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Acute Stress Reaction
Management Help with the removal of any ongoing traumatic event. For example, practical assistance with finding safe accommodation if necessary or protecting against further loss (possessions, job) Discussion about what happened during the traumatic event: e.g., what was seen, how the individual acted or felt, or what he or she…
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Adjustment Disorder
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Adult survivors of child abuse
2. Health Consequences of Childhood Abuse 3. Survival Mechanisms and Behavioral Adaptations Emotional Dysregulation: 4. Risk of Revictimization and Additional Trauma 5. Protective Factors for Resilience 6. Prevalence and Vulnerable Populations 7. General Practice Presentations Complex Trauma and Patient Presentation Understanding trauma-related behaviors through this lens reduces stigma and allows…
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Anorexia
Specify whether: Restricting type: Binge-eating/purging type: Specify current severity: Assessment: Examination Alert parameters include: Management Once DISCHARGED Prognosis
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Antidepressant Selcetion
Introduction Lifestyle Factors and Interventions for Depression Potential lifestyle risk factors Interventions Poor sleep pattern Encourage good sleep hygiene – regular bedtime and wake up time, bed is for sleep and not for other activities (TV, social media). There are useful apps that provide basic psychoeducation and a sleep diary.…
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Anxiety
Fear Anxiety DSM-IV Anxiety Disorders ANXIETY DISORDER TYPE CLINICAL FEATURES MANAGEMENT 1. PANIC ATTACK •Abrupt onset•A discrete period of intense fear of discomfort•Rapid onset <10mins•last no more than 15mins STUDENTS FEAR the 3 C’sS – SweatingT – TremblingU – Unsteadiness, dizzinessD – Depersonalization, derealizationE – Excessive heart rate, palpitationsN – NauseaT – TinglingS – Shortness of breathFEAR of dyingFEAR of…
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Bipolar Disorders
Epidemiology Onset Prognosis COURSE & PROGNOSIS: With DDx, always think: Bipolar I Disorder Bipolar II Disorder MANIC EPISODE Hypomanic Episode Mixed Features DEPRESSIVE EPISODES: Mental state Exam Depression Mania Appearance & Behaviour: generalised psychomotor retardation is the most common Sx (although ψ-motor agitation is seen, esp. in elderly 🡪 agitation…
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Bulimia Nervosa
Associated Features Management Prognosis
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Bullying in Children and Adolescents (Peer and Sibling)
from – https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/abuse-and-violence/children-and-young-people/sibling-and-peer-bullying General Overview Clinical Practice Recommendations Definitions and Characteristics of Bullying Sibling Bullying vs. Rivalry Prevalence Risk Factors Table 10.1 Risk factors for peer and sibling bullying Risk factors Bullying Peer Reference Sibling Reference Individual Physical (eg overweight, disability, chronic illness) Moderate association 65–68 …
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Challenging Behaviours
gathered from – Ten things I wish you knew about your child’s mental health – Dr Billy Garvey Understanding Behavioural Difficulties: Addressing Behavioural Issues: Long-Term Impact of Emotional Difficulties: Understanding and Addressing Behavioural Issues Role of Paediatrician as a Detective: Behaviour as Communication: Identifying Triggers and Patterns: The Volcano Analogy:…
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Dating Violence
Dating Violence as a Public Health Issue: Health and Behavioral Presentations: Gender Dynamics: Technology-Facilitated Abuse: Supportive Care Pathways: Clinical Context and Identification in General Practice Technology-Facilitated Abuse In Practice: Identification and Case-Finding Managing Privacy and Safety in Telehealth Practical Tips for GPs
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Depression (kids)
Presentation MDD symptoms How symptoms may present in a child Depressed mood Irritable, temper outburst, cranky, unhappy, miserable Anhedonia/lack of interest Loss of interest in pleasurable activities (eg does not want to see friends, do usual activities) Somatic symptoms Stomach ache, headache, musculoskeletal pain, fatigue Sleep disturbance Change in sleep…
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Eating Disorders
DSM-5 Classification: Epidemiology common comorbidities: Aetiology Risk Factors History and Physical Specific Disorders History Identifying Abnormal Thinking about Weight, Body Image, Diet, and Exercise: Family and Social History: Menstrual History: Additional History: Examination Pubertal Development: Signs of Recurrent Vomiting/Purging: Mental Health: Other Features of Severe Malnutrition: Treatment / Management Prognosis…
