PSYCH - MBBS - (Use Outline To Create Other Templates) Anggelos Notes

PSYCH Hx - MAJOR DEPRESSION D/O - Anggelos Notes
Friday, December 14, 2018 3:54 PM
MAJOR DEPRESSION - SIG E CAPS (These people tend to keep information to

themselves, so you have to drag the information out of them)
INTRO
Name and status
DEMO
Name, Age, Occupation
PC
"Why are you here"
DURATION
"How long has this been going on"
RULE IN
NB: MUST HAVE #1 AND ANY OTHER THREE FROM 2 - 9 to MEET
CRITERIA FOR 2 WEEKS
1. "Are you feeling sad for most of the days of the week?
2. SLEEP
3. INTEREST
4. GUILT
5. ENERGY
6. CONCENTRATION
7. APPETITIE
8. PSYCHOMOTOR AGITATION
a. Do you find that you are easily irritated (restless/restive)
b. Do you find that you feel a bit slow (lethargy)
9. SUICIDE
a. Ideations, Plans, Attempt
RULE OUT
Hallucinations
Audio, Visual, Gustatory, Somatic
Delusions
PSYCH - MBBS Page 1

Delusions
Grandiose
Persecutory
Religious
Reference
Somatic etc
4S's
STRESSORS
Anything bothering you recently?
Is there anything you are worried about?
Anything happened in your life in the past?
SUBSTANCE
Are there any drugs you use like marijuana or cocaine
Do you smoke?
Do you drink alcohol?
SEXUAL
Anyone ever touched you inappropriately?
If yes, is this in the past or currently?
SUICIDE + Homicide
Do you have thoughts if hurting yourself
Do you have plans to hurt others?
Do you think others want to hurt you?
MED HX
Chronic Illness
DM, HTN, Thyroid, SCD, Stroke
Medication
Rx, over the counter, herbs
Obs Hx
Did you have a child recently
Allergies
Are you allergic to food or medication?
LEVEL HX
Personal
Are you taking care of yourself?
Interpersonal
How is your relationship with your family and friends?
PSYCH - MBBS Page 2
Occupational
How your relationship at work with the other worker?
DIFFERENTIALS
Major Depressive D/O
Depression secondary to substance abuse
Depression secondary to underlying illness/condition
Schizophrenia
TREATMENT
BIO-PSYCHO-SOCIAL APPROACH
BIO
Anti-depressants (SSRI, TCA, MAOI)
Adjuncts (Atypical or Lithium)
PSYCHO
CBT (Cognitive Behavioral Therapy)
SOCIAL
Family support
Church support
Clinical follow up
Education on pathology
PSYCH - MBBS Page 3

PSYCH Hx - MANIA D/O - Anggelos Notes
Friday, December 14, 2018 4:39 PM
MANIA - DIG FAST (Remember these people will talk you out so need to talk
control of this interview)
INTRO
Name and status
DEMO
PC
"Why are you here"
DURATION
RULE IN
DISTRACTABILITY
Do you find that u can't stay focused on one task/thing?
IRRESPONSIBLE/ERACTIC BEHAVIOUR
Do you find that you are making unneeded purchases?
Do you find that you are giving away money?
GRANDIOSITY
Do you feel you are always on top of the world?
FLIGHT OF IDEAS
(Patient will state that they have many ideas to execute)
ACTIVITY INCREASE W/ INCREASE WEIGHT LOSS & INCREASE LIBIDO

Do you feel like you have extra energy?
Are you sexual active?
If yes how many sexual partners do you have?
Do you find that you are losing weight?
SLEEP
Are you getting enough sleep at night?
TALKATIVE
(This will be observed by you the interviewer)
RULE OUT
PSYCHOSIS
PSYCH - MBBS Page 4

PSYCHOSIS
Hallucinations
Delusions
Grandiose
Persecutory
Religious
Reference
Somatic etc
DEPRESSION
Have you ever felt sad any time before this?
4S's
STRESSORS
SUBSTANCE
Do you smoke?
SEXUAL
SUICIDE + Homicide (Patient may seem surprisingly very happy, do not

let this derail your purpose and forget to ask this very important
question. This happened to me in psych clerkship, DO NOT MAKE MY
MISTAKE)
MED HX
Chronic Illness
Medication
Allergies
PSYCH - MBBS Page 5
Allergies
LEVEL HX
Personal
Interpersonal
Occupational
DIFFERENTIALS
Manic Episode due to Bipolar I
Manic Episode secondary to underlying disease
Manic Episode secondary to substance abuse
TREATMENT
BIO
Mood Stabilizers
Lithium
Antipsychotics
Atypical (Risperidone)
Anticonvulsants
Valproate
Carbamazepine
PSYCHO
SOCIAL
Family support
Church support
Clinical follow up
PSYCH - MBBS Page 6

