Asociality not engaging with peers, little interest in sex

Schizophrenia types

Crazy People Hear Something

Catatonic unresponsive, fixed stupor

Paranoid often delusional, angry, jealous

Hebephrenic disintegration of personality, erratic speach

Simple disintegration of thinking process

Tricyclic Antidepressant (TCA) examples

ACID
Hallucinations: hypnogogic vs. hypnopompic definition "Hypnogogic
Amitriptyline
= go to sleep":
Hypnogogic hallucinations arise when go to sleep, hypnopompic arise
Clomipramine
when awaken.
Imipramine

Schizophrenia negative symptoms Dosulepin

The six As
Side-effects: anticholinergic symptoms involving eyes (blurred vision),
Affective flattening unchanging facial expression, reduced movement, mouth (dry mouth), bladder (urinary retention) and bowels (constipation)
poor eye contact

Alogia poverty of speech, thought block, delayed response

Anergia loss of energy

Anhedonia loss of interest in things/sex/relationships

Apathy poor hygiene, lack of interest

 ANxIOUS Posttraumatic stress disorder
TRAUMA5
Avoidance of social interaction fear of criticism/rejection Traumatic event
Re-experience
Need for physical security which places restrictions in life
Avoidance
Insecure belief that one is socially inept/unappealing Unable to function
Ostracised, worried about Month or more of symptoms
Arousal increased
Unwilling to be involved unless certain of being liked
Socially inept (beliefs of such)
Phobia symptoms

Generalized anxiety disorder FEAR

WATCHERS4 Fear of a specific object or situation
Worry
Anxiety Evasion of said fear
Tension in muscles
Anticipation anxiety e.g. if knows will be exposed to phobia
Concentration difficulty
Hyperarousal (or irritability) Restlessness and anxiety when exposed
Energy loss
Restlessness Dementia: main causes VITAMIN D VEST:
Sleep disturbance Vitamin deficiency (B12, folate, thiamine)
Intracranial tumour
Anxiety disorders: physical illnesses mimicking them "Physical Trauma (head injury)
Health Hazards That Appear Panciky": Anoxia
Phaeochromocytoma Metabolic (diabetes)
Hyperthyroidism Infection (postencephalitis, HIV)
Hypoglycaemia Normal pressure hydrocephalus
Temporal lobe epilepsy Degenerative (Alzheimer's, Huntington's, CJD, etc)
Alcohol Vascular (multi infarct dementia)
Paroxysmal arrhythmias Endocrine (hypothyroid)
Space occupying lesion (chronic subdural haematoma)
Toxic (alcohol)
Mania: cardinal symptoms DIG FAST: DIAGNOSING ADDICTION DISORDERS
Distractibility
Substance dependence: features (DSM IV) "WITHDraw
Indiscretion (DSM-IV's "excessive involvement in pleasurable activities")
IT":
Grandiosity
3 of 7 within 12 month period:
Flight of ideas
Withdrawal
Activity increase
Interest or Important activities given up or reduced
Sleep deficit (decreased need for sleep)
Tolerance
Talkativeness (pressured speech)
Harm to physical and psychosocial known but continue to use
Mania: diagnostic criteria Must have 3 of MANIAC: Desire to cut down, control
Mouth (pressure of speech)/ Moodl Intended time, amount exceeded
Activity increased Time spent too much
Naughty (disinhibition)
Substance abuse
Insomnia
WILD12
Attention (distractability)
Work, school, or home role obligation failures
Confidence (grandiose ideas)
Interpersonal or social consequences
Hypomania Legal problems
Dangerous use
TAD HIGH
Alcohol abuse
Talkative
CAGE13
Attention deficit Have you ever felt you should CUT DOWN your drinking?

Decrease need ofr sleep Have people ANNOYED you by criticizing your drinking?

High self-esteem/grandiosity Have you ever felt bad or GUILTYabout your drinking?

