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NAC-OSCE > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

History of presenting illness

A 
MOAPS
M: Ask one and the other if positive
 - Mood and Interest questions. If one +, MSIGECAPS.
 - Mania
O:
 -Organic: Endogenous (hypothyroidism and exogenous (MAD)
A 
-Anxiety 
P - Psychosis
S 
 - Suicide
 - Substance abuse
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2
Q

Major depressive disorder

A

MSIGECAPS
Start with Mood and Interest. If both negative, rule out.

M - Mood: Are you feeling sad or depressed most of the time?
S - Sleep: Having problems with your sleep? More or less? Problems falling or staying asleep?
I - Interest: Still enjoying things that you found pleasurable?
G - Guilty or worthless
E - Energy: Do you feel you have the energy to go throughout your day? Do you feel the lack of energy is because of your mood?
C - Concentration: Are you having difficulties to keep your focus and concentration? While reading/watching TV?
A - Appetite or weight changes
P - Psychomotor activity: Not asked
S - Suicide: Some people who are going through difficult times have thoughts that life is not worth living or it would be better without them. Do you? If so, people think they want to kill themselves? Do you? If so, planning?

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3
Q

Mania

A
  • Need for sleep decreased? 2 hours/night
  • Decision out of character?: Money, sex
  • Energy during these days?
  • Social or talking really fast during these times?
  • How was your mood? Hyper or overconfident?
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4
Q

Generalized anxiety

A

ANDICREST
A - Anxiety: Do you spend hours a day worrying about a lot of different things?
N - Not worry: Are you able to put your worries on the side?
D - Duration: How long? > 6 months
I - Irritability: Has all of this had an effect on your mood? Irritable?
C - Concentration: Are you having difficulties to keep your focus and concentration?
R - Restlessness: Does your worry make you feel you are always on the edge?
E - Energy: Do you feel you have the energy to go throughout your day?
S - Sleep: Having problems with your sleep? More or less? Problems falling or staying asleep?
T - Tension: Tension on your shoulders or muscles?

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5
Q

Social anxiety

A
  • Is the fear of being judged by others or embarrassed by people one of your greatest fears?
  • Has this fear ever prevented you from doing things?
  • Do you avoid situations where you would be the center of attention? If yes,
    • can you ask for help at a restaurant?
    • Can you stop a bus?
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6
Q

Panic disorder

A
  • Have you ever had a panic attack? How often?
  • Patient to DESCRIBE!
  • Anxiety: Do you have episodes where you are overcome by anxiety?
  • Palpitations: During these episodes, do you feel your heart is beating really fast?
  • Do you feel short of breath?
  • Numb or tingly?
  • Are you worried you are going to die or losing you ing?
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7
Q

PTSD

A
  • Have you ever experienced:
    • Physical
    • Mental
    • sexual abuse?
  • Have you ever witnessed horrible or terrifying situations?
  • In the past month, nightmares or rumination?
  • Avoidance: Have you tried to avoid places or situations?
  • Numb or detached?
  • Felt on guard or easily startled?
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8
Q

OCD

A
  • Frequent thoughts difficult to control?
  • Do you do anything to get rid of those thoughts?
  • Do you have any behaviours repetitive rituals that take up a lot of your day?
  • Do you wash your hands frequently?
  • Are these problems upsetting you?
  • Do they make sense?
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9
Q

Psychosis

A

*See/heard things that others don’t?
*Are you hearing voices? What? How many? Male or female?
-Do they tell you to do anything?
-Comment on your behavior?
-Do they criticize you?
*Can people read your mind?
When listening to the radio or TV, do you ever feel that they are talking to you?
*People conspiring against you?
*Taste or smell things that others don’t?
*Sensation of bugs crawling on your body?

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10
Q

Screening question: Mood (Depression)

A

M - Mood: Are you feeling sad or depressed most of the time?

I - Interest: Still enjoying things that you found pleasurable?

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11
Q

Screening question: Anxiety

A

A - Anxiety: Are you a worrywart? Do you feel you tend to worry about things that other people don’t? Do you spend hours a day worrying about a lot of different things?

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12
Q

Screening question: Psychosis

A
  • Have you ever seen things that others don’t?

* Have you ever heard things that others don’t?

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13
Q

Screening question: Suicide

A
  • Have you had any thoughts that life is not worth living or it would be better without them? How often?
  • If so, people who have had these thoughts often have thoughts like “I want to kill myself and this is how I am going to do it”. Have you?
    • Did you have a plan?
    • Leave a note?
    • Give away your belongings?
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14
Q

PMH & Psychiatric History

A
  • Have you ever been seen by a psychiatrist before?

* Have you ever had any therapy?

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15
Q

Family Psychiatric History

A
  • Any family members who have been diagnosed with any medical condition?
  • Any family members who have been diagnosed with any mental illness?
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16
Q

Management

A
  • Psychiatry consultation
  • Mini-mental status
  • Counselling
  • Community resources
  • Anti-psychotic medication
17
Q

Screening question: Substance abuse

A
  • Do you smoke cigarettes? If yes, how many per day?
  • Drink Alcohol?
  • Use of marijuana?
  • Use of other recreational drugs such as cocaine…?
  • Have you ever had treatment for substance abuse?
18
Q

Screening question: Mania

A

*Has there been a time in your life where you have felt euphoric, extremely talkative, had a lot of energy, and a decreased need for sleep?