PSYCH Hx - Panic D/O - Anggelos Notes
Tuesday, January 22, 2019 12:57 AM
Panic - STUDENTS Fear CCC
INTRO
Name and status
DEMO
PC
"Why are you here"
DURATION
MUST BE FOR 1 MONTH OR GREATER
RULE IN
MUST HAVE ATLEAST 4 OUT OF THE BELOW
Sweating
Trembling
Unsteadiness
Derealization/Depersonalization - Detached from self
Excessive Heart Beat
Nausea
Tingling (Paresthesia)
SOB
Fear of dying, losing control, going crazy
Chills or Heat fillings

Chocking
Chest Pain
RULE OUT
PSYCHOSIS
Hallucinations
Delusions
Grandiose
Persecutory
Religious
Reference
PSYCH - MBBS Page 7

Reference
Somatic etc
DEPRESSIONS
Feelings of sadness
SIG E CAPS if above is true
MANIA
Ever felt really happy
DIG FAST if above is true
4S's
STRESSORS
SUBSTANCE
Do you smoke?
SEXUAL
SUICIDE + Homicide
MED HX
Chronic Illness
Medication
Allergies
LEVEL HX
Personal
Interpersonal
PSYCH - MBBS Page 8
Interpersonal
Occupational
DIFFERENTIALS
Panic attack/episode
Panic attack/episode secondary to substance use
Panic attack/episode secondary to underlying cause
TREATMENT
INVESTIGATIONS
CBC, U&E
Thyroid
B12
C13, Syphilis
CT
MRI
Drug Test
BIO
SSR, TCA, Benzodiazepines as needed
PSYCHO
CBT + Desensitization therapy
SOCIAL
Group therapy
PSYCH - MBBS Page 9

PSYCH Hx - General Anxiety D/O - Anggelos Notes
Tuesday, February 12, 2019 11:36 AM
MAJOR DEPRESSION - = C-FIRST
INTRO
Name and status
DEMO
PC
"Why are you here"
DURATION
RULE IN
MORE DAYS THAN NOT FOR LAST 6 MONTHS
NEED >= 3 OUT OF THE BELOW
Concentration
Fatigue
Irritative
Restlessness
Sleep Disturbance
Tension of Muscles
RULE OUT
PSYCHOSIS
Hallucinations
Delusions
Grandiose
Persecutory
Religious
Reference
Somatic etc
MANIA
Ever felt really happy
PSYCH - MBBS Page 10

4S's
STRESSORS
SUBSTANCE
Do you smoke?
SEXUAL
SUICIDE + Homicide
MED HX
Chronic Illness
Medication
Obs Hx
Allergies
LEVEL HX
Personal
Interpersonal
Occupational

DIFFERENTIALS
TREATMENT
Lifestyle
Avoid caffine and EtOH
BIO
SSRI, Benzo
PSYCHO
Relaxation Techniques
SOCIAL
Group therapy

PSYCH Hx - Suicide - Anggelos Notes
Tuesday, February 12, 2019 4:28 PM
INTRO
Name and status
DEMO
PC
"Why are you here"
DURATION
RULE IN
Depression = SIG E CAPS
Mania = DIG FAST
Suicide Risk = TAIP SHAF
Thoughts
Attempt to suicide
Intent
Plans for suicide
Support group present/absent

Hopelessness
Access to weapons
Family history of suicide
4S's
STRESSORS
SUBSTANCE
Do you smoke?
SEXUAL

SUICIDE + Homicide
MED HX
Chronic Illness
Medication
Obs Hx
Allergies
Social Hx
Smoking, EtOH
Drug Hx
Marijuana, Cocaine
LEVEL HX
Personal
Interpersonal
Occupational
DIFFERENTIALS
TREATMENT
BIO
Appropriate antidepressants
PSYCHO-SOCIAL
Group sessions and aid in dealing with stressors/problems