Ideas that race Have you ever had a drink first thing in the morning to steady your nerves
or get rid of a hangover (EYE-OPENER)?
Goal-directed activity increased

High-risk activity
Depression: major episode DSM-IV criteria First, of course Hyper/hypothermia
depressed mood is one. Then: Intracranial process/infection
SIG E CAPS: Metabolic/meningitis
Sleep disturbance Poisons
Interest loss Status epilepticus
Guilt (or intense worthlessness)
Energy loss
Concentration loss
Appetite changes
Psychomotor agitation or retardation Deliriogenic medications
Suicidal tendency ACUTE CHANGE IN MS14
Antibiotics
Cardiac drugs
Urinary incontinence drugs
DIAGNOSING DELIRIUM
Theophylline
Causes Ethanol
I WATCH DEATH Corticosteroids
Infection H2 blockers
Withdrawal Antiparkinsonian drugs
Acute metabolic Narcotics
Trauma Geriatric psychiatric drugs
CNS pathology ENT drugs
Hypoxia Insomnia drugs
Deficiencies NSAIDs
Endocrinopathies Muscle relaxants
Acute vascular Seizure medicines
Toxins or drugs
Heavy metals

Life-threatening causes
WWHHHHIMPS*
Wernickes encephalopathy
Withdrawal
Hypertensive crisis
Hypoperfusion/hypoxia of the brain
Hypoglycemia
Male erectile dysfunction (MED): biological causes MED: DIAGNOSING PERSONALITY DISORDERS
Medicines(propranalol, methyldopa, SSRI, etc.)
Ethanol
Diabetes mellitus Cluster personality disorders Cluster A Disorder =
Atypical. Unusual and eccentric.
Male Erectile Dysfunction (MED): drugs causing it "STOP
Cluster B Disorder = Beast. Uncontrolled wildness.
erection":
Cluster C Disorder = Coward [avoidant type], Compulsive
SSRI (fluoxtine)
[obsessive-compulsive type], or Clingy [dependent type].
Thioridazone
methyldOpa Paranoid personality disorder
Propranalol SUSPECT9
Spousal infidelity suspected
Unforgiving (bears grudges)
Parasomnias: time of onset SLeep terrors and SLeepwalking Suspicious
occur during SLow-wave sleep (stages 3 & 4). Perceives attacks (and reacts quickly)
NightmaRE occurs during REM sleep (and is REMembered). Enemy or friend? (suspects associates and friends)
Confiding in others is feared
Autistic disorder: features AUTISTICS:
Threats perceived in benign events
Again and again (repetitive behavior)
Unusual Abilities Schizotypal personality disorder
Talking (language) delay ME PECULIAR9
IQ subnormal Magical thinking
Social development poor Experiences unusual perceptions
Three years onset Paranoid ideation
Inherited component [35% concordance] Eccentric behavior or appearance
Cognitive impairment Constricted or inappropriate affect
Self injury Unusual thinking or speech
Lacks close friends
Ideas of reference
Anxiety in social situations
Rule out psychotic or pervasive developmental disorders
Schizoid Attention (need to be the center of)
Influenced easily
DISTANT (4)
Style of speech (impressionistic, lacking detail)
Detached/flattened affect
Emotions (rapidly shifting, shallow)
Indifferent to criticism or praise
Make up (physical appearance used to draw attention to self)
Sexual interests of little interest
Emotions exaggerated
Tasks done solitarily
Absence of close friends Histrionic personality disorder
Neither desires or enjoys close relationships ACTRESSS*
Takes pleasure in few activities Appearance focused
Center of attention
Theatrical
Borderline personality disorder Relationships (believed to be more intimate than they are)
IMPULSIVE10 Easily influenced
Impulsive Seductive behavior
Moodiness Shallow emotions
Paranoia or dissociation under stress Speech (impressionistic and vague)
Unstable self-image
Narcissistic personality disorder
Labile intense relationships
GRANDIOSE11
Suicidal gestures
Grandiose
Inappropriate anger
Requires attention
Vulnerability to abandonment
Arrogant
Emptiness (feelings of)
Need to be special
Borderline personality: traits PRAISE: Dreams of success and power
Paranoid ideas Interpersonally exploitative
Relationship instability Others (unable to recognize feelings/needs of)
Affective instability/ Abandonment fears/ Angry outbursts Sense of entitlement
Impulsiveness/ Identity disturbance Envious
Suicidal behaviour/ Self-harming behaviour
Emptiness

