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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
Describe some common describing phrases for the components of the mental status exam.
- Appearance: grooming, stated age?, etc
- -behaviour: activity level, tics, agitation, tremors
- Speech: Quantity, rate, quality
- -Mood: emotional state that the patient percieves
- -Affect: flat, blunt, labile, content appropriate
- -Hallucinations: sensory experience without reality (auditory, visual, auditory, etc)
- -illusions are a misinterpretation of sensory input
- -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: Do they know what is going on with them?
- -Judgement: are they acting appropriately given the situation?
- Cognition: MMSE
What are the 4 things you NEED to ask for any psychiatric consult??
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)
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
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)
RF's for elder abuse (6)
- memory problems
- physical impairment
- substance abuse
- verbally or physically abusive
DDx for dementia with prevalences
- Alheimer's (47%)
- Mixed (alz + vasc) (33.7%)
- Vascular (9%)
- LBD/Park dim (2.5%)
- FTD (5.4%)
Pharma tmt for dementia
- 1) AChEi's for all
- 2) Memantine helps with AD only
THESE ONLY TREAT SX
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
Differentiate grief and depression (4 points)
- -worthlessness (D)
- -suicidal thoughts (D)
- -vegetative state (D)
- -want to be around others (G)
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
Highest risk group for suicide?
white males over 85
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.
What kills you in anorexia? (3)
- heat issues
What is a huge thing you need to worry about in people with schitzophrenia?
comorbid substance abuse (most are smokers) (47%)
What is the 4 step approach to treating psychosis?
- 1) assessment
- 2) treatment setting (disposition)
- 3) non-pharm strategies
- 4) biological tmts
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
Top 3 methods of suicide for Males and females ( just 2)
- Males: Hanging, poisoning, firearms
- Females: poisoning, hanging
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
What are the big 3 disorders that put you at risk for suicide?
- -depression (75%)
- -substance abuse (25%)
- -Psychotic states (5%)
7 RF's for suicide
- -age (seasons of suicide in your life)
- -FHx of suicide
- -Ethnicity (1st nations)
- -Previous self harm
- -current suicidal ideas
- -Psychiatric disorders (the big three)
How do you screen for mania?
- DIG FAST (3+ is diagnostic)
- Irresponsible behavior
- Flight of ideas
- Activity increased
- Sleep reduced
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
How do you diagnose a panic disorder
- STUDENTS Fear the 3 C's (4+ and worry of additional attacks is diagnostic)
- Unsteadyness, dizziness
- Excess heart rate
Fear of dying, losing control
3 C's: Chest pains, Chills, Choking
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