Psychiatry Flashcards
1
Q
Mental State Exam
A
A S E P T I C
Appearance and Behaviour
Speech
Emotions - Mood/ Affect
Perception - hallucinations
Thought content
Insight/ Judgement
Cognition
2
Q
Psychotic Disorders (5)
A
- Schizophrenia
- Schizophreniform
- Schizoaffective
- Delusional Disorder
- Brief Psychotic Disorder
3
Q
DSM-5 Schizophrenia
A
- Delusions *
- Hallucinations *
- Disorganized behaviour
- Disorganized speech
- Negative symptoms
4
Q
Timeframe for Schizophrenia
A
at least 6 months (unless successfully treated), continuous
5
Q
First line treatment of schizophrenia
A
Risperidone, Aripriprazole, Haloperiol
6
Q
Schizophreniform
A
Schizophrenia symptoms >1month but less than 6 months
7
Q
Brief Psychotic Disorder
A
Psychotic symptoms lasting >1 day but less than 1 month
Return to pre-morbid level of functioning
8
Q
Schizoaffective Disorder
A
Major mood episode (depression or mania) concurrent with schizophrenia symptoms
Must be a period of 2/52 or more with delusions or hallucinations but no mood symptoms
9
Q
Delusional Disorder
A
One or more delusions present for 1 month or more
10
Q
Time period for delusional disorder
A
at least 1 month
11
Q
Mood Disorders (5)
A
- Major depressive disorder
- Persistent depressive disorder
- Post partum blues/ depression
- Bipolar disorder
- Cyclothymia
12
Q
Symptoms of Depression (10)
A
- Depressed mood
- Anhedonia
- Loss of interest in daily activities
- Weight changes
- Changes in sleep pattern
- Suicidality/ self harm
- Fatigue
- Feelings of worthlessness
- Feelings of guilt
- Unable to concentrate
- Psychomotor symptoms
13
Q
Symptoms of Mania (7)
A
- Persistent elevated/ irritable mood
- Increased energy or activity
- Inflated self-esteem/ grandiosity
- Decreased need for sleep
- Pressure of speech
- Flight of ideas
- Distractibility
14
Q
Hypomania
A
- Manic symptoms BUT no marked impact on functional status
- Duration of at least 4 days
15
Q
Major Depressive Disorder
A
Depressive symptoms present >2 weeks
At least one symptoms is depressed mood or anhedonia
Clinically significant effect on ADL
16
Q
Risk factors for Depression
A
- Female
- FHx
- Childhood trauma
- Recent stressors
- Lack of relationships
- Low SES
- Personality disorder
17
Q
Treatment of Depression
A
- Lifestyle modification
- SSRIs (fluoxetine, sertraline, paroxetine, citalopram, escitalopram)
- SNRIs (venlafaxine, duloxetine, buproprion)
18
Q
Postpartum Blues
A
Transient period of mild depression, begins 2-4d after birth
Lasts up to 10 days
19
Q
Postpartum Depression
A
Onset during pregnancy or within 4 weeks postpartum
Symptoms can last up to 1 year
20
Q
Treatment Postpartum Depression
A
- CBT or IPT
- caution SSRIs for breastfeeding moms
21
Q
Bipolar I
A
- At least one manic episode has occurred
- Manic symptoms lead to hospitalization or if there are psychotic symptoms
- If manic
- Usually 1 MDE but not required for diagnosis
22
Q
Persistent Depressive Disorder
A
> 2 years of symptoms occurring most days
23
Q
Bipolar II
A
At least 1 MDE, and 1 hypomanic espisode
No manic episodes
24
Q
Treatment Bipolar Disorder
A
Lifestyle: education
Biological: lithium, carbamazepine (second line)
ECT if treatment resistant
25
Cyclothymia
Presence of numerous periods of hypomanic and depressive symptoms (not meeting full criteria for MDE or hypomania)
For >2 years
Treatment: mood stabilizer +/- psychotherapy
26
Anxiety Disorders (4)
1. Panic disorder
2. Agoraphobia
3. Generalized anxiety disorder
4. Social Anxiety
27
Panic Disorder
Recurrent panic attacks
At least 1 month of more of:
- worry about panic attacks
- maladaptive change in behaviour related to the attack
28
Treatment of Panic Disorder
1. CBT
2 SSRIs - treat for 1 year after symptoms resolve to prevent relapse
29
Agoraphobia Diagnosis (3)
1. Fear surrounding - use of public transport, being in open spaces, being in enclosed spaces, crowds, outside of the home
2. Fear/ anxiety surrounding these situations
3. Typically lasting >6 months
30
Generalized Anxiety Disorder
> 6 months
Excessive anxiety and worry in multiple events/ environments
Associated with 3 or more of:
- restlessness
- fatigue
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
31
Treatment of GAD
Lifestyle advice
CBT
SSRIs
B-blocker NOT recommended
32
Social Anxiety
>6 months fear in social situations
33
OCD
1. Recurrent persistent thoughts/ urges
2. Repetitive behaviours to relieve stress from thoughts
34
OCD Treatment
1. ERP - exposure response prevention
SSRI
35
PTSD
Symptoms > 1 month
Following threatened or actual trauma:
- recurrent distressing memories
- flashbacks
- intense distress to triggers of trauma
- distrubance in sleep
36
Time period for PTSD
1 month or greater
37
Treatment PTSD
1. Trauma CBT
2. EMDR
3. SSRI
Prazosin - for disturbed sleep
Benzos - for acute anxiety
38
What is EMDR?
