psychiatry Flashcards

Question

diagnostic criteria for schizophrenia | DSM 5

Answer 1

A. two (or more) of the following, each present for a significant portion of time during a 1 mo period (or less if successfully treated). At least one of these must be (1), (2), or (3) 1. delusions 2. hallucinations 3. disorganized speech (e.g. frequent derailment or incoherence) 4. grossly disorganized or catatonic behaviour 5. negative symptoms (i.e. diminished emotional expression or avolition)

Answer 2

* Acute onset * Shorter duration of prodrome * Female gender * Good cognitive functioning * Good premorbid functioning * No family history * Presence of affective symptoms * Absence of structural brain abnormalities * Good response to drugs * Good support system

Answer 3

• biological / somatic antipsychotics (haloperidol, risperidone, olanzipine, paliperidone; clozapine if refractory); often regiments of IM q2-4 wk used in severe cases to ensure compliance ■ adjunctive: ± mood stabilizers (for aggression/impulsiveness - lithium, valproate, carbamazepine) ± anxiolytics ± ECT ■ treat for at least 1-2 years after the first episode, at least 5 years after multiple episodes (relapse causes severe deterioration) • psychosocial ■ psychotherapy (individual, family, group), supportive, CBT (see Table 14, PS41) ■ ACT (Assertive Community Treatment): mobile mental health teams that provide individualized treatment in the community and help patients with medication adherence, basic living skills, social support, job placements, resources ■ social skills training, employment programs, disability benefits ■ housing (group home, boarding home, transitional home)

Answer 4

acute onset of A,D,E criteria lasting 1 month but less than 6. A. two (or more) of the following, each present for a significant portion of time during a 1 mo period (or less if successfully treated). At least one of these must be (1), (2), or (3) 1. delusions 2. hallucinations 3. disorganized speech (e.g. frequent derailment or incoherence) 4. grossly disorganized or catatonic behaviour 5. negative symptoms (i.e. diminished emotional expression or avolition) D. rule out schizoaffective disorder and depressive or bipolar disorder with psychotic features because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness E. rule out other causes: GMC, substances (e.g. drug of abuse, medication)

Answer 5

meets criteria A,D,E for schizophrenia but symptoms last longer than a day but less than a month

Answer 6

A. concurrent psychosis (criterion A of schizophrenia) and major mood episode - uninterrupted period of illness B. delusions or hallucinations for 2 or more wk in the absence of a major mood episode during the lifetime duration of the illness C. major mood episode symptoms are present for the majority of the total duration of the active and residual periods of the illness D. the disturbance is not attributable to the effects of a substance or another medical condition • specifiers: bipolar type, depressive type, with catatonia, type of episode, severity

Answer 7

A. the presence of one (or more) delusions with a duration of 1 mo or longer B. criterion A for schizophrenia has never been met Note: hallucinations, if present, are not prominent and are related to the delusional theme C. apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behaviour is not obviously bizarre or odd D. if manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods E. the disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder • subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified • further specify: bizarre content, type of episode (e.g. first episode, multiple episode), severity

Answer 8

``` MSIGECAPS at least 5: Mood: depressed Sleep: increased/decreased Interest: decreased Guilt Energy: decreased Concentration: decreased Appetite: increased/decreased Psychomotor: agitation/retardation Suicidal ideation ```

Answer 9

``` GST PAID at least 3? Grandiosity Sleep (decreased need) Talkative Pleasurable activities, Painful consequences Activity Ideas (flight of) Distractible ```

Answer 10

• criterion of a manic episode is met, but duration is ≥4 d • episode associated with an uncharacteristic change in functioning that is observable by others but not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization • absence of psychotic features (if these are present the episode is, by definition, manic)

Answer 11

lifestyle: increased aerobic exercise, mindfulness based stress reduction, zinc supplementation, medications: SSRI's SNRI's

Answer 12

• transient period of mild depression, mood instability, anxiety, decreased concentration; considered to be normal changes in response to fluctuating hormonal levels, the stress of childbirth, and the increased responsibilities of motherhood • occurs in 50-80% of mothers; begins 2-4 d postpartum, usually lasts 48 h, can last up to 10 d • does not require psychotropic medication • usually mild or absent: feelings of inadequacy, anhedonia, thoughts of harming baby, suicidal thoughts

Answer 13

* MDD with onset during pregnancy or within 4 wk following delivery * typically lasts 2-6 mo; residual symptoms can last up to 1 yr * may present with psychosis (rare, 0.2%), usually associated with mania, but also with MDE * severe symptoms include extreme disinterest in baby, suicidal and infanticidal ideation

Answer 14

Risk Factors • previous history of a mood disorder (postpartum or otherwise), family history of mood disorder • psychosocial factors: stressful life events, unemployment, marital conflict, lack of social support, unwanted pregnancy, colicky or sick infant

Answer 15

* psychotherapy (CBT or IPT) * short-term safety of maternal SSRIs for breastfeeding infants established; long-term effects unknown * if depression severe or psychotic symptoms present, consider ECT

Answer 16

Prognosis • impact on child development: increased risk of cognitive delay, insecure attachment, behavioural disorders • treatment of mother improves outcome for child at 8 mo through increased mother-child interaction

Answer 17

``` allegations by the child allegations by an adult injuries to genitalia or anus genital infection recurrent urinary tract infections unexplained behavioural changes psychological disorders ```

Answer 18

2 depressive episodes within 5 years three prior episodes long term treatment should be continued for at least 3-5 years

Answer 19

doesn't quite meet the DSM V criteria but has higher associations with major depression, physical disability, medical illness and high use of medical services

Answer 20

Depression increases risk of IHD in Men but not women Sertraline improves mood with lowest amount of cardiovascular side effects if no effect 50% will respond to a change in SSRI

Answer 21

Attention deficit hyperactivity disorder A syndrome of inattention, hyperactivity, and impulsivity. classified as a developmental disorder

Answer 22

9 signs and symptoms of inattention 6 of hyperactivity 3 of impulsivity must occur in at least 2 situations and manifest before the age of 12

Answer 23

does not pay attention to details has difficulty sustaining attention at school does not seem to listen when spoken to does not follow through on instructions or finish tasks has difficulty organising tasks and activities avoids, dislikes or is reluctant to engage in tasks that require mental effort often lose things easily distracted easily forgetful

Answer 24

``` often fidgets with hands or feet or squirms often leaves seat in class or elsewhere often runs about or climbs excessively has difficulty playing quietly often on the go as if driven by a motor often talk excessively ```

Answer 25

often blurts out answers before questions are finished has difficulty awaiting their turn interrupts or intrudes on others

Answer 26

blunting of affect poverty of speech anhedonia - diminished capacity to experience pleasure Asociality - lack of interest in relationships with others

Answer 27

``` chest pain or discomfort chills or heat sensation derealisation or depersonalization fear of dying fear of losing control or going crazy feeling dizzy, light headed, unsteady or faint feelings of choking nausea or abdominal distress palpitation or pounding heart or accelerated heart rate paresthesias sensations of Shortness of breath or smothering sweating trembling or shaking ```

Answer 28

``` MEDICAL: antidepressants Benzodiazepines work faster but high risk of dependance PSYCHOTHERAPY: cognitive behaviour therapy exposure therapy supportive psychotherapy ```

Answer 29

characterised by 1 or more episodes of depression lasting for at least 2 weeks without a past history of manic or hypomanic episodes

Answer 30

affects children entering school age and characterised by the persistent inability to speak in certain situations such as at school. But will happily talk at home.

psychiatry Flashcards

psych cards for MCCQE 1