amboss 6/27 Flashcards
what are post partum blues and what is the treatment
Feelings of mood instability and lability after pregnancy they usually resolve spontaneously. do not require treatment usually just reassurance
how frequent are post partum blues
the occur with 30-80% of pregnancy
how long do post partum blues usually last
two weeks
what is the cause of delirium tremens
chronic alcohol use causes the down regulation of GABA receptors which leads to neuronal excitability when alcohol is not present.
what is the mortality rate of DTs
5% if not treated immediately
what is the treatment of choice for bipolar disorder with mania and what is one exception to this treatment
lithium is the treatment of choice.
it CANNOT be used with kidney dysfunction
what is th drug of choice for bipolar disorder with kidney dysfunction or with other contraindications to lithium
valproate
what is the classification for bipolar II
characterized by hypomania for at least 4 consecutive days and major depression for 2 weeks.
what is the classification of bipolar I
characterized by at least one manic episode lasting ≥ 1 week with or without major depressive episodes
what is the classification of a manic episode
Manic episodes cause significant functional (e.g., occupational or social) impairment, often requiring hospitalization, and psychotic features may be present.
what is the most important side effect of clonazipine
agranulocytosis
what is a risk factor for psychosis
frequent marijuana usage
what does an MRI brain show of a person with schizophrenia
Lateral cerebral ventricle enlargement (in addition to decreased cortical volume) is one of the most consistent MRI findings in schizophrenic patients, with these ventricles being up to 30% larger than normal. The specific reason for ventricular enlargement is not known, but it seems to stem from diffusely decreased cortical volume and shrinkage of the thalamus and putamen.
what class of drug is fluphenazine
phenothiazine
what is a side effect of the phenothiazines
impaired thermoregulation.
what is the most common side effect of olanzapine
metabolic syndrome. dyslipidemia, weight gain, hyperglycemia, diabetes.
what two atypical antipsychotics are highly associated with metabolic sydnrome
olanzapine and clozapine
what is the presentation of ecstasy intoxication
euphoria and energeticism sometimes with dissociation. it also causes dehydration and some users drink excessive amounts of water which leads to hyponatremia. hyperthermia is also common
what is a common SE of the first generation antipsychotics
akathisia
what are some of the first gen high potency antipsychotics
haloperidol, fluphenazine, perphenazine, trifluoperazine pimozide
what are some of the first gen low potency antipsychotics
promethazine, thioridazine, chlorpromazine
what are the criteria for adjustment disorder
To diagnose adjustment disorder with depressed mood, symptoms of depression have to occur within 3 months in response to an identifiable psychosocial stressor (e.g., death of a loved one, serious illness, ending of a relationship). Full criteria for other psychiatric conditions, such as major depressive disorder, are typically not met.
what are the criteria for MDD
Sleep (insomnia or hypersomnia), Interest loss (anhedonia), Guilt (low self-esteem), Energy (low energy or fatigue), Concentration (poor concentration or difficulty making decisions), Appetite (decreased appetite or overeating), Psychomotor agitation or retardation, and Suicidality.
what is a common consequence of anorexia nervosa
bone loss and fractures
what are the characteristics of anorexia nervosa
BMI below the 10th percentile for her height and age, fear of gaining weight, and body image disturbance (“not be overweight anymore”) indicate anorexia nervosa, a condition mainly affecting adolescent girls and young women, and often resulting in lanugo hair and secondary amenorrhea. Weight loss is achieved intentionally either through reduced food intake and/or excess physical activity (restrictive type) or by vomiting or laxative abuse (binge-eating/purging type).
what are some dangerous consequences of anorexia
Severe complications include refeeding syndrome, osteoporosis and stress fractures, electrolyte imbalances, arrhythmias, and sudden cardiac death. Anorexia nervosa is also associated with other psychological conditions (e.g., depression, obsessive-compulsive disorder, anxiety disorders) and a higher rate of suicide.
What are the characterisitics of bulimia nervosa
also mostly affects young women that are counteracting weight gain and have a distorted self-perception, it is mainly characterized by a normal or increased BMI > 10th percentile for gender and age and generally has its onset in late adolescence or early adulthood. Patients with bulimia nervosa engage in compulsive binge eating followed by compensatory actions aimed at preventing weight gain. Despite this, patients are of normal weight or slightly underweight (BMI > 18.5 kg/m2 or ≥ 10th percentile).