PSYCH Hx - Schizophrenia - Anggelos Notes
Tuesday, February 12, 2019 11:57 AM
INTRO
Name and status
DEMO
PC
"Why are you here"
DURATION
Psychotic symptoms for > 6 months
#NB Same symptoms 1 month to 6 month = Schizophreniform
#NB Same symptoms 1 day to 1 month = Psychotic D/O
#NB Same symptoms lasting atleast 2 weeks with mood =

Schizoaffective
#NB 1 or more delusions for 1 month = Delusions D/O
RULE IN
!!! Basically an MSE of Thought Content, Thought Form, Perceptions +
other things like motor behaviors + -ve symptoms
Needs the presence of 2 symptoms but one of the 2 MUST be Thought

Content, Thought Form, perceptions and any other
D/O of Thought Form

Circumferential
Tangential
Looseness of Association
Word Salad
Neologisms
Thought blocking
Derailment
D/O of Thought Content

Delusions of:
Grandeur
Persecution

Persecution
Thought broadcasting
Thought insertion
Thought withdrawal
Reference
Religion
D/O of Perception
D/O of Motor/Catatonic
Automatisms
Echolalia
Echopraxia
Mannerisms
TICs
Weird positions
Movement
Over-excitement
Under-excitement
Negativisms
RULE OUT
Depression
Feeling sad
Mania
Feeling extra happy at times
4S's
STRESSORS
SUBSTANCE
Do you smoke?
SEXUAL
SUICIDE + Homicide
MED HX
Chronic Illness
Medication
Obs Hx
Allergies
Social Hx
Smoking, EtOH
Drug Hx
Marijuana, Cocaine
LEVEL HX
Personal
Interpersonal
Occupational
DIFFERENTIALS
TREATMENT
BIO
Typical or Atypical antipsychotics
PSYCHO
Occupational tx
SOCIAL
Family support
Church support
Church support
Clinical follow up

Schizophrenia Spectrum Disorders – Dr Ottey- Anggelos
Notes
Wednesday, January 30, 2019 12:24 AM
BELOW IS NOTES FORM THE LATE DR OTTEY WORD FOR WORD !!!
BEST FOR 4th PSYCH STUDIES
A group of conditions that includes psychotic disorders (where one’s ability to interpret reality is
inhibited). It includes:
- Schizophrenia proper
- Schizotypal
- Delusional D/O
- Brief Psychotic D/O
- Schizophreniform D/O
- Schizoaffective D/O
HISTORY
Emile Craple (German Psychologist)
o 1st description of condition. Called it DEMENTIA PRECOX

▪ Precox = due to early onset
▪ Dementia = due to it NOT being dementia
Eugene Vleuler (Swiss Psychologist)

o 1st to use the term Schizophrenia in 1911, but it became universal in 1930
o 4 A’s of Vleuler = Primary Symptoms of Schizophrenia. He thought all other symptoms were
secondary
▪ Associated disturbances/Looseness of association
▪ Affect disturbances
• Affect = Tone of emotion/minute by minute emotional response
• Eg. Laughing at a joke
▪ Autism
• Schizophrenia patient pre-occupied with their inner world
• The definition DOES NOT intend to describe the autistic children
▪ Ambivalence
• Co-existence of two (2) conflicting emotions at the same time
EPIDEMIOLOGY
- ~ 1% worldwide prevelence
- 1.5 per 10,000 people
- M:F is the same
- Age of onset
o M = 8 – 25 mainly (can be earlier)
o F = 25 – 35 mainly after 40 (Bimodal)
o NB rarely occurs < 10 OR > 60 years
o If it occurs after 45 = LATE ONSET OF SCHIZOPHRENIA
o FEMALES are LESS LIKELY to have -VE SYMPTOMS
o Prognosis in FEMALES are BETTER
o Prognosis in FEMALES are BETTER
▪ Better social health (health sucking behavior)
▪ Later onset
AETIOLOGY
Genetic (KNOW THIS FOR PSYCH ROTATION OSCE)
If there is a genetic component, there is a predisposition
▪ > Genetic predisposition = > severity

