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Medicine > Psychiatry > Flashcards

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

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2
Q

Psychotic Disorders (5)

A
  1. Schizophrenia
  2. Schizophreniform
  3. Schizoaffective
  4. Delusional Disorder
  5. Brief Psychotic Disorder
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3
Q

DSM-5 Schizophrenia

A
  1. Delusions *
  2. Hallucinations *
  3. Disorganized behaviour
  4. Disorganized speech
  5. Negative symptoms
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4
Q

Timeframe for Schizophrenia

A

at least 6 months (unless successfully treated), continuous

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5
Q

First line treatment of schizophrenia

A

Risperidone, Aripriprazole, Haloperiol

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6
Q

Schizophreniform

A

Schizophrenia symptoms >1month but less than 6 months

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7
Q

Brief Psychotic Disorder

A

Psychotic symptoms lasting >1 day but less than 1 month

Return to pre-morbid level of functioning

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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

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9
Q

Delusional Disorder

A

One or more delusions present for 1 month or more

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10
Q

Time period for delusional disorder

A

at least 1 month

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11
Q

Mood Disorders (5)

A
  1. Major depressive disorder
  2. Persistent depressive disorder
  3. Post partum blues/ depression
  4. Bipolar disorder
  5. Cyclothymia
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12
Q

Symptoms of Depression (10)

A
  1. Depressed mood
  2. Anhedonia
  3. Loss of interest in daily activities
  4. Weight changes
  5. Changes in sleep pattern
  6. Suicidality/ self harm
  7. Fatigue
  8. Feelings of worthlessness
  9. Feelings of guilt
  10. Unable to concentrate
  11. Psychomotor symptoms
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13
Q

Symptoms of Mania (7)

A
  1. Persistent elevated/ irritable mood
  2. Increased energy or activity
  3. Inflated self-esteem/ grandiosity
  4. Decreased need for sleep
  5. Pressure of speech
  6. Flight of ideas
  7. Distractibility
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14
Q

Hypomania

A
  • Manic symptoms BUT no marked impact on functional status
  • Duration of at least 4 days
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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

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16
Q

Risk factors for Depression

A
  1. Female
  2. FHx
  3. Childhood trauma
  4. Recent stressors
  5. Lack of relationships
  6. Low SES
  7. Personality disorder
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17
Q

Treatment of Depression

A
  1. Lifestyle modification
  2. SSRIs (fluoxetine, sertraline, paroxetine, citalopram, escitalopram)
  3. SNRIs (venlafaxine, duloxetine, buproprion)
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18
Q

Postpartum Blues

A

Transient period of mild depression, begins 2-4d after birth

Lasts up to 10 days

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19
Q

Postpartum Depression

A

Onset during pregnancy or within 4 weeks postpartum

Symptoms can last up to 1 year

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20
Q

Treatment Postpartum Depression

A
  1. CBT or IPT
  2. caution SSRIs for breastfeeding moms
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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
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22
Q

Persistent Depressive Disorder

A

> 2 years of symptoms occurring most days

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23
Q

Bipolar II

A

At least 1 MDE, and 1 hypomanic espisode

No manic episodes

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24
Q

Treatment Bipolar Disorder

A

Lifestyle: education
Biological: lithium, carbamazepine (second line)
ECT if treatment resistant

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25
Q

Cyclothymia

A

Presence of numerous periods of hypomanic and depressive symptoms (not meeting full criteria for MDE or hypomania)

For >2 years

Treatment: mood stabilizer +/- psychotherapy

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26
Q

Anxiety Disorders (4)

A
  1. Panic disorder
  2. Agoraphobia
  3. Generalized anxiety disorder
  4. Social Anxiety
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27
Q

Panic Disorder

A

Recurrent panic attacks
At least 1 month of more of:
- worry about panic attacks
- maladaptive change in behaviour related to the attack

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28
Q

Treatment of Panic Disorder

A
  1. CBT
    2 SSRIs - treat for 1 year after symptoms resolve to prevent relapse
29
Q

Agoraphobia Diagnosis (3)

A
  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
Q

Generalized Anxiety Disorder

A

> 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
Q

Treatment of GAD

A

Lifestyle advice
CBT
SSRIs

B-blocker NOT recommended

32
Q

Social Anxiety

A

> 6 months fear in social situations

33
Q

OCD

A
  1. Recurrent persistent thoughts/ urges
  2. Repetitive behaviours to relieve stress from thoughts
34
Q

OCD Treatment

A
  1. ERP - exposure response prevention
    SSRI
35
Q

PTSD

A

Symptoms > 1 month

Following threatened or actual trauma:
- recurrent distressing memories
- flashbacks
- intense distress to triggers of trauma
- distrubance in sleep

36
Q

Time period for PTSD

A

1 month or greater

37
Q

Treatment PTSD

A
  1. Trauma CBT
  2. EMDR
  3. SSRI

Prazosin - for disturbed sleep
Benzos - for acute anxiety

38
Q

What is EMDR?