Binge eating disorder is
characterized by frequent episodes of eating large portions of food in a short period of time, with patients feeling a lack of control over how much or how quickly they eat and typically feeling guilty thereafter, as seen in this patient. Many patients are obese. However, patients with binge eating disorder do not attempt to compensate for excess calorie intake and are not preoccupied with gaining weight.
what are some electrolyte abnormalities found in bulimia?
Repeated purging in bulimia nervosa can cause metabolic alkalosis, hyponatremia, hypokalemia, hypocalcemia, and hypochloremia, as well as dry skin and calluses on the knuckles from self-induced vomiting.
what is the treatment for bulimia
Treatment with cognitive behavioral therapy (first line) and selective serotonin reuptake inhibitors may help prevent additional complications such as esophagitis, poor dentition, cardiac arrhythmias, and hypotension.
what are the characteristics of oppositional defiant disorder
is characterized by anger, irritable mood, and defiant behavior towards figures of authority lasting ≥ 6 months, which may also cause problems at school, as seen in this patient. During early childhood, the disorder more commonly affects boys, whereas after puberty, there is an equal incidence in boys and girls. Frequent comorbidities include ADHD, anxiety, mood disorders, and/or learning disorders.
what are the characteristics of conduct disorder
which include aggression (e.g., arguing with teachers, cruelty to animals), certain criminal behaviors (e.g., destruction of property and theft), and serious rule violation. To make the diagnosis, the disturbance in behavior must persist over ≥ 12 months and significantly impair social, academic, or occupational functioning, as is the case in this patient. CD is more common in boys and typically presents during childhood or adolescence
what is the diagnosis if conduct disorder persists into adulthood or 18 years of age
but may persist beyond 18 years of age and result in antisocial personality disorder.
what is the treatment for ADHD if the child is under 6
CBT
what is the treatment for ADHD if the child is school aged
methylphenidate or stimulants such as atomoxetine
what is the treatment of body dysmorphic disorder
CBT or SSRIs
what is the treatment for binging purging bulimia nervosa
SSRIs
what is the treatment for someone with anorexia and unstable vital signs?
inpatient nutritional therapy
what can be used for performance-only social anxiety disorder
propranolol therapy.
when can propanolol therapy not be used
if the person has asthma because they can create airway resistance
what is the treatment of choice for performance-only social anxiety disorder
CBT
when is the onset of DTs
48-96 hours after the last drink
what is alcoholic hallucinosis
presence of hallucinations (e.g., hearing the wallpaper speak) with intact sensorium (i.e., alert and oriented) at least 12 hours since this patient’s last alcoholic beverage suggests alcoholic hallucinosis. This patient’s daily alcohol consumption places him at risk for alcohol withdrawal. His autonomic hyperactivity (e.g., anxiety, diaphoresis, tremor) supports this diagnosis.
what is the treatment for alcoholic hallucinosis
can be managed with Benzos
when does alcoholic hallicunosis usually resolve
within 24-48 hours
what is the presentation of wernickes encephalopathy
ophthalmologic and ataxia
what are the most likely side effects of SSRIs
delayed ejaculation and sexual dysfunction
Can SSRIs increase the risk of suicidality
yes, but only in patietns with suicidal ideations and under the age of 24
what are the side effects of TCAs
prolonged QRS complexes (≥ 100 ms), tachycardia, hypotension, mydriasis, confusion, dry skin, and urinary retention.
what is the treatment for TCA overdose
sodium bicarbonate
what is a side effect of the MAOIs
hypertensive crisis
what casues the hypertensive crisis with MAOIs
if the patient eats foods high in tyramine such as wine, cheeses, meats.
what are the MAOIs
Tranylcypromine
Phenelzine
Selegiline
Isocarboxazid
how does serotonin syndrome present
autonomic hyperactivity (nausea, diaphoresis, tremors, tachycardia, hypertension), neuromuscular hyperactivity (hyperreflexia, impaired gait), mental status changes (disorientation to place and time), and hyperthermia.
what can cause serotonin syndrome
taking an SSRI and an SNRI too close together
what is the indication for bupropion
MDD in someone that wants to quit smoking
what is another benefit of bupropion
decreased risk of sexual dysfunction when compared with the other antidepressants
what is a SE of mirtazipine
weight gain and sedation
what is the best choice of patient for treatment with mirtazipine
MDD, with low BMI and insomnia
how long do SSRIs take to become effective
4-6 weeks
how long before SSRIs have max effect
6-12 weeks
what are the criteria for generalized anxiety
results in excessive anxiety that persists for ≥ 6 months and revolves around certain themes (e.g., an individual’s occupation, a break-in) but is not focused on a single specific fear. GAD can also cause somatic symptoms such as tremor, muscle tension, restlessness, nausea, and insomnia.