▪ Siblings 8%
▪ 1 Parent or Dizygotic Twins 12%
▪ 2 Parents 40%
▪ Monozygotic Twins 40 – 73 or 75%
• Prevalence remains high even if twins were separated at birth
• Only common environment is inter-uterine
Environmental
o Seasonal Birth Theory

▪ Individuals with schizophrenia more likely to be born in LATE WINTER & EARLY SPRING
o Slow Virus/Viral Invasions
▪ Acquired virus manifest in WINTER or EARLY SPING (usually mixed with seasonal birth
theory)
Family Related Theories
o Double Binded Communication Theory

▪ Recurrent verbal expression where information given seem to e in conflict with each
other. Child cannot handle the communication method and develops a fantasy world (in
keeping with Vleuler’s Autism)
o High Level of Expressed Emotions
▪ Seen in families where there is MUCH HOSTILITY and CRITISM
Social Causation Hypothesis
o Schizophrenia is OVER REPRESENTED in the LOWER SOCIO-ECONOMIC CLASS in any

population. This is due to predisposing stressors
▪ Finance
▪ Housing poor
▪ Poor medical conditions
o NB: ALWAYS MENTION THE FOLLOWING
▪ DOWNWARD DRIFT HYPOTHESIS
• This is a rebuttal to the above theory
• It agrees that schizophrenia is over represented in the lower socio-economical
class but states that this is because:
o It starts early in life → affects the ability to get proper education and
cancer → causes slippage into the class that attains much social and
occupational function
Neurotransmitter Theory
o Schizophrenia arises due to OVER ACTIVITY OF DOPAMINE. This theory is blostered by:
▪ All antipsychotic drugs being dopamine antagonists
▪ Drugs that increase dopamine activity predisposes one to the pyscho-mimetic
syndromes (syndromes that are indistinguishable from schizophrenia). Eg.

syndromes (syndromes that are indistinguishable from schizophrenia). Eg.
Amphetamines, Marijuana
When a patient presents with hallucinations and delusions. ALWAYS RULE OUT DRUGS.
When a patient presents with hallucinations ALWAYS RULE OUT POSSIBLE MEDICAL CONDTIONS
- Epilepsy
o Temporal lobe epilepsy can cause auditory hallucinations
o Investigate with EEG
- Stroke/TIA
o Investigate with CT for early/MRI for late
- Encephalitis
o Toxic syndromes, fever
- Meningitis
- Mass occupying lesion
o Brain tumor, trauma
CLINICAL FEATURES
1. Disorder of THOUGHT
2. Disorder of EMOTION
3. Disorder of PERCEPTION
4. Catatonic Disorders/Motor Behavior
DISORDER OF THOUGHT
- Formal Thought Disorder/Disturbance of Association = Illogical Thinking

o Difficult to tell in early stages
o GLASS WALL EFFECT = Level of communication not coherent = vague
o Looseness of Association/ Derailment
▪ No logical connection between thoughts expressed
o Tangentiality
▪ Going off topic and not returning
o Circumstantiality
▪ Going off topic and returning
o Thought Blocking
▪ Actual blocking of thoughts
o Word Salad
▪ There is no link between words used
▪ SEEN IN THE END STAGE
o Neologism
▪ Creation of new words
- Procession of Thought
o Thought Insertion
▪ External force is placing thoughts into the mind
▪ PATIENTS ID THE THOUGHTS AS NOT BEING THEIR OWN
o Thought Withdrawal
▪ External forces removing thoughts from mind
▪ USUALLY ASSOCIATED WITH A SENSATION OF REMOVAL
o Thought Broadcasting

o
▪ Others can hear what the patient is thinking
- Content of Thought
o Delusions – Fixed false sense of belief that is not in keeping with a person’s culture and is not
amenable to evidence. (Other Classifications: Bizzare = NOT possible, Non-Bizzare = There is a
possibility but not likely to be occurring at the moment
▪ Grandiose
• Inflated self worth
▪ Persecutory
• People are out to get you
▪ Reference
• Items/Events from external environment has particular significance to the patient
▪ Somatic
• Delusions of the body
o Sensation of crawling on the skin
o Removal of organs
o Placement of organs
▪ Erotomatic
• Delusion surrounding love. Belief that another loves them (usually someone of
high status)
▪ Paranoid
• Delusions of trust
DISORDER OF EMOTIONS/DISTURBANCE OF AFFECT
- Blunted, Flattened, Restricted

