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diagnostic pneumonic

SIGECAPS depression
Depressed Patients Sound Anxious, So Claim Psychiatrists Depression and other mood disorders Psychotic disorders Substance abuse disorders Anxiety disorders Somatic disorders (somatic symptom disorder, eating disorders) Cognitive disorders (dementia, mental retardation, ADHD) Personality disorders
SIGECAPS 4/8 wi/depressed mood or anhedonia, for 2 weeks Sleep disorder Interest deficit Guilt (worthlessness, hopelessness, regret) Energy deficit Concentration deficit Appetite disorder Psychomotor retardation or agitation Suicidality
Persistent Depressive Disorder (Dysthymia): ACHEWS The dysthymic patient is “allergic” to happiness ACHEWS 2/6 w/depressed mood, for 2 years Appetite d/o Concentration Hopelessness Energy deficit Worthlessness Sleep disorder
Manic mood- DIGFAST Elevated mood 3/7, or irritable 4/7, for 1 week= manic episode: Distractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit (decreased need for sleep) Talkativeness (pressured speech)
Tempted With Cognac, is used for criteria for any drug or alcohol dependence 2/11, Tolerance, Withdrawal, Control (LOSS OF): More etoh than intended, Unsuccessful @quitting, TOO INVOLVED W/ETOH, Craving, continued use w/consequences, give up activities, Failure w/roles, interpersonal issues, use in situations physically hazardous
CAGE questionaire “Have you felt you should Cut back on your drinking?” “Has anybody Annoyed you with comments on your drinking?” “Have you felt Guilty about your drinking?” “Have you ever had an Eye-opener in the morning to get rid of a hangover?”
Panic Attack 4/13=3/5/5 heart 3-Palpitations Chest pain Nausea breathlessness cluster 5- SOB, Choking sensation, Dizziness. Paresthesias, Chills or hot flashes fear cluster 5-Fear of dying, " going crazy, Shaking, Sweating, Derealization or depersonalization
agoraphobia I have no mnemonic for agoraphobia, because there are really only two criteria: a fear of being in places where escape might be difficult and efforts to avoid such places.
PTSD patient Remembers Atrocious Nuclear Attacks 1--2-2- Reexperiencing memories, flashbacks, nightmares (one for dx), Avoidance of stimuli, Negative alterations in cognition/mood (2 for dx), Arousal increase (insomnia, irritability, hypervigilance, reckless behavior, and poor concentration (2 for dx)
GAD Macbeth 3/6 for 6 months- Macbeth Frets Constantly Regarding Illicit Sins: Muscle tension Fatigue Concentration problems Restlessness, feeling on edge Irritability Sleep problems
Bulimia Nervosa 4/4- Bulimics Over Consume Pastries (all four of these): Binging Out-of-control feeling while eating Concern with body shape Purging
Anorexia Nervosa Weight Fear Bothers Anorexics (all three of these): Weight significantly low Fear of fat Body image distortion
Dementia Memory LAPSE- at least 1/6 Memory Language Attention (complex) Perceptual-motor Social cognition Executive function
medical FRAT Delerium- need all 5 Medical cause of cognitive impairment Fluctuating course Recent onset Attention impairment Thinking (cognitive) disturbance
ADHD- MOAT 6/9- BEFORE AGE 12- many other criteria- too many to memorize Movement excess (hyperactivity) Organization problems (difficulty finishing tasks) Attention problems Talking impulsively
Mnemonic for Elements of the Mental Status Examination: All Borderline Subjects Are Tough, Troubled Characters Appearance Behavior Speech Affect Thought process Thought content Cognitive examination
Thought content (TC) refers to unusual or dangerous ideas and includes SI and homicidal ideation (HI), psychotic ideation, such as delusions and hallucinations
Thought process TP- TP refers to the flow of thought-(coherent vs. incoherent)
Impaired Thought Content (TC) refers to delusional thinking. A delusion is a belief about the world that most people would agree is impossible. Most delusions fit into two broad categories: paranoid delusions and grandiose delusions.
The patient having delusions of reference believes that casual events have a special significance in reference to her- strangers waiting at a subway thought to be staring at or talking about her or people on the radio or TV are discussing him or speaking directly to him.
circumstantiality long winded- you’ll recognize a circumstantial style because you will feel impatient and will be forced to interrupt often and redirect to finish the interview within a reasonable period.
looseness of association LOA-more severe tangentiality- statements that lead to other statements in a very loose way, so that the associative leaps are unclear- clearly associations going on somewhere in your pt’s mind, but you can’t make them out.
poverty of thought pt offers very little spontaneous speech- answers to questions are with the minimum number of words required- will often w/other negative s/s- such as poor hygiene, flat affect, or a hx of social isolation
disorganized behavior Observational clues include poor grooming, body odor, and bizarre clothing combinations
onset for schizophrenia varies by gender. Males generally have an onset between the ages of 10-25, females usually between the ages of 25-35.