who more commonly gets generalized anxiety
GAD is more common among women and has a peak incidence around the age of 30 years.
what is a contraindication for bupropion
However, it is contraindicated in patients who have predisposing conditions that increase the risk of seizures (e.g., seizure disorders, anorexia or bulimia nervosa, alcohol withdrawal, abrupt discontinuation of benzodiazepines) because it reduces the seizure threshold.
what are the two first-line drugs for smoking cessation
verenicline and bupropion
how is verenicline prescribed
Treatment should begin at least one week prior to smoking cessation and continue for a maintenance period of 12 weeks once smoking cessation is achieved.
what should be determined before verenicline treatment
Patients with pre-existing psychiatric conditions should be stable and suicidal ideation should be ruled out prior to initiating treatment.
what is acute stress disorder
presents with the sudden onset of psychiatric symptoms < 1 month after a specific event. However, to meet the criteria for this diagnosis, the event in question must be a traumatic event with exposure to actual or threatened death/serious injury/sexual violation, which is not the case in this patient. There would also be severe anxiety or distress related to recalling the event
what is adjustment disorder and what can accompany it
functional impact that is out of proportion to what would normally be expected. there is always an identifiable psychosocial stressor. symptoms resolve within 6 months. DOES NOT MEET CRITERIA FOR ANOTHER ILLNESS such as MDD
mood dysregulatoin can occur with adjustment disorder such as depressed mood
what is the treatment of choice for patients that need acute relief from depression if they have a very short life expectancy
stimulants like methylphenidate or ECT
what is a relative contraindication for ECT
brain cancer
what is the treatment of choice for panic attacks
clonazepam or long acting benzos
what is the presentation of a panic attack
spontaneous and unexpected onset of a period of intense fear, involving some of the symptoms seen in this patient, such as shortness of breath, dizziness, palpitations, and a sensation of choking
what is first line treatment for panic disorder
SSRIs
what is the treatment for someone who has had one episode of depression
SSRIs for 6 months
what is the treatment for someone who has had more than one episode of depression
SSRIs for 2 years and combine with CBT
what can be used as therapy for GAD instead of SSRIs
bupropion
what class is NOT recommended for someone with GAD/depression and erectile dysfunction
SSRIs they can worsen erectile dysfunction
what is first line treatment of tourettes
antipsychotics like risperidone
what is the most common side effect of marijuana intoxication
impaired reaction time
what is the recommended therapy for refractory bipolar disorder
Combination therapy of a mood stabilizer and an antipsychotic, such as valproic acid and quetiapine,
what is first line therapy for hoarding disorder
CBT and or SSRIs
what does heroin withdrawal look like
This patient presents with flu-like symptoms (rhinorrhea, chills, abdominal pain, diarrhea), features of sympathetic hyperactivity (tachycardia, hypertension, mydriasis, hyperreflexia) and CNS stimulation (insomnia, irritability). These features, especially in the presence of cool, damp skin with piloerection, are characteristic of heroin withdrawal.
what is the strongest predisposing factor for bipolar disorder?
genetic predisposition
what is the treatment of choice for adjustment disorder
CBT. NOT pharmacotherapy
obsessive-compulsive personality disorder (OCPD)
This patient presents with inflexibility, excessive perfectionism, and a preoccupation with orderliness. Changes to her rigid routines result in distress and worrying . Features of OCPD often occur at the expense of occupational success (e.g., missing deadlines), social relationships (e.g., excluding social activities to complete tasks), and pleasurable activities (e.g., not going on vacations).
what is a conversion disorder
a condition that manifests with neurologic symptoms that are inconsistent with neurologic disease.more common among young women who have a comorbid psychiatric condition and typically develops after an acute stressor (e.g., trauma, interpersonal conflict). The diagnosis of this condition requires thorough evaluation and ruling out of other possible diagnoses, such as retinal detachment in this patient with sudden, painless, monocular vision loss.