o Lack of emotional response to environmental stimuli
- Incongruous, inappropriate
o Emotional; response is opposite
DISORDER OF PERCEPTIONS
- Hallucinations
o Perception to stimuli that is absent
▪ Auditory (MOST COMMON)
▪ Visual
▪ Gustatory/Taste
▪ Olfactory/Smell
▪ Tactile/Touch
o Other reasons for hallucinations
▪ Substance
▪ Transition into sleep = hypNAgogic
▪ Transition from sleep = hypnopompic
o IF HALLUCINATIONS ARE REPORTED, ALWAYS ASK IF IT OCCURS WHILE SLEEPING, WALKING
etc
o PATHOGNOMONIC AUDITORY HALLUCINATIONS = 3rd person commentary hallucinations
Catatonic Disorders/Motor Behavior
- Motorisms
o Refers to motor UNDER/OVER REACTIVITY
▪ Over-activity

▪ Over-activity
• Purposeless activity
▪ Under-activity
• Patient is understanding what is being said but there is NO RESPONSE
- Automatisms
o Refers to strange behaviors
▪ Echolalia
▪ Echopraxia
o Negativism
o Abnormal mannerisms and waxy behavior
TYPES OF SYMPTOMS
- Positive Symptoms
1. Formal thought disorder
2. Hallucinations
3. Delusions
4. Grossly disordered t Cationic behavior
- Negative Symptoms (The 5 As)

1. Affective - Blunting
2. Alogia – Poverty of speech
3. Avulsion – Poverty of movement
4. Anhedonia – Inability to experience pleasure
5. Asociality – Withdrawn
SCHIZOPHRENIA
- Definition
o A mental disorder that is characterized by affecting an individual’s thinking, feeling and
perception. The HALLMARK of schizophrenia is PSYCHOSIS
- Diagnosis using DSM
o For Dx, negative symptoms are grouped as 1, hence there are 5 symptoms (4 +ve and 1 -ve)
▪ Negative is grouped as 1 because it is likely if a patient has any 1, the patient may have
the others as well.
▪ Together all symptoms are referred to as ACTIVE PHASE SYMPTOMS
o Has to be 6 moths with 1 month of active symptoms
o Need at at least 2 symptoms for diagnosis but out of the 1, 2 symptoms has to be wither
formal thought disorder, hallucinations or delusions (any of the 1st 3 positive symptoms)
o Before DSM 5, the following are conditions that could be used to dx schizophrenia right away
▪Bizarre delusions
▪2 or more distinct voices conversing
▪3rd person commentary delusions
- Outcome/Prognosis
o Poor
▪ Early onset
▪ Being male
▪ Higher number of -ve symptoms
▪ Low level of functioning prior to onset
▪ Poor or No support system
▪ History of substance abuse

▪ History of substance abuse
▪ Family history of disease
o Good
▪ Late onset
▪ Being female
▪ +ve symptoms
▪ High level of function ing prior to onset
▪ Good support system
▪ No history of substance abuse
▪ No family history of disease
SCHIZOPTYPAL (Seen in Type A Cluster of Personality D/O)
- Description
o Lifelong pattern of behavior where the patient has difficulty making close emotional bonds
with others.
o Associated with odd thoughts, magical thinking, superstition, social anxiety/isolation
o Day to day , think and speak in a strange way
- Treatment
o ANTIPSYCHOTICS
▪ 1st or 2nd gen
▪ Both have the same efficacy but different side effects
▪ 2nd gen has better/reduced side effects
o Clozapine is RESERVED for REFRACTORY ANTIPSYCHOTICS CASES
▪ It is NOT a 1st line 2nd gen b/c it may cause AGRANULOCYTOSIS
DELUSION D/O
- Description
o Characterized by having:
▪ 1 NON BIZZARE DELUSION
▪ Last >/= 1 MONTH
o NO HALLUCINATIONS
▪ If Hallucinations occur, they are transient and not related to delusion
o NO LOSS OF OCCUPATIONAL FUNCITON
o
- Types of Symptoms = SUM JPEG
o Somatic
o Unspecific (Cant put into specific hype)
o Mixed (Mixture of more than one type)
o Jealous (usually involves a love one)

o Persecutory (most common)
o Erotomaniac
o Grandiose
- Treatment
o Antipsychotics
o Psychotherapy
BRIEF PSYCHOTIC D/O

