Psychiatry Flashcards
4 P’s of the biopsychosocial model
- Predisposing
- Precipitating
- Perpetuating
- Protective
Suicide Risk Factors
SAD PERSONS
- Sex: male
- Age: >60
- Depression
- Previous attempts
- Ethanol abuse
- Rational thinking lost (i.e. Delusions, hallucinations, hopelessness)
- Suicide in family
- Organized plan
- No spouse
- Serious illness
(Think of the young 29y/o punk in PICU)
Important elements (4) to a safety plan
- Not harm themselves
- Avoid drugs, EtOH, and triggers
- Follow up at designated time
- Go to Emerg, call HCP, or call someone
Important elements (3) to a safety plan
- Not harm themselves
- Avoid drugs, EtOH, and triggers
- Follow up at designated time
- Go to Emerg, call HCP, or call someone
Time line for:
- Brief psychotic disorder
- Schizophreniform disorder
- Schizophrenia
- Brief psychotic disorder
- Schizophreniform disorder 1-6 months
- Schizophrenia > 6 months
Schizoaffective Disorder: DSM 5 Criteria
2 weeks or more with no mood symptoms
DSM 5 criteria for Schizophrenia
6 months of disturbanc, with at least 1 month of continuous symptoms (min 1 from each list) + _>_3 of the following:
Positive symptoms:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behaviors
Negative symptoms
- Anhedonia, avolition, alogia, affective blunting Think of ‘Robert’
Basic activities of daily living
DEATH
- Dressing
- Eating
- Ambulating
- Toileting
- Hygiene
Instrumental activities of daily living
SHAFT
- Shopping
- Housekeeping
- Accounting
- Food-preparation
- Transportation
Types of Dementia
- Alzheimer’s (60-70%)
- Vascualar (10-20%)
- Lewey body (10-20%)
- Frontatemporal/Pick’s (5-15%)
- Parkinson’s Disease
- Hungtington’s Disease
CAM
Confusion Assessment Method
Guideline taught to nurses to assess baseline cognition for every patient over 65 years of age.
Delerium Accronym
DIMS-O
- Drugs/Drug withdrawal
- Infection
- Metabolic
- Structural
- Organ System
PRISME
Identify and addresses factors contributing to delerium
- P: pain, poor nutrition
- R: retention, restraints
- I: infection, inmobility
- S: skin, sleep, sensory deficits
- M: mental status, metabollic, medications
- E: environment
4 Traditional Anti-Psychotics
- Haloperidol
- Loxapine
- Chlorpromazine
- Perphenazine
5 Atypical Antipsychotics
- Aripiprazole (AbilifyTM)
- Clozapine (ClozarilTM)
- Olanzapine (ZyprexaTM)
- Risperidone (ResperidolTM)
- Quitiapine (SeroquelTM)
Benzodiazapine list
- Lorazipam is Ativan
- Diazepam is Valium
- Oxazepam is Serax
- Clonazepam
Venlafazine (EffexorTM)
- Drug class
- SNRI
Extra Pyramidal Symptoms
TAP’D
- Tardive Dyskinesia - abnormal involuntary movement disorder (SSRI’s & antipsycotics)
- Akathesia
- Pseudoparkinsonianism
- Akinesia/Bradykinesia
- Rigidity
- Rabbit Tremor
Tardive Dyskinesia
- Involuntary muscle movement
- Starts months after meditcation
- Often permanent; non-treatable with benztropine
- Generally starts around mounth and tongues
- Can get grinding teeth (can lose teeth)
- Can spread to other parts of the body
- Tx: ween the patient off the offender
Akathisia
- The preception of restlessness
- Onset weeks after offender
- Tx: beta-blockers
General anti-psychotic side effects
- EPS (risperidone)
- Sedation (quitiapine)
- Dizziness/Orthostatic Hypotension (quitiapine)
- Anti-cholinergic effects (olanzapine)
- Metabollic syndrome (olanzapine!)
Symptoms treated by Anti-Psychotics
- Delusions
- Hallucinations
- Physical/verbal aggression
- Manic-like
- Sexually inappropriate behaviour
Major Neurodegnerative
6 Common SSRI’s
- Sertraline (ZoloftTM)
- Escitalopram (CipralexTM)
- Citalopram (CelexaTM)
- Paroxetine (PaxilTM)
- Fluoxetine (ProzacTM)
- Fluvoxamine