MOOD
What are the features of PHQ-9 Questionnaire?
Mood
Interest
Sleep
Guilt
Energy
Concentration
Appetite
Psychomotor Sx
Suicide
Medical and Psychiatric conditions that can Mimic Anxiety?
Medical Conditions: Arythmies, Angine, Hypo/Hyperthyroidism, Pheochromocytoma,MI,PE
Psychiatric conditions: Panic attacks, Social Phobia, OCD, Substance abuse anxiety disorder.
What is the first line treatment for Eating disorders?
CBT
What are the pharmacological treatment options for depression and what is the first line treatment for Major Depressive Disorder?
SSRIs- First line
SNRI:Venlafaxine,Duloxetine
Atypical anti depressants: Bupropion, Mirtazapine
Serotonin modulators: Trazodone
Tricyclic Antidepressants:Imipramine, Clomipramine.
Monoamine oxidase inhibitors: Phenelzine.
What is the age cut off for diagnosis of ADHD?
Symptoms have to be present before age 12 yrs
What are the medications that can cause depression?
Anti- Parkinsonism Medications
Beta blockers
Corticosteroids
Anti- psychotics.
Alcohol abuse.
What are common disorders associated with OCD?
Depression
Substance Abuse
How do we screen for eating disorders?
S-Do you make yourself Sick because you feel uncomfortably full?
C-Do you worry you have lost Control over how much you eat?
O-Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three-month period?
F-Do you believe yourself to be Fat when others say you are too thin?
F-Would you say that Food dominates your life?
How long do we treat with first line medication for depression to consider it as an appropriate trial?
6-12 weeks
What are the psychiatric co morbid conditions of ADHD?
Depression
Mania
Anxiety
Substance abuse disorder
Intermittent explosive disorder.
What are the features of Bipolar disorder?
D- Distractibility
I- Irresponsibility, Erratic behaviour
G-Grandiosoity
F- Flight of ideas
A- Increased activity
S- Sleep- decreased
T:Talkativeness
Duration: 1 week
What is the management of Panic Disorder?
Non Pharmacological:
CBT, Relaxation Training, Desensitization.
Pharmacological:
SSRIs,Benzos, Imipramine and MAOs.
What are the features of Avoidant restrictive food Disorders?
Avoiding or restricting food intake, which may be based upon lack of interest in food, the sensory characteristics of food, or a conditioned negative response associated with food intake following an aversive experience (eg, choking).The eating behavior leads to a persistent failure to meet nutritional and/or energy needs, manifested by at least one of the following:Clinically significant weight loss, or in children, poor growth or failure to achieve expected weight gain and or Nutritional deficiency.
The lack of food intake is not based on fear of gaining Wt.
What are the classes of medications with an example of each class that can be used to treat GAD?
SSRIs: Sertraline, Escitalopram, Citalopram
SNRIs: Venlafexine, Duloxetine
Anti anxiety agent: Buspirone
Benzodiazepines: Lorazepam
What are the risk factors for Suicide?
Previous suicidal attempt
Male gender
Age>65
Loss of support/ social isolation
Psychiatric illness
Chronic pain
Organized plan
Family history of suicide/mood Disorders
H/O physical or sexual abuse
What are the patient populations which are at increased risk of depression?
Lower socioeconomic groups
Immigrants
those who suffer from substance abuse
Chronic disease patients
Postpartum women
Chronic pain sufferers
How would you diagnose Adjustment Disorder?
Symptoms of Anxiety, Depression and irritability occurring within 3 months of a profound change in persons life that are not severe enough to fit into any other category.
How do you differentiate between Anorexia Nervosa and Bulimia Nervosa?
Based on BMI.
What are the Side effects of SSRIs?
Insomnia, Agitation, Drowsiness, Headache, Tremors, GI toxicity,Sexual dysfunction, QTc Prolongation.
What are the Clinical Manifestations of PTSD?
Traumatic Event
Intrusion Symptoms: unwanted thoughts, nightmares and flashbacks of the traumatic event
Avoidance: of stimuli associated with traumatic event.
Negative cognition and Mood: Depressed and they might blame themselves for the event
Arousal and reactivity changes: Irritability, aggressive behaviour, substance abuse.
Management plan for patient with depression?
Assess risk for suicide
Assess for need for hospitalization or close follow up which depends on severity of Sx,Psychotic features and Suicide risk
Medications, Psychotherapy and supported self management
Look for and diagnose other co morbid psychiatric conditions: Anxiety, BPD,PD.
What is the diagnostic criteria for generalized anxiety disorder?
B- Blank Mind
E- Easily fatigued
S-Sleep disturbance
K- Keyed up
I- Irritability
M- Muscle tension
Duration: 6 months, Multiple life circumstances are causing anxiety.
What are the criteria for hospitalization in patients with Anorexia Nervosa?
Pulse <40 beats/minute,Blood pressure <80/60 mmHg
Orthostatic changes in BP or Pulse
Cardiac dysrhythmia Cardiovascular, hepatic, or renal compromise
Marked dehydration
Serious medical complication of malnutrition (eg, electrolyte imbalance,hypoglycemia, or syncope)
Body mass index <14 kg/m2 or <70% ideal body weight
What are the specific indications for various pharmacological options in treatment for depression?
Sertraline- Elderly, least SE
Paroxetine- Avoided in pregnancy
Fluoxetine: Adolescent population
Mirtazapine: Appetite, Wt gain. Sleep
Trazodone: Highly sedating
Bupropion: Less sexual effects, no Wt gain. Avoid in seizures.
MAOI: atypical Sx
TCAs: Avoid in Elderly.
Diagnostic criteria for antisocial personality disorder?
A pattern of socially irresponsible ,exploitive and guiltless behaviour that begins in childhood or early adolescence and is manifested in many areas of life including family relations, work, schooling,laws, marriage.