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Enuresis (bed wetting)
Enuresis Overview: types Epidemiology: Associated Conditions: Pathophysiology: History Much of the history should focus on voiding habits Examination Evaluation: Treatment/Management: Pharmacological Therapy Desmopressin: MinirinTM melt/tablet DOSING: Intranasal route is not recommended due to higher risk of hyponatraemia Prognosis: Complications: Consider referral to a general paediatrician or continence service when
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Gender dysphoria
from – AFP > 2015 > November > Gender dysphoria Volume 44, Issue 11, November 2015 Gender Dysphoria and Transgender Care: definitions Gender Sex Sex Characteristics Sexual Orientation Trans and Cis Innate Variations of Sex Characteristics Objectives for General Practitioners (GPs): Initial Consultation and Diagnostic Approach: Risk and Support Assessment: Physical Examination: Differential Diagnosis: Investigations: Management…
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Generalised Anxiety Disorder
Risk Factors Symptoms BE-SKIM DDx Assessment Complications: Management: The evidence does not support the routine combination of CBT and Pharmacotherapy, but when patients do not benefit from CBT, a trial of pharmacotherapy is advisable, and vice versa. Medication 1st line Monotherapy: agomelatine, duloxetine, escitalopram, paroxetine, paroxetine CR, pregabalin, sertraline, venlafaxine…
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Major Depressive Disorder (MDD)
EPIDEMIOLOGY Prognosis having a longer duration of depression before initiation of Tx → these pts may benefit from long-term antidepressant Tx Risk factors DSM-IV-TR for Major Depressive Episode (SADAFACES) S – sleep (insomnia esp. terminal or hypersomnia) A – anhedonia (loss of interest/pleasure in all activities most of the day)…
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Major Medication adverse reactions and toxicities
Neuroleptic Malignant Syndrome (NMS) 2. Serotonin Syndrome 3. Lithium Toxicity 4. QT Prolongation 5. Hepatotoxicity 6. Rhabdomyolysis 7. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) 8. Agranulocytosis 9. Neutropenia 10. Thrombocytopenia 11. Acute Kidney Injury (AKI) 12. Ototoxicity 13. Hyponatremia 14. Hyperglycemia 15. Hyperkalemia 16. Angioedema 17. Anaphylaxis
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Medications in Psychiatry
1. Antidepressants SSRIs (Selective Serotonin Reuptake Inhibitors) SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) Tricyclic Antidepressants (TCAs) 2. Antipsychotics Typical Antipsychotics Atypical Antipsychotics 3. Mood Stabilizers Lithium Valproate (Valproic Acid) 4. Anxiolytics Benzodiazepines 5. Stimulants Used primarily for ADHD
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Mental Health in Kids
In 2013–14, children living: Signs of mental health problems in children
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Mental health problems in pregnancy
Risk factors for perinatal depression Antidepressant use during pregnancy b Potential benefits and harms to the patient and fetus associated with psychotropic use during pregnancy [NB1] [NB2] Fetus Patient Potential harms of psychotropic use miscarriagefetal death in utero stillbirthpreterm birthcongenital abnormality [NB3]growth restrictionpoor neonatal adaptationlong-term neurodevelopmental effects [NB4] stress…
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Mood Disorders
ELEVATED MOOD DEPRESSED MOOD expansivenessflight of ideasdecreased sleepheightened self-esteemgrandiose ideas loss of energy & interestguilt feelingsdifficulty concentratingloss of appetite thoughts of death/suicide MOOD DISORDER FEATURES Major Depressive Disorder (Unipolar depression) only major depressive episodes (at least 2/52) Bipolar disorder both manic & depressive episodes or if mania alone (mania alone also…
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Mood Disorders in Children and Adolescents
MAJOR DEPRESSIVE DISORDER lifetime prevalence DISRUPTIVE MOOD DYSREGULATION DISORDER BIPOLAR DISORDER Anxiety Disorders in Children and Adolescents SEPARATION ANXIETY DISORDER SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA) SELECTIVE MUTISM GENERALIZED ANXIETY DISORDER SPECIFIC PHOBIA OCD Oppositional Defiant Disorder Conduct Disorder
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Obsessive-compulsive disorder (OCD)
Risk Factors pts experience either Obsessions Common Obsessions Descriptions/Examples Contamination Concerns about dirt, germs, body waste, illness Symmetry Needing things “just so”, even, or lined up a certain arbitrary way Aggressive Most commonly focused on inadvertent harm, such as being responsible for a fire or break-in; also includes horrific thoughts…
