Psychiatry Flashcards
psychiatric history components
Information, introductions, PC, HPC, SH, ICE, PPH, PMH, DH, FH, PH, PP
Information, introductions, PC, HPC, SH, ICE, PPH, PMH, DH, FH, PH, PP
categories for a psychaitric history
psychiatric history: information
PT details, under section vs informal visit, PT vs collateral history
PT details, under section vs informal visit, PT vs collateral history
points to cover in the information section of a psych history
psych history: introductions
who’s who, roles, purpose of interview, consent, permission to take notes
who’s who, roles, purpose of interview, consent, permission to take notes
points to cover in the intriductions section of a psych history
psych history: PC
ideally get PT’s own words
ideally get PT’s own words
for psych PC in hisory
psych history: HPC
can use SOCRATES, cause, triggers/recent precipitating events, coping strategies, ever happened before
psych history: HPC depression
SOCRATES, is mood always low, when worst, anything to lift mood, look forward to anything, tearful, guilty, worthless, hopeless, self harm, suicide (–> RISK), LOA, weight loss, sleep (trouble getting to sleep indicates mild, early waking indicates severe), lack of motivation, aches/pains, libido, caused probems at home/work, thoughts abouth themselves, the world, the future
SOCRATES, when worst, look forward to anything, tearful, guilty, worthless, hopeless, self harm, suicide (–> RISK), LOA, weight loss, sleep (trouble getting to sleep indicates mild, early waking indicates severe), lack of motivation, aches/pains, libido, caused probems at home/work
HPC things to ask about if depressive PC
can use SOCRATES, cause, triggers/recent precipitating events, coping strategies, ever happened before
for HPC psych
psych history: HPC psychosis
strange thoughts, others commented on strange things, plots against you/out to get you, interference with thoughts (insertion, withdrawal, broadcasting), see/hear things that others can’t, get messages from things you see/hear, insight, controlled by others, how longs has this been going on, has it changed over time
strange thoughts, others commented on strange things, plots against you, interference with thoughts, see/hear things that others can’t, insight, how longs has this been going on, has it changed over time
questions to ask in HPC for psychosis
psych history: HPC generalised anxiety
general feeling, on edge, worry, irritable, unable to relax, fears, increased vigilance, insomnia (initial/middle/fatigue on waking), tremor, tachycardia
general feeling, on edge, worry, irritable, unable to relax
psych history HPC to ask for generalised anxiety
psych history: HPC panic attacks
hyperventillation, SOB, CP, palpitations, sweating, tremor, duration of attacks, triggers, fear, impending doom
hyperventillation, SOB, CP, palpitations, sweating, tremor, duration of attacks, triggers
HPC questions to ask in panic attacks PC
psych history: HPC phobias
fears that you/others may consider irrational, obsessive thoughts
fears that you/others may consider irrational, obsessive thoughts
things to ask in HPC for someone presenting with phobias
psych history: SH
lives with, where, friends/family to confide in, ADLs, additional support/benifits, job, dependencies, financial/legal problems
lives with, where, friends/family to confide in, ADLs, additional support/benifits, job, dependencies, financial/legal problems
psych history: SH
psych history: PPH
contact with MH services, MH admissions/treatment, sections, history of self harm/attempted suicide, triggers
contact with MH services, MH admissions/treatment, sections, history of self harm/attempted suicide, triggers
psych history: PPH
psych history: DH
current medication, allergies, previous regimes, recreational drugs, alcohol (CAGE), side effects, compliance/feelings towards their medications
current medication, allergies, previous regimes, recreational drugs, alcohol, side effects, compliance/feelings towards their medications
psych history: DH
psych history: FH
who is in their family, who close to, occupations, an MH disease in family/suicides
who is in their family, who close to, occupations, an MH disease in family/suicides
FH psych history to ask
psych history: PH
childhood: where born, parents together, schooling (attendance, grades, friends), moved a lot, siblings, enjoyed childhood, abuse
occupational: jobs held, reason for leaving, free time
psychosexual: first sexual encounter, orientation, relationships/marital status, reasons for ending, children
forensic: any problems with the police
childhood, occupational, psychosexual, forensic
ask about in PH
psych history: PP
(maybe good to get a collateral history here)
personality (happy go lucky, tense, shy, greedy, insecure, anxious, obsessive), relationships (peers, superiors), hobbies/interests
(maybe good to get a collateral history here)
personality (happy go lucky, tense, shy, greedy, insecure, anxious, obsessive), relationships (peers, superiors), hobbies/interests
psych hisotry: PP
CAGE questionnaire
have you ever felt that you should cut down your drinking?
have you ever felt annoyed by someone commenting on your drinking?
have you ever felt guilty about the amount that you drink?
have you ever had an eye opener?
have you ever felt that you should cut down your drinking?
have you ever felt annoyed by someone commenting on your drinking?
have you ever felt guilty about the amount that you drink?
have you ever had an eye opener?
