BEHAVIORAL/PSYCH Flashcards
Requires the presence of excessive worry about numerous aspects of daily life on more than not for at least 6 months w/inability to control symptoms w/3 other symptoms (irritability, muscle tension, sleep problems, poor concentration, fatique, restlessness).
GAD, generalized anxiety disorder
Dx of MDD icludes 2+ weeks of what symptoms?
SIGECAPS:
sleep, interest/anhedonia, guilt, energy, concentration, appetite, psychomotor, suicide
The pt is excessively preoccupied w/one or more somatic symptoms like back pain that gets worse w/stress. These symptoms may or may not originate from an underlying disease.
Somatic symptom disorder
Tx includes frequent follow ups
Clinical manifestations of autism present when
typically in the first 2 years of life
__________________ refers to a persistent emotional and bahavioral problems such as purposeful agression towards people and animals in children and adolescents.
Conduct disorder
Adjustment disorder symptoms typically last ______________
less than 6 months
Rapid onset of cognitive deficits associated with MDD in the elderly is likely
pseudodementia , treat w/ SSRIs
What is general first line tx for social phobias like public speaking?
BBlockers
Panic attacks, we tx with…
Benzos and or CBT
First line tx for GAD
CBT and then SSRI if needed
Must start within 3 months of stressor and not last beyond 6 months
adjustment disorder
_________________ worrying about most things throughout the day on most days of the month that produces no acute issue but provokes chronic loss of function.
Generalized anxiety disorder (GAD)
What would we give in the setting of a panic attack to hault the symptoms?
Lorazepam, alprazolam, or some other kind of benzo
A young woman with no medical history that sounds like a myocardial infarction relieved with benzodiazepines is classic for
panic attacks
TRUE OR FALSE: All SSRI/SNRI medications are first line for MDD, are indistinguishable from one another, and areequally efficacious.
true
The patient will experience a depressed mood for >2 yearsbut without symptoms >2 months at a time. This patient will be functioning but will have depressed mood. This is the person you get the feeling is depressed, but doesn’t meet the severe symptoms of an MDEpisode
Dysthymia-Persistent Depressive Disorder
How do we treat dysthymia?
SSRI
Kids having constant irritability with recurring behavioral outbursts, disproportionate to situations. Happens at least 3x per week, andis evident before 10 years old(manifests ages 6-18)
Disruptive Mood Dysregulation Disorder
Women must have at least 5 symptoms in the week before onset of menses, start to improve within a few days of onset, and they must beabsent in the week postmenses
Premenstrual dysphoric disorder
When suspecting MDD or Dysthymia, what must you rule out?
Hypothyroid
What are symptoms of bipolar i
What is the diagnostic criteria for Bipolar I
To be classified as Bipolar I, the patient must have “E” with another 3 symptomsfor at least one week. Bipolar disorder has equal rates in men and women. Suicide is 15x higher in bipolar patients. Bipolar can be characterized as mania, but may also have modifiers for catatonia, rapid cycling, peripartum, and psychotic features
What do we qualify as Bipolar II?
Bipolar II is hypomania AND major depression. There must be a current or previous major depressive episode to be diagnosed bipolar. Hypomania is defined by all the same symptoms of mania, except they are less severe (not as impairing), and for less time (at least 4 days).
How do we dx cyclothymia
Bipolar I is mania. Bipolar II is hypomania with depression. Cyclothymia is Bipolar II, just not as bad. Patients have had at least 2 years of hypomanic and a major depressive episode, plus symptoms that fails to meet the criteria for Bipolar II.
Why do we avoid intidepressants in bipolar disorders?
A manic episode can be provoked (revealing the underlying bipolar disorder) by use of them. Even if major depressive episode is predominating, if it’s known they’re bipolaravoid SSRIs
_________________is the classic mood stabilizer. It has a narrow therapeutic index, can rapidly become toxic in renal failure, and has a dirty side effect profileincluding diabetes insipidus, vomiting / abdo pain, and progresses to encephalopathy, ataxia, and hyperreflexia.
Lithium
What am I: valproate
mood stabilizer, used to tx bipolar disorders
What am I: carbamazepine
mood stabilizer, used to tx bipolar disorders
What am I: lamotrigine
mood stabilizer, used to tx bipolar disorders
What am I: quetiapine
antipsychotic
How long and how many sigecaps do you need to have to be dx’d w/MDD?
greater than or equal to 2 weeks w/5Sigecaps
How does suicidal ideation change out approach to MDD?
