Structure Class Flashcards
PSYCHIATRY RULES*
=>Dont follow ASEPTICJ 3R blindly.
=>They will access communication skills
=>Build basic psychiatry history
=>There is no any lab test or investigation in psychiatry.
=>HX and MMSE makes diagnosis.
=>Emphasize on openended questions 1 or
=>Get a starting point. Ask leading questions,what brings you here today
=>can you tell me more about your condition.
DELUSION STRUCTURES
EROTOMANIC TYPE: another person is secretly in love with them
GRANDIOSE TYPE:they have special talent ,unusual fame or major achievement.
JEALOUS TYPE:spouse is unfaithful and finds evidedence to support it.
PERSECUTORY TYPE:preoccupied by delusion they are being persecuted,conspired against or potentially harmed
SOMATIC TYPE:something is wrong with their body, generally go to one doctor to another
HEADSS: is for preparing for interiew, home and envionment, education and employment
HOME& ENVIRONMENT, EDUCATION&EMPLOYMENT, ACTIVITIES, DRUGS, SEXUALITY,
SUICIDE/DEPRESSION. (HEADSS)
HEADSS IS TO PREPARE ADOLESCENTS FOR INTERVIEW AND TO GET ENGAGE.
IN ORDER TO BREAK THE ICE THEY USUALLY WANT US TI START WITH THE HEADSS FOR NON ENGAGING PT.
START WITH HEADSS THEN MOVE ON TO PSYCOSOCIAL HX. IT STARTS WITH ASKING ABOUT LESS SENSITIVE ISSUE TO ASSIST WITH DEVELOPING RAPPORT WITH YOUNG PERSON AND EASING THEM INTO ASSESTMENT .
DEPRESSION & BIPOLAR MOOD DISORDER
PSYCHOSOCIAL HX:(PSYCHI PART & SOCIAL PART)
1.start with confidentiality first before taking hx, avoid wasting time. like just before we start ask for confidentiality.
2.any +ve ans needs further exploring, hows your sleep,, not good,, explore further.
HISTORY TAKING(APPLY FOR ALL CASES)
1.CONFIDENTIALITY AND EMPATHY,: HI i am dr x.. taking your care today, i’d like to start with telling you today that iam here to help you and everything we discuss will be confidential between you n me unless there is risk of harm to you n others.
2.OPEN ENDED QUESTIONS: HOW CAN I HELP YOU TODAY. IF PT IS NOT ENGAGING
ASK 2ND OPEN ENDED QUESTION. CAN YOU TELL ME LITTLE BIT MORE ABOUT IT,
- EXPLORE THE COMPLAINT: FOCUS ON COMPLAINT TIMING
like,, how long?.. on n off continous?.. worse or better?
PSYCHO: 3 GROUPS N 3QS
1. MOOD:hows your mood been lately?
2. SLEEP:hows your sleep going? if you get ans like its not good explore it further, like problem with falling asleep or wakes up in middle and hard to get back to sleep.
3. APPETITE:how has your appetite been? any weight change?
2ND GROUP:
1.SUICIDE:key question..ask very clearly. have you ever thought about harming or killing yourselve or other..if ans is yes sometimes then ask any previous attempts or plans?
if previous attempts or plannings( high risk)
=any previous attempts
=any plans
=prepare any means or weapons.
= have you decided date or write note.
2.HALLUCINATIONS.. do you see, feel or hear things that other people dnt
third question below
3.DELUSION:
=REFERENCE: do you feel people are talking about you?
you are reciving messages like from tv newspaper?
=CONTROL:anyone trying to control you, spying on you chasing you?
=JEALOUSY:DO YOU THINK PEOPLE ARE JEALOUS OF YOU, ARE YOU FEELING JEALOUS
=GRANDIOSITY.have superpowers
=GUILT: DO YOU FEEL GUILTY
=WITHDRAWL INSERTION BROADCASTING:do you feel anyone ants to steel your ideas, insert ideas in your head or tv radio inserting ideas in your head
ASK DELUSION WITH SCREENING: do you have thoughts that other people thinks strange
3RD GROUP
COGNITION: do you know who i am? where you are? what time it is?
JUDGMENT:if room set on fire what will you do?
INSIGHT: do you think you need help
IMPACT /FUNCTION:how are these symptoms affecting your life
SOCIAL PART.
HEADSS
HOME:who are you living with, relationship, stress.
EDUCATION/EMPLOYMENT:are you working or studying ,any stress.
ANHEDONIA/ACTIVITY: do you enjoy activities you used to enjoy before.
DRUGS:
SEXUSL HX. depression-dec libido.. bipolar=hypersexual
STRESS
SADMA.. Smoking alcohol drugs medication.
KEYPOINTS IN PSYCHI HX:
1.rule out organic causes… Depression anxiety: thyroid
psychosis mania… brain tumor, head injury, brain infec
if weight gain by quietapine.. rule out wgt gain causes.
2.previous mental health& admission n medication. treated and given medication.
complient with medication? if stopped , did you stop by yourself or your gp stopped it?
PMHX OR FMHX OF MENTAL HEALTH DISORDER
DEPRESSION CASE? DONT SKIP HALLUCI AND DELUSION
KEY POINTS
1.DEP=MAJOR DEPRESION.
