Psychiatry Assessment Techniques

Psychiatric Assessment and Disorders

• PTSD and mood disorders can complicate diagnosis; tools like the Minnesota Multiphasic Personality Inventory are useful.
• Social anxiety disorder risk factors include having a parent with an anxiety disorder.
• Night terrors are characterized by fear during sleep, often without recall upon waking.
• Panic disorder often co-occurs with agoraphobia, leading to avoidance of places where panic attacks may occur.

Anxiety Disorders and Treatments

• Exposure therapy is effective for specific phobias; one-session exposure can be a time-efficient method.
• Generalized anxiety disorder features excessive worry and physical symptoms, but is differentiated from panic disorder which involves acute episodes of intense fear.
• Cognitive restructuring combined with exposure therapy is a key treatment for social anxiety disorder.

Physiological Symptoms and Diagnosis

• Hyperventilation syndrome presents with symptoms like rapid breathing and tetany; often misinterpreted as cardiac issues.
• Cardiac evaluations such as ECG are essential before changing medications, especially for patients with a history of panic disorders and familial heart issues.
• Obstructive sleep apnea (OSA) treatment includes lifestyle changes and CPAP, especially for patients with significant AHI scores.

Substance Use and Management

• Chlordiazepoxide is the first-line treatment for alcohol withdrawal due to its safety profile in tapering procedures.
• Naltrexone helps reduce cravings but is ineffective for immediate withdrawal symptoms.
• Disulfiram induces adverse reactions when alcohol is consumed, necessitating careful patient selection.

Other Notable Conditions and Treatments

• Serotonin syndrome requires prompt treatment like cyproheptadine to alleviate hypertensive symptoms.
• Malignant hyperthermia, characterized by elevated temperature and muscle rigidity, is managed with dantrolene.
• Amphetamine toxicity showcases severe anxiety and physical symptoms like tachycardia and can escalate to seizures.

Epidemiology and Risks

• Anxiety disorders have a 33.7% prevalence in the adult population over a lifetime and are associated with high suicide risk.
• Conditions are more common in females and often present with comorbid disorders.

Terminology Definitions

• Agoraphobia: Anxiety over being in situations where escape might be difficult, usually accompanied by panic attacks.
• Social anxiety disorder: Fear of judgment or embarrassment in social situations, leading to avoidance behaviors.
• Selective mutism: A childhood disorder where a child does not speak in certain social settings despite being able to communicate in familiar environments.### Olanzapine Treatment Monitoring
• Monitor lipid profile due to potential weight gain and metabolic effects associated with olanzapine usage.

Antisocial Personality Disorder

• Characterized by lack of remorse, disregard for societal norms, and impulsivity.
• Commonly shows irritability, aggressiveness, and a pattern of deceitfulness.

Prognostic Factors in Schizophrenia

• Blunted or flat affect is considered a poor prognostic indicator in schizophrenia.

Neurocognitive Disorder Sleep Disturbances

• Decreased slow-wave sleep is commonly observed in patients with neurocognitive disorders.
• Overall sleep disturbances include increased fragmentation and decreased total sleep time.

Treatment Options for Depression

• Electroconvulsive therapy (ECT) is beneficial for severe depressive symptoms, particularly in cases unresponsive to medications.
• Mirtazapine, an alpha-2-adrenergic receptor antagonist, may be effective in treating depression but can also affect sleep.

Bright Light Therapy for Seasonal Affective Disorder

• Sessions should ideally occur in the morning for effective treatment of seasonal affective disorder.
• Phototherapy involves exposure to light at a minimum intensity of 10,000 lux over 30-90 minutes.

Screening and Assessment Recommendations

• Conduct suicide screening, especially in older adults experiencing grief and loss.
• In pediatric populations with special educational needs, healthcare providers should actively participate in the Individualized Education Program (IEP) meetings.

Substance Use and STIs

• Screen individuals who share needles for HIV and hepatitis B due to high-risk behaviors.

