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Describe a good mnemonic to screen for major depressive episode
- SIGECAPS (5+ sx for at least 2 weeks
- Sleep - insomnia or hypersomnia every day
- Interest - decreased ability to experience pleasure
- Guilt - worthlessness or inappropriate guilt
- Energy - fatigue or loss of energy
- Concentration - decreased ability, indecisiveness
- Appetite - 5% change (up or down) without trying
- Psychomotor agitation or slowing - observable by others
- Suicidal - thought of, or attempts
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Describe some common describing phrases for the components of the mental status exam.
- ASEPTIC
- Appearance: grooming, stated age?, etc
- -behaviour: activity level, tics, agitation, tremors
- Speech: Quantity, rate, quality
- Emotions:
- -Mood: emotional state that the patient percieves
- -Affect: flat, blunt, labile, content appropriate
- Perception:
- -Hallucinations: sensory experience without reality (auditory, visual, auditory, etc)
- -illusions are a misinterpretation of sensory input
- Thoughts:
- -Content: Delusions (grandiose, religious, thought insertion, etc), obsessions, compulsions, phobias
- -Process: coherent?, logical?, stream (goal oriented, circumstantial (comes back to point), tangential (doesn't), flight of ideas, loose associations
- Insight/Judgement:
- -Insight: Do they know what is going on with them?
- -Judgement: are they acting appropriately given the situation?
- Cognition: MMSE
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What are the 4 things you NEED to ask for any psychiatric consult??
- PASS!!!
- Psychosis
- Abuse
- Substances
- Suicide
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Describe the three clusters of personality disorders
- Cluster A (MAD): Schizotypal (close to schizophren.), Schizoid (distant, anthony hopkins), Paranoid (suspect wife of cheating)
- Cluster B (BAD): Histrionic (daughter from married with children), Narcissistic (Sherlock), Borderline (fear of abandonment, intense relationships, "fatal attraction"), Antisocial (the Joker)
- Cluster C (SAD): Avoidant (afraid of neg evaluation, socially inhibited), Dependent (what about Bob), OCPD (med students)
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List the 6 anxiety disorders we talked about in class
- 1) Panic disorder
- 2) Specific phobia
- 3) Social Anxiety Disorder
- 4) GAD
- 5) OCD
- 6) PTSD
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Generally what are we using to treat anxiety disorders?
- 1) CBT for all
- 2) SSRI's (first line for all but specific phobia)
- 3) benzo's (specific phobia, after exposure therapy)
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RF's for elder abuse (6)
- >75
- memory problems
- physical impairment
- substance abuse
- verbally or physically abusive
- depression
-
DDx for dementia with prevalences
- Alheimer's (47%)
- Mixed (alz + vasc) (33.7%)
- Vascular (9%)
- LBD/Park dim (2.5%)
- FTD (5.4%)
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Pharma tmt for dementia
- 1) AChEi's for all
- 2) Memantine helps with AD only
THESE ONLY TREAT SX
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Depression prevalence is higher or lower in the elderly?
lower. All the depressed people have died
-
Differentiate dementia and depression (4)
- Dementia vs Depression
- -Conceals vs highlighting health probs
- -insidius vs subacute onset
- -no psych hx vs hx of depression
- -stable vs variable cognitive loss
-
TCA recommended for use in the elderly
Nortryptiline
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Differentiate grief and depression (4 points)
- -worthlessness (D)
- -suicidal thoughts (D)
- -vegetative state (D)
- -want to be around others (G)
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What should you think of when you see a manic patient older than 65?
Some other medical condition causing mania. BPAD has usually presented well before 65
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Highest risk group for suicide?
white males over 85
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If someone comes in with new onset anxiety and are older than 65, what should you think?
depression. Primary anxiety usually presents well before this.
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What kills you in anorexia? (3)
- suicide
- heat issues
- pancreatitis
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What is a huge thing you need to worry about in people with schitzophrenia?
comorbid substance abuse (most are smokers) (47%)
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What is the 4 step approach to treating psychosis?
- 1) assessment
- 2) treatment setting (disposition)
- 3) non-pharm strategies
- 4) biological tmts
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Treatment phamacology for schizophrenia
- 1) Secong gen AP (e.g. rispiridone) (not clozapine!) or an oral 1st gen AP (if tolerated before)
- 2) another 2nd gen AP (not clozapine!)
- 3) 3rd 2nd gen AP OR clozapine
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Top 3 methods of suicide for Males and females ( just 2)
- Males: Hanging, poisoning, firearms
- Females: poisoning, hanging
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Some key points on suicide (3)
- -4 x more males than females
- -rates climb in the young and are stable in middle age
- -second most likely cause of death from 10-35
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What are the big 3 disorders that put you at risk for suicide?
- -depression (75%)
- -substance abuse (25%)
- -Psychotic states (5%)
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7 RF's for suicide
- -Male
- -age (seasons of suicide in your life)
- -FHx of suicide
- -Ethnicity (1st nations)
- -Previous self harm
- -current suicidal ideas
- -Psychiatric disorders (the big three)
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How do you screen for mania?
- DIG FAST (3+ is diagnostic)
- Distractibility
- Irresponsible behavior
- Grandiosity
- Flight of ideas
- Activity increased
- Sleep reduced
- Talkitiveness
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How do you screen for depression
- SIGECAPS (5+ for 2 weeks is diagnostic for major depressive disorder)
- Sleep probs
- Interest decreased
- Guilt or worthlessness
- Energy level decreased
- Concentration diminished
- Appetite changes
- Psychomotor changes
- Suicide thoughts
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How do you diagnose a panic disorder
- STUDENTS Fear the 3 C's (4+ and worry of additional attacks is diagnostic)
- Sweating
- Trembling
- Unsteadyness, dizziness
- Depersonalization
- Excess heart rate
- Nausea
- Tingling
- SOB
Fear of dying, losing control
3 C's: Chest pains, Chills, Choking
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Prototypical SSRI
citalopram
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