MSIGECAPS USED IN MDD
MANIC EPISODES IN BIPOLAR
DEPRESSION WTH PYCHOTIC FEATURES(ASK HALLUC & DELUSION)
FOR EG LADY HAS GUILT THAT IT WAS HER FAULT THAT CAT HAD DIED, CORONER HAS CLEARED HER THAT IT WAS NOT HER FAULT, BUT SHE STILLS BELIEVES THAT ITS HER FAULT
GUILT IS CRITERIA OF DEPRESSION BUT IF IT BECOMES FIRM BELIEVE(DELUSION)
1pt low mood, insomnia,anhedonia,tiredsuicidal ideation no mania(MDD)
2.low mod,insomnia,anhedonia,tired,suicidial ideation,episodes of feeling good,gambling,inc sex( bipolar)
3.low mood insomnia anhedonia tired suicidial ideation severe guilt delusion(MD e psychotic features)
4.low mood hallucinition delusion grandiosity & persecutory,-ve symptoms,memory problem,disorganized speech(schizophrenia)
BIPOLAR KEYPOINTS: MDD features=criteria
&MANIA(grandiosity,dec sleep,inc talking,racing or flight of ideas,distraction,inc pleasureable activities)
ques to ask: do you think you have spec powers? more talkitive, felt distracted,
sex hx:hypersex, sexual active?ever engage in high risk sex activity.
recent gambling , spending spree,.
impairment in function.
depression=tick criteria n keypoints, R/O mania,psychotic features,
guilt=normal or guilt delusion
SCHIZOPHRENIA:
KEYPOINTS: delusions hallucinations, look for disorganized speech and behaviour(odd eratic behaviour
SCHIZOEEFECTIVE KEYPOINTS?
ANXIETY DISORDER(r/o ddx)
DDX:GAD,Panic disorders,PTSD,Phobias,OCD.
PANIC ATTACKS:
chest pain sob sweating tremors, LOC,
Fear of dying(key point) during the attack were you scared that you may die?
PANIC DISORDER:
recuring panic attack result in behaviour change& worry about concequences.
multiple panic attacks, fear of getting another,fear leads to sigificant change in behaviour(avoid crowded places, keeps phone all time)
acces phobias as well(agarophobia) R/O PHOBIA
Q: are you worried of having another attack? has that worry changed your daily activity?
have you been avoiding crowded places?
SOCIAL ANXIETY DISORDER(SOCIAL PHOBIA)
Avoid social gatherings
intense fear when doing speech infront of people
all symptoms persist for 6 or more months.
if person comes and says i am affraid to do public speeches bcz if i do god is gonna kill me then it is not anxity disorder( schiophrenia)
AGAROPHOBIA:
Symptoms for 6 months, intense fear n anxiety , impairment in social occupational or other imp areas of functioning
pt with phobic disorders R/O :
other anxiety disorders, deoression, suicidial ideation, substance related disorder
R/O other causes in anxiety disorder
GENERALIZED ANXIETY DISORDER
A.excessive anxiety and worry
B.difficult to control
c.anxiety of worry associated with 3 or more of the 6 symptoms with atleast some symptoms been present for more days than not for past 6 months
D.clinically significant distress,
R/O organic causes,
ques:
are you genrally an anxious person?
do you worry alot without any reason? anything specific?any reason?
are you able to concentrate? tired? is the anxiety difficult to control
PTSD:
<1month=acute stress disorder>1 month=ptsd.
experienced traumatic event
re experincing of event: nightmares.
avoidance of traumatic trigger.
-ve changes in mood low mood.
increased outburst or arousal.
KEY AREAS:
CAUSATION: traumatic event? serious injurt sexual abuse? directly experienced or wittnessed? traumatic event to close family members?
REEXPERIENCING; nightmares , flasbacks
AVOIDANCE: thoughts feelings or conversion associated with the events. avoidance of people places that trigger the event.
NEGATIVE ALTERATION:
inability to remember an important aspect of event, persistant negative emotional state, markedly diminish intrest
HYPERAROUSAL: anger outbrust, hypervigillance.
QUES: have you ever had traumatic event?
do you have flashblacks that you are reliving the event, or nightmares?
have you been avoiding places, people activites and talking about that event? avoiding that person who did sexual abuse?
have you forgotten some parts of the event?
have you ever had anger outburst or extremely anger?
R/O anxiety, ocd gad
ADJUSTMENT DISORDER:
emotional symptoms develop in response to stressor within 3 months of onset of stressor. marked distressed out of propotion can cause significant func impairment.
R/O MDD ANXIETY PTSD
SHOULD NOT GRIEF OR BEREAVMENT
R/O Organic causes
EG: girl 22 brokenup with boyfriend low mood no anhedonia no guilt no worthless no suicide appetite normal, sleep disturbance tired concentration fine.(ADJUSTMENT DISORDER)
it is mal diversion of MDD OR PTSD that doesnot tickoff all criteria
6 specifiers:
AD with depressed mood
AD with anxious mood
AD with mixed anxiety and depressed mood.
with disturbance of conduct
with mixed disturbance of emotions n conduct.
unspecified.
GRIEF:
GRIEF:
ask basic psychosocial hx, R/O prolong grief disorder: have you been avoiding things that reminds you of her?
are you feeling lonely or numb? how is your relationship with firnds? life is meaning less?
R/O MDD PTSD PANIC DISORDERS ANXIETY
PROLONGED GRIEF DISORDER:
persist for OVER 12 months of death.significant symptoms, severity of disbelieve avoiding lonliness numbness, impaired social .
EATING DISORDER:
20 yr girl dental carries eats alot but induce vomit, ??
ANOREXIA NERVOSA: anorexia nervosa has 2 types: Restrictive type , binge eating /purging type
BULEMIA NERVOSA:
