Psychiatry Flashcards
What is SICK FM
Symptoms of anxiety:
Sleep disturbance
Irritable
Concentration poor or mind goes blank
Keyed up or restless/on edge
Fatigued easily
Muscle tension
Contraindications for psychostimulants
Glaucoma, untreated hypertsh, mod htn, cardio dz, mania/psychosis
Early warning signs of autism at any age
Parental concerns
Developmental regression
Loss of social behahaviour and communication
Early warning signs of autism at age 6-12 months
Decreased smiles
Limited eye contact
Limited sharing of sounds
Limited facial expressions
Decreased babbling, gestures, response to name
Early warning signs of autism at age 9-12 months
Repetitve behaviours
Unusual play
Early warning signs of autism atvage 15-24 months
Diminished, atypical or no spontaneous or meaningful 2 word phrases
Diagnostic criteria for autism
Persistent deficit in social communication and social interaction across multiple contacts as manifested by the following:
- deficits in social-emotional reciprocity
- deficits and non-verbal communication
- deficit in relationships
Restricted repetitive patterns has manifested by at least two of the following:
- stereotyped repetitive motor movements
- insistence on sameeness, inflexible adherence to routine or retualised patterns
- highly restricted fixated interest
- hyper or hypo reactivity to sensory input
Bipolar 1 vs Bipolar 2
Bipolar 1: One or more manic or mixed episode. Depressive episode not required. Manic episode lasts at least one week, most of the day, most days of the week. Cause functional impairment, not related to substance use or medical condition.
Bipolar 2: One or more major depressive episode and one or more hypomanic episode lasts 4 or more days but <7 days.
Cyclothymic disorder
Several hypo, manic and depressive episodes that do not meet criteria for two or more years, not without symptoms for more than two
What is the monitoring for lithium?
12 hour trough levels, five days after dose change
Cr, TSH, calcium every 3-6 months
What is the monitoring for divalproex?
12 hour trough levels
CBC, LFTs every 3-6 months
What is the monitoring for atypical antipsychotics?
Monitor BP, FBG lipids every 12 months
Acute management of mania?
Monotherapy: lithium, quetiapine
Combination: Quetiapine + Li/DVP
Four categories relating to conduct disorder
Aggression to people and animals
Destruction of property
Deceitfulness and theft
Serious violations of rules
Treatment for conduct disorder
** Psychotherapy
SIGECAPS for depression
Depressed mood most of the day
Sleep - insomnia or hypersomnia
Interest - diminished in almost all activities most the day
Guilt
Energy low
Concentration low
Appetite - increased or decreased
Psychomotor agitation or retardation
Suicidal ideation
What antidepressants require a two week washout period
MAOIs
Best antidepressants for elderly
Duloxetine, sertraline, Mirtazapine
Antidepressants for perimenopausal
Desvenlafaxine
Symptoms of discontinuation syndrome
Flu like symptoms
Insomnia
Nausea
Imbalance
Sensory disturbance
Hyperarousal
What antidepressants are most commonly associated with discontinuation syndrome?
Paroxetine
Venlafaxine
What antidepressants are the least commonly associated with discontinuation syndrome?
Fluoxetine
Vortioxetine
Symptoms and signs of serotonin syndrome
Mild:
Nervousness, insomnia, tremor, nausea, and diarrhoea, big pupils
Moderate:
Hyperreflexia, sweating, agitation, and restlessness, inducible clonus, side to side eye movements
Severe:
Fever higher than 38.5, confusion and delirium, sustained clonus, and rigidity, rhabdomyolysis, death
Highest risk meds for serotonin syndrome
MAOI
ex. Selegiline
Treatment for serotonin syndrome
Discontinue maths, restart lowest dose or alternative, ER and cyprohepatadine
Definition of obsessions and compulsions
Obsessions: recurrent unwanted and intrusive thoughts, images or urges that cause marked anxiety.
Compulsions: repetitive behaviours for mental acts that are performed to reduce the anxiety generated by the obsessions
Schizoid personality disorder
DISTANT
Detached/Flat affect
Indifferent to criticism/ praise
Sexual experiences of little interest
Tasks done soilitarily
Absence of close friends
Neither desire nor enjoys relationships
Takes pleasure in few activities
Schizotypal personalitiy disorder
ME PECULIAR
Magic thinking or odd beliefs
Experiences unusual perceptions
Paranoid ideation
Eccentric behaviour or appearance
Constricted or inappropriate affect
Usual thinking and speech
Lacks close friends
Ideas of reference
Anxiety in social situations
R/O pyschosis
Antisocial personality disorder?
CORRUPT
Conforming to law lacking
Obligations ignored
Recklessness disregard for safety
Remorseless
Underhanded
Planning insufficient - impulsive
Temper issues
**Prior diagnosis of conduct disorder
Bordline personality disorder?
AM SUICIDE
Abandonment
Mood instability
Suicidal
Unstable/intense relationships
Impulsivity/irritability - spending
Control of anger
Identity disturbance
Dissociative
Emptiness
Tx: Dialectical behavioural therapy
Histrionic personality disorder?
ACTRESSS
Appearance focused
Center of attention
Theatrical
Relationships considered more intimate then they are
Easily influenced
Seductive behaviours
Shallow emotions
Speech - vague
Narcissistic personality disorder?
SPEEECIAL
Special - believe they are unique
Preoccupied with fantasies
Envious
Entitlement
Excess admiration required
Conceited
Interpersonal exploitation
Arrogance
Lacks empathy
Avoidant personality disorder?
AVOIDER
Avoids social type of work
Views self is inept or an appealing
Occupied with fear of rejection or criticism
Inhibited in new interpersonal relationships
Don’t get involved when uncertain of being liked
Embarassement prevents new activities
Restraint within intimate relationships
Dependant personality disorder?
RELIANCE
Reassurance required
Expressing disagreement difficult
Life responsibilities, assumed by others
Initiating projects difficult
Alone
Nuturance
Companionship
Exaggerated fears of being left to care for self
Obsessive compulsive personality disorder?
OBSESSOR
Obsessed over details
Both miserly with self and others
Shows perfectionism that interferes with task completion
Excessively devoted to work
Super consciousness
Supervision required for delegated tasks
Object hoarder
Rigidity
Schizophrenia diagnosis
2 or more of the following symptoms present for most of a month, at least one symptom must be in the first three:
- delusions
- hallucinations
- disordered, thinking speech
- grossly, disorganised or catatonic behaviour
- negative symptoms, for example, diminished, emotional expression
- mark, social occupational or self care dysfunction
- continuous signs of disturbance for six or more months with over one month of symptoms
What is Wernicke encephalopathy caused by
Low thiamine
What does delirium tremens happened?
3 to 5 days after last drink
When do alcohol withdrawal seizures happen
24 to 72 hours after last drink
Treatment for alcohol withdrawal inpatient
Benzodiazepines
Diazepam 10 mg QID then decrease by 10 mg a day \
Lorazepam 2 mg Q4H for two days and 1 mg Q4H for two days
Treatment for alcohol withdrawal as an outpatient
Diazepam 5 mg QID + 5 mg Q4H PRN (max 2) the decrease by 5 mg per day
Medical options for alcohol dependence
Naltrexone. Contraindicated in liver, failure and ongoing opioid use, Monitor LFTs.
Can also trial gabapentin