Histrionic personality disorder

PRAISE ME9
Provocative or seductive behavior
Avoidant personality disorder
Relationships considered more intimate than they are
CRINGES9
Criticism or rejection preoccupies thoughts in social situations
Restraint in relationships due to fear of shame
Inhibited in new relationships
Needs to be sure of being liked before engaging socially
Gets around occupational activities with need for interpersonal contact
Embarrassment prevents new activity or taking risks
Self viewed as unappealing or inferior
Dependent personality disorder
RELIANCE9
Reassurance required
Expressing disagreement difficult
Life responsibilities assumed by others
Initiating projects difficult
Alone (feels helpless and uncomfortable when alone)
Nurturance (goes to excessive lengths to obtain)
Companionship sought urgently when a relationship ends
Exaggerated fears of being left to care for self
Dependent personality disorder features
RELIANT
Relies on others to make important decisions (needing reassurance)
Encourages others to make decisions
Limited capacity themselves to make decisions (about life responsibilities)
Inability to care for oneself (fears of such) so are uncomfortable alone
Abandonment fears of caring for oneself
Needs of others put first and unduly compliant with others requests
Tolerance inability to disagree with others
Dissocial (antisocial) personality disorder features
CORRUPT Blame
Callous unconcern for the feelings of other
Obligations (social) and rules ignored
Remorse lacking (no empathy)
Relationships unable to be maintained (although can often be started)
Underhanded deceitful, lying and manipulative although can have
superficial charm
Punishment does not yield benefit unable to profit from punishment
Temper low tolerance to frustration and low threshold for anger
Blames others or attempts to offer rational explanations for behaviour
Obsessive-compulsive disorder diagnosis
TORE (for obsessional symptoms)
Thought or act resisted unsuccessfully
Own thoughts in the patients mind (i.e. not psychotic)
Repetitive and unpleasant obsessions (thoughts, images or impulses)
Ego-dystonic the patient does not enjoy these thoughts and finds them
distressing
ICD-10 criteria. Obsessional symptoms or compulsive acts (or both) present
on most days of the week for longer than 2 weeks. There needs to be
associated distress or interference with activities as a result.
Obsessive-compulsive personality disorder
SCRIMPER*
Stubborn
Cannot discard worthless objects Serotonin syndrome
Rule obsessed HARMED
Inflexible Hyperthermia
Miserly Autonomic instability
Perfectionistic Rigidity
Excludes leisure due to devotion to work Myoclonus
Reluctant to delegate to others Encephalopathy
Diaphoresis

Kubler-Ross dying process: stages "Death Always

DIAGNOSING MEDICATION ADVERSE EFFECTS
Brings Great Acceptance":
Denial
Anger
Antidepressant discontinuation syndrome Bargaining
FINISH7 Grieving
Flu-like symptoms Acceptance
Insomnia
Nausea
Imbalance
Anorexia nervosa features
Sensory disturbances
Hyperarousal (anxiety/agitation) Low FAT

Neuroleptic malignant syndrome Low weight (BMI <17.5 kg/m2)

FEVER8
Fear of weight gain/increasing
Fever
Encephalopathy Amenorrhoea
Vital sign instability
Elevated WBC/CPK Thin aspirations (desire to be thin)
Rigidity
WBC: white blood cell count
CPK: creatine phosphokinase

Assessing suicidal attempts

PPM PAIN HRU

Precipitating factors e.g. stress, divorce, death

Planning of suicide act

Method used e.g. overdose, hanging

Precaution against discovery e.g. locked doors, driven far away

Alone were they alone or were people nearby?

Intoxication e.g. alcohol or other substances

Note was a suicide note left?

Help sought afterwards? Who phoned ambulance

patient/relative/friend?

Regret about the act?

Understanding what did he understand by the attempt e.g. did he think

20 tablets would end his life?

Other pointers:

Always ask about symptoms of depression/psychosis

Will they be returning home to the same situation?

What are his thoughts about the future?

Any suicide thoughts still ongoing i.e. are they still actively suicidal after an
attempt?