Somatic symptom disorder is
a condition in which a patient has persistent somatic symptoms (e.g., headache, fatigue) that result in excessive thoughts and/or behaviors that disrupt daily life. However, a diagnosis of somatic symptom disorder requires symptoms to persist for ≥ 6 months
what is schizotypal personality disorder
characterized by constricted affect and a lack of close friends due to acute discomfort in social interactions and impaired capacity for close relationships. However, further symptoms include distortions of perception and cognition (e.g., magical thinking, superstitions), as well as eccentric behavior (e.g., peculiar speech),
what is schizoid personality
social withdrawal, a preference for solitary activities, and flattened affect, all of which are features of schizoid personality disorder. Individuals with schizoid personality disorder neither desire nor enjoy close relationships. They show little interest in interpersonal or sexual contact and often appear indifferent or emotionally cold towards others.
what is the treatment for PTSD nightmares
prazosin
what is the treatment of choice for PTSD
trauma-focused CBT or exposure based
what is illness anxiety disorder
exhibits a persistent preoccupation with having diabetes for ≥ 6 months, despite no clinical evidence to support this diagnosis. She exhibits excessive health-related behaviors (e.g., daily use of a glucometer, extensive internet research, numerous doctor’s visits) and has only mild somatic symptoms (e.g., fatigue). Based on these findings, she most likely has illness anxiety disorder (previously referred to as hypochondriasis).
what is the treatment for illness anxiety disorder
Treatment for illness anxiety disorder includes regular scheduled primary care physician visits to address patient concerns and cognitive behavioral therapy. Comorbid psychiatric diseases should also be treated if present.
what is a brief psychotic disorder
Brief psychotic disorder is characterized by psychotic symptoms lasting > 1 day but ≤ 1 month, and these are usually triggered by stressful situations.
what is shcizophreniform disorder
Schizophreniform disorder is a clinical diagnosis that is made using the same diagnostic criteria as schizophrenia. The main difference, however, is the duration of the disorder. Schizophreniform disorder is diagnosed in patients who present with delusions, hallucinations, disorganized speech, and/or negative symptoms that impair social, occupational, and person functioning and lasts for 1–6 months. fi longer than 6 months then it is schizophrenia
what is highly associated with panic disorder
major depression
what tests should be performed before initiating therapy for bipolar (manic episode(
TSH, beta-HCG and creatinine
what happens if lithium is given with hypothyroidism
can worsen preexisting thyroid disease
what is depersonalization disorder
not usually cause gaps in memory. Instead, it is characterized by feeling detached with respect to one’s own thoughts, feelings, body, and actions
Dissociative identity disorder
can result in the inability to recall personal information or events of daily life. Wandering or purposeful travel of which the patient has no recollection is a possible feature of dissociative identity disorder that is seen in this patient. The diagnosis of dissociative identity disorder requires the presence of at least two distinct personality states that cause identity disruption and dominate at different times
what is dissociative amnesia with dissociative fugue
The main finding is inability to recall autobiographical information, which occurred after a stressful event Since there is no other diagnosis that could better explain these symptoms (e.g., substance use disorder, pre-existing psychiatric disorders), a diagnosis of dissociative amnesia is most likely. Since this patient’s episode of dissociative amnesia involved travels, the specifier “dissociative fugue” applies.
what has a more favorable outcome for schizophrenia patients
acute onset of symptoms
onset later in life
no other psychiatric disorders or suicidality
what has a poorer outcome for schizoprehnia
lack of social support, earlier age, prolonged onset of symptoms, predominance of negative symptoms, male sex
what are the criteria for schizophrenia
tends to present initially with a prodrome of negative symptoms (e.g., social withdrawal as in this case) that precedes the positive psychotic symptoms, such as delusions (e.g., bizarre thoughts of aliens watching him) and disorganized speech as seen in this patient. The diagnosis also requires that these symptoms have been present for ≥ 1 month and that some sign of illness must persist for at least 6 months.
how to differentiate between mood disorder with psychotic features or schizoaffective disorder
need to determine if the psychotic features are only during mood disorder or if they are present alone. also which came first is a clue
how long must GAD be present for a diagnosis
greater than or equal to 6 months
how long for diagnosis of delusional disorder
one or more delusions for greater than a month
what is the strongest single predictor for future suicidal events
previous suicide attempt
what are some risk factors for suicide
male sex, lack of social support, access to firearms
what are common SE of stimulant therapy
elevated arterial blood pressure, tachycardia, sweating, insomnia, decreased seizure threshold, and a reduced appetite/stunted growth.