Eye movement desensitization reprocessing
39
Adjustment Disorder
Emotional or behavioural symptoms in response to an identifiable stressor
Occurring within 3 months of the onset of the stressor
Treatment: psychotherapy
40
Grief
Normal response to bereavement
Symptoms >12 mo consider dx of MDD or "persistent complex bereavement disorder"
Can still have MDD in the context of grief
41
Somatic Symptom Disorder
Multiple physical symptoms causing significant distress.
No identifiable medical cause.
High level of anxiety associated with symptoms and significant time and energy spent on health concerns
42
Management of Somatic symptom disorder
1. CBT
2. Regular appt with same physician
3. Minimise unwarranted tests/ investigations
43
Illness Anxiety Disorder
Hypochondriac, fear of having a disease with significant impairment due to this anxiety.
Duration >6mo
Tx: CBT
44
Conversion Disorder
One or more symptoms voluntary motor/ sensory.
Cannot be explained by neurological pathology
Tx: psychotherapy, physical therapy.
45
Factitious Disorder
Intentional invention/ induction of symptoms for medical attention or sympathy
46
Malingering
The intentional fabrication or exaggeration of symptoms for secondary gain (time off work, insurance money etc.)
47
Gender Dysphoria
Strong cross-gender identification
Desire to be rid of sexual characteristics
Treatment:
1. psychotherapy
2. Hormone therapy
3. Gender affirming surgery
48
Anorexia Nervosa
1. Low body weight
2. Behaviours that interfere with weight, fear of gaining weight
3. Body dysmorphia, lack of insight into seriousness of current weight
49
Athletic Triad
1. Amenorrhea
2. Disordered eating
3. Osteoporosis
50
Management of anorexia nervosa
CBT
Physical health work-up
51
Criteria to admit to hospital: AN (5)
1. <65% of SBW (<85% SBW in adolescents)
2. Abnormal blood chemistry
3. Hypovolaemia needing IVF
4. HR <40bpm
5. Actively suicidal
52
Bulimia Nervosa
Binge and purge cycle
Happens at least once a week for at least a period of 3 mo
Tx: CBT + SSRI
53
Associated feature of bulimia nervosa (4)
1. fatigue and muscle weakness
2. tooth decay/ mouth ulcers
3. orbital oedema
4. Russell's sign (knuckle callus)
54
Binge eating disorder
Recurrent episodes of bingeing
At least 1/52 for 3 months
Tx: CBT
55
Avoidant/ restrictive food intake disorder
Lack of interest in food to the point of inadequate nutritional intake
56
Physical signs of AN
Low BP, low HR, orthostatic drops, amenorrhea, cold intolerance, lanugo, dry skin, GORD, constipation, arrhythmias, refeeding/ electrolyte disturbances
57
First line SSRI in children with MDD
Fluoxetine
58
Autism
Deficits in -
1. Social/ Emotional reciprocity
2. Nonverbal communication
3. Developing/ maintaining and understanding relationships
59
ADHD Diagnosis
Requires onset before 12 yo
>6 months symptoms
60
ADHD Treatment
methylphenidate, amphetamine
61
Canadian guidelines treatment of acute psychosis in emergency
Haloperidol 5mg IM +/- lorazepam 2mg IM
61
Atypical APs
CAROQ
Clozapine, aripiprazole, risperidone, olanzapine, quetiapine
61
SE's Atypical AP
Clozapine - agranulocytosis
Olanzapine - weight gain
Quetiapine - Orthostatic hypotension
62
Neuroleptic malignant syndrome
Mental status change, rigidity, fever, autonomic instability
63
Extrapyramidal symptoms
Dystonia, akathisia, parkinsonism, dyskinesia
64
Serotonin Syndrome/ Discontinuation syndrome symptoms
Symptoms: N+V, diarrhea, hyperthermia, palpitations, chills, restlessness, confusion, sweating
65
Lithium Toxicity - symptoms and management
GI upset, N+V, confusion, ataxia, slurred speech, lack of coordination, drowsiness, tremor, UMN, myoclonus
Tx:
1. Discontinue lithium for several days then restart at smaller dose
2. IVF
3. Monitor lithium level, U+Es
66
Lithium associated with which foetal abnormality?
Ebstein's anomaly - malformed tricuspid valve in RV causing tricuspid regurgitation and RV enlargement
