Royal College: Emergency Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

This deck covers Chapters 100-105 in Rosens, comprising all of psychiatry. (21 cards)

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1
Q

List 8 pharmacologic agents that can cause acute psychosis.

A
  1. Steroids
  2. Anticholinergics
  3. Antihistamines
  4. Anticonvulsants
  5. Cocaine
  6. Amphetamine
  7. PCP
  8. LSD
  9. Mushrooms
  10. Benzos
  11. Isoniazid
  12. Rifampin
  13. TCAs
  14. Digoxin
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2
Q

List 8 medical disorders that can cause acute psychosis.

A
  1. Hyperthyroidism
  2. Hypercalcemia
  3. Hyponatremia
  4. Hypoglycemia
  5. Hypoxia
  6. SLE
  7. Hepatic encephalopathy
  8. CVA
  9. Encephalitis
  10. MS
  11. Cancer
  12. Parkinson’s
  13. Addison’s
  14. Cushing’s
  15. Post-partum
  16. Vitamin B1/B2/B9/B12 deficiency
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3
Q

How do you differentiate organic vs functional psychosis?

A

MADFOCS

  • Memory deficits
  • Organic is more recent
  • Functional is more remote
  • Activity
  • Organic is slower, ataxic, tremor
  • Functional is repetitive, rocking
  • Distortions
  • Organic is visual
  • Functional is auditory
  • Feelings
  • Organic is labile
  • Functional is flat
  • Orientation
  • Organic is altered
  • Functional is intact
  • Cognition
  • Organic has periods of lucidity
  • Functional is persistent
  • Some other findings
  • Organic is usually older, AbN vitals
  • Functional is usually younger, normal vitals
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4
Q

List an example of a high, intermediate, and low potency antipsychotic. List 3 atypical antipsychotics.

A
  • High = Haloperidol
  • Intermediate = Loxapine
  • Low = Chlorpromazine

Atypical

  1. Olanzapine
  2. Seroquel
  3. Abilify
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5
Q

List 6 complications from antipsychotic medication.

A
  1. Tardive dyskinesia
  2. Pseudoparkinsonism
  3. Dystonia
  4. Akathisia
  5. Metabolic syndrome
  6. NMS
  7. Orthostatic hypotension
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6
Q

What is a useful mnemonic for symptoms of depression? Mania?

A

SIGECAPS: 5+ for 2+ weeks = MDD

  • Sleep Issues (insomnia/hypersomnia)
  • Interest loss
  • Guilt
  • Energy loss
  • Concentration difficulty
  • Appetite changes
  • Psychomotor changes
  • Suicidal thoughts

DIG FAST: 3+ with > 1-week big mood (or irritable)

  • Distractibility
  • Indiscretion
  • Grandiosity
  • Flight of Ideas
  • Activity increase
  • Sleeping less
  • Talkativeness
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7
Q

List 10 medical illnesses associated with causing depression.

A

CNS

  1. MS
  2. Stroke
  3. Parkinson’s
  4. Head Trauma

Cancer

  1. Pancreatic
  2. Brain tumour
  3. Disseminated cancer

Endocrine

  1. Hypothyroid
  2. Hyperthyroid
  3. Cushing’s
  4. Diabetes
  5. Addison’s

Infectious

  1. HIV

Cardiac

  1. MI

Renal

  1. Dialysis
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8
Q

List 5 medications that can cause depressive symptoms. List 5 medications that can cause manic symptoms.

A

Depressive

  1. Beta-blockers
  2. Clonidine
  3. Benzos
  4. Phenytoin
  5. Valproate
  6. Anabolic steroids

Manic

  1. Corticosteroids
  2. SSRIs
  3. Acyclovir
  4. Sulfa drugs
  5. NSAIDs
  6. Digoxin
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9
Q

What are 4 criteria for hospitalization of a patient with an acute psychiatric episode.

