Deck 1 COPY COPY Flashcards
what medication is best for helping with sleep hygeine
zolpidem
which benzo do you use for short term panic and anxiety
alprazolam
do you use benzos in sleep disorders
maybe a long acting but not a short acting, Z drugs are better to try first
when do you see delerium tremens
> 48 after last drink
what class of drug is doxepin
TCA
TCA OD signs
anticholinergic symptoms (mydriasis, flushed skin, tachy, HTN) + prolonged QT
which drug to use in a patient with poor kidney function in bipolar disorder
valproate (not lithium)
side effects of lithium
hypothyroidism, nephrogenic diabetes insipidus,
first step in elderly patients with acute changes in memory
medication review
what can MAO inhibitors lead to with wine and cheese
tyramine excess which causes a hypertensive crisis
when is it considered anorexia
<18 BMI
SS vs NMS reflexia
SS has hyperreflexia and NMS has regular reflexes
facial features of fragile X
Long face, wide set ears, macrocephaly
when does postpartum psychosis occur
within 2 weeks of delivery
can steroids cause acute mood disorders`
yes, especially in adolescents
if a patient has an OD on methadone, what do you do
naloxone and then you have to keep them in the hospital for >2 days because the half life of methadone is very long
if a patient does not want their procedure but a POA does, what do you do
get an eval to determine competency
treatment of bulemia and bing eating disorder
SSRI
treatment of anorexia
nutriitonal therapy and occasionally olanzapine
what class of drug is paroxetine
SSRI
treatment of premature ejaculation
SSRI
how to treat patients who are hyperventilating due to stress
reassurance and breathing retraining (no Paper bag!)
what types of therapy besides medication help prevent relapse of schizophreniaI
family therapy
imaging findings of patients with long history of schizophrenia
dilated ventricles
time range of brief psychotic disorder
1 day to 1 month
when do you keep patients on antidepressents indefintely
when they have had >2 relapses
what can you give to patients to immediately sedate if they are agitated
IM lorazepam or haldol (often given in combo)
dx of a patient keeps seeing herself killing mom with knife when using a knife
OCD
treatment of OCD
SSRI
can hypothyroid cause mood symptoms
yes extreme mood symptoms
TCA OD signs
seizures, anticholinergic effects, prolonged QT, mental status changes
PTSD diagnosis timeline
> 1 month symptoms
does adjustment disorder follow violence
no just after a stressful event, violence is more liely PTSD
presentation of pediatric depression
often irratibility rather than depressed mood
signs of cannabis withdrawal
irritability, depression, anxiety, weightloss, stomach pain, headache, shakiness, fevers, chills etc.
after what age should an imaginary freind be considered worrisome
after age 6
comorbid conditions of tourettes
OCD and ADHD
when do you use sertraline over citalopram
recent MI history
main AEs of clozapine
lowers seizure threshold and can cause agranulocytosis
timeframe of acute stress disorder
> 3 days < 1mo
can pregnant people take methadone
yace its safer than having them withdrawal
what is a nromal score on the MOCA
> or equal to 26/30
for a patient that just had one depressive episode how long do you trt them
6 months after remission, do not reduce the dose
next steps for a patient that has a SI and a plan and means
hospitalize them
what is considered an adequate trial on an antidepressant
> 6 weeks
waht do you do if an SSRI doesnt work for a patient
you try another SSRI or SNRI first before moving onto other antidepressants
signs of NMS
fever, muscle rigidity, normal reflexes, hyperthermia, altered mental status
how do differentiate between meth use and schizophrenia
meth will have severe dental problems like bruxism or tooth rot dry mouth etc
how to differentiate between normal adolescent behavior and depression
significant change to baseline and if their irratibility/moodniness is impacting their grades and social life
group A personality disorders
paranoid, schizoid, schizotypal
paranoid personality disorder
suspcioin and distrust of others, perception of benign remarks as attacks, oversensitivity
schizoid personality disorder
prefers to be alone, loaner, lack of interest in social connection, constricted affect
schizotypal personality disorder
kinda weird, socially awkward, ecessive discomfort in social situations
cluster B Personality disorders
antisocial, borderline, histrionic, narcissistic
antisocial PD
lack of respect for others rights, lack of remorse, kids with ODD have this >18
borderline PD
extreme opinions, unstable emotions, difficulty maintaining relationships, high suicide attempts, intense anger, hates feeling abandoned
narcissistic PD
excessive need for attention, lack of empathy, taking advantage of others
histrionic PD
attention seeking and intensely emotional behavior, inappropriate, sexually provocative towards others
cluster C personality disorders
avoidant, obsessive-compulsive, dependent
avoidant PD
excessive shyness, sensitive to critism, low self esteem, fears relatinoships for fear of being rejected, strong desire for relationships
OC personality disorder
need for order and control, efficiency, low flexibility
dependent PD
fear of separation, excessive need for connection, difficulty diong things alone
signs of tardive dyskinesia
abnormal involuntary movements, tongue protrusion, foot tapping, restlessness,
how do you treat tardive dyskinesia
switch to a different non first gen antipsychotic (clozapine), reduce dose, use valbenazine (VMAT2 inhibitor)
advice for parents for chlidren with specific phobias
read them stories about it, exposure etc.