Drug Interactions and Pharmacokinetics

• St. John’s Wort may decrease the efficacy of oral contraceptives and should be monitored in patients using both.
• Atomoxetine levels may be increased by concurrent antidepressant therapies that inhibit CYP 2D6.

Major Depressive Disorder Characteristics

• Symptoms include depressed mood, sleep disturbances, weight changes, and suicidal ideation.
• Effective pharmacotherapy options include Bupropion, which is less likely to affect sexual function compared to SSRIs.

Risks of Antiepileptic Drugs during Pregnancy

• Carbamazepine can cause craniofacial and neural tube defects in neonates if taken during pregnancy, making valproate a safer alternative for women planning pregnancy.

Common Side Effects of Carbamazepine

• Includes nausea, vomiting, drowsiness, diplopia, blurred vision, and ataxia.### Hematological and Dermatological Side Effects
• Mild anemia, leukopenia, and thrombocytopenia are common hematological side effects of certain treatments.
• Electrolyte disturbances, including hyponatremia, are often observed.
• Hepatotoxicity may also occur, posing risks to liver function.
• Development of a rash within the first 6 months can indicate serious dermatological reactions, such as Stevens-Johnson syndrome (SJS), prompting potential discontinuation of medication.

Premenstrual Dysphoric Disorder (PMDD)

• PMDD is characterized by severe mood swings, irritability, and distress beginning before menstruation, affecting personal and professional life.
• Oophorectomy with hormone replacement therapy may effectively treat PMDD.
• SSRIs are established as the gold-standard pharmacological treatment for PMDD.
• SSRIs show a rapid onset of action within hours to days, allowing for intermittent dosing.

Neurological Assessment

• Signs of subcortical arteriosclerotic encephalopathy include dysmnesia, dysexecutive syndrome, slowness, and apathy.
• Patients may exhibit a "frontal" or "magnetic" gait and pseudobulbar palsy due to damage along corticobulbar tracts.
• Brain damage in related conditions is most likely present in the periventricular white matter.

Antipsychotic Management

• Aripiprazole is identified as a partial D2 receptor agonist among common antipsychotics.

Cognitive Behavioral Therapy (CBT)

• The initial step in CBT for conditions like generalized anxiety disorder involves educating patients about symptoms, treatment processes, and goal setting.

Wernicke-Korsakoff Syndrome

• Characterized by specific ocular changes (e.g., abducens nerve paralysis, nystagmus), this syndrome is associated with heavy alcohol use and thiamine deficiency.

Personality Disorders

• Dependent personality disorder is marked by excessive reliance on others for emotional support and decision-making.
• Behavior indicative of this disorder includes seeking approval and prioritizing others' needs over one’s own.

Diagnosis in Depressive Disorders

• Generalized anxiety disorder can coexist with alcohol use disorder; identifying comorbid conditions is crucial for proper diagnosis.
• Major depressive disorder with postpartum onset requires symptom onset within four weeks of delivery.
• Other Specified Depressive Disorder-Recurrent brief depression involves depressive symptoms occurring for 2-13 days at least once per month over a year.

Down's Syndrome Complications

• Infants with Down's syndrome are at risk of duodenal atresia, presenting in early life with severe emesis.
• Common clinical features include short palpebral fissures, macroglossia, hypotonia, and various organ abnormalities.

Substance Use Disorders

• Sniffing glue can lead to the detection of hippuric acid in urinalysis, indicating toluene use.
• Cocaine metabolite, benzoylecgonine, is associated with cocaine use.

Delusional Disorder

• Occurrence of one or more delusions lasting over a month is classified as a delusional disorder with specific subtypes, such as somatic type.
• Symptoms do not significantly impair functioning and behavior remains relatively normal aside from delusions.

Formication

• Formication is the sensation of insects crawling on or under the skin, often linked with certain psychiatric conditions.

This quiz focuses on various psychological assessment instruments used in psychiatry. It evaluates your knowledge of different diagnostic tools that may assist in refining a diagnosis for patients with mood disorders and PTSD. Test your understanding of these essential evaluation methods.