Psychiatry Notes
Top more important than the ones below:
• Organic: thyroid disorder, derlirium, dementia, substances
• Psychotic disorders: first episode of psychosis, schizophreniform, schizophrenia,
schizoaffective
• Mood: Major depressive episode, Bipolar I and II, dysthymia (PDD), cylothymia,
disruptive mood dysregulation, premenstrual, reactive, grief
• Anxiety: panic disorder, generalized anxiety, specific phoba, acute stress, post-
traumatic stress
• Personality: Cluster A, B, C (borderline) and somatoform related disorder
Studying psychiatric disease:
• DSM V criteria: write down the criteria and LEARN how to ASK questions
• Learn to explain disease (bio-pscyho-social dramework)
When studying management for each disease:
• Need to know the theory Like Y3
• Need to know how to explain management
OSCE stations Plausible:
• Differential diagnosis or risk assessment
• Examination (MSE, mini-mental)
• Explanation (disease counseling, drug counseling, psychotherapy counseling)
• CONFIRM MEDICAL POWER OF ATTORNEY FOR ALL DEMENTED PATIENTS!
• Always SIDESTEP questions where patient ask you if you believe them. Do
NOT lie to patients. Howver, SIDESTEP it by saying: I would have to ask
you more questions and conduct a full work up before I can be
sure
TIPS for OSCE
• Be patient centered and not focused on your question only
• Have more open questions
• You get marked for asking open questions and how you change to fit the
situation
• Mangement:
o ALWAYS MAKE in IMMEDIATE, SHORT TERM, LONG TERM
Note that thyroxine, aripiprazole and other antipsychotics in standard
dosing can augment the SSRI antidepressant activity, especially for
female patients for which pharmacotherapy has yet to be very effective.
Management Plan:
• Investigations:
o Urine: urine drug screen/toxicology, Urine MCS
o ECG
o Bloods: FBE, UEC, LFT, TFT, CMP, Fasting glucose, fasting lipids,
blood cultures, CRP, Blood alcohol concentraion
o Imaging: CXR, head CT/MRI, EEG
• Immediate:
o Inpatient vs outpatient
o Voluntary vs involuntary
o Request collateral history if possible
o Need for further investigations?
o Treatment
§ Interventional (ECT)
, § Pharmacological
§ Other (fixation of fractures, removal of bullet, cleaning of sores,
wounds from neglect)
• Short term (within current admission)
o Regular clinical reviews
o Serial risk assessments
o Collateral history from relatives
o Review other medical/social issues
o Plan for discharge
§ Optimize social situation
§ Arrange F/U
§ Ensure therapeutic durg levels maintained
§ Appropriate multidisciplinary referrals
• Long term
o Multi disciplinary care
o Involve family members + psychoeducation
o Always consider other health aspects such as exercise, diet, smoking,
alcohol, weight, sleep hygiene
o Biopsychosocial approach
§ Biological: manage comorbidities, monitor drug levels + S/E
§ Psychological: psychotherapy + psychoeducation
• Identify triggers for relapse and manage risk
§ Social:
• Family + group therapy
• Social skills training
• Support groups
• Employment + reintegration into community
• Support structure in place
General adaptation syndrome
Alarm stage has the decrease in resistance to stress
Bimodal disease:
1. Crohn
2. Schizophrenia
3. Myasthenia Gravis
4. Hodgkin lymphoma
5. Guillain barre
6. Polyarticular JIA
Axis 2 conditions: personality disorders and neurocognitive developmental delay
• Use mood stabilizers and antipsychotics at times
Tips on taking Psych consult:
• Ask patients about their substane use will help you avoid complications of alcohol
withdrawal
• Remember to do a risk assessment
• Ask patient about mental health history, ask if they are happy to see psychiatry
, • Speak to patient’s GP: request health summary and copies of relevant
correspondence
• Find out who else is involved (public and private)
• Get copy of most recent psychiatric discharge summary
Drug Counselling
Drug counseling
• Introduction
• Mechanism of action
• How to take it (before, during, after)
