions to trauma reminders.
  • Re-experiencing: Flashbacks, nightmares, or intrusive thoughts.
  • Emotional numbness: Feeling detached or unable to feel
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14
Q

Qs that you ask to R/O PTSD?

A
  • Have you ever had any traumatic events or experiences?
  • Re-living:
    • Have you had nightmares?
    • Have you had flashbacks?/ Have you ever had flashbacks that you are reliving the events?
  • Have you been avoiding places activities or people or talking about it?
  • Do you feel that you are unable to remember some important aspects of the events ?/ Have you forgotten some information of the event?
  • Anhedonia/moods
  • Have you had an anger outburst?
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15
Q

How do you explain OCD to a patient?

A

OCD is a condition that you have unwanted / repetitive / intrusive thoughts which leads to repetitive behaviors or activities in response to the thoughts. Not following up with these thoughts result in extreme stress & anxiety.

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16
Q

What’s CBT in OCD?

A
  • CBT - Exposure & Response Prevention
    • The exposure component of ERP refers to practicing confronting the thoughts, images , objects , and situation that make you anxious or provoke your obsessions . The response prevention part of ERP refers to making choice not to do a compulsive behavior
    • ERP encourages you to confront what makes you anxious and prevent yourself from doing the things that temporarily make the anxiety go away. Over time, this can help reduce the intensity of your anxiety and break the cycle of obsessive thoughts and compulsive behaviors.
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17
Q

DDx for OCD?

A
  • GAD
  • Specific phobias
  • PTSD
  • MDD
  • Schizophrenia
  • Substance abuse disorder
  • Thyroid problem
18
Q

What’s the difference between panic attack & Panic disorder?

A

Panic attack: somatic sym + fear of dying
Disorder: Multiple episodes + change lifestyle to avoid it

19
Q

How do you explain panic attack?

A
  • You have a condition called Panic disorder and agoraphobia
    • Panic attack - sudden onset of somatic symptoms such as chest pain, palpitations, SOB, Dizziness & especially anxiety & intense fear of dying, although there is no problem in the body.
    • Panic disorder -If you have a repeated panic attack and this creates some concern or worry about the other attack and you change your daily routine or behavior.
  • When the body is feared with the immediate danger it triggers the “flight or fight response” by activating some nerves and releasing some chemicals.
  • During a panic attack the fight and flight attack is triggered without an immediate reason and it causes extreme anxiety or fear of dying.
20
Q

What are the screening Qs for social phobia?

A
  • Do these symptoms happen in crowded places or situations where you have to talk to people or when you are observed?↳ Try to see whether it’s happening in multiple places
  • Have you been trying to avoid these symptoms?
  • How are these affecting your life? Social/ Occupation
21
Q

Social phobia DDx?

A
  • Panic attack
  • GAD
  • Adjustment disorder
  • PTSD
  • Schizophrenia
  • Drug induced psychosis
22
Q

How do you explain social phobia to a patient?

A

It’s a condition where you develop severe anxiety and distress as a response to social situations such as when you need to talk , meet people or when you get observed .

23
Q

How due you explain post partum psychosis to a patient?

A

You have been diagnosed with a condition called postpartum depression with psychotic features, this is a serious condition that happen to mothers after delivering their child because of all the changes that happens to your mind and body during pregnancy. The first weeks of taking care of a newborn can be overwhelming& it affect your mental health.

One aspect of this conditions is depression which called baby blues. This is when you feel low, disturbed sleep, lose appetite, start having suicidal ideation or thinking about harming your baby. The other aspect is the psychotic features, which means you loose sense of reality and start hearing things, seeing things or feeling things that other people don’t and you may start having some strange thoughts or ideas.”

24
Q

How do you explain somatic symptoms disorder to a patient?

A

I know that you have abdominal pain & I am not telling you that it’s not real. But we have done extensive Ix and couldn’t find anything abnormal.

Now, what’s really interesting about this condition is that it often happens when our emotions and stress levels are running high. Our bodies can react to these feelings, and it might make us feel physically unwell, even though nothing is seriously wrong with our bodies.

Think of it like this: when you’re feeling really stressed, sometimes your muscles might get tense, right? Well, in a similar way, your emotions can sometimes make your body feel uncomfortable in different way

The good news is that we can work together to help you feel better. We’ll explore strategies to manage stress and emotions, which can, in turn, help reduce these physical symptoms. It might involve talking to a therapist or counselor, learning relaxation techniques, or trying other methods to improve your overall well-being.

25
Q

What are short term & long term SE of Li?

A
  • Short term SE
    • Tremors, general fatigue, diarrhea, thirst, polyuria, nausea, headache, and vomiting.

Long term:
- Kidney - polyuria & IIry thirst, Diabetes insipidus, contribute to ESRF
- Thyroid - ↓ effect of thyroxine(Hypothyroidism), in turn ↑ depression risk. BUT hypothyroidism itself is not a CT for Lithium
- Parathyroid - ↑PTH function → ↑ Ca conc.

26
Q

What are the support groups in Alcohol abuse counseling? What are the drugs used in alcohol withdrawal?

A

Alcoholic anonymous
Alcohol & drug services

Medication such as
- Naltrexone
- Acamprosate
- Disulfiram

27
Q

What are the drugs given to stop Heroin addiction? What’s there effect?