SI+–>Plan+–> hospitalize
SI+–>no Plan–> contract for safety
NO SI–> psychotherapy
What am I: haloperidol
bezo
Emergency anti-agitation treatment in patients with acute mania is IM or IV benzos or antipsychotics, of which lorazepam and haloperidol are the most common.
The fastest, most effective method of improving depression is actually
electro-convulsive therapy
If there’s mostly depression but the emphasis remains focused on the deceased(it’s NOT pervasive in all their life), or the duration has exceeded 12 months but they don’t meet depression criteria, call it
Persistent Complicated Bereavement Disorder
How might you be able to tell the difference between MDD and PCBD on exam?
For test purposes, think bereavement that is longer than 12 months, but not MDD. This is persistent complex bereavement.
Watch out for questions with young females and weight. Young female, concern with weight, frequency diarrhea…
MIGHT BE BULEMIA
be able to ID metabolic acidosis
Loss of bicarbonate in the stool through induced diarrhea provokes acidemia. Because this acidemia is not caused by an increase in cations (such as in DKA or lactic acidosis), there is no anion gap (Na - [Cl + HCO3] < 12), as in this patient, whose anion gap is 10. Once you have found non-gap acidosis, you use the urine gap to determine if there is a renal tubular acidosis (which can be induced through diuretic use) or not. If not, then you are left with diarrhea. A positive gap is renal tubular acidosis, a negative gap is diarrhea.
How can you tell the difference between anorexia nervosia w/binging versus bullemia nervosa?
Look for out of control binging to pin bullemia.
Distinguishing among the different eating disorders can be difficult.
Anorexia: Look for LOW WEIGHT/BMI, behaviors are ego-SYNTONIC.
Bulimia: Can be NORMAL weight, binge-purge behaviors, but ego-DYSTONIC.
Although there may be binge-purge behaviors in anorexia, the difference is that, in bulimia, the patient feels “out of control” during the binging episodes, and so uses the purging behaviors to compensate for an initially unwanted behavior (the binge). As such, they may maintain a normal weight, and these behaviors are often ego-dystonic (they do not want to be doing this). In contrast, patients with anorexia are typically very underweight, and their behaviors (whether restriction or binge/purge) are ego-syntonic.
When might you see an eating disorder w/acidosis?
In the setting of bullemia SPECIFICALLY W/PURGING via LAXATIVES
Escitalopram, fluoxetine, paroxetine, sertraline
SSRIs
Escaping florence paradoxically on the sertraLINE railroad
Des/Venlafaxine, Duloxetine
SNRIs
Sir SnRi De Venlafax is deluxe
SNRI des venlafaxine dueloxetine
Mirtazapine and trazadone are what?
Serotonin Modulators
Mirta and Traz were terrible moderators for the trampoline competition
Mood stabilizer, spina bifida
Valproate, mood stabilizer teratogen that can cause spina bifida
Carbamazepine
Mood stabilizer (third choice), teratogenic
Issues w/SSRIs
Sex dysfunction
Convulsions, cardiac, coma
TCAs
Hypertensive emergency w/eating wine and or cheese
MAOi’s
Atypical antidepressant and seizures
Bupropion
Teratogen, Nephrotoxic, Nephrogenic Diabetes insipidus
Lithium
First line and second line agents
First: Li, valproic
Second: Quetiapine, Lamotrigine
What 3 major tests need to be done before starting Lithium?
- Pregnancy Test
- Creatinine
- TSH
Prophylactically using a a medium-acting _________________ can prevent the syndrome of alcohol withdrawal.
benzodiazepine like chlordiazepoxide
Mental health med and seizures associated with WITHDRAWAL
Benzos!
and alcohol
Before starting an atypical antipsychotic, what must you always obtain first ?
ECG, they can cause QTc prolongation
Major side effect of quetiapine
drowsiness
what major side effect does olanzapine have
DM and weight gain
What are extrapyramidal effects?
Akathisia, acute dystonia, dyskinesis, tardice diskinesia
What medications do we worry about for extrapyramidal effects?
Antipsychotics, think antipsychotics–>dopamine modification–>parkinson like side effects
Don’t give the antipsychotic ________________ in a patient w/exisiting concern for metabolic syndrome
Olanzapine
Olanzapine sounds similar to ozempic
Last resort, failed 4 previous medications
Clozapine
What major things do you need to remember/look out for in order to spot substance use disorder
1Controlling use, 2social impairment, 3risk-taking, and 4physical/pharm changes
Major side effect to keep an eye on for venlafaxine
HIGH BLOOD PRESSURE
Recall venlafaxine is an snri
Sir SnRi De Venlafax is deluxe
SNRI des venlafaxine dueloxetine