- Description
o Psychosis lasting for >/= 1 DAY but </= 1 MONTH
o Uses the same diagnosis criteria as schizophrenia in terms of symptoms (not same time line)
▪ Delusions/Hallucinations usually after STRESSFUL SITUATION
o Of all the psychotic disorders that present for the 1st time, only 9% of them are BPD, as they
resolve within a month.
▪ If it does not resolve, they move up the spectrum to SCHIZOPHRENIFROM D/O
- Treatment
o Benzodiazepines
▪ Can calm the patient
o Antipsychotics
SCHIZOPHRENIFORM D/O
- Description
o Psychosis lasting >/= 1 MONTH but </= 6 MONTHS
o NO DECLINE IN FUNCTION (cognitive, occupational, social)
o Uses same dx as schizophrenia with regards to symptoms (not same time line)
▪ If it does not resolve, they move up the spectrum to SCHIZOPHRENIA
- Treatment
o Same as schizophrenia
- Patient will get better when treatment is stopped/removed as vs that of schizophrenia. It is for
this reason that schizophrenia patient always need to be on medication (so symptoms will not
return)
SCHIZO-AFECTIVE D/O
- Description
o SCHIZOPHRENIA WITH A MOOD D/O
o Active phase symptoms ONLY for at least 2 weeks BEFORE or AFTER the mixtures of active
phase and mood disorder symptoms
▪ Having the active phase symptoms only aids clinicians to conclude that there have
been psychotic symptoms
o MDD for 2 weeks followed by 2 weeks of MDD and psychotic features = MDD with psychotic
features
- Other Notes
o Life time prevalence = 0.3%
o F > M (due to depressive features)
o Better prognosis than schizophrenia (due to depressive features)
- Treatment
o Psychotic symptoms – Antipsychotics
o Mood symptoms – Mood stabilizers (Bipolar), SSRI (MDD)

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PSYCH Hx - MAJOR DEPRESSION D/O - Anggelos Notes

Friday, December 14, 2018 3:54 PM

MAJOR DEPRESSION - SIG E CAPS (These people tend to keep information to

PSYCH - MBBS Page 1

PSYCH - MBBS Page 3

ACTIVITY INCREASE W/ INCREASE WEIGHT LOSS & INCREASE LIBIDO

PSYCH - MBBS Page 4

SUICIDE + Homicide (Patient may seem surprisingly very happy, do not

PSYCH - MBBS Page 6

Panic - STUDENTS Fear CCC

Fear of dying, losing control, going crazy

Chills or Heat fillings

PSYCH - MBBS Page 7

PSYCH - MBBS Page 9

MAJOR DEPRESSION - = C-FIRST

PSYCH - MBBS Page 10

PSYCH - MBBS Page 11

PSYCH - MBBS Page 12

Support group present/absent

PSYCH - MBBS Page 13

PSYCH - MBBS Page 14

#NB Same symptoms 1 month to 6 month = Schizophreniform

#NB Same symptoms 1 day to 1 month = Psychotic D/O

#NB Same symptoms lasting atleast 2 weeks with mood =

#NB 1 or more delusions for 1 month = Delusions D/O

Needs the presence of 2 symptoms but one of the 2 MUST be Thought

D/O of Thought Form

D/O of Thought Content

PSYCH - MBBS Page 16

PSYCH - MBBS Page 19

o 1st description of condition. Called it DEMENTIA PRECOX

Eugene Vleuler (Swiss Psychologist)

▪ > Genetic predisposition = > severity

o Seasonal Birth Theory

o Double Binded Communication Theory

o Schizophrenia is OVER REPRESENTED in the LOWER SOCIO-ECONOMIC CLASS in any

PSYCH - MBBS Page 21

- Formal Thought Disorder/Disturbance of Association = Illogical Thinking

PSYCH - MBBS Page 22

DISORDER OF EMOTIONS/DISTURBANCE OF AFFECT

- Blunted, Flattened, Restricted

PSYCH - MBBS Page 23

- Negative Symptoms (The 5 As)

PSYCH - MBBS Page 24

o Jealous (usually involves a love one)

BRIEF PSYCHOTIC D/O

PSYCH - MBBS Page 25

PSYCH - MBBS Page 26

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