19
Q

DDx: Psychosis

A
  • 1ry: Schizophrenia
  • 2ry: Delirium
  • Drugs induced
  • Infections
  • Metabolic
  • Structural
20
Q

CAGE

A

C - Have you ever feel you need to cut down your drinking?
A - Do you get annoyed by people criticizing your drinking?
G - Do you feel guilty because of your drinking behaviour?
E - Do you feel like drinking the first thing in the morning when you wake up?

21
Q

Mania: DIG FAST

A

D - Distractibility: Do you have a lot of projects? Were you able to finish it to the end?
I - Impulsivity: Are you over-spending or over-using credit cards? Hyper-sexuality?
G - Grandiosity: Do you feel very special? Do you have a special mission?
F - Flight of ideas: Do you have a lot of thoughts?
A - Activity:
S - Sleep (insomnia): Do you feel you need fewer hours of sleep?
T - Talkativeness: People around have noticed that you speak faster?

Is there any point in your life in which you felt the opposite? High-low?

22
Q

Dementia (Major neurocognitive disorder ->Questions

A

DEATH - SHAFT
D - Dressing: Difficulty dressing and undressing yourself?
E - Eating: Do you remember to eat all your meals?
A - Ambulatory: Do you have difficulties moving around?
T - Toileting: Have you ever wet yourself?
H - Hygiene: Any difficulties taking showers?

S - Shopping: Who is responsible for shopping?
H - Housekeeping: Are you able?
A - Accounting: Who is responsible for banking at home?
F - Food: Do you cook? Forgot to turn off the stove?
T - Traffic: Difficulty driving? Lost your way?

23
Q

DDx: Dementia

A
  • Vascular dementia
  • Alzheimer disease
  • Thyroid disease (patient <60)
  • Depression
  • HIV
  • Pernicious anemia
  • NPH (Normal Pressure Hydrocephalus): If patient has difficulty in AT of the “DEATH” ->Ataxia-Urinary incontinence
24
Q

Dementia: Questions categories

A
  • Memory assessment
  • Behavioral changes
  • DEATH
  • SHAFT
25
Q

Dementia: Memory assessment questions

A
  • Memory assessment
    • Fluctuations in memory?
    • Deterioration gradual, or stepladder?
    • Difficulty
      • memorizing numbers?
      • finding words?
      • reading, writing, calculating?
      • organizing your schedule?
      • doing tasks you used to do before; like tying a tie?
      • Recalling new events (breakfast), or old events (president in WWII)?
    • Lose your stuff?
    • Make lists to remind things you usually do?
26
Q

Dementia: Behavioral questions

A
  • Behavioral changes
    • Anyone told you about changes in your personality?
    • If there is a fire in a building, what do you do?
    • How is your sleep? Dementia is fragmented. Delirium is reversed sleep.
27
Q

Mini Mental State Exam

A
  • Orientation to time
    • Season/Year
    • Month
  • Orientation to place
    • Country
    • Province
    • City
    • Hospital/Clinic
    • Floor
  • Registration
    • Name 3 unrelated objects, slowly & clearly to the patient
    • Ask the patient to repeat the same
  • Attention
    • Ask the patient to spell the word “world” backwards
  • Recall
    • Ask the patient to repeat the 3 objects talked about earlier
  • Language
    • Examiner shows 2 objects, such as a watch and a pencil
    • Repeat the phrase “No ifs and buts”
    • On a blank paper write “Close your eyes” and ask patient to read and follow the command.
    • Ask the patient to write a sentence containing a noun and a verb.
28
Q

Suicide: SAD PERSONS

A

SAD PERSONS
S - Sex: Male
A - Age >65
D - Depression

P - Previous attempts
E - Ethanol (ask SAD)
R - Rational thinking lost: What did you think would be achieved by ending your life? Sometimes people hear voices asking them to end their life, did you hear that?
S - Suicide in family
O - Organized plan
N - No support (ask HEADSSS)
S - Serious illness (ask PMH)
29
Q

Suicide: Notes

A
  • No eye contacts, wasting time, no patient interaction: Assure confidentiality!
  • If you hear “car accident”: Show empathy / did you hurt yourself / ask about who was in the car / was anyone injured?
  • Person driving <18 years and alone: Be curious
  • The girl asks you to tell her mother that she crashed her car
    • I cannot do that
    • Why do you think this would help?
    • Life is full of challenges. It is better that you learn how to deal with challenges by yourself.
    • We can help you to tell your mother yourself. We can arrange a meeting with your mother., I can be present, or a nurse or social worker.
  • The girl does not want to tell her parents that she attempted suicide
    • You assess her and if she is to be released, e.g. regrets about what happened, she is happy to be saved, no SAD PERSONS risk, and is competent -> respect!

NAC-OSCE (25 decks)

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