CAGE questionnaire
psych assessment includes
psych history + MSE
psych history + MSE =
full psych assessment
MSE components
appearance, behaviour, speech, mood, thoughts, perception, cognition, insight
appearance, behaviour, speech, mood, thoughts, perception, cognition, insight
MSE components
appearance + behaviour
self care, eye contact, face, pupils, aggitation, psychomotor retardation, posture, abnormal movements
self care, eye contact, face, pupils, aggitation, psychomotor retardation, posture, abnormal movements
appearance + behaviour
speech
form: rate + flow, incoherent
content: appropriateness, congruency
tardive dyskinesia
involuntary movements fo face + neck, may follow use of antipsychotics
involuntary movements fo face + neck, may follow use of antipsychotics
tardive dyskinesia
waxy flexibility
PT stays in the same position that they’ve been put in e.g. schizophrenia/structural brain disorder
PT stays in the same position that they’ve been put in e.g. schizophrenia/structural brain disorder
waxy flexibility
forced grasping
takes examiner’s hand whenever offered, e.g. dementia/chronic schizophrenia
takes examiner’s hand whenever offered, e.g. dementia/chronic schizophrenia
forced grasping
stereotypies uniform
repetitive non-goal directed actions e.g. schizophrenia
repetitive non-goal directed actions e.g. schizophrenia
stereotypies uniform
form: rate + flow, incoherent
content: appropriateness, congruency
speech
presure of speech
goal directed, jumping from one thought to another e.g mania (if connections between thoughts), schizophrenia (if no connection between thoughts)
goal directed, jumping from one thought to another e.g mania (if connections between thoughts), schizophrenia (if no connection between thoughts)
pressure of speech
mutism
severe depression/schizophrenia
perseveration
repeating the same words/phrases e.g. dementia/frontal lobe trauma
repeating the same words/phrases e.g. dementia/frontal lobe trauma
perseveration
neologisms
creating new words e.g. schizophrenia
creating new words e.g. schizophrenia
neologism
echolalia
repeating the same words/phrases as examiner e.g. schizophrenia
repeating the same words/phrases as examiner e.g. schizophrenia
echolalia
mood
subjective vs objective, depression, anxiety, mania, congruency, lability
subjective vs objective, depression, anxiety, mania, congruency, lability
mood
thoughts
delusions, disorders (ask RE concentration/thoughts block), obsessions, compulsie rituals
delusions in schizophrenia
primary delusions, thought alienation, presecutory delusions
primary delusions, thought alienation, presecutory delusions
delusions in schizophrenia
delusions in depression
nililistic, hypochondrial, worthless, guilt, hopelessness
nililistic, hypochondrial, worthless, guilt, hopelessness
delusions in depression
delusions in mania
grandiose
grandiose
delusions in mania
thought alienation
insertion, withdrawal, broadcast, plots to harm you
insertion, withdrawal, broadcast, plots to harm you
thought alienation
depersonalisation
feeling unreal/any part of the body is unreal e.g. in anxiety disorders
feeling unreal/any part of the body is unreal
depersonalisation
derealisation
feeling that things around them are unreal e.g. in anxiety disorders
feeling that things around them are unreal
derealisation
delusions, disorders (ask RE concentration/thoughts block), obsessions, compulsie rituals
thoughts
perception
aka hallucinations, illusions
aka hallucinations, illusions
perception
cognition
orientation to person, place + time, MMSE, AMTS, ACE-R
MMSE, AMTS used to assess
cognition
insight
recognise abnormal experiences as extraordinary, result of disease process, can be controlled by medicaiton, risk assessment
recognise abnormal experiences as extraordinary, result of disease process, can be controlled by medicaiton, risk assessment
insight
auditory illusion
auditory sound misinterpreted by listener
auditory sound misinterpreted by listener
auditory illusion
illusions
can occur in any sensory modality and aren’t usually an indicator of a mental illness/psychiatric problem
can occur in any sensory modality and aren’t usually an indicator of a mental illness/psychiatric problem
illusions
affect illusion
associated with specific mood state e.g. someone may see a loved one who has recently died
associated with specific mood state e.g. someone may see a loved one who has recently died
affect illusion
completion illusion
inattention when reading e.g. misreading words, completing faded letters
inattention when reading e.g. misreading words, completing faded letters
completion illusion
pareidolia
perception of vivid picture via vague/obscure stimulus e..g seeing images in the clouds
perception of vivid picture via vague/obscure stimulus e..g seeing images in the clouds
pareidolia
most common side efffect of clozapine
urinary incontinence
side effect of clozapine that we’re most worried about
agranulocytosis
agranulocytosis
side effect of clozapine that we’re most worried about
urinary incontinence is the most common side effect of
clozapine
methylphenidate
CNS stimulant used to treat ADHD, also used as an apetite surpressor + in the treatment of sleep disorders e.g. narcolepsy
CNS stimulant used to treat ADHD
methylphenidate
methyylphenidate SE
insomnia, agitation, HTN, weight loss
insomnia, agitation, HTN, weight loss
methylphenidate SE
psychiatric drugs which cause weight gain
olanzapine (SGA), mirtazapine (NaSSA)
olanzapine + mirtazapine can cause
weight gain