A

Eye movement desensitization reprocessing

39
Q

Adjustment Disorder

A

Emotional or behavioural symptoms in response to an identifiable stressor

Occurring within 3 months of the onset of the stressor

Treatment: psychotherapy

40
Q

Grief

A

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
Q

Somatic Symptom Disorder

A

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
Q

Management of Somatic symptom disorder

A
  1. CBT
  2. Regular appt with same physician
  3. Minimise unwarranted tests/ investigations
43
Q

Illness Anxiety Disorder

A

Hypochondriac, fear of having a disease with significant impairment due to this anxiety.

Duration >6mo

Tx: CBT

44
Q

Conversion Disorder

A

One or more symptoms voluntary motor/ sensory.

Cannot be explained by neurological pathology

Tx: psychotherapy, physical therapy.

45
Q

Factitious Disorder

A

Intentional invention/ induction of symptoms for medical attention or sympathy

46
Q

Malingering

A

The intentional fabrication or exaggeration of symptoms for secondary gain (time off work, insurance money etc.)

47
Q

Gender Dysphoria

A

Strong cross-gender identification

Desire to be rid of sexual characteristics

Treatment:
1. psychotherapy
2. Hormone therapy
3. Gender affirming surgery

48
Q

Anorexia Nervosa

A
  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
Q

Athletic Triad

A
  1. Amenorrhea
  2. Disordered eating
  3. Osteoporosis
50
Q

Management of anorexia nervosa

A

CBT
Physical health work-up

51
Q

Criteria to admit to hospital: AN (5)

A
  1. <65% of SBW (<85% SBW in adolescents)
  2. Abnormal blood chemistry
  3. Hypovolaemia needing IVF
  4. HR <40bpm
  5. Actively suicidal
52
Q

Bulimia Nervosa

A

Binge and purge cycle

Happens at least once a week for at least a period of 3 mo

Tx: CBT + SSRI

53
Q

Associated feature of bulimia nervosa (4)

A
  1. fatigue and muscle weakness
  2. tooth decay/ mouth ulcers
  3. orbital oedema
  4. Russell’s sign (knuckle callus)
54
Q

Binge eating disorder

A

Recurrent episodes of bingeing

At least 1/52 for 3 months

Tx: CBT

55
Q

Avoidant/ restrictive food intake disorder

A

Lack of interest in food to the point of inadequate nutritional intake

56
Q

Physical signs of AN

A

Low BP, low HR, orthostatic drops, amenorrhea, cold intolerance, lanugo, dry skin, GORD, constipation, arrhythmias, refeeding/ electrolyte disturbances

57
Q

First line SSRI in children with MDD

A

Fluoxetine

58
Q

Autism

A

Deficits in -
1. Social/ Emotional reciprocity
2. Nonverbal communication
3. Developing/ maintaining and understanding relationships

59
Q

ADHD Diagnosis

A

Requires onset before 12 yo
>6 months symptoms

60
Q

ADHD Treatment

A

methylphenidate, amphetamine

61
Q

Canadian guidelines treatment of acute psychosis in emergency

A

Haloperidol 5mg IM +/- lorazepam 2mg IM

61
Q

Atypical APs

A

CAROQ
Clozapine, aripiprazole, risperidone, olanzapine, quetiapine

61
Q

SE’s Atypical AP

A

Clozapine - agranulocytosis

Olanzapine - weight gain

Quetiapine - Orthostatic hypotension

62
Q

Neuroleptic malignant syndrome

A

Mental status change, rigidity, fever, autonomic instability

63
Q

Extrapyramidal symptoms

A

Dystonia, akathisia, parkinsonism, dyskinesia

64
Q

Serotonin Syndrome/ Discontinuation syndrome symptoms

A

Symptoms: N+V, diarrhea, hyperthermia, palpitations, chills, restlessness, confusion, sweating

65
Q

Lithium Toxicity - symptoms and management

A

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
Q

Lithium associated with which foetal abnormality?

A

Ebstein’s anomaly - malformed tricuspid valve in RV causing tricuspid regurgitation and RV enlargement

Medicine (16 decks)

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