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ORGANIC ILLNESS (to rule out)
Organic causes of PSYCHOSIS Organic causes of DEPRESSION Organic causes of MANIA Organic causes of ANXIETY
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Other Disordered Eating Patterns
PICA Rumination Disorder Avoidant/Restrictive Food Intake Disorder Binge-Eating Disorder
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Panic Attack
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Panic disorder
Prognosis Risk Factors Screening and Rating Scales History investigations Treatment should be offered (as medication may be especially helpful in cases where symptoms are too distressing for patients to be able to do exposure therapy) First-line Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, paroxetine CR, sertraline, venlafaxine XR Second-line Alprazolam, clomipramine, clonazepam,…
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Phobic Disorders
3 types of phobias: Social phobia 1st line Monotherapy: escitalopram, fluvoxamine, fluvoxamine CR, paroxetine, paroxetine CR, pregabalin, sertraline, venlafaxine XR 2nd line Monotherapy: alprazolam, bromazepam, citalopram, clonazepam, gabapentin, phenelzine 3rd line Monotherapy: atomoxetine, bupropion SR, clomipramine, divalproex, duloxetine, fluoxetine, mirtazapine, moclobemide, olanzapine, selegiline, tiagabine, topiramate. Adjunctive therapy Aripiprazole, buspirone, paroxetine,…
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Post-traumatic stress disorder
T – Traumatic event (experienced, witnessed, or was confronted, and the person experienced intense helplessness, fear, and horror) R – Re-experiencing (intrusive thoughts, nightmares, flashbacks, or traumatic memories/images) A – Avoidance (emotional numbing, detachment from others, flattening of affect, loss of interest, lack of motivation, and persistent avoidance of things…
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Premenstrual dysphoric disorder (PMDD)
Premenstrual Syndrome (PMS) Premenstrual dysphoric disorder (PMDD) Historical Nomenclature DSM-5 Criteria for PMDD Etiology and Risk Factors Epidemiology Pathophysiology Uncertain: Linked to hormonal fluctuations (estrogen surplus, progesterone deficiency) and serotonin regulation. Mechanisms: Lifestyle Factors: Genetics: Potential role in PMS/PMDD development. Symptoms Evaluation Treatment and Management Differential Diagnosis Interprofessional Management
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Psychiatric History Taking & Mental Status Examination (MSE)
Put patient at ease & establish rapport (use open ended questions & leave about 5 mins for this) Assess the 4 P’s: Nb: must look at the subjective perception of life events as we all react differently Consequences of symptoms Category Ever Used Used in 1st month Date last used…
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Psychotic Disorders
Signs and Symptoms can be grouped into the following categories: Positive Symptoms – Presence of Something That Should Be Absent Negative Symptoms – Absence of Something That Should Be Present Cognitive Deficits Mood Disturbances Lack of Insight Clinical Course 3 stages of SCZ: Types of delusions and hallucinations Persecutory delusion…
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Separation anxiety disorder
Diagnosis when separation from major attachment figures occurs or is anticipated. Time disturbance causes Epidemiology Prognosis Comorbidity Risk Factors Treatment
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Sleep Hygiene
Behavioral Strategies for Managing Symptoms Sleep Hygiene Practices: Other: CBT-I techniques 1. Sleep Restriction Therapy 2. Stimulus Control Instructions 3. Cognitive Restructuring Example of a CBT-I Session
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Sleep-Wake Disorders
Category Disorder Description Management Dyssomnias(insufficient,excessive or altered timing of sleep) Insomnia disorder Difficulty initiating/maintaining sleep or early-morning awakening with inability to return to sleep; can be acute or chronic (≥3 months) Sleep hygiene measuresCBT for insomniaNon-benzodiazepines (zopiclone /zolpidem)Antidepressants (trazodone, amitriptyline) Hypersomnolence disorder Excessive daytime sleepiness despite sleeping at least 7…
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Substance/Medication-Induced Anxiety Disorder
Delirium
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Suicide Risk screening
So how do you ask about suicide? Explore ambivalence: reasons to die vs. reasons to live RISK LEVEL/INTERVENTION RISK FACTORS FOR SUICIDE: “SADPERSONS” If have untreated depression 🡪 10-15% risk of suicide If have psychosis 🡪 15% risk of suicide 🡪 risk is greatest once they are discharged, the delusions…