Psychiatry Review and Patient Presentation Flashcards
If someone comes in and it looks like they have dementia, what do we do for workup?
- CBC
- Comprehensive metabolic profile
- Imaging: CT/MRI
- B12, Folate
- MMSE (mini mental status exam)
Do we treat the lab values or the patient?
-the patient
does dementia have a long onset?
- yes
- delerium doesn’t
tx for this dementia pt
- treat any underlying lab abnormalities
- medications
- behavioral modifications
- family support
When is a good time for someone to take their SSRI?
-right before they take their pill because those things will cause sexual dysfunction
What is connected with CV disease?
- depression
- and vice versa
Which system is stimulated according to the stress theory?
- the autonomic nervous system
- the sympathetics mostly
What happens when we activate Noradrenergic systems?
-catecholamine release
Activate serotonergic systems
-increased serotonin turnover
What do glucocorticoids do in stress?
-enhance serotonin function
What happens to dopaminergic neurotransmission as a response to stress?
-Increased
What are some endocrine responses to stress?
- CRF (hypothalamus) triggers release of ACTH
- promotes energy use, increasing cardiovascular activity, and inhibiting functions such as growth, reproduction, and immunity
What happens to the immune system during stress?
-Inhibition of immune functioning
How does SLE present medically?
-fever, photosensitivity, butterfly rash, joint pains, headache
How does SLE present psychiatrically?
-depression, mood disturbances, psychosis, delusions, hallucinations
How does MS present medically?
-transient motor/sensory disturbances, impaired vision, diffuse neurological signs with remissions and exacerbations, slurred speech, incontinence
How does MS present psychiatrically?
-anxiety, euphoria, mania
what came first, cardiovascular disease, or depression?
- who knows?
- they just really go together
Psych sx of hyperthyroidism?
-nervousness, excitability, irritability, pressured speech, insomnia, psychosis, visual hallucinations
psych sx of hypothyroidism?
-lethargy, depressed, personality change, paranoia
Psych sx of diabetes mellitus
-frustration, loneliness, dejection, depression
Thiamine deficiency
- Medical: neuropathy, cardiomyopathy, wernicke-korsakoff, malaise, alcoholics
- Psych: poor concentration, confusion, confabulation
Cobalamin (vit B12) deficiency?
- Medical: pallor dizziness, peripheral neuropathy, dorsal column signs, ataxia
- Psych: irritability, inattentiveness, psychosis, dementia
If there is a frontal lobe problem, what will that look like?
-mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, loss of smell
main difference between delerium and dementia?
-time of onset
difference between dementia and depression in old ppl?
-those that have dementia will not have insight
what drug do we avoid in old ppl?
-Benzodiazepines
if we give someone with COPD corticosteroids, what could happen?
-mania, psychosis
what do we avoid using in elderly with delirium?
-benzos
What can antidepressants give us?
-mania (bipolar pt)
What is schezoeffective disorder?
- psychosis with some inserted mood episodes
- < 6 months
If the pt is old, what will w be looking for?
-dementia or delirium depending on onset
Young ppl
-schizophrenia or psychotic disorder
Prognostic variables for schizophrenia
- positive sx: better prognosis
- negative sx: poor
- better prognosis: pts with mood disorders= schizoaffective disorder, major depression with psychotic featrues or bipolar disorder
- Poor prognosis: negative sx, poor cognitive performance on testing, poor supports, younger onset
- Poor premorbid functioning, insidious onset
What is a positive symptom?
- sx added to the presentation
- Delusions, hallucinations, catatonia, agitation
- typically present in the active phase
What is a negative symptom?
- symptoms that appear missing from the presentation
- affective flattening, apathy, social withdrawal, anhedonia, poverty of thought, content of speech
- typically present in the residual phase
In Schizophrenia, what receptors do we want to block?
-Dopamine receptors!
What is Delusional disorder?
- delusions of at least 1 month’s duration
- doesn’t meet criterion A for schizophrenia
- no other impairment dysfunction besides the delusion
Type 1 bipolar
- single manic episode is necessary to diagnose
- at least one manic or mixed episod
Type 2 bipolar
- pts have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes
- more prevalent that BPD-1
What is cyclothymic disorder?
- dysthymic disorder with intermittent hypomanic periods
- pt who, over the last 2 years, experiences repeated episodes of hypomania and depression
what’s the tx for binge eating disorder?
-vyvanse!… lisdexamphetamine
