psychiatry Flashcards
ICD 10 diagnosis of depression
over 2 week period (must have 2 of the following)
- persistent low mood *
- anhedonia *
- fatigue or low energy
(if any other above then ask)
- disturbed sleep
- poor concentration/indecisiveness
- low self confidence
- suicidal thoughts or acts
- agitation or slowing of movement
severity:
- 4 symptoms: mild
- 5-6 symtoms: moderate
- 7+ symptoms: severe
treatment of depression
- sleep hygiene
- regular exercise
- CBT/group therapy
- antidepressants
guidelines for antidepressant therapy
- try one antidepressant, if not respondent
- give another antidepressant from same class
- if not respondent, review depression
- give combinant of antidepressants
- if still doesn’t work, augment to lamotrigine/lithium
when do you refer a patient to psychiatric services for depression
- patient is not getting any better after 2-3 weeks of treatment
- significant perceived risk of suicide, harm to others or significant self neglect
- any psychotic symptoms
- history or clinical suspicion of bipolar disorder
- all cases where a child or adolescent is presenting with major depression
diagnosis of mania
A. elevated, expansive or irritable mood, with increased activity or energy lasting at least one week
B. 3 of the following (inflated self esteem or grandiosity, decreased need for sleep, more talkative than usual, flight of ideas, distractibility, increase in goal-directed activity, excessive involvement in activities that have a high potential for painful consequences)
C. marked impairment in social or occupational functioning or necessitates hospitalisation)
D. the episode is not attributes to effects of a substance or to other medical condition
diagnosis of hypomania
similar to mania but
A. needs to last at leat 4 days
C. change in functioning that is noticed by others (not impaired)
difference between suicide and self harm
suicide: wanting to end life
self harm: coping mechanism
physical symptoms in anxiety
- autonomic arousal symptoms: increased HR diarrhoea/nausea/increased micturition increased RR sweating
- symptoms of tension
muscle tension/aches and pains
lump in the throat - general symptoms:
hot glossed, numbness/tingling
GAD7 questionnaires for anxiety
- feeling nervous anxious or on edge
- not being able to stop or control worrying
- worrying too much about different things
- trouble relaxing
- being so restless that it is hard to sit still
- becoming easily annoyed or irritable
- feeling afraid, as if something awful is going to happen
management of GAD
- education about GAD + active monitoring
- coping strategies
- CBT
- SSRI/SNRI
when do you refer GAD to secondary services
if severe anxiety with marked functional impairment in conjunction with:
- risk of self harm/suicide
- significant comorbidity (substance misuse, personality disorder or complex physical health problems)
- self neglect
- inadequate response to CBT
diagnostic overshadowing in psychiatry (foulds hierarchy)
rule out in following order:
- organic
- drug and alcohol related
- psychosis
- mood disorders
- anxiety/Stress related
- personality/behavioural disorders
diagnosis of OCD
A. either obsessions (thoughts, ideas or images) or compulsion (acts) or both
B. originate in mind of person, repetitive and unpleasant, carrying our thought or at is not pleasurable
C. causes distress or interferes with social or individual functioning
D. cannot be due to other mental disorders
at least present for 2 weeks
diagnosis of PTSD
- exposure to stressful event
- flashbacks
- avoidance
- hypervigilence
- associated symptoms: sleep problems, irritability, outbursts of anger, difficulty in concentrating
symptoms need to be present within 6 month of event and for at least 1 month
panic disorder diagnosis
A. discreet episode of intense fear or discomfort, starts abruptly, reaches crescendo wishing few minutes
B. autonomic arousal symptoms
C. cannot be due to physical disorder, organic mental disorder, other mental disorder
GAD diagnosis
A. ‘several’ months with prominent tension, work, apprehension about every day events and problems
B. autonomic, general, tension symptoms
C. should not meet criteria for panic, phobic, OCD or hypochondriac disorders
D. not sustained by physical disorder (hyperthyroidism), organic mental disorder, psychoactive substance related disorder or withdrawal from benzos
diagnosis of phobic anxiety disorders
- feeling of anxiety, associated with dear (dying or losing control)
- linked with specific situation
- symptoms disappear when taken out of situation
what scale do you use to measure postnatal depression
Edinburgh postnatal depression scale
differentials for GAD
- cardiovascular/pulmonary disease (COPD, arrhythmia)
- Hyperthyroidism, hypoglycaemia
- substance abuse or withdrawal
- Other anxiety/mental disorders
- Intrusive thoughts in OCD
difference between MI and panic/anxiety attack
- chest pain from anxiety more localised and sharp (compared to dull and radiating chest pain in MI)
- panic attacks rarely causing vomitting
- panic attacks are more systematic, peak at 10 minutes then slow and stead decline
- no TLoC in anxiety
- anxiety: cold, MI: hot
schizophrenia symptoms
positive symptoms:
- delusions (reference, persecution, control)
- hallucinations (auditory)
- thought disorder
negative symptoms:
- flat or blunted affect and emotion (alogia)
- poverty of speech
- anhedonia
- lack of desire to form relationships
- lack of motivation
cognitive impairements
- particularly memory and executive functions
risk factors of schizophrenia
- ACEs
- cannabis/substance misuse
- second generation ethnic minority/immigration
- peri natal oxygen deprivation
- urban living
- genetics
management of schizophrenia
first episode:
- routine set of blood tests
- antipsychotic +
- psychological intervention (family and CBT)
- offer crisis resolution and home treatment teams as first line service
- art therapy (for neg symptoms)
mental and behavioural disorders due to psychoactive substance use
acute intoxication dependence syndrome harmful use withdrawal state psychotic disorder amnesic syndrome
ICD10 description of harmful use
- damage to health (mental and/or physical)
- harmful patterns criticised by others and associated with adverse social consequences
CAGE screening
- have you ever attempted to CUT down on alcohol
- do you ever get ANNOYED when people complain about your drinking
- do you sometimes feel GUILTY about things you have done while drinking
- EYE OPENER
ICD10 description of dependence syndrome
3 of the following:
- Compulsion and craving
- Difficulty in controlling substance-taking behaviour
- tolerance
- withdrawal state
- relief of withdrawal by substance
- neglect of other interests
- persisting with substance use despite clear evidence of overtly harmful consequences
symptoms of acute alcohol withdrawal
- physical: headache, nauseas/vomitting, paroxysmal sweating, tremor
- cognitive: auditory, visual and tactile hallucinations (formiction), disorientation, anxiety, agitation, increased urge and cravings
symptoms of delirium tremens
- autonomic instability
- disorientation
- hallucinations
- agitations/aggression
- seizures
