Common psychological histories

• • Anxiety and worry persistent/very frequent

• • Worry about everything

• • Long-term

• Panic attacks (palpitations, sweating, SOB, chest pain etc.)
• Unpredictable but certain situations may predispose (e.g. busy places)

• Panic attacks (palpitations, sweating, SOB, chest pain etc.)
• Unpredictable but certain situations may predispose (e.g. busy places)

Excessive, persistent, irrational fear to a specific object, situation, or activity

• • Caused by stressful life event

• • Intense anxiety with insomnia, nightmares and flashbacks

• • Obsessive thoughts

• • Compulsions, e.g. need to check everything, cleaning/washing, arranging/organising

Positive depression screen

• Acute coronary syndrome
• Arrhythmia
• Hyperthyroidism
• Phaeochromocytoma

• • Schizophrenia first rank symptoms

• • Other positive symptoms: odd behaviour, hallucinations

• • Negative symptoms: apathy, anhedonia, asociality, lack of motivation

• • Non-bizarre delusions

• • No other psychiatric symptoms

• • intermittent depressive and manic episodes

• • Manic features: elevated mood, pressure of speech, flight of ideas, grandiosity, gambling,  insomnia, delusions, hallucinations

Features of bipolar disorder and schizophrenia in same episode

Depression with psychotic symptoms, e.g. delusions or hallucinations

Severe mental illness days/weeks after childbirth

• Elderly patient with current/recent infection
• Reduced level of consciousness
• Fluctuating
• Inversion of day/night cycle

Especially Lewy body dementia

• • Long history of progressive memory loss

• • Cognitive deficits

• Medication side effects (e.g. corticosteroids, levodopa, antimalarials)
• Recreational drug use
• Alcohol/drug withdrawal
• Epilepsy-related (e.g. complex partial seizures, postictal psychosis)
• Degenerative neurological disorders (e.g. Huntington’s)
• HIV
• Neurosyphilis
• Autoimmune/paraneoplastic/HSV encephalitis

• Positive depression screen

• • Intermittent depressive and manic episodes

• • Manic features: elevated mood, pressure of speech, flight of ideas, grandiosity, gambling,  insomnia, delusions, hallucinations

• • Triggered by specific stressor
  • Significant emotional or behavioural symptoms out of proportion

Depression with psychotic symptoms, e.g. delusions or hallucinations

• Depression days/weeks after childbirth
• Often recurrent

• • Hypothyroidism

• • Drug side effects

• • Cerebral pathology

• • Grief reaction

• • Progressive decline

• • Disinhibition

• • Personality changes

• Stepwise decline
• Cardiovascular risk factors
• Preserved insight

• • Fluctuating dementia

• • Visual hallucinations
  • Parkinsonism

• Prominent personality changes

• Positive depression screen

• Reduced level of consciousness
• Fluctuating
• Inversion of day/night cycle
• Evidence of infection

• Drug and alcohol use
• Vitamin deficiencies
• Degenerative neurological diseases (e.g. Huntington’s, MS)
• Space occupying lesions
• Neurosyphilis
• HIV-associated neurocognitive disorder

• BMI <17.5
• Intense fear of gaining weight
• Distorted body image
• Efforts to lose weight: dieting, diuretics/laxatives, vomiting, excessive exercise
• Consequential symptoms: amenorrhoea, diarrhoea,, developmental delay, myopathy

• BMI >17.5
• Regular binge eating
• Compensatory behaviours e.g. starvation, vomiting, laxatives, excessive exercise

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