A
  1. SI/HI
  2. Lacks capacity
  3. Inadequate social support for safe OP treatment
  4. Comorbid medical condition
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10
Q

List 10 somatic symptoms of anxiety.

A
  1. Chest pain
  2. Palpitations
  3. Hyperventilation
  4. Dyspnea
  5. Headache
  6. Abdominal pain
  7. Sweating
  8. Tremor
  9. Dry mouth
  10. Frequent stooling
  11. Frequent micturition
  12. Erection failure
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11
Q

What are 6 predictors of organic anxiety?

A
  1. Age >35 onset
  2. No stressors
  3. No PMHx of anxiety
  4. No FHx of anxiety
  5. Lack of avoidance behavior
  6. Poor response to antianxiety medications
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12
Q

List 10 medical disorders that can present with anxiety.

A
  1. Dysrhythmia
  2. Hypoxia
  3. MI
  4. Pheochromocytoma
  5. Hypercalcemia
  6. Hypoglycemia
  7. Seizure
  8. Asthma
  9. PE
  10. Hyperthyroidism
  11. Drug use
  12. Withdrawal
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13
Q

Differentiate somatoform disorder vs factitious disorder vs malingering.

A
  • Somatoform
  • Believe they are ill
  • Factitious
  • Pretend to be ill for primary gain
  • Like the sick role
  • Malingering
  • Pretend to be ill for secondary gain
  • Avoiding work/jail
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14
Q

Give 5 DDx for somatoform disorder.

A
  1. MS
  2. Myasthenia gravis
  3. GBS
  4. SLE
  5. Hyperparathyroidism
  6. Thyroid disorders
  7. Botulism
  8. CO poisoning
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15
Q

Differentiate primary vs secondary gain.

A

Primary

  • Internal motivations
  • Using symptoms to avoid unpleasant emotions
  • Conversion disorder (Functional Neurologic Disorder)

Secondary

  • External motivations
  • Using symptoms to benefit the patient (avoid jail, skip work)
  • Malingering/Somatoform
  • Which can be Functional, Illness Anxiety, or Somatic Symptom D/O
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16
Q

What are the 4 diagnostic criteria for Munchausen’s Syndrome by Proxy?

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A
  1. Apparent illness produced by parents
  2. Presentation for medical treatment
  3. Failure of parent to acknowledge the deception
  4. Cessation when parent removed
17
Q

List 4 characteristics of malingering.

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A
  1. Medicolegal context of presentation
  2. Discrepancy between symptoms and findings
  3. Poor cooperation with testing
  4. Poor compliance with treatment
  5. Antisocial traits
18
Q

List 10 risk factors for suicide.

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A

SADPERSONS

  1. Sex
  2. Age
  3. *Depression
  4. Previous attempts
  5. EtOH/Drugs
  6. *Rational thinking loss (psychosis)
  7. Separated/Divorced
  8. *Organized attempt
  9. No social supports
  10. *Suicidal ideation

* = highest impact

19
Q

List 5 factors that are reassuring for low risk of imminent suicide.

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A
  1. Low SADPERSONS score (<6)
  2. Stable housing
  3. Contracts to safety
  4. Social supports available
  5. No gun at home
  6. Young women who take non-lethal overdose/cut
  7. Future-oriented
  8. Good follow-up plan
20
Q

What criteria must be met for involuntary admission (psychiatric)?

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A
  1. Assessed by an MD within 7 days
  2. Fail the Past/Present test
    * Harm to self
    * Harm to others
    * Physical impairment
  3. Fail the Future test:
    * Documentation of mental disorder

This will vary slightly by jurisdiction

21
Q

What are the 5 DSM-5 criteria for schizophrenia?

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A
  1. Two or more of:
    * Delusions
    * Hallucinations
    * Disorganized speech
    * Disorganized behaviour
    * Catatonia
  2. Impacts school/work/relationships
  3. Symptoms persist for >6 months
  4. Not directly associated with a mood disorder
  5. Not attributable to a GMC/Drug
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