• Benefits
• Side-effects
• Drug-drug interactions
• Compliance/adherence
• Alternatives
Developmental history
1. What was your mother like?
2. How was your relationship with her?
3. What was your father like?
4. How was your relationship with him?
5. Did you ever suffer from any abuse?
, Neurobiology of mental illness
• A multilevel approach:
o Experience (observations)
o Mind/brain (correlation, subjective vs objective)
§ If no brain, there is no mind and works together
o Microscopic level
§ Circuits
§ Cells
§ Membranes
§ Moleules
§ Genes
Neuroanatomy
• Prefrontal cortex and executive function:
o Dorsolateral: hypoactivity linkd with schizophrenia
o Orbitolateral: impulse control/ affectve value of reinforcers, decision making
and expectation
o Generalised: dementia
• Limbic system and emotions:
o Amygdala: fear (has input and output to all areas, when you have
dysfunction, you may have sensory input but not emotional component)
§ Larger amygdala linked with higher anxiety (basolateral amygdala)
o Hippocampus: working memory (processing speed)
§ Some cognitive impairment
Top more important than the ones below:
• Organic: thyroid disorder, derlirium, dementia, substances
• Psychotic disorders: first episode of psychosis, schizophreniform, schizophrenia,
schizoaffective
• Mood: Major depressive episode, Bipolar I and II, dysthymia (PDD), cylothymia,
disruptive mood dysregulation, premenstrual, reactive, grief
• Anxiety: panic disorder, generalized anxiety, specific phoba, acute stress, post-
traumatic stress
• Personality: Cluster A, B, C (borderline) and somatoform related disorder
Studying psychiatric disease:
• DSM V criteria: write down the criteria and LEARN how to ASK questions
• Learn to explain disease (bio-pscyho-social dramework)
When studying management for each disease:
• Need to know the theory Like Y3
• Need to know how to explain management
OSCE stations Plausible:
• Differential diagnosis or risk assessment
• Examination (MSE, mini-mental)
• Explanation (disease counseling, drug counseling, psychotherapy counseling)
• CONFIRM MEDICAL POWER OF ATTORNEY FOR ALL DEMENTED PATIENTS!
• Always SIDESTEP questions where patient ask you if you believe them. Do
NOT lie to patients. Howver, SIDESTEP it by saying: I would have to ask
you more questions and conduct a full work up before I can be
sure
TIPS for OSCE
• Be patient centered and not focused on your question only
• Have more open questions
• You get marked for asking open questions and how you change to fit the
situation
• Mangement:
o ALWAYS MAKE in IMMEDIATE, SHORT TERM, LONG TERM
Note that thyroxine, aripiprazole and other antipsychotics in standard
dosing can augment the SSRI antidepressant activity, especially for
female patients for which pharmacotherapy has yet to be very effective.
Management Plan:
• Investigations:
o Urine: urine drug screen/toxicology, Urine MCS
o ECG
o Bloods: FBE, UEC, LFT, TFT, CMP, Fasting glucose, fasting lipids,
blood cultures, CRP, Blood alcohol concentraion
o Imaging: CXR, head CT/MRI, EEG
• Immediate:
o Inpatient vs outpatient
o Voluntary vs involuntary
o Request collateral history if possible
o Need for further investigations?
o Treatment
§ Interventional (ECT)
, § Pharmacological
§ Other (fixation of fractures, removal of bullet, cleaning of sores,
wounds from neglect)
• Short term (within current admission)
o Regular clinical reviews
o Serial risk assessments
o Collateral history from relatives
o Review other medical/social issues
o Plan for discharge
§ Optimize social situation
§ Arrange F/U
§ Ensure therapeutic durg levels maintained
§ Appropriate multidisciplinary referrals
• Long term
o Multi disciplinary care
o Involve family members + psychoeducation
o Always consider other health aspects such as exercise, diet, smoking,
alcohol, weight, sleep hygiene
o Biopsychosocial approach
§ Biological: manage comorbidities, monitor drug levels + S/E
§ Psychological: psychotherapy + psychoeducation
• Identify triggers for relapse and manage risk
§ Social:
• Family + group therapy
• Social skills training
• Support groups
• Employment + reintegration into community
• Support structure in place
General adaptation syndrome
Alarm stage has the decrease in resistance to stress
Bimodal disease:
1. Crohn
2. Schizophrenia
3. Myasthenia Gravis
4. Hodgkin lymphoma
5. Guillain barre
6. Polyarticular JIA
Axis 2 conditions: personality disorders and neurocognitive developmental delay
• Use mood stabilizers and antipsychotics at times
Tips on taking Psych consult:
• Ask patients about their substane use will help you avoid complications of alcohol
withdrawal
• Remember to do a risk assessment
• Ask patient about mental health history, ask if they are happy to see psychiatry
, • Speak to patient’s GP: request health summary and copies of relevant
correspondence
• Find out who else is involved (public and private)
• Get copy of most recent psychiatric discharge summary
Drug Counselling
Drug counseling
• Introduction
• Mechanism of action
• How to take it (before, during, after)
• Benefits
• Side-effects
• Drug-drug interactions
• Compliance/adherence
• Alternatives
Developmental history
1. What was your mother like?
2. How was your relationship with her?
3. What was your father like?
4. How was your relationship with him?
5. Did you ever suffer from any abuse?
, Neurobiology of mental illness
• A multilevel approach:
o Experience (observations)
o Mind/brain (correlation, subjective vs objective)
§ If no brain, there is no mind and works together
o Microscopic level
§ Circuits
§ Cells
§ Membranes
§ Moleules
§ Genes
Neuroanatomy
• Prefrontal cortex and executive function:
o Dorsolateral: hypoactivity linkd with schizophrenia
o Orbitolateral: impulse control/ affectve value of reinforcers, decision making
and expectation
o Generalised: dementia
• Limbic system and emotions:
o Amygdala: fear (has input and output to all areas, when you have
dysfunction, you may have sensory input but not emotional component)
§ Larger amygdala linked with higher anxiety (basolateral amygdala)
o Hippocampus: working memory (processing speed)
§ Some cognitive impairment