what type of antidperessant is paroxetine
SSRI
how long do you have to have SIGECAPS to be dx
> 2 weeks
onset of NMS vs. SS
NMS can be over a couple of days (not as acute) and SS is more rapid like <24 hours
what is projection
this is when you attribute thoughts to another PERSON vs. displacement is a less threatening person/object
what is denial
avoiding anxiety provoking thoughts by not accepting reality
what is regression
this is when you revert to a child like state or move backwards in a maturational state
what is displacement
this is when you shift your focus to a less threatening person or object
what is intellectualization
Using abstract, rational, and/or logical reasoning to avoid affective expression and distance oneself from stress
what is rationalization
Offering excuses or feasible explanations in an attempt to justify behaviors, attitudes, or beliefs to avoid self-blame
what is reaction formation
Complete denial and/or rejection of an unacceptable impulse by acting in a diametrically opposite manner to avoid anxiety-provoking thoughts
what is sublimation
this is when you shift your unacceptable/unattainable thoughts to soemthing goal directed
what is suppression
this is when you conscoiuly suspend an anxiety provoking thought
what is depersonalzation/derealization disorder
persistent feelings of being unattached to self or being an outside observer to your life or experiencing the surroundings as unreal
what is dissociative amnesia
inability to recall information about yourself usually due to a stressor
what is dissociative identity disorderq
discontinuity of self and loss of personal agency with >2 alters, associated with trauma/abuse
signs of sleep apnea
depressed mood with normal range of affect, sleepiness, high BMI, male sex, HTN
what can happen with prolonged QT
patients can go into torsades
dx criteria for cyclothymia
> 2 yrs in adults of fluctuating moods not manic or major depressive episodes by hypo of both
what is somatic symptom disorder
somatic symptoms (like leg pain) causing significant distress with repeated medical treatment despite negative workups
risk factors for somatic symptom disorder
female, lower education level, hx of chlid abuse, sexual trauma, chronic illness
what do you need to monitor for patients on antipsychotics
you need to check their metobolic levels (lipids, glucose, etc.)
highest risk antipsychotics for metabolic effects
olanzapine and clozapine
what is a distinguishing factor between major depressive disorder and normal stress resposne
MDD has to affect your life and ability to function in school, work, family etc.
what is akathesia
subjective restlessness, inability to sit still
how do you treat akathisia
decrease antipsychotic and add propanolol
how do you treat parkinsonium
this is when you use benztropine and amantadine
how do you treat acute dystonia
benztropine and diphenhydramine
reaction formation
this is when you have a position but then do the exact opposite
sublimation vs. reaction formation
in sublimation the behavior provides satisfaction and in reaction formation it does not
if a patient has increased anxiety from starting an SSRI what do you do
you decrease their SSRI dose
if a patient has a difficult time giving a history of events and they have been sexually abused what is the likely dx
dissociative identidy disorder
what do you do with an aggressive patient
first make sure their needs are met like offering food and water, keep a safe distance, keep door open
drugs to treat opioid withdrawal
clonidine, methadone, benzos, antiemetics, antidiarrheals
sleep changes in depression
decreased REM latency time, and decreased slow wave sleep (Phase III and IV)
treatment of depression with psychotic features
antidepressant with antipsychotic or electroconvulsive therapy
signs of language disorder in a child
persistent difficulties with comprehension and/or production (expression), ex grammar, syntax, content..
what is PMDD
pre menstrual dysphoric disorder where you get really irritable and bloaty before a period
what is the pathophys of NMS
decreased central dopaminergic activity
treatment of PTSD non medical
CBT
treatment of acute stress disorder
CBT
ways to decrease rate of rehospitalization in schizophrenic patients
LAI, family therapy
DMDD dx timeline
before age 10
treatment for acute mania
antipsychotic, lithium, valproate
treatment for acute dystonia
diphenhydramine
how to manage a patient with body dysmorphic disorder
Ask them how others would perceive of them
if a patient has suicidal thoughts what do you do
you need to first do a suicide risk assessment and then based on that can 302 them
what is kleptomania
the intense urge to steal things of small monetary value, guilt and shame usually follow
treatment for acute bipolar depression
quetiapine and lorasadone
what substance can buproprion help with
cigs
what substances can buprenophrine help with
cocaine, meth, opioids
what do you give to reinforce abstinance in a patient that has not relapsed on opioids
naltrexone
what drug do you use for patients with high risk OUD or in current using
methadone
treatment of acute serotonin syndrom
sedation with a benzo, cyproheptadine, short term antihypertensives like esmolo
what is bromocriptine
dopamine agonist used to treat NMS
if a patient failed one antipsychotic whats next
try a different class, clozapine only after two fails
what are the non stimulant drugs for ADHD
clonidine, guanfacine, atomoxetine
what are signs of adrenal insufficiency
depression, decreased body hair, craving saltiness
how do you test for primary adrenal insufficiency
cosyntropin test (synthetic ACTH)
what is the hallmark of bulemia
bing eating WITH compensatory behavior (vomiting, excess exercise, etc)
treatment of body dysmorphic disorder
SSRI
if a patient has both poor appetite and insomnia what is a good antidepressant to use
mirtazapine
how do you monitor opioid use in a chronic pain patient
query the prescription drug database every month
what is delusional disorder
when you have one specific delusion but it does not impede other functioning
early side effects of SSRIs
headache nausea insomnia
signs of suripticious sulphonylurea use
weight loss, hypoglycemia sx, high insulin and C-peptide
what medications can be used for alcohol use disorder
acomprosate, naltrexone
, disulfiram
when does postpartum depression occur
4-6 weeks post birth but up to a year after
treatment of postpartum depression
SSRI
when do postpartum blues occur
2-3 days post birth, no trt
what is the principle of proportionality
methods used to achieve a goal are necessary, appropriate and not excessive
signs of cocaine withdrawal
acute depression, hyperphagia, increased sleep, increased vivid dreaming, drug cravings
is there more or less slow wave sleep in depression
less
