Psychiatry Review and Patient Presentation

Question 1

If someone comes in and it looks like they have dementia, what do we do for workup?

Answer 1

• CBC
• Comprehensive metabolic profile
• Imaging: CT/MRI
• B12, Folate
• MMSE (mini mental status exam)

Question 2

Do we treat the lab values or the patient?

Answer 2

-the patient

Question 3

does dementia have a long onset?

Answer 3

• yes

- delerium doesn’t

Question 4

tx for this dementia pt

Answer 4

• treat any underlying lab abnormalities
• medications
• behavioral modifications
• family support

Question 5

When is a good time for someone to take their SSRI?

Answer 5

-right before they take their pill because those things will cause sexual dysfunction

Question 6

What is connected with CV disease?

Answer 6

• depression

- and vice versa

Question 7

Which system is stimulated according to the stress theory?

Answer 7

• the autonomic nervous system

- the sympathetics mostly

Question 8

What happens when we activate Noradrenergic systems?

Answer 8

-catecholamine release

Question 9

Activate serotonergic systems

Answer 9

-increased serotonin turnover

Question 10

What do glucocorticoids do in stress?

Answer 10

-enhance serotonin function

Question 11

What happens to dopaminergic neurotransmission as a response to stress?

Answer 11

-Increased

Question 12

What are some endocrine responses to stress?

Answer 12

• CRF (hypothalamus) triggers release of ACTH
• promotes energy use, increasing cardiovascular activity, and inhibiting functions such as growth, reproduction, and immunity

Question 13

What happens to the immune system during stress?

Answer 13

-Inhibition of immune functioning

Question 14

How does SLE present medically?

Answer 14

-fever, photosensitivity, butterfly rash, joint pains, headache

Question 15

How does SLE present psychiatrically?

Answer 15

-depression, mood disturbances, psychosis, delusions, hallucinations

Question 16

How does MS present medically?

Answer 16

-transient motor/sensory disturbances, impaired vision, diffuse neurological signs with remissions and exacerbations, slurred speech, incontinence

Question 17

How does MS present psychiatrically?

Answer 17

-anxiety, euphoria, mania

Question 18

what came first, cardiovascular disease, or depression?

Answer 18

• who knows?

- they just really go together

Question 19

Psych sx of hyperthyroidism?

Answer 19

-nervousness, excitability, irritability, pressured speech, insomnia, psychosis, visual hallucinations

Question 20

psych sx of hypothyroidism?

Answer 20

-lethargy, depressed, personality change, paranoia

Question 21

Psych sx of diabetes mellitus

Answer 21

-frustration, loneliness, dejection, depression

Question 22

Thiamine deficiency

Answer 22

• Medical: neuropathy, cardiomyopathy, wernicke-korsakoff, malaise, alcoholics
• Psych: poor concentration, confusion, confabulation

Question 23

Cobalamin (vit B12) deficiency?

Answer 23

• Medical: pallor dizziness, peripheral neuropathy, dorsal column signs, ataxia
• Psych: irritability, inattentiveness, psychosis, dementia

Question 24

If there is a frontal lobe problem, what will that look like?

Answer 24

-mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, loss of smell

Question 25

main difference between delerium and dementia?

Answer 25

-time of onset

Question 26

difference between dementia and depression in old ppl?

Answer 26

-those that have dementia will not have insight

Question 27

what drug do we avoid in old ppl?

Answer 27

-Benzodiazepines

Question 28

if we give someone with COPD corticosteroids, what could happen?

Answer 28

-mania, psychosis

Question 29

what do we avoid using in elderly with delirium?

Answer 29

-benzos

Question 30

What can antidepressants give us?

Answer 30

-mania (bipolar pt)

Question 31

What is schezoeffective disorder?

Answer 31

- psychosis with some inserted mood episodes | - < 6 months

Question 32

If the pt is old, what will w be looking for?

Answer 32

-dementia or delirium depending on onset

Question 33

Young ppl

Answer 33

-schizophrenia or psychotic disorder

Question 34

Prognostic variables for schizophrenia

Answer 34

- positive sx: better prognosis - negative sx: poor - better prognosis: pts with mood disorders= schizoaffective disorder, major depression with psychotic featrues or bipolar disorder - Poor prognosis: negative sx, poor cognitive performance on testing, poor supports, younger onset - Poor premorbid functioning, insidious onset

Question 35

What is a positive symptom?

Answer 35

- sx added to the presentation - Delusions, hallucinations, catatonia, agitation - typically present in the active phase

Question 36

What is a negative symptom?

Answer 36

- symptoms that appear missing from the presentation - affective flattening, apathy, social withdrawal, anhedonia, poverty of thought, content of speech - typically present in the residual phase

Question 37

In Schizophrenia, what receptors do we want to block?

Answer 37

-Dopamine receptors!

Question 38

What is Delusional disorder?

Answer 38

- delusions of at least 1 month's duration - doesn't meet criterion A for schizophrenia - no other impairment dysfunction besides the delusion

Question 39

Type 1 bipolar

Answer 39

- single manic episode is necessary to diagnose | - at least one manic or mixed episod

Question 40

Type 2 bipolar

Answer 40

- pts have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes - more prevalent that BPD-1

Question 41

What is cyclothymic disorder?

Answer 41

- dysthymic disorder with intermittent hypomanic periods | - pt who, over the last 2 years, experiences repeated episodes of hypomania and depression

Question 42

what's the tx for binge eating disorder?

Answer 42

-vyvanse!... lisdexamphetamine