BASIC PSYCHIATRY 101
OSCE BASED NOTES
MD ZAKI MEDICAL NOTES
COMMON DISORDERS
MAJOR DEPRESSIVE DISORDER SCHIZOPHRENIA GENERALIZED ANXIETY DISORDER
“SIG E. CAPS” “Na.B.I Hu.D” “WATCHERS”
1. Sleep (Early awakening, hard to Worry (Do you feel excessive worry that
initiate sleep, intermittent N – Negative Symptoms you are difficult to control)
awakening) A – 5 A’s Anxiety (Do you have any excessive
- Anhedonia(Do you notice you have any loss of interest ?) anxiety doing certain things )
2. Interest ( Loss of interest , where - Affect (Do you notice any decrease in face expression) Tension in muscles (Do you feel tension
previously interested) - Alogia (poverty of speech) (Do you notice that you in muscle)
decrease talking / not talking to anyone recently) Concentration difficulty OR (Do you
3. Guilt (Do you feel guilty about - Avolition feel difficulty in concentrating or mind
yourself) - Attention - Do you have difficulty in concentration going blank)
Hyperarousal (or irritability)
4. Energy ( Do you fatigue / feel B – Disorganized Behavior Energy loss (Do you fell easily tired)
tired easily ) I – Disorganized Speech Restlessness (Do you feel restlessness
recently)
5. Concentration (Do you have Hu – Hallucination : Sleep disturbance (Do you any difficulty
difficulty in concentration) - Did you see anything that other people don’t see or hear in falling or staying asleep )
?
6. Appetite ( Do you any change in - Did you hear any outside voices when there is no one “BESKIM”
appetite) around ?
Blank Mind
7. Psychomotor Ds (Do you feel that D – Delusion : Easy Fatigue
your brain processed slower - Did you have any special belief that no one else belief ?
recently`) Sleep Problem
SCHNEIDER FIRST RANK SYMPTOMS :
8. Suicidal ideation (Do you have Keyed Up
thoughts to harm yourself / end 3 : Auditory Hallucination
your life) ✓ Audible thoughts / Thought Echo – (Do you heard your Irrritability
Muscle tension
- Hopelessness thought spoken out loudly)
- Helplessness ✓ Voices arguing / 3rd person Auditory Hallucination – (Do
- Worthlessness (Do you feel that you hear voices about you but not to you)
you are worthless) ✓ Voices commenting on action / Running commentary –
(Do you hear any voices commenting on your action)
3 : Made
✓ Made Volition / Action (Do you feel that external forces
control your action)
✓ Made Affect / Feeling (Do you feel that external forces
control your feeling)
✓ Made Impulse (Feel that external forces that make you
do impulsive action)
3 : Thought
✓ Thought withdrawal ( Do you feel any external force
withdraw thoughts from you)
✓ Thought insertion ( Do you feel any external force had
inserted thoughts to you)
✓ Thought broadcasting (Do you feel other person can
read your mind)
2:
✓ Somatic passivity (Experiencing externally controlled
body changes) – Do you feel any bodily sensation made
by external forces
✓ Delusional Perception (Real percept elaborated in a
delusional way) – Do you feel that you are
interpretating what you see and hear differently from
other people ?
PANIC DISORDER OCD MANIC EPISODE
Da PANICS WORTH LIM “DIG FAST”
Work (Do you like to work or are you a productive person) - Distractibility (Do you notice that you
D - Dizziness, disconnectedness, Organization (Are you an organized type of person) easily distracted by things around while
derealization (unreality), Rigid and stubborn (Are you a stubborn type of person ) focusing on one thing ?)
depersonalization (detached from Hoard of Things (Do you like to keep things that you - Irritable mood (Do you feel that you are
self ) cannot throw away) easily irritable) /insomnia (Do you feel
P - Palpitations, paresthesias Task delay ( Do you have delay in completion of work) that you need any reduced of sleep )
A - Abdominal distress - Grandiosity (- Did you special about
N - Numbness, nausea Leisure (What type activity do you do during leisure) yourself / some ability that other people
I - Intense fear of dying, losing Inflexible (Are you a flexible type of person) don’t have ?)