Schneider’s 1st rank symptoms of schizophrenia
auditory hallucinations (thoughts spoken aloud/voices referring to themselves in the 3rd person/commentary) thought withdrawal/insertion/interruption/broadcasting delusional perceptions feelings/actions controlled by external agents (passisivity)
auditory hallucinations, thought disordered, delusional perceptions, feelings/actions controlled by external agents
schneider’s 1st rank symptoms
schizophrenia diagnosis
6/12 duration, at least 2 symptons (1 must be positive)
6/12 duration, at least 2 symptons (1 must be positive)
schizophrenia
negative symptons schizophrenia
avolition, asocial, apathetic, affect blunting, alogia, attention deficit, paucity of speech, poor memory
avolition, asocial, apathetic, affect blunting, alogia, attention deficit
negative symptons schizophrenia
brief psychotic disorder
symptoms <1/12
psychotic symptoms <1/12
brief psychotic disorder
schitzoaffective disorder
mix of psychotic and affective symptoms, alternating not simultaneously
mix of psychotic and affective symptoms, alternating not simultaneously
schizoaffective disorder
ICD-10 diagnostic criteria for depression
- persistent low mood/sadness
plus at least 1 of the following most days/most of the time for at least 2/52: 2. loss of interest/pleasure 3. fatigue/low energy
associated symptoms: 4. disturbed sleep 5. poor concentration/indecisiveness 6. low self-confidence 7. poor/increased appetite 8. suicidal thoughts/acts 9. agitation/slowing of movement 10. guilt/self-blame
of the ICD-10 10 symptoms of depression 0-3/10
not depressed (don’t forget to also assess functional impact)
of the ICD-10 10 symptoms of depression 4/10
mild depression (don’t forget to also assess functional impact)
of the ICD-10 10 symptoms of depression 5-6/10
moderate depression (don’t forget to also assess functional impact)
of the ICD-10 10 symptoms of depression 7-10/10
severe depression +/- psychosis, symptoms >1/12, every symptom should be present for most of every day
not depressed score according to ICD-10
0-3/10 (don’t forget to also assess functional impact)
mild depression score according to ICD-10
4/10 (don’t forget to also assess functional impact)
moderate depression score according to ICD-10
5-6/10 (don’t forget to also assess functional impact)
severe depression score according to ICD-10
7/10 every symptom should be present for most of every day, symptoms for >1/12
first line medical management of depression
SSRI
second line medical management of depression
switch to a different SSRI
DSM-IV criteria for subthreshold depression
<5/10 symptoms
DSM-IV criteria for mild depression
few if any symptoms > the 5/10 to make the diagnosis, minor functional impairment
DSM-IV criteria for moderate depression
symptoms/functional impairment -/- mild + severe
DSM-IV criteria for severe depression
most of the /10 symptoms, marked interference with functioning, +/- psychotic symptoms
DSM-IV <5/10 symptoms
subthreshold depression
DSM-IV 5/10 symptoms
mild depression
DSM-IV most of the /10 symptoms
severe depression
all severities depression management
treat comorbid physical ailments, treat substance misuse problems
mild depression management
self help groups, structured physical activity groups, guided self help, computerised CBT, behavioural couples therapy
moderate depression management (+ unresponsive mild)
add antidepressant, individual CBT, interpersonal therapy
severe depression management
ECT (poor PO intake), admission, crisis team, antipsychotic (if psychotic)
third line medical management of depression
SNRI
flight of ideas
mania
thought block
sudden interruption in train of thought e.g. schizophrenia, depression
circumstantiality
thinking proceeds slowly via convoluted path, final point is eventually reached e.g. particular personality traits, mania
psychomotor retardation
slowing of thoughts/speech e.g. depression
tangentiality
deflected path of speech, never reaching point/answering question e.g. psychosis, dementia, delerium
sudden interruption in train of thought
thought block e.g. schizophrenia, depression
thinking proceeds slowly via convoluted path, final point is eventually reached
circumstantiality e.g. particula personality traits, mania
slowing of thoughts/speech
psychomotor retardation e.g. depression
deflected path of speech, never reaching point/answering question
tangentiality e.g. psychosis, dementia, delerium
delusional mood
feels something going on around them, can’t describe it, becomes > clear /specific when the delusional idea/perception occurs
feels something going on around them, can’t describe it, becomes > clear /specific when the delusional idea/perception occurs
delusional mood
delusion of love
2’ delusion (come about from another experience), certain that s/o else is in love with them, even if they havent met
2’ delusion (come about from another experience), certain that s/o else is in love with them, even if they havent met
deluson of love
de Cleraumbault’s syndrome
delusion of love involving a celebrity
delusion of love involving a celebrity
de Cleraumbault’s S
delusional perception
delusion forms in response to an ordinary object e.g. traffic light changing sending a message
delusion forms in response to an ordinary object e.g. traffic light changing sending a message
delusional perception
autochthonous delusion
delusional ideas that arise out of nowhere, appear fully formed in the PT’s mind
delusional ideas that arise out of nowhere, appear fully formed in the PT’s mind
autochthonous delusions