Dopamine hypothesis for schizophrenia 1. antipsychotic drugs have the ability to act as antagonists of the dopamine type 2 (D2) receptors 2. Drugs that increase dopamine activity -amphetamine or cocaine, are psychotomimetic
mesolimbic dopamine pathway A part of the limbic system of the brain- many behaviors such as pleasurable sensations, powerful euphoria of drugs of abuse, and positive symptoms, such as delusions and hallucinations, from increased levels of dopamine
mesocortical dopamine pathway Affects cognitive, negative, and affective symptoms due to decreased levels of dopamine
Nigrostriatal dopamine pathway part of the extrapyramidal nervous system and controls motor function and movement
Tuberoinfundibular dopamine pathway Controls prolactin secretion
Glutamate: “NMDA receptor hypofunction hypothesis of schizophrenia” Hypoactivity of glutamate at NMDA receptors causes cognitive, negative, and affective symptoms of schizophrenia. ***Glutamate is excitatory!!
Serotonin in schizophrenia Implicated in the patho- excess of this neurotransmitter= both positive & negative symptoms. Also, demonstrated as helpful in tx of +/- s/s. Atpical antipsychotic medications have strong serotonin agonist properties.
GABA and schizophrenia research indicates less GABA neurons could lead to the hyperactivity of dopaminergic neurons
Acetylcholine & Nicotine- decreased muscarinic and nicotinic receptors in the caudate-putamen, hippocampus, and select regions of the PFC- plays a role in the regulation of neurotransmitter systems that affect cognition.
limbic system and schizophrenia involved in the patho of depression d/t role in controlling emotions & from schizophrenic pts have shown a decrease in the size of the region (includes the hippocampus, parahippocampus, and amygdala.
Basal Ganglia and Cerebellum: These brain regions are of interest in schizophrenia due to: often patients with schizophrenia have odd movements, (not related to medication-induced movement disorders)- r/t psychosis
phase 1 acute schizo Onset or exacerbation of florid, disruptive symptoms Loss of functional abilities causing increased care and/or hospitalization.
Phase II-Stabilization-schizo Symptoms diminish with a movement toward previous functional ability- Can be treated at a day program , residential treatment center or supervised group home setting may also bee needed
Phase III- Maintenance-schizo Patient is at or nearing baseline functional level. Symptoms are absent or diminished Patient can return to community Recovery with few or no residual symptoms
To dx schizo *Delusions, *hallucinations, *disorganized speech, grossly disorganized or catatonic behavior, negative s/s - 2 or more present for at least 1 mo. (one of the symptoms must be delusions, hallucinations, or disorganized speech)- duration 6 mo- loss of fx
Echopraxia- mimicking of movements of another
Neologisms made-up words that have meaning for the patient; have a different on nonexistent meaning to others
Positive s/s Alterations in behavior Catatonia Motor retardation Motor agitation Stereotyped behavior Automatic obedience Waxy Flexibility Negativism Impaired impulse control
negative s/s the absence of something that should be present (blunted affect, poverty of thought {alogia}, Loss of motivation {avolition},inability to experience joy or pleasure {anhedonia}.
Scizophreniform differs from schizophrenia in that the symptoms have a duration of at least 1 month but less than 6 months.
Schizoaffective disorder: A manic or depressive syndrome develops with the major symptoms of schizophrenia
Conventional Antipsychotics- strong agonists at the D2 dopamine receptors. These drugs bind at these receptors and block the attachment of dopamine to reduce the positive symptoms of psychotic disorders such as schizophrenia
treatment for schizophrenia- what other meds do Antagonist of the muscarinic receptors for acetylcholine, α1 adrenergic receptors for norepinephrine, and histamine-1-which play a strong role in the cause of extrapyramidal side effects (EPS).
typical antipsychotic s/e Hyperprolactinemia= amenorrhea in woman and galactorrhea in men and gynecomastia. Blurred vision, dry mouth, constipation, urinary hesitancy. Memory impairment Orthostatic hypotension Sexual s/e Tardive Dyskinesia Neuroleptic Malignant Syndrom
Atypical s/e Metabolic syndrome: This is an increase in weight, blood glucose, and triglycerides. Tardive Dyskinesia
PTSD assessment tools Can utilize screening tools such as the PTSD checklist or the Primary Care PTSD Screen.
Disruptive Mood Dysregulation Disorder r/t children and adolescents ages of 6 -18.- behavioral /emotional responses that are out of proportion to the situation- mood between outbursts is noted to be irritable
Created by: arsho453