A
  1. Buprenorphine/ Suboxone
  2. Methadone
    It prevents the development of withdrawal symptoms, reduce craving & ↓ euphoric effect of Heroin if relapse occurs.
28
Q

What are the support groups for Heroin?

A

Turning Point
Reach-out Australia

29
Q

What are the withdrawal symptoms patient have after stopping a substance?
(Common to all of them)

A

Occurs within 24hrs:
- Depression or otherwise feeling unwell
- Insomnia
- Restlessness & irritability
- Anxiety
- Increase in appetite
- Craving for sweet things & substance

Usually peak over the 1st 4 days & improve significantly within a months

30
Q

Medications used to help quit smoking?

A
  1. NRT
  2. Medications
    • Champix ( varenicline) -
      • This medication will help you reduce your craving & we will start it as you are smoking and then decide on a quit date.
      • SE: slight ↑ risk of suicide
      • CI: CKD
    • Bupropion (Zyban)
      • CI: eating disorders, Seizures
    • Nortriptyline
31
Q

What are the available support groups for:
- Alcohol
- Heroin
- Smoking
- MArijuana

A
  • Alcohol- Alcoholic anonymous, Alcohol & drug services
  • Heroin - Reachout Australia, Turning point
  • Smoking - Quitline
  • Marijuana - Marijuana Anonymous, Turning point, Alcohol & drug services
32
Q

What drugs that you use for withdrawal sym?
- Alcohol
- Heroin
- Smoking
- Marijuana

A

For Alcohol:
- Naltrexone
- Acamprosate
- Disulfiram

For Heroin:
- Buprenorphine/ Suboxone
- Methadone

For smoking:
- NRT
- Medications:
Champix ( varenicline)
Bupropion
Nortriptyline

For Marijuana: symptomatic Mx

33
Q

How do you explain ECT to a patient?

A

> In ECT (Electroconvulsive treatment) you will be put to sleep in general anesthesia and you will be given medicine to relax muscles. Your doctor will place two small wires/ electrodes on your head which will give you small electrical impulse and this will cause a seizure that lasts 20-60 seconds. After this, you will wake up from anesthesia and the procedure usually lasts 20-30 min“

  • It works by rebalancing the chemicals in your brain.

Used for Rx resistant diseases: BAD, MAD, Schizophrenia, Schizoaffective, sever post partum psychosis

34
Q

Difference between Gender dysphoria & Gender Incongruence?

A
  • Both identify a difference between their own experienced gender and their IIry sexual characteristics
    ↳ But only in dysphoria, it causes significant distress to the patient
35
Q

DDx for Gender Dysphoria?

A
  • Transvestic disorder - involves dressing as a sexual urge or fantasy
  • Body dysmorphic disorder - stress is aimed at about specific body part
  • Psychotic patients .
  • Borderline personality disorder
36
Q

What are the key Qs asked in Gender dysphoria?

A

📍Key questions

  1. At the onset of puberty, everyone begins developing specific sexual characteristics, such as body hair growth and voice changes (which we are normalizing). Can I ask how you felt about these changes? How did you react to them?
    ↳ ‼️Access any distress
  2. Any specific part of your body that bother you ?( to rule out body dysmorphic disorder)
  3. Have you ever thought to change these feature ?
  4. Do you feel that your emotions align more closely with those typically associated with males or females?
37
Q

What are short acting SSRI? What drug conversions gives rise to serotonin syndrome?

A

Citalopram, Esitalopram, Paroxetine & Sertaline
- Changing to Fluoxetine if OK

But changing to SNRI, TCA, MAOI needs to wait for couple of days (2-4 days)

38
Q

What are the triad of serotonin syndrome?

A
  1. Altered mental state
  2. Autonomic hyperactivity
  3. Neuromuscular abnormality
39
Q

DDx for serotonin syndrome?

A
  • Other toxidrome:
    • Anticholinergic toxicity
  • Sepsis
  • Hyperthermic syndromes
    • Neuroleptic malignant syndrome
    • Malignant hyperthermia
  • Thyrotoxicosis
  • Encephalitis, Meningitis
40
Q

What’s the antidote for Serotonin syndrome?

A

Cyproheptadine

41
Q

Causes of Delirium?

A
  • DELIRIUM
    • D- drugs (painkillers - opioids, benzodiazepines)
    • E-electrolyte imbalance
    • L- lack of drugs ( withdrawal of above medications and alcohol)
    • I- infections
    • R-reduced sensory input - Hearing or visual impairment
    • I- Intracranial - stroke , infection, tumor
    • U-urinary retention & constipation
    • M - Myocardial and Pulmonary= MI, HF, pneumonia, Hypoxia
42
Q

What are the SE of MDMA overdose?

A
  • Ecstasy:
    • CVS : ↑ HR, ↑ BP
    • Hyperthermia
    • Hyponatremia - similar to SIADH mechanism
    • CNS: Agitation, hyperactivity, anxiety & delirium
    • Hepatotoxicity: jaundice, abdominal pain, vomiting
    • Serotonin syndrome findings
43
Q

What are the SE of BDZ overdose?

A

AMC Pediatrics (4 decks)

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