what is an illusion
where sensory data is misinterpreted as something else
what is sleep terror disorder
Sleep terror disorder is a type of parasomnia in which children present with abrupt, incomplete arousal from sleep, screaming, crying, and/or trying to escape from an unseen threat. It also typically involves sympathetic hyperactivity (mydriasis, sweating, tachycardia, tachypnea), unresponsiveness to efforts at calming, and no recollection of the event on waking.
what is first line therapy for psychosis
second generation antipsychotic like risperidone
Patients with a disruptive mood dysregulation disorder (DMDD) are
intolerant of frustration and chronically irritable for ≥ 12 months. Intolerance of frustration manifests as recurrent temper tantrums (≥ 3 times per week) and/or physical aggression grossly out of proportion to the triggering event occurring in ≥ 2 settings (e.g., with parents and with peers). DMDD is more common among males and the onset of symptoms occurs before the age of 10 years.
what is associated with DMDD
major depression and anxiety disorder
when do you give naltrexone
reduces cravings but can only be given without symptoms of withdrawal
what is the best medication for opioid withdrawal
methadone
what is identification
Identification (psychiatry) refers to the unconscious modeling of one’s behavior, whether good or bad, on another person. Identification may occur with a victim of aggression (e.g., an abused mother), an aggressor, a love interest, or a lost individual (e.g., a sibling or friend who passes away). The classic example of identification with an aggressor is an abused child who later becomes an abusive parent.
what is social communication disorder
Children with social communication disorder present at an early age with difficulties in both verbal and nonverbal communication, such as adapting to social settings (e.g., being quiet during a performance) and using communication methods adequately (e.g., body language, eye contact)
what is selective mutism
ndition in which a child consistently refuses to speak when expected to (e.g., when asked a question in school) although his/her communication skills are not impaired. This behavior typically has a negative impact on normal life (e.g., academic performance) and is not exhibited in settings in which the child feels comfortable and safe
what are the SE of ECT
Electroconvulsive therapy has several possible side effects, with the most common being reversible amnesia (retrograde more often than anterograde amnesia), tension headaches, nausea, and transient muscle pain.
what is the first line treatment for kleptomania
CBT. can add SSRIs
what is the first line treatment for OCD
CBT. can add SSRIs
trichotillomania (TTM
Individuals with) present with patchy hair loss and, in some cases, may be reluctant to admit to hair pulling. Typically, the patches of hair loss are ill-defined and the hair shafts may be of different lengths, as seen in this case. The scalp, eyebrows, and eyelashes are common sites of hair pulling. Puberty is a common age of onset of TTM and the condition is more common in females.
what is the reversal agent for benzodiazepine od
flumazenil
what is the presentation of bath salts intoxication
combativeness, diaphoresis, tachycardia, hyperreflexia, peripheral vasoconstriction, hyperthermia, hallucinations, paranoia, mydriasis, altered mental status, combativeness.
what will a urine tox screen show for bath salts
ethyl glucuronide synthetic cathinone
how long do you have to wait before prescribing an MAOI instead of an SSRI
at least 5 weeks
are MAOIs first line therapy
NO. they are fourth line due to their drug interactions and their hypertensive crises
what is an example of an MAOI
phenelzine
what foods cannot eaten while taking MAOI
meats, cheeses, wines
what interacts with MAOIs
SSRIs, TCAs, st johns wort, meperidine, tramadol, methadone, mirtazipine
what should be given to patients with stimulant overdose
benzodiazepine
can you give someone opioid pain meds when they are on methadone
yes
what is WHO pain ladder
1) mild pain –non-opioid; 2) moderate pain give non-opioid and then add mild opioid if needed; 3) severe pain give non-opioid then add strong opioid
give adjuvant drugs if needed
what is the best thing to give to someone with methadone maintenance therapy
short acting opioids like morphine every three to four hours on schedule, NOT on demand
what is the preferred initial treatment for an acute episode of mania with combativeness
haloperidol
Do you use valproate for an acute manic episode
no. long term maintenance can be beneficial
what is the treatment of choice for aviophobia
CBT
what is presentation of antihistamine intoxication/OD
confusion, drowsiness, dry skin, dry mucous membranes, mydriasis, tachycardia, constipation
what mediates the effects of antihistamine toxidrome
anticholinergics
what is PEP for HIV
tenofovir, raltegravir, emtricitabine
what is used to prevent vertical transmission of HIV
zidovudine
what is the best treatment for PTSD
CBT (trauma focused) with or without SSRI
what is the pharmacological treatment for performance only social anxiety
propanolol 30-60 minutes prior to the presentation