control or “going crazy” Miserly spending (Are you very cautious with money / Do - Flight of ideas (Do you have too many
C - Chills, chest pain you like to spend) ideas / too many things to do and you
S - Sweating, shaking, shortness of tend to forget other ideas)
breath - Agitation/ Activity : (Do you feel that
you have many activity that you want to
All of this are feature of panic attack do at any one time)
-> Then ask how many attack per - Speedy thoughts/ speech (Do you feel
month -> Ask do you feel that you are more talkative than usual/
continuously worry about speak louder/faster than usual)
experiencing subsequent attacks / - Thoughtless-ness: seek pleasure
their consequences without regard to consequences (Do you
have any involvement in high risk activity
such as spending a lot of money)
+ Elevated Mood (Do you notice any
elevated mood)
HYPOMANIA SUICIDE RISK DYSTHYMIA (PERSISTENT DEPRESSIVE
DISORDER)
TAD HIGH SAD PERSONS
HE’S 2 SAD
Talkaltive Sex—male
Attention deficit Age >60 years Hopelessness
Decreased need for sleep Depression (Do you feel depressed) Energy loss or fatigue
Hgh self esteem / Grandiosity Previous attempt (Do have any previous Self-esteem is low
Ideas that race attempt to end your life) 2 years minimum of depressed mood most of
Goal-directed activity increased Ethanol/drug abuse (Do you consume any the day, for more days than not
High-risk activity alcohol) Sleep is increased or decreased
Rational thinking loss / psychosis Appetite is increased or decreased
Suicide in family (Do you have any family that Decision-making or concentration is impaired
have end their own life )
Organized plan (Do you have any plan to end
your life in the future)
No support (Do you have anyone close to rely
one / express feelings)
Sickness (Do you have chronic illness)
MEDICATION ADVERSE EFFECTS
ANTIDEPRESSANT DISCONTINUATION NEUROLEPTIC MALIGNANT SYNDROME SEROTONIN SYNDROME
SYNDROME
FEVER HARMED
FINISH Fever Hyperthermia
Flu-like symptoms Encephalopathy Autonomic instability
Insomnia Vital sign instability Rigidity
Nausea Elevated WBC/CPK Myoclonus
Imbalance Rigidity Encephalopathy
Sensory disturbances WBC: white blood cell count Diaphoresis
Hyperarousal (anxiety/agitation) CPK: creatine phosphokinase
SUBSTANCE ADDICTION
SUBSTANCE DEPENDENCE SUBSTANCE ABUSE ALCOHOL ABUSE
ADDICTeD WILD CAGE Question
Activities are given up or reduced Work, school, or home role obligation failures Have you ever felt you should CUT DOWN
Dependence, physical: tolerance Interpersonal or social consequences your drinking?
Dependence, physical: withdrawal Legal problems Have people ANNOYED you by criticizing your
Intrapersonal (Internal) consequences, Dangerous use drinking?
physical or psychological Have you ever felt bad or GUILTY about your
Can’t cut down or control use drinking?
Time-consuming Have you ever had a drink first thing in the
Duration or amount of use is greater than morning to steady your nerves or get rid of a
intended hangover (EYE-OPENER)
DELIRIUM
CAUSES LIFE-THREATENING CAUSES DELIRIOGENIC MEDICATIONS
I WATCH DEATH WWHHHHIMPS ACUTE CHANGE IN MS
Infection Wernicke’s encephalopathy Antibiotics
Withdrawal Withdrawal Cardiac drugs
Acute metabolic Hypertensive crisis Urinary incontinence drugs
Trauma Hypoperfusion/hypoxia of the brain Theophylline
CNS pathology Hypoglycemia Ethanol
Hypoxia Hyper/hypothermia Corticosteroids
Deficiencies Intracranial process/infection H2 blockers
Endocrinopathies Metabolic/meningitis Antiparkinsonian drugs
Acute vascular Poisons Narcotics
Toxins or drugs Status epilepticus Geriatric psychiatric drugs
Heavy metals * Created by Gary W. Small, MD ENT drugs
Insomnia drugs
NSAIDs
Muscle relaxants
Seizure medicines
Others :
- Auditory Hallucination details :
✓ Clear Consciousness (Not in sleep, hypnagogic or hypnapompic)
- Delusion :
✓ Externally (Not inside the mind)
1 – Fixed, false belief
✓ Details :
2 - Unshakable
- How many voices, Do you recognize them
3– Out of keeping with cultural and social background
- Language, Male or Female
4- Held with conviction despite given evidence
- What did it say
otherwise
- Duration, frequency (+ What time, how long per day)
- What’s your reaction toward the voice
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“When the world pushes you to your knees, you're in the PERFECT POSITION TO PRAY”
