Psychogenic symptoms Flashcards
1
Q
Delirium
A
- most common
- Acute; hours, days, waxing-waning, DAY-NIGHT reversal
- Look for the trigger: new med or stop med, lyte abnormality or infections
- Change from baseline, disorganized though processing, inattention
- Presentation - HYPO-ACTIVE: Sleepy, Lethargy, obtunded.
- Hyperactive: common: restless, hallucinate, myoclonus.
- Indicate DAYS to WEEKS prognosis: Terminal delirium
2
Q
Depression
A
- Chronic: More than 2weeks
- Anhedonia, guilt/worthless, hopelessness/self defacing, escalating pain, weight change, sleep change
3
Q
Anxiety
A
- Chronic: Days to weeks
- ON EDGE, Loss of control, HIGH energy, Restless, Jittery, fearful, SOB, Tachycardia
- +ve history of anxiety
4
Q
Delirium Triggers
A
Drugs, Dehydration
Electrolyte abnormalities
Low Oxygen states
Infections
Retention
Ictal state
Under-medications/withdrawal
Metastasis, Metabolic changes
5
Q
First-treatment for delirium
A
- Haldol, Risperidol or olanzapine
- Chlorpromazine
- Keep Ativan for withdrawal, seizure or h/o EtOH
6
Q
Treatment plans for delirium
A
- Symptomatic: anti-psychotic
- Treat the underlying cause if possible
- ENSURE adequate pain control
- Wean off Benzo, anti-cholinergic medications
7
Q
Anticipatory grief VS Depression
A
Temporary/ Periodically vs Persistent
- Fleeting mood VS Persistent sadness
- Hope for CURE or life-prolongation VS HOPELESS
- Pleasure in life VS Persistent anhedonia
- Better with activities, socialization VS Helplessness
- Temporary desire for Death vs Persistent
8
Q
Adjustment disorder
A
- IDENTIFIABLE stressors
- Within 3months onset
- Excessive and OUT of proportion leading to impairment in social, occupational, or educational functioning.
- NO anhedonia, Self-defacing, Sadness
9
Q
Demoralization
A
- Self perception or understanding of the stress and assigns meanings and place of the future.
- Specific distress that occurs when individuals feel their intactness or integrity as persons is threatened
- Associated with chronic illness, disability, social ISOLATION
- SUICIDAL ideation is HIGH
- Promoted by poor symptom control, poor communication, dismissive attitudes, and avoidance behavior
- NO anhedonia, Self-defacing, Sadness
- Anhedonia separates depression from demoralization.
- Management: make a connection to the patient by touch and by assuring the patient that you are there for them and will not abandon them.
10
Q
SUICIDE in terminal illness
A
- Threats of self-harm -> STAT psychiatry
- Once attempt,pt will go on to committed suicide
11
Q
Management Depression
A
- Treat unrecognized untreated pain
- Psychotropic/ stimulantSSRI: 1st line, 3-6weeks,TCA: consider when sedation is desired, or neuropathic pain; nightly, ANTICHOLINERGIC
-Psychotherapy
14
Q
When to refer the patient?
A
- Suicidal
- history of major psychiatic disorder
- Psychotic or confused
- Unresponsive to first-line antidepressants
- Dysfunctional family
15
Q
Psycho-stimulant: Methylphenidate, pemoline
A
Psycho-stimulant only for patient with limited prognosis.
- Effective in 24-48hr;
- Small dose and titrate to effectiveness
- SEs: arrhythmia, anorexia, confusion.
- Hepatotoxin: Pemoline
15
Q
SSRI: citalopram, setraline, escitalopram, paroxitine
A
- PTSD, depression - once daily
- Effect sees after 3-6 weeks
- Serotonin syndrome, libido, drug-INTERACTION
16
Q
Antidepression side-effects
A
