mental status exam
- Appearance + Behaviour
- Motor activity
- Speech
- Affect + Mood
- Thought process
- Thought content
- Perception
- Sensorium + Cognition
- Insight
- Judgement
anxiety disoders
generalized anxiety disorder
panic disorder
OCD
phobia
stressor or trauma disorders
-stress
-adjustment disorder
organic causes of anxiety
- Endocrine: Hyperthyroidism, Pheochromocytoma, Hyperparathyroidism
- Cardiopulmonary: Heart failure, Arrhythmias, Asthma or Chronic obstructive
pulmonary disease (COPD) - Neurologic: Temporal lobe epilepsy or Transient Ischemic Attacks (TIAs)
- Medication: corticosteroids, cocaine, amphetamines, caffeine; withdrawal
fear vs phobia
Fear - an emotional, physical, and behavioral response to an immediately recognizable external threat (within normal or typical range)
Phobia - an excessive fear response to a specific object or situation that is out of proportion to the actual danger (can occur with no danger is present) and cause significant dysfunction due to avoidance behavior
anxiety definition
Anxiety - a distressing, unpleasant emotional state of nervousness and unease; causes are less clear and timing is less tied to a threat (anticipatory, persistent, none identifiable). Can have physical changes and behaviors similar to those caused by fear.
stressor related disorder definition
- a single, discrete event or multiple events, or ongoing problems that lead to mental distress that is more intense than what is typically expected or when the person’s ability to function is significantly impaired.
panic attack vs panic disorder
vs agoraphobia
panic attack= discrete
panic disorder= repeat
- panic attack: the sudden onset of a discrete, brief period of intense discomfort, anxiety, or fear that reaches a peak within minutes and is accompanied by somatic and/or cognitive symptoms
- panic disorder: the occurrence of repeat panic attacks followed by at least 1 month of persistent concern about having another panic attack, worry about the possible implications or consequences of the attacks, or a significant behavioural change related to the attacks
- agoraphobia: an anxiety disorder (phobia) with a fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong; if in a stressful situation, will usually experience symptoms of a panic attack
dysphoria
unease and disatisffied with life
feeling unable to relax, dissatisfied, tense, and unable to find the energy or interest to do anything.
minor depressive episodes vs major depressive disorder vs dysthymia (persistent depressive disorder)
- dysphoria - a mood state, as indicated by feelings of sadness, despair, anxiety, emptiness, discouragement, or hopelessness; having no feelings; or appearing tearful (may be normal or a symptom of a psychopathological syndrome or a general medical disorder).
- minor depressive episode - a mood syndrome with clinically significant distress and impaired functioning, but with fewer symptoms (2 to 4), and tends to have shorter episodes, less comorbidity, less psychosocial and physical impairment, and fewer recurrences than major depression
- major depressive disorder - a mood syndrome with clinically significant distress and impaired functioning, but with greater symptoms (≥ 5) and tends to have greater psychosocial and physical impairment
- dysthymia (persistent depressive disorder) - similar to minor/major depression, but symptoms persist for 2 or more years
DEPRESSION acronym
- D = Depressed mood (Dysphoria), most of the day
- E = Energy loss (Anergia) - fatigue
- P = Pleasure lost (Anhedonia) - markedly diminished interest or
pleasure most of the day - R = Retardation or excitation (psychomotor, observable by others)
- E = Eating changed - significant appetite or weight change
- S = Sleep changed - either decreased (insomnia) or increased
(hypersomnia) - S = Suicidality - recurrent thoughts of death or suicide, or suicide
attempt - I = I’m a failure (loss of confidence, thoughts of worthlessness or
hopelessness) - O = Only me to blame (inappropriate guilt or regret)
- N = No concentration - impaired concentration or memory
anxiety and depression are
comorbid
symptoms of anxiety
***Excessive Physiologic Arousal
- Muscle tension
- Irritability
- Fatigue
- Restlessness
- Insomnia
***Distorted Cognitive Processes
- Poor concentration - Unrealistic
assessment of
problems - Worries
***Poor Coping Strategies- Avoidance
- Procrastination
- Poor problem-solving
skills
OCD
Obsessive-compulsive disorder - fears focus on primal themes (e.g. contamination, harm), compulsions tend to be ritualistic or “rule driven” and either unrelated to feared outcome or clearly excessive
organic diseases looking like anxiety
Hyperthyroidism - ↓ serum TSH
- Pheochromocytoma - urinary normetanephrine and platelet norepinephrine, abdominal CT
- Heart failure - ECG
- Arrhythmias - Holter monitor, ECG
- Asthma - spirometry
- Chronic obstructive pulmonary disease (COPD) - spirometry
- Anemia (iron-deficiency) - ↓ serum hemoglobin and red blood cells, ↓ ferritin
bipolar
presence of mania/hypomania episode
adhd
impaired concentration, inattention, and fidgeting are pervasive in ADHD (vs. only become pronounced during an episode); can be co-morbid
borderline personality disorder
mood states that fluctuate within a single day
(vs. marked dysphoria), can also include identity disturbance, frantic efforts to
avoid abandonment, and chronic feelings of emptiness
schizophrenia and schizoaffective disorder
psychotic symptoms (including
delusions and hallucinations) can and do occur in the absence of MDD (vs. only in an episode)
organic diseases that look like MDD
Systemic Lupis Erythematosus (SLE) - positive anti-nuclear antibodies (ANA)
- Addison disease - ↓ cortisol + aldosterone; Cushing syndrome - ↑ cortisol
- Diabetes mellitus - ↑ fasting blood sugar (FBS) and hemoglobin A1c (HbA1c)
- Hyper- or hypo-thyroidism - ↓ or ↑ TSH
- Head trauma - examination of head, CT
- Multiple sclerosis - imaging (MRI, identifies demyelinating lesions)
- Parkinson’s disease - bradykinesia + resting tremor or limb rigidity
- Stroke (left frontal lobe) - imaging (MRI or CT)
- Pernicious anemia (Vitamin B12 deficiency) - ↓ serum B12 levels
- Coronary artery disease - BP, cholesterol, ECG, stress test, coronary
angiography
- Fibromyalgia - Widespread Pain Index (WPI) scale, Symptom Severity (SS) scale
- Renal failure - ↑ serum creatinine, ↓ eGFR; ↑ protein in urine
- Hepatic failure - normal or ↑ AST, ALT and ↑ LFTs (PT/ INR, bilirubin, albumin)
MDD vs meds
- Amphetamine withdrawal
- Amphotericin B
- Anticholinesterase insecticides
- Barbiturates
- Beta-blockers (e.g. propranolol)
- Cimetidine
- Corticosteroiods
- Cylcoserine
- Estrogen therapy
- Indomethacin
- Mercury
- Methyldopa
- Metoclopramide
- Oral Contraceptives - Phenothiazines
- Reserpine
- Thallium
- Vinblastine
- Vincristine
anxiety vs meds
- Alcohol or its withdrawal
- Amphetamines
- Analgesics
- Anesthetics
- Anticholinergics
- Anticonvulsants
- Antidepressants (e.g. SSRIs)
- Antihistamines
- Antiparkinsonians
- Antipsychotics
- Caffeine
- Cannabis
- Carbon mon- and di-oxide
- Corticosteroiods
- Cocaine
- Hallucinogens (LSD, Phencyclidine) - Mood stabilizers (e.g. Lithium)
- Organophosphate insecticide
- Sedative withdrawal
- Sympathomimetics
- Thyroid medications
- Volatile substances (gasoline,
paint)
7 questions for GAD7 (3 point scale)
GAD2 is just the first 2 questions
Rank on 3 point scale (GAD7)
1. Feeling nervous, anxious or on edge.
2. Not being able to stop or control worrying
3. Worryingtoomuchaboutdifferentthings
4. Trouble relaxing
5. Being so restless that it’s hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen
GAD2 first 2 questions
MSE for anxiety
-psychomotor agitation, fast or pressured speech, disheveled, worried, afraid, tense, irritable, depressed, rumination, difficulty concentration
anxiety definition and DSM5 criteria
Excessive worry about everyday issues >6 months
DSM5:
-anxiety and worry >6 months
-cant control worry
-restless, fatigued, irritable, muscle tension, sleep problems
-effect social, occupation
-not from substance
